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I had posted here a few months ago about mom's skin discoloration on her feet and her legs had turned 'black'. Her Dr said it was severe dry skin and prescribed 12% AL lotion.





For the past one week, mom's skin on left feet developed blisters and the skin on both feet had eally turned very scaly and ugly. Yesterday I did a tele-call with the Dr (she is on vacation ). She looked at it thru the phone camera and said it was severe eczema caused by allergies but not from the AL lotion.
Mom doesn't go anywhere and the AL lotion is the only new thing happening to her in the last one month. The Dr prescribed steroid pills and another lotion. The Dr says anyone going outside (me) could expose mom to allergens and that's what's causing the scaly skin. Really???



The Dr says it will affect mom's diabetes and make her very hungry. I'm very nervous about the side effects of these pills. Apparently they are tiny pills and mom has to take 6 a day, then 5, then 4 & so on for a week.



Should I get a second opinion?? This Dr has been ok so far and mom is generally ok under her care.

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Remember people, Weary's mother is not on Medicare or Medicaid because she has not lived here for 5 yrs. Medicare she will never receive because she didn't work here. So her insurance is private. She probably needs to stay "in network" for her PCP and specialists. So, the doctors available to her are probably few. She just can't go and get any doctor. This is why I won't get a Medicare Advantage. They are PPOs and HMOs. Medicare you can't go anywhere, MAs not so.

I agree that PCPs know a little about everything and alot about nothing. They used to be called General Practitioners, the name says it all.

Glad you took Mom to a dermatologist. For her diabetes you would go to an Endocrinologist. But if Moms numbers are good stay with who you have.
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wearynow Apr 2022
Thank you for explanining:-)
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To me a good doctor is one who recognizes when they need to pass you along to a specialist, how can you ever trust this doctor's advice after this?
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Is mom's pcp a geriatrics specialist? If not, I would find one.

You don't have to "break it off". You have the new doc request mom's records from old doc.

There are plenty of patients to go around.
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wearynow Apr 2022
Yes, she's a geriatrics specialist. We do see her in person and this was the only time she did tele-call. For what it's worth, she has 3.6 rating on healthgrades.com
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Hi wearynow, so glad you got a 2nd opinion (dermatologist). No doctor will ever say it's their fault something happens. Definitely trust your gut, and you did (realizing there's something bad about the doctor's prescription). And doctors/medical people often will not criticize a colleague/friend. (In the same way, police stick together. Lawyers stick together. Medical people stick together.)

How to break off with the old doctor? Try to find the most polite way, without saying much: maybe the new doctor's office is closer to your house, and therefore geographically easier for you to reach.
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LeaLonnie, mom is doing ok with the PCP's diabetes medications and she was recommended by people we know. Now if I change PCPs, how do I break it off with the old one? What should I tell her without getting into an argument?
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lealonnie1 Apr 2022
You don't owe the old PCP any explanations. You just pick a new one and ask mom's records to be transferred over. There may not be any talk at at with the old PCP. But I'd have no qualms myself telling her exactly why I was switching. She made a misdiagnosis and then prescribed a harmful medication to a diabetic patient. You have every right to be upset and not expect an argument about why you're switching, it happens all the time. But that decision is up to you. Good luck.
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Eczema is very common in the elderly. The exact cause is not known, but various factors are involved, such as genetics, immune system activity, environmental triggers, stress and others. Steroids reduce the skin inflammation rapidly. They do have unwanted side effects but the treatment lasts only a few days. Eczema will improve but it might not go away entirely.
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UPDATE: Thank you Lealonnie and GardenAartist for your feedback.
I took mom to a dermatologist this evening and he said it was stasis dermatitis & mom has poor blood circulation and iron is leaching into her skin and making it black. Mom needs to wear the compression socks and apply an ointment. He was very emphatic that mom should not be taking steroids since she has diabetes.

It turns out the dermatologist and mom's PCP know each other. The Derm. said PCP was wrong but no need to change her since she's a good doctor otherwise,
The Derm said "if you ask me about blood pressure, I've no clue, that's not my specialty. That's why the PCP got the diagnosis wrong." My brain is fried now.
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MJ1929 Apr 2022
I've long concluded that both PCPs and pediatricians know a little bit about a lot of things, but not much about any one thing. They're the last ones I confer with about very specific issues. I've added ER doctors to that list as well after being recently diagnosed with an ulcer based on very little evidence. It turned out to be a gallbladder gone south and pancreatitis. VERY different problems than an ulcer.
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Odd, b/c Ammonium Lactate is a generic skin moisturizer used to treat dry or irritated skin, such as eczema, psoriasis, and diaper rash. Ammonium Lactate works by drawing moisture into the skin from surrounding tissues.

It sounds like she could indeed be having an allergic reaction to the cream, though and that's why the doc is prescribing the steroids (Prednisone?) Yet she's claiming mom is having eczema DUE to the AL cream? Sounds fishy, I agree. Is this doctor a dermatologist? That may be your best bet; to consult with a skin doctor to see what s/he feels is going on with mom's feet and why they turned black to begin with!

Here is a list of side effects possible from AL12

Ammonium lactate topical may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
stinging (especially on cracked or broken skin)
skin redness, burning, or itching.
skin irritation (especially on the face)
skin peeling.
rash.
dry skin.


Steroids are prescribed exactly as you mention; on a declining scale, staring high dose and weaning off slowly but surely. That should take care of the issue mom is having but it may cause side effects such as hunger and aggressive/agitated/emotional behaviors. I've been on steroids (Prednisone) MANY times for bad asthma and while they work a charm, the side effects can be snarky. But they DO the job. I wouldn't worry TOO much about the steroids, but I might consider getting a new doctor for mom, honestly.

What worried me all along about this situation with your mom is that her feet turned black AND she is diabetic. My SIL lost her foot due to diabetes. Things can turn ugly in short order when feet are involved with a diabetic and if they're black, that is a worrisome situation in MY book. Did your mother's doctor ever SEE her in person or run tests to determine that her feet were black due to 'dryness' issues alone? Or was that determined via a 'telehealth' conference over the phone? I've honestly never heard of an elder's feet turning black due to 'dry skin' issues, have you? Yet diabetic foot issues are RAMPANT and when sores appear on their feet, trouble is imminent b/c they do not like to heal!

And now she's throwing steroids into the mix and saying that outsiders are bringing in 'allergies' to make mom's feet blistered when DIABETES is at play. That's what I don't like, personally. I feel like your mom needs to be seen in person, tests run to see what her numbers look like, and to rule out other blood issues being the cause for her feet having turned black to begin with. But that's just my non-medical opinion on the matter, and what I'd do if it were my mother, that's all.

Good luck!
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What kind of doctor are you seeing?  If not a podiatrist, I'd research and find a good one.  

I don't know if there are podiatrists who specialize in diabetic applications, but I'd try to find one.  

The pills that will produce hunger:  did you research online to determine what side effects exist?   The PDR online was my go-to source:

https://www.drugs.com/pdr/

This must be very unsettling; I hope you find some support quickly.
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