Forgotten Infection Friday — Nocardia: The Weakly Acid‑Fast Impostor
26/06/2026 | 24 min
A 62-year-old man with poorly controlled diabetes presented with weeks of cough, weight loss, night sweats, and cavitary lung lesions initially suspected to be tuberculosis or malignancy. Sputum TB tests were negative and symptoms progressed.
Bronchoscopic lung biopsy showed branching gram‑positive filaments that were weakly acid‑fast, consistent with Nocardia species. Nocardia commonly infects immunocompromised hosts, can disseminate to the brain, and is often mistaken for TB, fungal infection, or cancer. Diagnosis relies on modified acid‑fast stain, prolonged cultures, or molecular testing.
Treatment requires prolonged antibiotic therapy (commonly TMP‑SMX), sometimes IV agents for severe disease, and early recognition in diabetic or immunosuppressed patients is critical to prevent dissemination.
The Hair Test One of the Simplest Clues in Limb Salvage
25/06/2026 | 18 min
Imagine a patient with no complaints whose foot hair has vanished. This episode explains the "hair test"—how absent hair on the toes and feet can be an early bedside clue to poor circulation, peripheral arterial disease, and limb-threatening ischemia in people with diabetes.
It reviews hair follicle biology, how reduced blood flow interrupts hair growth, associated skin and nail changes, limitations of the sign (aging, genetics, friction, shaving), and practical next steps including pulse exam, Doppler, ABI/toe pressures, and vascular referral. Hair is a quick clue, not a diagnosis.
Nystatin Uncovered: Why It Heals Some Foot Fungi and Fails Others
24/06/2026 | 20 min
This episode of Diabetic Foot Files dives into nystatin: its history, how it kills Candida, and why it often works for moist, macerated toe-web infections but fails against dermatophyte-caused athlete's foot.
Dr. G explains the importance of delivery method (powder vs. cream/ointment), diabetic risk factors like moisture and hyperglycemia, and practical prevention tips for patients.
The episode also covers real-world issues such as supply shortages and cost, plus effective OTC alternatives and when to seek professional evaluation.
Zaynich: A New Weapon Against MDR Gram-Negatives
23/06/2026 | 17 min
In this episode of Diabetic Foot Files, Dr. G explores Zaynich (cefepime + ZD-bactam), a newly FDA-approved IV antibiotic designed to overcome multi-drug resistant gram-negative infections. He explains the drug's dual-target mechanism, its potential role in limb salvage for severe diabetic foot infections, common side effects, dosing, current FDA indications, and when to involve infectious disease specialists.
Listeners will learn why this combination may be a game-changer for difficult-to-treat infections, the importance of antibiotic stewardship, and practical considerations for use in wound care and limb salvage scenarios.
This episode explains sarcopenia—the progressive loss of skeletal muscle—and how diabetes accelerates it, increasing risk of poor mobility, delayed wound healing, and higher mortality in patients with diabetic foot ulcers.
Dr. G reviews the causes (insulin resistance, inflammation, ubiquitin–proteasome activity), clinical signs and tests, and practical treatments including resistance training, protein/leucine supplementation, vitamin D, and tighter glycemic control to preserve muscle and improve outcomes.
June is Wound Healing Awareness Month (WHAM)! Join us in raising awareness, advancing education, and improving outcomes for patients with wounds—because every wound deserves the chance to heal. Celebrate Wound Healing Awareness Month (WHAM) this June with the American Board of Wound Management (ABWM) and take the next step in your wound care career with 25% off your first certification application- https://abwmcertified.org/promo/
👟✨ We’ve teamed up with DARCO to bring you 25% off the POGO shoe! Want to stay active, reduce pressure, and help prevent ulcers before they begin? Visit darcodirect.com/product/pogo/ and use our exclusive code FootFiles25 at checkout to save 25% off your pair.
Welcome to the Diabetic Foot Files Podcast and the LIMBWatch series — where diabetic foot surveillance, wound intelligence, prevention science, and limb preservation come together. I’m Dr. G / Dr. WoundPicasso aka Dr. Gabrielle Hutcheson Donaldson, podiatrist and wound care specialist, and I’m here to educate, empower, and guide you through the evolving world of diabetic foot care.
From wound healing and pressure injuries to surveillance systems and amputation prevention, we break down the science, challenge the myths, and share strategies that help save limbs and improve lives. Whether you’re a patient, caregiver, clinician, or healthcare professional, this is your destination for diabetic foot education, prevention, and preservation.
So let’s dive in — because when you take care of your feet, they take care of you.LIMBWatch: Surveillance Before Salvage.
France