doctored with foot ulcer since feb 14, but still not healed. Yesterday the foot doctor said he was puzzled as to why it is not healing.  Some spots heal then they come back again so he sending Dad to a dermatologist to get a biopsy. From what I have read about foot sores, a biopsy  probably should've been done in the beginning... Please help. Dr. says no signs of gangrene or close to the bone, but it sure looks raw to me.

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Bella, this is going to sound harsh towards your dad, but to save your sanity you do have to remember that everything that is happening to him is the consequence of his own choices. Which he had every right to make, fine, yes; but this is where it's got him and it just has to be accepted. Sympathise with what he's going through by all means, but don't fall in to the trap of imagining that if you only try hard enough and do enough and care enough you'll be able to protect him indefinitely. No one can.
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Other factors in the healing process include adequate blood circulation to the area. Often diabetics have diminished blood flow to the affected tissue due to PVD ( peripheral vascular disease). His PCP is a good start, maybe he will order a Doppler study to assess the blood flow of the arteries and veins in his legs, which can be treated by a stent or even a bypass of the veins (speculation on my part). High blood sugars and diabetes not in good control will effect healing, but often other issues that go along with Diabetes & high blood pressure effect healing as well. 
His PCP can get the ball rolling by assessing the wound and maybe send your dad to a wound care surgeon for better evaluation and possible debridement.
In the interim keep the wound area clean and inspect it daily for s/s of infection, gangrene. Check for redness, pus like drainage, swelling.  Elevate the affected leg and if it's a pressure sore, "float" the heels by placing a pillow at the bottom of the bed and prop up the feet to not allow them to hit the mattress. 
You are doing the right thing by taking him to his PCP first. Good luck!
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It sounds like you have gotten your dad to a place where he is cared for and as protected as he can be. IT's a personal decision, but, I would really give a lot of thought before bringing him home to care for. It sounds like he needs much more care than one person can provide in the home. I'd read a lot about what is likely in store in making that decision.

My LO also had issues similar to your dad's. I would beg her to get treatment, but she would ignore it. Eventually, it happened. She got Vascular Dementia. Her Primary told her one day bad things could happen and there are some things worse than death. I didn't know what he meant at the time, but, now I do. I thought he meant amputation, blindness, etc., but no. It was the dementia. She now is in the Last stage of dementia in an MC.

You can only do so much. Does your dad have an Advanced Healthcare Directive (Living Will)? I'd make sure he has that and any other POA documents so that you can help him when he is not able to give input.

My questions on the Diabetes issue:
Did the Primary get your Dad's A1C? That would be very valuable. It'll tell you what his average blood sugar level has been for the last 3 months. I don't understand why with the Metformin and Lantus that he is taking, his blood sugar is running high? If he'll go, I'd see the Endo, even though, it's a distance away. The reason is that a person can get Type I diabetes at any time in life, even as a senior. That could mean that he's not producing any insulin. So, he may need fast acting with meals. The only way to determine this is with a complete exam and blood test with Endo. Also, pills don't have any impact on a Type I. Did his Primary mention this? I don't want to scare you, but, high blood sugars long term can also cause things like Diabetic Ketoacidosis. It's horrible.

You have a lot on your plate. I hope there's someone to help you. Take care of yourself too.
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What kind of foot doctor is this?

Uncontrolled diabetes, established neuropathy - what is there to be puzzled about? Your father's bloodstream is full of sugar that shouldn't be there. It is very bad news for the blood's ability to supply oxygen to his body's tissues, and that is why the foot is not healing properly and why new areas of skin continually break down. He may well also have other problems by now, but step one: get him to a competent medical practitioner.
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I suspect that you are right that your dad is not likely to be compliant with an endo's care plan than he has been up to now. But I still think it would be worth the trip. The AL can keep him considerably more compliant than he has ever been on his own, and if they have an appropriate care plan to follow the results can be optimized.

I really, really hope your father can stay in the ALF. You can visit and provide the love, but as professionals they can more easily enforce good practices than your dad would ever let you do!
Helpful Answer (5)

Thanks all!!

Home now from dermatologists appt. he's calling it bacterium, took antibiotic, foot soak in weak bleach water!?😳...,dry it, moisturizer everywhere on foot/between toes, topical antibiotic, elevate when sitting,go back in 2 wks

I had to ask him to check other foot (I never thought to ask "foot doc" to check at other appts...I'm brain dead at times)...other foot is starting to get it now😡😥

Dad went to sit in a chair today with no arms on it at my house and hit the happened in slow motion right before my balance at all, week legs/arms...normal person could've caught themselves...I helped him up, was a struggle (204lbs), he's ok,  little cut on finger...hate to see my dad bleed.   2nd time in 2wks he's missed a chair!

Anywhoooo, I loved the puddin outta my dad today, no frustration, and laughed a lot 😊I treated this day as it could be my last one with him.  I sat with him at AL as he ate his "frozen-food like lunch...he said "yes" when offered cherry pie...guess my long talk about eating healthy with diabetes on the hour drive home went in one ear and out the other....I silently judged him for his bad "choice",  then hugged him gbye and said, "I love you dad"...he grabbed my hand, kissed it, and said "I love you too"..............😢😍

Today, I feel blessed

And,if, this was the last day with my dad, it will be one of my best days ever!!❤️️

I'm thanking all of you sweet, special, supportive, caring peeps here!!!  And taking all advice!!!

Heavy heart/Smiling/Trusting/Gaining more confidence

Love, Bella😍
Helpful Answer (4)

I'd take dad to an endo 1.5 hours away as a part of a bigger plan: to have him in ALF for as long as possible. It sounds like dad does not own his own place, so he may not have many assets and may be eligible for Medicaid-funded NH in the future. Having a good diagnosis with the medical direction that he needs to live in ALF or NH for care is an excellent starting point.

At your endo appointment, help the doc by giving the check in person a letter for doc asking for a firm recommendation that the pt be in assisted living or NH because of the lack of ability to take care of themselves as evidenced by the AIC and foot sores. Then you are able to shrug your shoulders and say, "there's nothing we can do dad, your diabetes is causing you problems, and we have to solve them before you can come home." You and I know the sores on his feet are a symptom of a bigger problem, one that he is not addressing. That means he chooses to stay in a facility. You blame other people for you not being able to give him what he wants because you follow doc's orders!

Boundaries by Townsend and Cloud is a great book.
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Bella, don't play the could've, should've, would've game. It is easy to think what you should have done in hindsight, but you clearly did the best you could at the time. You are acting in love. It is a huge challenge to manage the medical care of two elders who aren't always cooperative. You should be proud of your efforts. Please don't go off on a guilt trip -- you are needed where you are!

April is coming up soon. Another few weeks isn't as important as the fact that he will be seen by a specialist. Gather all the information you can, and bring it with you in writing. If you dad has his own glucose meter, bring it in -- they will download the data. If the AL uses their meter and they write down the results, bring in that list. Find out when the readings are done (in relation to eating) and write that down. Talk to the medical director at the AL and find out if your dad has displayed symptoms when he has had such low readings. No one expects that you "should've" been on top of all these things, but now that you are seeing a specialist it would be good to clarify some of these details so you can share them.

I take my blood glucose reading before meals, because that is partly how I determine how much fast-acting insulin to take. Since your father isn't taking fast-acting insulin why would they take his before meals? Well, maybe that is just their routine for people with diabetes. But I think it would be worth confirming the timing of those readings so you can tell the endo doctor.

Getting educated via the internet is valuable. BUT it is not the same as having many years of training and experience and having a license to practice medicine.

The problem with internet self-training is that without knowing the relative importance of various symptoms you can focus on the wrong things. An even bigger risk is that the people writing the articles can have excellent credentials or be total quacks or snake-oil salesmen. I check lots of things out on the internet, but I stick to reliable sources like Mayo Clinic, various University sites, and National Institutes of Health sites. I hope you do the same.

I'm concerned about your father's low readings! I suggest you look up Hypoglycemia on the May Clinic website, just as background for your visit with the endo.

Hang in there! You are doing your best, and that is all any of us can do.
Helpful Answer (3)

Usually the dressing is applied wet and then allowed to dry Sunnygirl (called wet to dry dressing). Weakened  bleach solution is also common now, especially if they think it's fungal. Sounds like they are covering all their bases. It's probably not healing quickly due to bad circulation from age & diabetes. Make sure he elevates his legs when he is sitting.
Will the staff at AL do the dressing? Pretty sure a nurse has to do it, so let the staff there know - they will need a copy of the order and wound care supplies too.
Eewww- bad infection control at the foot doctor's office! I would tell the doctor about it. He should know- that can cause bad cross infections. Yuck!
You are doing a swell job, Bella. Gotta move forward - the past is the past!
Helpful Answer (3)

Brilliant, Bella :) I'm smiling because I think you really are focusing on the right things: hugs, kisses and cherry pie.

The feet... Well, I'm glad that somebody's taking proper control; that gives your father the best possible chance to heal. "Best possible" may not be all that great, is the only thing. Not to depress you, just so you don't get knocked sideways if it doesn't go so well.
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