Diabetes Amputation Prevention

Even President Obama Doesn't Understand the Cost of a Diabetic Foot Amputation

2009-11-16T08:59:00.000-08:00

click here for President Obama's Video of Getting the Cost of Diabetes Wrong

http://www.youtube.com/watch?v=SG56B2et4M8

Diabetic foot amputations are preventable. True. But only with diabetic patients and doctors working together diligently.

The reality is that nearly all health problems related to diabetes could (in theory) be prevented if medical intervention was started early enough. But that is not what typically happens with diabetes.

On average, it is believed that most people are diabetic for 2-5 years before diagnosis. This has been changing in recent years with more screening and early testing. If a person has diabetes that is out of control, damage happens. If the diabetes is out of control with skyrocketing blood sugar for a number of years, lots of damage happens.

If the nerves to the feet are damaged one is placed at enormous risk of diabetic foot ulcers that can easily become infected and lead to amputation. Once a sore begins, poor blood flow to the feet (common in diabetes) makes healing slow. Infections set in. If the skin infection spreads rapidly or spreads to the underlying bone (osteomyelitis) then an amputation becomes necessary.

There has ben a great deal of discussion in the media about the cost of diabetic foot amputations. After all they are expensive. The talk however has reached conspiracy theory fever with the misspoken words of President Obama while he was running for the office.

He said that if a surgeon amputates a foot, Medicare directly pays the surgeon $30,000-$50,000.

That statement is, of course, ridiculous at best.

We do know that the total cost (to Medicare) of an amputation related to diabetes is upwards of $50,000. However that cost includes hospitalization for the associated infection, antibiotics (which can cost as much as $1,000 per dose), lab tests, Xrays, MRI studies, follow-up care after the surgery and custom made prosthetic limbs, wheelchairs, home-health care, etc.

You might be surprised to know how little Medicare pays a surgeon for an amputation. Depending upon the level of a diabetic foot amputation, the surgeon would be paid anywhere from just over $200 to just over $1,000. That fee included surgery AND all of the postoperative care for 90 days. That means office all follow-up visits, hospital visits, removing stitches, wound care to get it all healed, and the cost of all bandages applied in the office.

In most cases the doctor who performs an amputation related to diabetes actually makes very little money or actually loses money providing this care.

With this in mind see the video clip and you will understand where much of the confusion about health care reform comes from, given that even the President seems to misunderstand some of the details.

click here for President Obama's Video of Getting the Cost of Diabetes Wrong

New Report Shows Increasing Rates of Amputation Related to Diabetes in Hospitalized Patients

2009-09-25T06:44:00.001-07:00

A recently published study may spell bad news for diabetics who don't seek early treatment and competent preventative care. Once neglected, Diabetes leads to host of complications including kidney failure, open wounds that won't heal, foot and leg amputation and death. Many of these problems which can be prevented with proper early treatment are reported to be on the rise. In an age of the most advanced treatments, this should be warning sign ton policy makers, health care advocacy groups and diabetics patients world-wide. For all the details, read the full article here:

LancasterOnline.com:News:Hospital report: Mixed ratings

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Diabet Foot Treatment Skill #7: Continually Re-Evalaute After Surgery, In Order To Avoid Re-Ulceration, Re-Hospitalization, And Re-Amputation

2009-07-03T09:57:00.000-07:00

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment must possess. As a better educated person determined to thrive in spite of your diabetes, you’ll be able to evaluate the competency of your treatment team. A competent team will give you the best chance of avoiding a diabetes-related amputation.

Finally we’ll discuss essential skill number seven:

7. Continually re-evalaute after surgery, noting the risk of recurring problems in order to avoid re-ulceration, re-hospitalization, and re-amputation of the diabetic foot.

When you think about all of the things you know about how diabetic foot problems begin, this last skill at your diabetic foot treatment team should possess seems obvious.

But in fact, it is one of the frequently missing pieces. The unfortunate reality is that many doctors are trained to recognize a disease or condition and treat it successfully. Fortunately, many do exactly that. The problem is that modern Western medicine is based on disease cure or "management" and not disease prevention.

Because of this, doctors will often times "heal" a diabetic foot infection and then pat themselves on the back and send the patient on their way. They think they are done. While it is certainly worth applauding the foot doctor for healing a diabetic foot infection, and helping the patient to dodge a bullet so to speak, the patient is still actually in very dangerous territory.

Any patient with a prior history of the ulceration related to diabetes is at very high risk of developing another diabetic foot problem.

If the past episode actually led to an amputation, things are worse. Even if it was just one toe, the patient is at much higher risk of amputation in the future. Statistically, we know that one year after a patient undergoes a diabetic amputation, 26.7% will have another amputation. Three years after a diabetic foot or leg amputation, almost 50% will have another amputation. And five years after a diabetes related amputation, over 60% will have another amputation.

The fact is the odds are not in the favor of the diabetic patient. So diligence is required on the part of both the patient and the diabetic foot treatment team.

Whether it is an amputation of a toe or diabetic foot surgery to remove infected bone, bone spurs, or other deformities, the biomechanics of the foot are altered. The patient may then walk differently. The changes in the way someone walks can increase pressures tom part of the foot and put the patient at risk for developing another open sore.

This is why intensive monitoring after one of these episodes is so essentional.

The unfortunate reality of this however is that many doctors believe that following the patient closely is not within the guidelines of insurance coverage. In essence, they feel that this care will have to be free if they provid it. And in today’s turbulent healthcare environment, most doctors are struggling to see as many pain patients as they can.

The insurance companies have it set up in such a way that if you have diabetic foot surgery, all of your care is included in the surgical fee for 90 days. To the doctor this means that all the care that you need for the next three months is free. This only applies to doctors that Medicare or accept other insurance assignment. They are bound by the contracts that they signed.

For this reason, in most cases, the doctors will tell patients, “Just call my office if you have a problem.” But this usually is not enough. It is much more appropriate for doctors to see their patients at ever increasing intervals following surgery so that they can actually monitor the foot they operated on themselves. This type of intensive monitoring by the foot surgeon is just good medicine.

In my private practice, I would see every surgical patient within one week of the date of surgery. I would then see them one week later and one week after that. And depending on their progress might put them off for two weeks following that. But on average, most patients and had surgery would be seen six to 10 times during the postoperative period. In talking to my colleagues, I discovered that I see patients far more frequently than virtually every other podiatrist I know. But this is just good medicine.

When evaluating your diabetic foot treatment team in order to determine whether or not your doctors are providing the very best care for you, you must look closely at how often they want to see you. They should see you often.

If you have a concern and feel that you need to see your doctor, they should see right away. If you ever hear the phrase “I’m sorry, but your insurance company will not cover that.” You should become concerned.

All doctors take an oath to provide the best treatments and care for their patients. They do not take an oath to only take care of patients if they’re going to get paid well by the insurance companies that they agree to work for. Sometimes doctors just have to do what is right and not just what pays.

As long as your doctors have your best interests at heart, they will take very good care of you and you will get very intensive monitoring. This intensive continued evaluation after a diabetic foot emergency can help you prevent a diabetic foot amputation. As stated before, however it requires a great deal of diligence both from the patient and the diabetic foot doctor and team. But with this care, most diabetic patients will do well.

Diabetes amputations are preventable. Don't just survive...thrive with diabetes!

Dr. Christopher Segler is an award-winning diabetic foot doctor and foot surgeon. He firmly believes diabetic foot problems and related amputations are preventable. It is his mission to share his expertise ad teach strategies that can empower diabetic patients and stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Essential Skill #6 of Your Diabetic Foot Team: Evaluate Cultures and Change Antibiotics to Fight Bacteria Causing the Infection

2009-06-30T09:52:00.000-07:00

In these discussions, we cover each of seven critical skills that your diabetic foot treatment must possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number six:

6. Be prepared o evaluate the cultures and change the antibiotics to most effectively fight the bacteria causing the infection.

As explained in the discussions regarding Essential skill #3 (Obtain wound cultures to determine if any dangerous organisms such as MRSA are present and use appropriate culture techniques.) it is critical that you receive the antibiotics that will be the most effective at curing your infection by killing off the bacteria.

The world is filled with bacteria. In fact keeping your skin is covered in bacteria right now. But just because you have bacteria covering your skin does not mean you are in fact it. Doctors refer to the presence of normal bacteria on the skin or in the tissue as colonization. The difference between colonization and infection is that when there is an infection, the bacteria is growing rapidly and causing damage to the tissue. Rapidly growing bacteria producing damage to the tissue is what results in a diabetic foot infections and can lead to a diabetes related amputation.

There are a number of different types of bacteria which can be found in diabetic foot ulcerations and diabetic foot infections. This is why it is important to take wound culture is and determine exactly which bacteria is the one causing the infection. This helps the doctors determine which antibiotics will be the most affective.

For example, if the infection is caused by Staphylococcus aureus and antibiotic such as cephalexin (Keflex) will be highly effective. If however cultures determined that the Staphylococcus aureus is a drug-resistant strain such as methicillin-resistant Staphylococcus aureus (MRSA) then cephalexin (Keflex) will not be affective at all. In fact, giving Keflex as a treatment for an infection caused by MRSA can even make the infection worse.

When there is a great deal of infected material available, the doctors can obtain a sample of the infection and perform a Gram stain. This is a very simple way to get a good idea, of which class of drugs might be affected. Based on this test, your doctors will likely begin antibiotics based on an educated guess of which organism it will be. This is what is known is emperic antibiotic therapy.

But within 48 to 72 hours of obtaining the wound culture is, your doctors should be receiving more detailed information about the bacteria causing the diabetic foot infection. They should also be receiving information about which antibiotic drugs to the infection causing bacteria as well as any concerns of antibiotic resistance. Based on this information, your doctors will then prescribe the appropriate antibiotics.

In the rush of taking care of multiple patients in multiple facilities at the same time, it is easy for your doctors to miss out on this information, and not receive it as soon as it's available. However, it is critical that you are started on the very best antibiotics as soon as possible.

If you have a diabetic foot infections and have not heard from your doctor for several days after cultures were taken, you should call the office and follow-up with that doctor. Otherwise, the report from the lab. That explains the wound culture results may just be sitting in a pile waiting for the doctor's signature in their office.

Treating a diabetic foot infection is an active process that plays itself out over several days. Your diabetic foot treatment team needs to be continually evaluating and reevaluating your condition as well as all of the reports that are coming in over those initial several days in order for you to be able to get better and avoid a diabetic foot amputation.

Diabetic foot amputations are preventable. Preventing a diabetes foot or leg amputation requires diligence on both the patient and the diabetic foot treatment team. Whether surgery is needed or not, the evaluation of the effectiveness of your antibiotics each to be rapid and performed at regular intervals. If you have any concerns about whether or not, you might be responding to the antibiotics you are given, always contact your doctor immediately.

Diabetes amputations are preventable. Live long and enjoy an active life!

Dr. Christopher Segler is an award winning diabetic foot doctor. He believes diabetes related amputations are attributable to a failing health care system that neglects patient education. It is his passion to teach strategies that can empower diabetic patients and stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Essential #5 of Your Diabetic Foot Team: Be Prepared to Surgically Drain Infection or Remove Gangrene.

2009-06-28T12:58:00.000-07:00

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment must possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number five:

5. If necessary, be prepared to surgical drain any infection or surgically remove any dead tissue (gangrene) at the bedside (debridement).

This is a topic that is not for the squeamish. So prepare yourself.

All amputations in diabetic patients start out as some type of foot infection. The foot infection becomes worse, the bacteria rages out of control, and gangrene sets in. Gangrene is a scary term but simply means death of tissue. Dead tissue happens to be a fabulous medium for bacteria.

This skill is the one most typically referred to as “limb salvage.” If you look up the word “salvage” in the dictionary, you will find “property saved from destruction in a calamity (as a wreck or fire).”

Only by aggressively removing infected and dead tissue can the destruction of a diabetic foot infection be halted.

Emergency surgery is very common in treating diabetic foot infections. The very best way to treat a bad diabetic foot infection is by physically removing the infection…not by giving antibiotic pills. This means opening any area of infection to remove all of the bacteria. The infected compartment of the foot has to be irrigated. This is in addition to antibiotics, not instead of antibiotics.

Your team must be prepared to perform emergency surgery if the infection is bad enough that it is deemed a “limb threatening infection.” You have to keep in mind that the diabetic patient has an immune system that is weak. Because of this one is often unable to fight off an infection.

You have to also remember that poor circulation in the feet and legs (called peripheral arterial disease) is very common in diabetics. Most people with diabetes who are at high risk of a diabetic foot or leg amputation suffer from problems with the circulation in their legs and feet. Any antibiotics are delivered through the bloodstream. So poor circulation means poor delivery of the infection fighting antibiotic drugs.

In 2005, there was a research paper published in medical journal that discussed the risk of hoping to avoid surgey in diabetic foot infections. The article was entitled “Osteomyelitis of the Foot and Toe in Adults Is a Surgical Disease Conservative Management Worsens Lower Extremity Salvage.”

Osteomyelitis is the medical term for a bone infection. The point of this paper was to stress to physicians that hoping for the best and just giving antibiotics does not work. In fact, as the title suggests, that actually makes things worse. Surgery is necessary in order to save a leg from a diabetic foot infection.

Diabetes is a scary disease. Diabetic foot infections likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about surgery, infections, gangrene and amputations can certainly be alarming, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Diabetic foot amputation is preventable. Live long and enjoy your life!

Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Why don’t you accept insurance?

2009-06-13T10:15:00.000-07:00

Before I went to medical school and I would go see a doctor, I always thought that the insurance company was on my side. I would receive an explanation of benefits that showed that my insurance company had gone to bat for me and dramatically decreased the fee that the doctor was “allowed” to charge me. It made me feel as though they were protecting me from the doctor who is out to “overcharge” me.

Having been a foot doctor and surgeon in private practice who did at one time accept insurance, I realized that the insurance company is only interested in protecting their profits. In fact, the CEO of United Insurance company once stated that the insurance company would never attempt to keep doctors on the insurance plans at the expense of their profits.

Some insurance companies contracted rates that they offer as pay to doctors are so low that it is simply impossible to provide good patient care.

I once received a package via FedEx in my office from an insurance company. The delivery person said that I needed to sign for the package in order to receive it. When I opened the package there was a contract modification that dramatically reduced the rate the insurance companies said they would pay me for taking care of their members. Unbelievably, at the end of his contract was a paragraph that stated that by signing for receipt of the package constituted agreement to all of the conditions contained within the contract inside the package. It is absolutely ludicrous to think I would have agreed to rates without ever even opening a package. But these are the games that the insurance companies play.

The insurance company industry representatives have stated that any doctor should be able to see a patient in five to seven minutes. If you’ve ever been to the doctor, this is ridiculous. Now having said that, I have worked in clinics where I saw 60 people a day. I also believe that the patients did not receive quality care.

What I believe is quality care is providing evidence-based medicine as well as thorough explanations and patient education. All of this is necessary in order for a patient to participate in their own care. Providing a prescription for an order for an MRI or just an recommending that someone return in a few months is not really providing care.

Anyone with diabetes or any complicated medical condition deserves to have explanations. They also deserve to have their questions answered. And they certainly deserve more than five to seven minutes.

I have had multiple other doctors contact me and ask me for surgical second opinion on the patient. I have had many cases where these patients clearly needed a procedure that the insurance companies said they would not pay for. Those doctors then asked me what the second-best procedure was. I would supply them with my opinion. In most cases these other doctors would say, will you please come scrub in with me on the procedure that is covered by the insurance company.

In this scenario, my answer was always the same… absolutely not! , I would tell them that if you want to allow an insurance company to tell you to do the wrong procedure just because it cost them less money than you can do it yourself, and I will not participate.

At the end of 2008, I decided that under no circumstances would I allow an insurance company to tell me how long I can spend with the patient. Under no circumstances can insurance company tell me that the cheaper procedure is necessarily better. At least not better for the patient. So I opted out of Medicare and decided to no longer accept any insurance whatsoever.

High quality medical care is expensive. It doesn’t have to be prohibitively expensive, but it does have to provide the best outcome for the patient. Making decisions based only on price is a mistake for the patient. It is also a mistake to the doctor in the long run. A string of bad outcomes (whether because the wrong procedure or wrong medication was chosen) would certainly not be good for any doctors reputation. But when doctors choose to follow the guidelines of the insurance companies rather than their own medical decision-making, this is exactly what happens.

But this is not a problem for me, because I don’t accept insurance. Patient care comes first and cost is second.

Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed plenty of diabetic foot amputations, he firmly believes that diabetic foot amputations result from a continually worsening health care system that the force patients to live with the lowest cost treatments and deprive them of patient education. He does not accept insurance assignments of that he has the time necessary in order to provide the education for his patients that can prevent diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Your Diabetic Foot Treatment Team: Why they must evaluate the depth and character of the wound.

2009-06-12T18:40:00.000-07:00

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment should possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number four
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
Open sores on the feet of diabetic patients are very common. These of course are referred to as diabetic foot ulcerations. Not every diabetic foot ulcer will lead to an amputation. Having said that, most diabetic foot or amputations start as a diabetic foot ulcer.

Because of this, it is extremely important for you ta make sure your diabetic foot treatment team thoroughly evaluates any diabetic wound.

Anytime you have a serious medical condition, the first question is…how bad is it? For example if you have cancer, you want to know what stage of the cancer. The stage of the cancer will tell you the extent of the spread and likelihood that you will live or die.

In the same way, staging a diabetic foot ulcer can determine whether or not your foot will live or die. Determining the wound stage will help to determine whether or not you will need to be hospitalized, have intravenous antibiotics, surgery, or even an amputation.

Before describing the staging process, let me caution you as a patient. It is my long-held belief that medical school is a way for doctors to teach student doctors how to lose their ability to communicate with patients.

Classification systems are a very good example of this. In my residency (that had a heavy focus on diabetic foot training), my director understood this more than most. In our surgical conferences if a student or resident doctor mentioned a classification of any condition, Dr. Young would always demand that they explain exactly what that classification meant. This is a vital skill for clear communication. It shows that the doctor can know and explain what is really going on.

Many doctors lose disability. They become so familiar with the technical language and classification schemes, that they are simply unable to describe in simple terms what they see when they evaluate a wound, an illness or a condition.

So without giving you all the specifics about each of the different classification schemes, we will explain what the components are that need to be evaluated and why each is important.

The first component of a diabetic foot ulcer (open wound) classification system that should be evaluated by your treatment team is the size of the hole. It doesn’t really matter how big it is across your foot, but it doesn’t matter how deep. The skin on the foot is very thin and when a diabetic ulcer gets deeper, tendons, ligaments, and bone can become exposed and damaged or infected. Bones and joints that is clearly exposed to the external world through an open diabetic wound can only very rarely be saved.

Not surprisingly, as the wound becomes deeper. The condition is taken much more seriously. In general, skin will not just grow in and cover exposed tendons and ligaments, joints or bones. Action must be taken. In many cases this means surgery. A hope and a prayer is rarely enough.

Once your team has decided how deep it (and what tissues are exposed through the wound) they should next determined whether or not infection is present. This is usually not difficult. Any experience treatment team should be able to determine easily if the wind is infected or not. By definition, if your team cultures the wound, they believe that it is infected. See essential number three.

Next they should determine whether or not there is sufficient blood flow to heal the wound. Poor blood flow to an area is referred to by doctors as “ischemia.” You have to remember that any antibiotics are delivered to the foot through the bloodstream. If the blood flow is poor, the antibiotics can’t even get to the site where the battle is taking place. In addition, there is very little chance of the wound healing without good blood flow.

If the ischemia (or poor circulation) gets bad enough, gangrene can set in. Gangrene is nothing more than death of the tissue. It is often related to infection. Obviously is critical to your team and evaluates the blood flow to your feet whenever you have a diabetic foot wound.

If you have ischemia and an open sore on a single toe, and your treatment seem decides to amputate that toe, it is possible that the blood flow is so bad that the amputation site won't heal. This could create an even larger problem hole in your foot. It is a very basic tenant of diabetic foot surgery that the level of amputation must have sufficient blood flow to heal. Otherwise you may end up with each of your little piggy’s going to market one at a time.

By evaluating the depth of the wound ( including skin, tendon, joint, and bone involvement), presence or absence of infection, and presence or absence of ischemia, a much more realistic prognosis can be determined. All of these factors must be considered in order to determine whether or not the wound is likely to heal without hospitalization and/or surgery.

If you have a diabetic foot ulceration that is being treated without evaluating all of these factors, it might serve you well to seek a second opinion. You should also feel you have the liberty to ask your doctor whether or not you have an infection, any ischemia, or exposed tendon or bone. This is your right. Expect your doctor to explain what is going on.

Beware of doctors who feel you don’t deserve answers.

Diabetes is a complicated disease. Diabetic foot problem likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about amputations can certainly be frightening, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Amputations are preventable. Live long and enjoy life!

Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

How to Check Your Diabetic Feet

2009-06-09T12:45:00.000-07:00

Amputations are preventable. Having said that, you must understand that an amputation is not preventable if you have already developed gangrene and a bone infection (known as osteomyelitis).

However, gangrene and bone infections are always preceded by much smaller problems. The key with any diabetic foot amputation prevention program is to make sure that you are watching out for the smaller problems. If you check your feet twice a day, you will always be able to seek immediate treatment and prevent an amputation, before it is too late.

Your daily diabetic foot check should include several points of inspection. First and foremost, inspect your socks when you remove them from your feet. Anyone who is diabetic should only wear white diabetic socks. And you ask "why white?"

Well it turns out, there was a study that compared two goups of diabetic patients. I in the study, one group was given white socks and the other was given dark socks. At the end of the study, it was shown that patients who wore white socks had a lower risk of developing the type of complications that can lead to hospitalization and diabetic foot or leg amputations.

The reason for this is actually quite simple. If you develop a blister or draining open sore, it is very easy to see the drainage and know there is a problem if your socks are white. It is very difficult to see this sort of drainage on a dark colored sock. So look at your socks as soon as you take them off.

Once you have removed your socks, you should inspect the bottoms of your feet. Any area of redness or open wounds demand immediate attention. Areas that are red, hot, or swollen can signify an infection. Diabetic foot infections are easy to treat when they first start, but become much more difficult to treat as time progresses. Early intervention is the key.

If you are inflexible and it is difficult for you to see the bottoms of your feet, use a mirror specifically designed to help you see the bottoms of your feet. An illuminated mirror works best. Otherwise have someone help you look at your feet.

Always inspect between the toes. Look for open sores or area of white-ish discoloration of the skin. This can mean that your skin is becoming too moist between the toes. This can also put your risk of skin breakdown and an open sore. If you notice these sorts of problems, immediately see your doctor.

Next inspect the heels. The skin on the heels will frequently become dry and cracked in diabetic patients. This is the opposite problem of too much moisture that occurs between the toes. Even though it is the opposite problem, it can still lead to an open sore. Any open sore can serve as an opening for bacteria to get in and cause a diabetic foot infection.

Make sure to use lotion on the heels that is specifically designed for those with diabetes. Keeping the heels soft and supple will prevent the skin from cracking that can lead to a diabetic foot ulceration and the infection that ultimately leads to amputation.

Check the borders of the toenails to make sure that your toenails are not becoming ingrown. If you notice redness or drainage immediately seek treatment from a foot doctor. I myself have performed multiple amputations on diabetic patients that started out as nothing more than a neglected ingrown toenail.

By performing these simple daily diabetic foot checks, you can stay ahead of the diabetic foot game and stay out of trouble. When it comes to diabetes and your feet, a little preventative maintainance goes a long way.

Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed many diabetic foot amputations, he believes that diabetic leg amputations result from a failing health care system and inadequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Your Diabetic Foot Treatment Team: Why they should obtain wound cultures to determine if any dangerous organisms such as MRSA are present.

2009-06-08T11:06:00.000-07:00

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number three
3. Obtain wound cultures to determine if any dangerous organisms such as MRSA are present. Use appropriate culture techniques.

The primary reason that a person ends up with a diabetic foot amputation is because of a poor blood supply and uncontrolled infection. When ever a diabetic foot ulceration (open sore) develops, bacteria that is normally growing on the skin will live within the wound.

Doctors call this colonization. Colonization is what a normal process. Your entire skin is colonized with bacteria. In most instances, colonized bacteria do not cause harm or disease. The difference between colonization and infection is that one is a normal process and another causes harm.

One definition of infection is “to do well in internally endoparasitically as opposed to externally.” A parasite always lives at the expense of its host. When bacteria in an open wound on a diabetic foot begins to invade the tissue, rather than just living on the surface a diabetic foot infection begins.

In order to remove any infecting bacteria it is important to differentiate the organism causing the infection from other organisms that are normally growing on the skin and may not be causing any harm. The most reliable way to differentiate these two groups of bacteria is by obtaining a wound culture.

A wound culture is a process whereby a doctor obtains a sample of infectious material and places it in an artificial medium, where it will grow. The basic idea, is to take samples of the bacteria in the wound and transfer them to a petri dish and place them in an incubator. The bacteria will then start to grow.

If several samples of different antibiotics are placed with in the petri dish and marked, the bacteria will not grow, near the antibiotics to which they are susceptible. This is how doctors determine which antibiotics are likely to kill the bacteria and remove the infection from a diabetic foot.

In order to remove an infection, you must take the appropriate antibiotics. This can only be determined accurately with a culture.

Not only is it important to take a wound culture and make sure that a diabetic foot infection is being treated correctly, timing is also important. It takes a couple of days for cultures to determine which antibiotics are going to be effective. Because of this, most diabetics with an infected open sore will be started on antibiotics that are probably going to work. It is critical that the wound culture is taken before these antibiotics are given. Once antibiotics have been given, but when cultures become unreliable.

If the diabetic foot infection is not treated with the right antibiotics, they can take much longer to remove the infection. Most antibiotics are processed and removed from the bloodstream by the kidneys. Diabetics are at high risk for kidney damage. Often times when someone who is a diabetic takes antibiotics for a long period of time, they can damage the kidneys further. This can lead to complete renal failure, which places the patient on dialysis. A diabetic patient who has had kidney failure will die without dialysis to remove impurities from the blood.

This being the case is understandable why it is important to make sure that any antibiotics taken are going to the effective and only administered for the shortest period of time.

Whenever you go to the emergency room or see a doctor because you believe that you have an infected diabetic foot ulceration, you must insist that cultures are obtained before you start any antibiotics. This will help speed your healing, minimize the chances of any kidney damage, and reduce the risk that you will end up with a diabetic leg amputation.

Keep in mind that early treatment is key. If you believe that you are developing a diabetic foot infection, you should seek treatment immediately. No matter what time of day or night. You should call your treating physician and explain to them, what is happening so that treatment can begin right away.

This is why it is so important for everyone with diabetes to have a doctor that they feel they can call at any hour to discuss their concerns. In most cases, a short discussion can help you determine whether or not, you need to get out of bed and go to the emergency room or if this is a smaller issue, or if it can wait until the next day.

No issue is too small to discuss with your diabetes doctor. Diabetics are at extraordinary risk for having what seems like a minor problem end up as a life-changing amputation. Amputations are preventable.

Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed many diabetic foot amputations, he believes that diabetic leg amputations result from a failing health care system and inadequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Honey for Wound Dressings... Is It Scam or Science?

2009-06-01T08:11:00.000-07:00

One of the “newest” topical wound dressings is a form of medical grade honey. Honey is actually not a new dressing. It has been used for about thousands of years. There have been documented reports of honey being used in Egypt around 2,000 B.C.. It was also documented as a wound treatment in the Middle Ages.

But recently it has been gaining popularity again. That’s right, the favorite food for Winnie the Pooh. People are putting honey right on burns, radiation therapy wounds and diabetic foot ulcers. The questions is, why would a food product help a wound. Today we will discuss the medical reasoning behind honey as a diabetic wound dressing.

One of the interesting properties of honey is that it is very resistant to spoilage. No refridgeration required. For some reason, it just doesn’t get infested by microorganism like other foods left at room temperature. We will see that this is one of the properties of honey that is important in helping wounds heal.

So how then does honey help wounds? It turns out that honey has several properties that aid in wound healing. First, honey smeared on a wound forms a protective physical barrier, like a liquid band-aid. It keeps moisture in and bacteria out of the wound.

Second honey has a low pH of about 3.6 (7.0 is neutral). Bacteria don’t really grow well in acidic environments so this slight acidity retards their growth. The best environment for healing a wound is one which is friendly to the tissue to unfriendly to bacteria. Honey is both.

The third characteristic of honey that is good for wounds is its hygroscopic properties. This means that the honey can actually soak up excess moisture in the wound. Too much moisture can impede healing while providing food for bacteria that can turn into an infection.

The fourth interesting property of honey is that it is truly antibacterial. Honey contains an enzyme called peroxidase which is added to the nectar gathered by honey bees. This enzyme causes hydrogen peroxide to be present in the wound in just the right concentration that it kills bacteria, without being toxic to the human cells that are healing the wound. In addition, the plant nectar that is collected by the bees can influence the antibacterial properties of the honey. Honey collected from the Leptospermum species in New Zealand and Australia seems to be particularly antibacterial.

There is good science behind all of this as well. One of the first clinical studies of honey as a wound dressing was in 1988. In that study, it was shown that honey could reduce the number of positive wound cultures in burns and gangrene. This just means that less wounds were growing bacteria.

Since that time, many other studies have shown promising properties for honey in the treatment of leg ulcers, venous wounds, and the prevention of infection by dangerous bacteria such as MRSA (methicillin-resistant Staphylococcus aureus). Several other studies have since shown that honey does work in keeping antibiotic resistant strains from growing in wounds. This is important because antibiotic-resistant strains of bacteria, sometimes referred to as “superbugs” are on the rise. When antibiotic drugs don’t work, the infection can run rampant and lead to an amputation or even death.

Although the original use of honey as wound dressing hundreds or even thousands of years ago has been effective, scientist have developed it further to make it most effective. The original application was right from the source, just plain old honey. The medical-grade honey used in wound care is purified, sterilized, and contains the optimal concentrations of anti-bacterial agents.

Honey is available everywhere, but now even medical-grade honey is available without a prescription. It is also FDA approved. Supermarket honey may work much as it did thousands of years ago, but it is not tested to determine its wound healing properties. In addition, it may contain impurities which would be harmful to the wound. Honey appears to be an effective treatment for many types of wounds even though it is an ancient remedy.

Dr. Christopher Segler is an extensively published author and award winning diabetic foot specialist. Once he realized how diabetic leg amputations are resulting from a lack of patient education, it became his passion to teach strategies to stop diabetic amputation. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

2009-05-25T12:23:00.000-07:00

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number two.

2. Test for neuropathy to help determine the risk of ulceration and amputation.

In the simplest of terms, nerves are the wiring system of the body. They carry information from the outer reaches of the body (such as the hands and feet) all the way back to the brain where this information is processed. One thing that wires and nerves have in common is that they both transmit electrical signals. However, it is probably not a surprise that by comparison, electrical wiring system is significantly simpler than a nervous system.

There are a number of processes that happen within the body that can affect the function of nerves. In the diabetic patient in particular, this includes the way the body is using insulin, levels of blood sugar, levels of circulating lipids (or fats in the blood), blood supply to the nerves themselves, and energy metabolism with in the nerve cells that make up an individual nerve.

Although there are many different processes which can damage nerves, high circulating levels of blood sugar are likely the most damaging. In the United States, diabetic peripheral neuropathy (nerve damage in the feet related to high levels of blood sugar) is the most common type of sensory nerve damage.

Although the nervous system is very complex, checking for nerve damage can be remarkably simple. The most reliable test in order to evaluate whether or not a diabetic patient is at risk of developing neuropathic ulceration that might lead to hospitalization or amputation of the leg can be done in only a few minutes and at very low cost. Because of this, it is absolutely inexcusable that a doctor treating a diabetic would not evaluate the function of the nerves in the feet.

In addition to being low cost and simple to perform, there is one test that is the most useful of all exams in determining whether or not a patient is at risk of developing a problem that might lead to a diabetic foot amputation.

This test is called the Semme’s-Weinstein 5.07 monofilament test. In this test, a 5.07 mm diameter monofilament wire is used to apply precisely 10 grams of pressure to the skin of the diabetic foot in order to determine whether or not
the patient has what is known as “protective sensation”.

During this test, the doctor will ask you to close your eyes. He or she will then touch different parts of your feet with this monofilament asking you to say “right” or “left” whenever the doctor touches either of your feet.

If you can feel every area where the doctor touches your feet, you are at low risk of developing a diabetic foot ulceration that might lead to amputation.

If you do have some loss of sensation, the damage is usually at the ends of the longest nerves in the body. The longest nerves of course happen to go from the spinal cord all the way down the legs and out to the end of the toes. Because of this, the damage seems to appear in what doctors call a “stocking glove distribution pattern.” This means that the damage occurs starting the end of the toes and will usually stop in the same area on both feet as if one has rolled socks on to both feet at the same time.

For example, someone may have lost all of the sensation in the toes, but has all of the station present in the ball of the foot. This means that the patient is at risk of having an open sore develop in the toes but less likely in the midfoot or ball of the foot.

Because this can get worse over time, it provides a good baseline to determine if the diabetic foot problems are staying the same or getting worse.

The implications of this test are that if you have lost “protective sensation,” you are at high risk of starting to develop a blister and not being able to feel that there is a problem. The patients that have this sort of nerve damage will oftentimes step on foreign objects such as splinters, thumbtacks, or slivers of glass and never even noticed that anything has happened. It is this type of open sore that can rapidly develop into an infected diabetic ulceration and later lead to a diabetic foot amputations.

There are a number of other tests that can be used to evaluate the function of the nerves in the diabetic foot. Simply touching a specific type of vibrating tuning fork to the feet and ankles can get a great deal of information about early nerve damage that may be present but not yet concerning for the kind of damage that can lead to open sores.

Other screening tests that your doctor might use include checking hot/cold sensation, two-point discrimination, and evaluating light touch sensation. Nerve conduction velocity exams are more invasive tests and should be reserved for those with indications of problems such as tarsal tunnel syndrome.

Even if there is nerve damage, the open sores that result primarily from existing nerve damage are still mostly preventable. It just requires a little extra vigilance on the part of the patient and the doctor.

If there is only one screening test is performed your doctor evaluating your risk of foot problems that could lead to an amputation, it is the SWMF 5.07 test. For this reason, you must make sure that your diabetic foot doctor checks your feet initially to determine your risk of developing the sort of problems.

Only then will you know whether or not you are at imminent risk of and amputation.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot surgeon. After discovering how diabetic leg amputations resulted from inadequate patient education, it became his passion to teach strategies to stop diabetic amputation. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #1: Assessing the Circulation to the Feet and Legs.

2009-05-23T11:02:00.000-07:00

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number one.

1. Assess the circulation (blood flow) to the feet and legs to determine the risk of gangrene.

There is a long-held joke among podiatrists that the only function of the heart is to pump the blood to the feet. The suggestion with this is the over-emphasis on the importance of delivering oxygenated blood to the tissues in the feet in order to keep a diabetic patient from developing a problem that might lead to premature death.

It is a well-researched fact that diabetics develop problems with their blood flow at a much faster rate than other people. This happens everywhere in the body. Through the process known as atherosclerosis (or hardening of the arteries) blood vessels become lined with plaques that are deposited over time. As these deposits increase, the diameter of the inside of the blood vessel becomes smaller and smaller, effectively decreasing blood flow.

This has been well documented in the coronary arteries of diabetic patients. We know that if you take two patients (one who is diabetic and one who is not) who are otherwise identical, the patient who has diabetes is four times more likely to have a heart attack. In large part this is due to the accelerated rate of atherosclerosis.

This same process occurs in the arteries of the feet and legs. Because of this process, the blood flow to the feet is dramatically reduced over time. Without blood flow, there is no oxygen delivered to the tissues. Without oxygen tissues die. Gangrene is nothing more than death of the tissue. Gangrene is one of the leading causes of amputation among diabetic patients.

With all of this is in mind, it is very easy to understand why your doctor must assess the blood flow to your feet. There are many ways to do so.

The simplest tests (and those most likely to be performed by any doctor evaluating a diabetic patient’s blood flow to the feet) involve a simple physical examination. During this exam, the doctor will likely attempt to feel the pulses behind the inside of your ankles (posterior tibial artery pulses) and on the tops of your feet (dorsalis pedis artery pulses). If the clinician is able to feel these pulses easily, the chances of developing extraordinarily bad blood flow known as critical limb ischemia are very small.

If the clinician is unable to feel these pulses, a hand-held Doppler device will typically be used in order to further evaluate the blood flow. This is a simple easy to perform test that does not cause any discomfort to the patient and can give a great deal of information about the state of blood flow.

More extensive tests are sometimes needed. Other tasks include transcutaneous oxygen pressure measurements (Tcp02), toe Doppler wave form analysis and toe pressures, and arterial duplex ultrasound.

If the results of these studies show severely compromised blood flow, it may be necessary to perform other more expensive exams including computed tomography angiography or magnetic resonance angiography. These are tests that use either CT scans are MRI evaluations to closely evaluate the state of blood flow in the feet and legs. They can provide an extraordinary amount of information but are oftentimes difficult to get approved by insurance companies due to their extraordinary cost.

The combined results of all of these exams are considered closely with the patient’s history, other physical exam findings and symptoms. In many cases all that is needed is continued monitoring of the patient. However, if findings warrant rapid intervention, it may be necessary to have an angioplasty or arterial stent placement in the leg in order to restore blood flow by a vascular surgeon. Other times an open arterial bypass is sometimes needed.

One thing that is clear is that delays in evaluation of the blood flow to the feet and legs can create huge problems. The most obvious of these would be development of gangrene as a result of critical limb ischemia that would make an amputation necessary.

The bottom line is that any doctor evaluating a diabetic patient should check (at the bare minimum) the pulses in both feet. If you see your diabetic doctor and the he/she does not ask you to take off of your shoes to evaluate the pulses in your feet, you should immediately find another doctor.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

7 Essential Skills Your Diabetes Treatment Team Must Have

2009-05-22T13:03:00.000-07:00

A recent publication was released in e-Plasty, an open access journal of plastic surgery. The subject matter of this article contain new guidelines for treating physicians (who may or may not be experts in diabetic foot disorders) to prevent amputations among diabetic patients.

We know that diabetes worldwide is becoming an epidemic. In the United States the growing population of diabetic patients is now almost 26 million. Because more and more doctors are being forced to take care of diabetic patients, guidelines are needed to provide guidance and standards to help all treating medical professionals understand the steps to take and ensure their patient doesn’t unnecessarily wind up with a diabetic below knee amputation.

This article cited seven essential skills that are absolutely necessary in order to provide the very best outcomes in terms of diabetic limb salvage.

1. Assess the circulation (blood flow) to the feet and legs to determine risk of gangrene.
2. Test for neuropathy to help determine risk of ulceration and amputation.
3. Obtain wound cultures to determine if any dangerous organisms such as MRSA are present. Use appropriate culture techniques.
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
5. If necessary, be prepared to surgical drain any infection or surgically remove any dead tissue (gangrene) at the bedside (debridement).
6. Be prepare to evaluate the cultures and change the antibiotics to most effectively fight the bacteria causing the infection.
7. Continually re-evalauet after surgery, noting the risk of recurring problems in order to avoid re-ulceration, re-hospitalization, and re-amputation of the diabetic foot.

Over the next week or so, we will discuss each of these in depth.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

New Technology For Treating Diabetic Wounds Has the Potential to Increase the Rate of Operating Room Infections.

2009-04-30T08:41:00.000-07:00

Diabetic foot ulcers or an increasingly common problem. In fact, the majority of Americans will at some point require wound care treatment in order to heal diabetic ulcers, venous ulcers or pressure ulcers. To meet this growing demand, those in the wound care field are developing in producing new technologies which have a great deal of promise in helping to treat these wounds which are typically difficult to heal.

One new such technology is a water scalpel. I have personally used these devices in surgery when in residency training. I found them to be extremely helpful at removing dead and infected tissue when preparing a difficult to heal diabetic ulcer for a skin or tissue graft. Unfortunately, recent research has shown that these water scalpels can send bacteria flying through the air in the operating room and lead to potential contamination of other surgery patients.

This week at the Annual Symposium on Advanced Wound Care and the Wound Healing Society Spring Meeting hosted the largest gathering of multidisciplinary wound care specialists in America.

Research conducted by clinicians at the University of Arizona won the top award in the research poster category which demonstrated that bacteria found in diabetic ulcers and other wounds can become airborne when using the water scalpel in a mock operating room environment. This study suggests that additional precautions are needed when using these devices in the operating room to prevent the spread of dangerous infections from one wound patient to another.

Additional research is needed in order to determine ways to confirm the risk of contamination as well as develop new ways of shielding patients from these dangerous types of infections. It is already known that hospital acquired infections are increasingly common and often involve the transmission of the most dangerous types of bacteria such as MRSA.

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

LA Times Article on Diabetic Foot Amputations

2009-03-24T08:18:00.001-07:00

This past Sunday the Los Angeles Times ran a front page story on amputation of feet and legs related to diabetes. In the story, a vascular surgeon stated that those losing legs from amputation are generally poor, obese, and/or elderly. While there may be some truth to this, a diabetic foot amputation can happen to anyone.

We also know that because the prevalence of diabetes among younger people is rising rapidly, there will be more and more young adults losing legs and becoming disabled. It is estimated that in the next 10 years the number of those suffering this preventable complication will double. Giving the current down economy and high rate of unemployment, it is frightening to think of even more people being forced out of work to to such a tragic, yet preventable, medical condition.

If wealthy educated successful executives can wind up with the completely avoidable loss of a leg due to diabetes, then the health care system must be failing. Every diabetic patient should take charge of their futures and learn how to prevent such an amputation related to diabetes.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

How Would Your Life Change if You Lost a Leg to a Diabetes Amputation?

2009-01-13T13:25:00.000-08:00

60% of all amputation are the result of foot problems from diabetes. Every single minute, 2 legs are amputated from diabetes. If you have diabetes you are at risk (about 25%) that you will get diabetic neuropathy (numb feet from diabetes), a diabetic foot ulcer (an open sore on the foot that is difficult to heal) or worse, a diabetic amputation. If you have ever talked to a person who has a lost a leg to diabetes, they will tell you it is tough to deal with. If this happened to you, what would your life look like?

Award winning diabetic foot strategist and podiatrist Dr Christopher Segler discusses the difficulty a diabetic amputation can cause, and how it can disrupt your life.

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

What Does it Cost to Save a Leg and Prevent a Diabetic Foot Amputation?

2009-01-10T16:10:00.000-08:00

Whenever a person with diabetes discovers that the problems leading to diabetic amputations are preventable, the first question is...what does it cost? In this video, the Director of the American Limb Preservation Society discusses the cost of limb preservation as well as the cost of having a diabetic amputation.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Diabetic Foot Infection

2009-01-09T17:49:00.000-08:00

Today I saw a patient who had a diabetic foot partial amputation only 3 weeks ago. He called the office and said he had a new spot he was worried about. Just earlier this week I had taken out his stitches from the amputation site. He had already been admitted to the hospital, taken to the operation for emergency surgery and then had an amputation.

Today the new spot was a blister right next to the amputation site. He said that his neuropathy causes his feet to feel cold. So he sleeps with a heating pad on his feet. Unfortunately the heating pad caused a second degree burn which since became infected.

So, today I used a scalpel and tissue nippers to trim off the dead and infected tissue. I took some wound cultures from the pus draining out of the blister. That way we can tell what bugs are living in there and causing the infection. I also started him on antibiotics. But his still has an open sore and the potential for another preventable diabetic foot disaster.

This episode illustrates the way additional amputations can happen in a those with diabetes and numb feet. Statistically a person with a diabetic foot amputation will experience re-amputaion in less than 5 years.

In all likelihood, this incident will be less eventful than the last, but it was also avoidable. As with just about every other diabetic foot problem, an ounce of prevention is worth a ton of cure.

Some basic rules:

1. Always check your feet for open sores, red areas or new problems. Check twice-a-day.
2. Never sleep with a heating pad, hot water bottle, or other heat source near your feet.
3. Seek treatment immediately as soon as you see a new sore or detect a problem.

If the antibiotics work, he will stay out of the hospital. If the infection gets worse he will be admitted to the hospital with more of the hideously expensive intravenous antibiotics beating up his already weak diabetic kidneys. If it goes badly he will get diabetic foot amputation #2.

Lets hope for the best.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Phantom Limb Pain After Diabetic Amputation

2009-01-08T18:06:00.001-08:00

At one time, surgeons thought that phantom limb pain was a hoax. Really, doctors thought patients were making it up. They were crazy. It was all in their heads. Well, in fact it is in their heads, in a way.

There is an old saying that "pain is in the brain." That is certainly true with any amputation leading to phantom limb pain. For example, we now know that there are several factors that can influence the risk of developing severe, debilitating phantom limb pain after an amputation.

The first is pre-operative pain control. For some reason, patients that suffer with poorly controlled pain just before the limb is amputated will have a higher chance of developing phantom limb pain. We also know that "control" has an influence as well. For example, if you think that a diabetic limb amputation is inevitable, and you actually get to have some say in the decision making process, your chances of having phantom pain goes down. If however, you feel you had no control or perceive you were forced into it, you willbe more likely to develop phantom limb symptoms.

We also think that your perception of post-amputation disability can have an impact. If you have worked with an orthotists and feel you be able to recover, walk and enjoy life, your risk of post-op chronic phantom pain goes down.

Knowing this, you must work with your doctor to decrease your chances of developing phantom limb pain. You must report pain and be honest about how much your foot or leg hurts in the time leading up to the operation. Pain medicine and local infusions of numbing agents can be very successful in controlling your pain before the amputation. You won't get a medal (but might get phantom pain) for trying to "tough it out" through the pain. Be smart. Control the pain.

Join an amputee support group and get counseling so yo can meet other amputees who have gotten their lives back after a diabetic leg amputation. Don't just rot away in a wheel chair parked in front of a television.

Meet with a specialist in prosthetics to get an understanding of limb prosthesis advances and options. I can personaly say that the devices are amazing. I was once passed by an amputee at Ironman Arizona. That race is 140.6 miles. All in one day. And for that person, on one leg. You can stay active too. Don't let diabetes (or even an amputation) get you down.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

High Rate of Diabetes and Diabetic Related Foot Amputations

2008-12-30T08:54:00.000-08:00

Monday, December 29, 2008: the Pittsburgh Post-Gazette reports on the high rate of diabetes and diabetic related foot amputations.

It has been reported that between 2003 and 2006, the national average diabetic amputations is 1.1 amputations per 1,000 per Medicare beneficiaries. By contrast, Pennsylvania has 1.23 lower-limb amputations per 1,000 Medicare beneficiaries. That is a rate that is about 38% higher than nearby state of Rhode Island and Michigan.

The newspaper article highlights a 77-year-old type 2 diabetic who ended up with partial foot amputation. The story explains that the gentleman had a bone spur and persistent diabetic foot ulcerations, which lead to an infection. Because of the spread of the infection, it was necessary to perform a partial foot amputation in an attempt to save his leg. He had been borderline diabetic for about 10 years prior to the amputation. Amputation was followed by a stay in a nursing home, where he received powerful antibiotics.

Unfortunately many Southern states actually have even worse rates of amputations than Pennsylvania. Geography is the not the only contributing factor. It was also reported that African-Americans nationwide have a risk that is about four times the amputation rate for Caucasians. The rate is actually nearly 7 times as bad if they live in Louisiana, South Carolina or Mississippi.

Poor diet and lack of exercise are all contributing factors to these sorts of complications related to diabetes. Patterns of diet and exercise appeared to have geographic correlation.

The Dartmouth Atlas also reveals that African-Americans nationwide have four times the amputation rate of whites, with nearly seven times the national average in portions of Louisiana, South Carolina and Mississippi. Texas actually has some of the highest rates of amputation with McAllen, Corpus Christi and Harlingon being the worst areas. These areas have imputation rates that are nearly twice the national average.

The diabetic foot partial amputee highlighted in this story credits his podiatrist with saving his legs so that he can still walk. Early detection with these sorts of complications is essential to preventing a worse amputation.

Is absolutely necessary for your doctor to check your at your visit, if you are a diabetic, any new open sore or concerning area on the foot must be checked immediately. We know that early intervention can prevent open sores, infections, and amputation related diabetes. It’s hard to believe, but true, that something as simple as ingrown toenail can lead to the sort of infection results in a diabetic amputation.

Lower limb amputations related to diabetes, are often the result of poor blood sugar control, diabetic foot neuropathy, and a compromised immune system. Unfortunately, these are not the only problems and develop diabetes. Many diabetics also develop heart disease, kidney disease and blindness.

Of all of these complications, diabetic foot ulcers, wounds, and other problems that can lead to gangrene and amputation may be the most preventable. Although there has been increasing awareness of the problems related to diabetic orders, it seems to be very slow progress in the area of actual prevention of these problems. Many new technologies do exist which can aid in the detection and early prevention of the open sores that the heat infections in amputations among diabetics.

The more traditional methods of preventing these problems include seeing a podiatrist to check the pulses in the feet in order to assess blood flow. If there is any compromise of the circulation referral to a vascular surgeon may be arranged. Often times blood flow to the feet and legs can be restored through stent placement or angioplasty. Sometimes a bypasses performed in order to restore blood flow to defeat. Checking for neuropathy, or diabetic nerve damage, is also important. Diabetic shoes are also helpful in reducing friction and shear forces to the feet that can lead to open sores.

Unfortunately, even these well-documented interventions are not available to everybody. It is well known that poverty and a lack of access to podiatrists and other healthcare practitioners can increase the rates of complications leading to diabetic foot amputation.

The worst part about all of this is that we know that once in amputation does occur, life expectancy and dropped to only about 18 months. This is often because of decreased mobility, increase risk of developing pneumonia and other health-related problems.

Source: http://www.post-gazette.com/pg/08364/938218-114.stm

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

One Fourth of Diabetic Amputees Wish They Saw a Podiatrist Sooner

2008-12-29T18:00:00.000-08:00

A 2008 study conducted by an an independent research firm for the American Podiatric Medical Association found 25 percent of 600 diabetics who were surveyed and had suffered an amputation related to their diabetes said they should have seen a diabetic foot specialist like a podiatrist. Thirty percent of amputees believed that watching closer and heeding known early warning signs, such as “hot spots” and diabetic foot ulcers, might have prompted them to visit their doctor before things worsened.

In total, 75 percent of the survey participants were type-2 diabetic. The remaining 25 percent were considered at high risk for developing the disease, sometime called "per-diabetic" or "bordeline." The study results showed also found that Hispanics were the least likely ethnic group to be tested for diabetes, compared to African-American and Caucasians. Surveye participants said the reason for not getting tested for diabetes was primarily due to normal blood sugar levels or not having noticeable symptoms.

“This survey shows just how immensely important it is for those diagnosed with diabetes, and those at risk, to have their feet examined by a physician during their annual checkup” the APMA president said. “Regardless of one’s ethnic background, taking a proactive approach to your health in asking your physician to check your feet can save both your limbs and your life.”

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE reportt “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Gene Therapy may be the Future in Amputation Prevention in Diabetics with Poor Blood Flow

2008-12-26T06:12:00.000-08:00

Cardiologists and vascular surgeons at Rush University Medical Center are now studying in innovative but investigational new medication that involves gene therapy. Researchers are working to determine whether or not gene therapy can promote new blood vessel growth in the feet and legs of patients who suffer from critical limb ischemia.

Critical limb ischemia is a condition that results in a severe lack of blood flow to the patient’s feet and legs. This often occurs in patients with diabetes. Peripheral vascular disease and disruptions in blood flow to the feet and legs are a major cause of amputation in the United States. At present, about 70% of all amputations are related to diabetes.

When a patient has diabetes, the process of atherosclerosis which clogs the arteries happens faster. If this process goes on for long enough, critical limb ischemia can develop. Because the arteries become clogged, there is less circulation to the feet and legs.

This results in a lack of oxygen and, in a sense, starves the tissues of nutrients. Without nutrients, the tissue start to die off and ulcers (or diabetic foot sores)can develop. “The goal of gene therapy is to stimulate the growth of new blood vessels. The additional blood vessels will carry more blood into the legs, alleviating pain and healing ulcers,” one of the researchers said.

The research is presently being done at Rush University involves Phase III clinical trials which will evaluate the effectiveness of gene therapy in preventing amputations in people with critical limb ischemia.

At present there are no prescription drugs at all available which can effectively treat critical limb ischemia. Because there are so few interventions that are effective, new therapies are needed in order to prevent the sorts of amputations.

This type of gene therapy is known as angiogenesis therapy, which means growth of new blood vessels. This sort of gene therapy appears to induce the production of a protein called fibroblast growth factor (FGF-1) which stimulates the growth of blood vessels at the site of injection.

The clinical trials that are now under way will last for one year. Participants are over 50 years of age, have stable ulcerations of the skin and noninfected gangrene on a foot or leg. All have also been diagnosed with peripheral arterial disease and critical limb ischemia. The participants will receive for injections of the investigational medication or a placebo into the leg muscle a two week intervals.

It is known that about 8 million people suffer from peripheral arterial disease. In the United States, that means one out of every 40 adults. It is a very common disease. It is often underdiagnosed. Because it is so common in diabetic patients, this might provide new hope for the prevention of diabetic foot amputations.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

UNC Basketball Player: Diabetic Foot Amputation?

2008-12-24T04:16:00.000-08:00

The Asheville Citizen just reported that UNC Asheville basketball player Kenny George has been released from the hospital after having a foot amputation. Although the patient and his parents have declined comment, is suspected that this was a similar episode was expected with diabetes and amputations.

What we do know is that the 7-foot-9, 375-pound center had to have part of his right foot amputated earlier this year. As part of that treatment he also spent three months in the hospital. The reason for such a prolonged hospitalization and amputation was that he contracted MRSA.

MRSA (or methicillin-resistant Staphylococcus aureus), is a type of bacterial infection, which is resistant to many antibiotics. This is now a much feared complication of hospitalization and surgery performed in hospitals throughout the United States. About 10 years ago, the vast majority of these infections were contracted while patients were in the hospital. Today these infections are growing more and more common. In some communities 85% of all skin and soft tissue structure infections involve the drug-resistant bacteria.

Because these bacteria have become more resistant to most of the antibiotics that are taken by mouth, it is often necessary for a patient to be hospitalized in order to treat the infection. These intravenous (I.V.) antibiotics are typically very expensive. Often times the antibiotics can cost $1000 per day. If these infections move into the bone, surgery and up to six weeks of antibiotics can be necessary.

In diabetics, the only effective way to reliably treat these infections is through amputation of the foot. Diabetes substantially reduces a person’s ability to fight off one of these infections. MRSA infections are much more common in people with diabetes. Recent research has shown that about 70% of all amputation to related to diabetes. Although it is not clear that this basketball player is diabetic, it is certainly unusual for a non-diabetic patient to end up with a sort of problem particularly at a young age.

At the end of November, the patient was released from the hospital and is at home recovering. It is hoped that the infection has now been completely cleared.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

National Health Service Increases Funding for Diabetic Foot Programs Related to Podiatry

2008-12-17T05:54:00.000-08:00

Children with diabetes in certain areas of the United Kingdom will be getting extra financial support.

The National Health Service has recognized the critical nature of funding diabetic programs for children. His most recent funding will help to pay for pediatric diabetic nurses as well as psychological support for children with type 1 diabetes. It is known that type 1 diabetes in children is linked with high levels of depression as well as eating disorders.

In addition to counselors who specialize in diabetes related to children and pregnancy, extra podiatrists have been added as well. For many years podiatrists in the United Kingdom have been recognized as critically important to preventing complications lead amputation. They have recognized that intensive monitoring by foot and ankle specialists, particularly podiatry, lead to early interventions and help to provide rapid treatment for diabetic foot ulcerations and open sores that can lead to amputation.

It has long been known that open sores in diabetic patients can rapidly become infected and lead to gangrene. Is also known that bone infections known as osteomyelitis are typically preceded by diabetic foot ulcers.

The hope of the additional funding is that diabetic patients will taking off of waiting lists and will be able to be evaluated sooner.

In addition to funding for type 1 diabetic patients, there’s a great need to assist with those with type 2 diabetes. Type 2 diabetes is becoming increasingly common. This rising type 2 diabetes, directly correlates with the increase in obesity within any given population.

At present, approximately 10% of the entire National Health Service annual budget is spent on treating diabetic foot ulcers, open sores on the feet, diabetic foot infections, and other diabetic foot complications.

Is well known that by having patient work closely with their primary care doctors and podiatrists, it is easier to keep diabetes under control and prevent diabetic foot amputations. It is also important to make sure that they podiatrist is closely involved one of diabetic patient begins a new program of exercise to help control the persons blood sugar.

Diabetes is not have to lead to amputation. With good blood sugar control, proper diet and exercise, diabetic patients can hope to lead a healthy and active life.

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

American Limb Preservation Society Site is Up!

2008-12-15T21:41:00.001-08:00

The new website for the ALPS is now up. It will be full of diabetes facts and information about diabetic foot sores (diabetic foot ulcers), foot infections, and diabetic amputation prevention. Go to www.ineedmyfeet.com to learn more about staying healthy and active, in spite of your diabetes.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Diabetic Foot Infection... Emergency Surgery as it Happened Today

2008-12-11T20:16:00.001-08:00

Today was one of the days I dread. I was coming out of a treatment room and Sherrie stopped me to ask if we could ad an emergency diabetic patient. A diabetic man man was on the phone. He had called and said his big toe was "black and blue and squirting blood." Never a good sign. I told Sherrie to tell him to either come in immediately or go straight to the Emergency Room.

Twenty minutes later he was in my podiatry office sitting in a treatment room. He was right, it was black and red. But squirting more pus than blood. I started to trim a way some of the thick hard callus to drain the infection. And drain it did, odor and all. Paula, who was assisting me, asked to leave the room.

I explained that he was going to need surgery. I had him sign a consent form and explained what we would need to do. I took some cultures, wrapped up the foot and sent him straight to the hospital to be admitted for powerful antibiotics and to get ready for surgery. I sent over some orders and then saw the rest of the patients.

After I finished seeing all of the post-op bunion patients, heel pain cases, and a guy that almost lost his toe a year ago, I went home to eat with my wife and son Alex. He's going to be a year old next week. We ate dinner and I waited for the hospital to call, to tell me when we could start. After Alex went to sleep, I headed back to the hospital.

In the operating room, I took a scalpel and opened the end of the big toe. The bone in the end of the toe was mushy and soft. I took some pieces to send for culture (to see what kind of bacteria is growing in there). I removed the bone and flushed it out to wash away the pus and bacteria. I packed the end of the toe and wrapped it up.

In a few days we will go back to the O.R. and remove whatever looks dead or infected. Or if all is well, I will close it so he can go home for Christmas.

The reality is that this episode was preventable. With proper monitoring and careful attention to the feet, this man would not be in the hospital. I would have been at home with Alex. He would have been home with his family instead of in the hospital.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Statistics on Life Expectancy After Diabetes Leg Amputation from Gangrene

2008-12-10T16:52:00.000-08:00

One question I was asked recently is was... What are the statistics on life expectancy after diabetes leg amputation from gangrene?

Well, I wish I had good news. Whenever a loved one gets gangrene, it can be traumatic. Not just for the diabetic who winds up with an amputation, but the spouse as well. The kids, the whole family take a beating emotionally. They see the foot turn black, they smell the foul odor. They watch their loved one go from a lively person to someone who will be luckey to ever walk with a prosthetic leg.

Dancing on your 50th wedding anniversary..nope. Going for 18 holes of golf..nope. Running down the street to teach your grandson to fly a kite...nope. So the patient sees all these things that were taken for granted, drifting away. And the family sees it too. Then they start to wonder about the bigger picture. How long can you live after an amputation?

The statistics regarding diabetic life expectancy after an amputation related to diabetes complications (such as gangrene, diabetic foot infections, and bone infections (osteomyelitis)) are quite bad. Every 30 seconds a limb somewhere is amputated as a consequence of diabetes.

In fact, we know that diabetes makes you 46 times more likely you will have an amputation. Within one year after a diabetic foot amputation, 26.7% will have another amputation. Three years after the first diabetic amputation, 48.3% will have another amputation. Within 5 years of a diabetes related amputation, 60.7% will have another amputation.

If that isn't bad enough, diabetics with amputations don’t live very long. We know that about 50% of all diabetics with an amputation are dead 3 years after the amputation.

65% of all of those with a diabetic amputation are dead 5 years.

In spite of this, there is hope... most are preventable. Watch your blood sugar. Check your feet every day and see a podiatrist, podiatric surgeon, or foot surgeon specializing in diabetic limb salvage if you start to get any open sore or wounds on your feet. Do not wait until it is infected.

With these simple interventions you can keep your feet. And maybe you will dancing on your 50th after all.

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Diabetic Former Pro Baseball Player. No Legs and No Hall of Fame.

2008-12-09T16:42:00.000-08:00

Ron Santo is true icon in baseball. And he has seen some tough times. If nothing else, he knows how to persevere.

If you don’t know him, he has too many records to list. Here are a few. Santo played third base for the Chicago Cubs from 1960 to 1973. During his career, he was a 9-time All Star, won 5 consecutive Golden Glove Awards, and is the only third baseman in history to go 8 straight seasons with 90 runs batted in. In addition he is true team player as evidenced by the fact that from 1966 to 1974 he held the NL record for assists in a single season.

By any measure he should be a Hall-of-Famer. But again this year its not in the cards. "Everybody felt this was my year," Santo told the Chicago Tribune paper on Monday, in his typical gracious manner, even though the years are slipping away.

He is already 68 years old. No spring chicken for a double amputee with diabetes. "To me, two years, because of what I have with the diabetes and [getting] older, it's like eternity," he recently said. He is not alone, because every 30 seconds, another leg is cut off due to diabetes related complications. Statistically, most people who have diabetes are dead within 5 years of having amputations of both legs.

Santos has fought with diabetes for decades, but kept it a secret for most of his career with Cubs. In the late 1960’s he started having trouble. The pro baseball player ended up with the common diabetic sores that led to more than 24 surgeries and partial amputation of both legs. But he still roots for the Cubs from the bench.

"I don't know how he does it; his spirits are always up," said his friend Savelli. "I'm sure he's taking it like a man. Ronnie's a hard-core guy. He has to be to take all he's taken. I'd have been dead a long time ago."

Santos is one of those lemons-from-lemonade types. Whenever he is not working as a member of the Cubs broadcasting team, he is fighting diabetes through community involvement and fundraising. He started the Ron Santo Walk to Cure Diabetes about 30 years ago. Through that effort he has raised $60 million for juvenile diabetes research. He keep high hopes both about a cure for diabetes, as well as his chances for induction into the Hall of Fame.

Personally, I hope he gets both.

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor located in Chattanooga. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

How Can Becoming an Athlete Prevent a Diabetic Foot Amputation?

2008-12-08T17:39:00.000-08:00

One of the very best ways to treat diabetes is with exercise. We know that when a patient has diabetes, diet and exercise can significantly change the course of the disease. In fact, we know that after 45 minutes of aerobic exercise, such as running, a diabetic patient’s insulin sensitivity may increase for up to 48 hours. This is extremely beneficial for type 2 diabetics.

Not only can exercise such as running help a diabetic patient by changing the way that the body can use insulin, it also can help a number of other conditions.

We know that in all people, exercise can dramatically affect cholesterol levels. Hyperlipidemia or high cholesterol is one common condition affecting diabetic patients. We know that the VLDL and LDL (bad cholesterol) is lowered with exercise, while HDL (good cholesterol) is increased.

In addition, regular exercise can significantly affect a person’s blood pressure. Hypertension or high blood pressure is a common complication of diabetes. We know that regular exercise can typically reduce blood pressure by an average of 10 mm/Hg.

Obesity is another problem that is commonly associated with diabetes. Obesity alone is a major cardiovascular risk factor. It also leads to insulin resistance, further complicating diabetes. When a diabetic patient loses at least 15 to 20 pounds, fasting insulin levels can drop by 30 to 50%. As a result, there is much better blood glucose control.

Heart attacks and strokes are very common in type 2 diabetic patients. Regular aerobic activity such as walking and running have been shown to reverse the effects of increased levels of an enzyme called plasminogen activator inhibitor-1, which can in turn significantly reduce the risk of heart attack and stroke.

All of the disease processes mentioned can help clog the arteries and decrease blood flow to the legs. When this happens, you can get an open sore... it doesn't heal... it gets infected... and then you get gangrene. Once you get a diabetic foot infection with gangrene of the foot you will either get an amputation or you will die. But not to worry... it is all preventable!

With all of these possible benefits of exercise, it is understandable why any diabetic patient would (and should) embark on a program of exercise. The whole emphasis with diabetes is preventing long-term complications. Train Smart...Live Long!

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

Is Diabetes a Handicap?

2008-12-07T14:21:00.000-08:00

Although diabetes is a serious disease, it should only be considered a handicap when it limits the activities that allow you to enjoy life. One obvious way this can happen is through an amputation or blindness. But it doesn’t have to be this way.

Although we know that diabetes can lead to heart disease, stroke, blindness and open sores on the feet that lead to amputation or death, this is largely preventable.

Research shows that regular exercise and a healthy diet are two ways that can help people prevent diabetes, or even to alter the course of a person’s disease if they do already do have diabetes.

One of the very best ways to make sure the diabetes does not become a handicap is with exercise. We know that when a patient has diabetes, diet and exercise can significantly change the way your body uses insulin and help fight the disease. In fact, we know that after 45 minutes of aerobic exercise, such as running, a diabetic patient’s, insulin sensitivity may increase for up to 48 hours. This is extremely beneficial for type 2 diabetics.

Exercise not only changes the way that your body uses insulin, but it can reduce problems associated with cholesterol, blood pressure, risk of a heart attack or stroke and obesity. We know that when a diabetic patient will lose 15 to 20 pounds, it improves insulin levels from anywhere to 30 to 50%. This results in much better blood sugar control that can prevent many of the complications from diabetes that we worry about.

In United States diabetes is the fifth deadliest disease. We actually think it might be much worse than this because people who do have diabetes might die from other complications including heart attack, stroke or complications of an amputation with gangrene related to a diabetic foot sore.

Whether you are a type 1 or type 2 diabetic patient, exercise can provide a tremendous benefit. You just have to be careful and make sure that you manage your blood sugar correctly.

Oral hypoglycemic medicines ( pills to keep your blood sugar down) may also have a significant impact on your blood sugar when you exercise. For example, sulfonylureas (glipizide, glyburide, etc.) and meglitinides (prandin, starlix, etc.) may require dosing adjustments in order to prevent hypoglycemia (low blood sugar) during exercise. Metformin (glucophage) and thiazolinediones (actos and avandia) are less likely to cause hypoglycemia when you exercise. However if you are taking any of these medicines it is important to talk to your endocrinologist or primary care physician to make sure that you don’t get into trouble.

You should also make sure that you get checked by a podiatrist to make sure that you do not have any problems with your feet, such as diabetic peripheral neuropathy ( loss of feeling) that can put your risk of developing the kind of open sore that can lead to an amputation. An annual diabetic foot exam with a podiatrist is a good way to make sure that you are not at risk of an amputation.

And amputation is one sure way they diabetes can become a handicap. Once a leg is amputated, it’s very difficult to move around the home. Even something as simple as turning on a ceiling fan can become a major challenge. We also know that there are a number of risks associated with having an amputation. About half of all patients who have an amputation on one foot will have any vacation on the other leg within five years.

We also know that diabetic patients who have indications on both feet will most often die within five years.

In spite of all this gloom and doom, there is hope for diabetes. There are a number of available technologies which can significantly reduce the risk of amputation of diabetes. This requires intensive intervention from a specialist in diabetic limb preservation. Unfortunately, not covered by insurance, but is essential to making sure that in amputation is prevented.

Although it can be frustrating when you find out you have diabetes, it does not have to be a negative life altering situation. They can be a very positive thing because many of these people will start a new exercise routine, lose weight, and develop a healthy lifestyle that includes athletic activities that they might find intensely enjoyable.

For many of these people, what started out as a bad thing turns into a way to begin to enjoy life. So if you have been diagnosed with diabetes, don’t worry, it doesn’t have to become a handicap.

Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

39-Year-Old Woman's Diabetic Foot Amputation: an Illustration in Real Life

2008-12-06T19:58:00.000-08:00

Most people think that amputations are for crusty old pirates. Well think again. Rebecca is a 39-year-old woman who recently lost her right foot and lower leg to a diabetic foot amputation. Following the amputation she had to spend five months in a nursing home. She felt out of place there, as most of the other residents were twice her age. But she had no choice as she simply could not fully recover from the tragic operation at home. Now that her surgical wound (at the stump where her foot and ankle used to be) is healed she is back home with her husband David and her dog Rusty.If you have ever been to a nursing home, you can understand why she would be grateful to be back home.

“It's a huge responsibility to move someone out of a nursing home,” Rebecca said. “The process of moving out really tests them.” Most people don't even realize that their home will need expensive structural modifications, such as widening doors, reconfiguring bathrooms, and installing wheelchair ramps. They also usually need remote controls for ceiling fans and light switches that are impossible to reach from a wheelchair. In can be financially destructive.

All of this started when two sores (known as diabetic foot ulcers) started to appear on Rebecca's right foot. Eventually gangrene set in and the leg had to be cut off. “Once gangrene sets in, (amputation) is pretty inevitable,” she said. Gangrene is basically the death of a persons living tissue. The dying tissue becomes a breeding ground for bacteria which quickly spreads through the body. Without quickly removing the infected limb through amputation or limb salvage. If not, the person can die.

Even though the sores that typically start these sorts of episodes are largely preventable, insurance companies don't pay for preventative care. As a result, many patients like Rebecca can wind up missing a leg and feeling stranded in a nursing home. Most people don't realize the amount of care that is required when someone has this type of surgery. They need to be in a bed 24/7. If not cared for properly, they can get bed sores.

Given the huge cost associated with this sort of preventable amputation, you would think that more would be done to stop the amputations. But insurance companies refuse to pay for the care and monitoring to prevent diabetic sores and diabetic foot amputations. Rebecca was able to get government assistance, but not everyone can qualify.

The thing to keep in mind is that even if you or someone you love has diabetes, these sorts of episodes are preventable. Doctor's today have the capabilities to prevent most diabetic foot amputations. With intense monitoring, patient education, and access to the latest technologies, diabetic foot amputations are preventable. Don't let the insurance companies tell you otherwise.

Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://ineedmyfeet.com.

Diabetes and Feet...What’s the Big Deal?

2008-11-30T19:36:00.000-08:00

Whenever I have a new diabetic patient in my practice, I always ask them if they have know anyone who had a diabetic amputation. Almost all say yes. Then I ask if they know what happened to the friend, relative or co-worker that led to them losing the leg. In most cases there is some vague mumbling about an open sore or some kind of infection, but never any details. No real clear understanding of what transpired.

Shouldn’t every diabetic know the details so this could be prevented?

With each and every new patient with diabetes, they either fully comprehend the risks of diabetes to their feet (very rare) or they have no clue (very common). With every one of these folks I feel that the one goal is to get them to understand that diabetic foot problems are optional.

Diabetes can be a tough disease to deal with. Your doctor starts telling you what to eat, telling you to exercise, lecturing about heart attacks. Then you are at home learning about blood sugar monitoring, taking medicine, pricking your finger every day. Now I gotta think about my feet too? Seems like such a hassle.

And it is.

But the good news in all of this is that everything bad that can happen to you because of diabetes is preventable. Everything. All it takes is the right learning, a little lifestyle change, and little daily effort. The goal of this article is to get you to understand the basics of how diabetes can affect your feet...so you can do something about it.

When you have diabetes you have three main problems, all working together and conspiring against you, that can lead to a diabetic foot amputation. It involves your nerves, blood flow and immune system.

When your blood sugar is high, there is a chemical reaction that directly damages the ends of the longest nerves in your body. The longest ones start in your back (where they exit the spine) and head all the way down to the toes in one long piece. Because the ends get damaged first, any nerve damage starts in the toes and gradually creeps up the foot toward the ankles.

It is always damaged at the same level in both feet. For example, if you have nerve damage (neuropathy) at the ball of the foot, the nerve damage is only in the toes. In this case the arches and heels might be fine.

Neuropathy makes it hard for you to tell if you are getting a blister or an open sore, and puts you at risk for problems. It is deceptive because you might be able to feel other things like the position of your feet, shoes and socks squeezing, but not a blister, cut or sore.

The second problem is blood flow or circulation in the feet and legs. The arteries get clogged faster when you have diabetes. If you take two people who are identical except one is diabetic, the one who is diabetic is four times more likely to have a heart attack. That is because of the increased rate of clogging up those arteries through the process called atherosclerosis. But this process happens everywhere, not just the heart. The blood vessels to the legs get plugged up too. Then when you get a sore it takes longer to heal. It is also harder for your infection fighting white blood cells to get down there.

The last problem is your immune system. When your blood sugar is high, the white blood cells (called macrophages) have a hard to time fighting off those nasty bacteria. The white macrophages find bacteria through a process called chemotaxis. It is like following a trail of chemicals to its source. This is not very effective when the blood sugar is elevated. In effect, they are lost in the dark, simply bumping around hoping stumble into some bacteria to kill. Very inefficient and not very effective.

Once they do find the bacteria they have a bigger problem. The high blood sugar prevents them from eating the bacteria. The process where the white blood cells engulf the bacteria (called phagocytosis) is essentially disabled. So they bump up against they bacteria, but can’t do anything. Imaging a great white shark with his mouth wired shut trying to eat a smaller fish for dinner. Because of all of the this, the immune system is ineffective, the bacteria continue to grow and the infection quickly gets out of hand.

So an amputation goes something like this. You get a little nerve damage, can’t feel a blister starting, and it pops. Just like that, you have an open sore. Your blood flow is a little sluggish and takes a long time to heal. Then it gets infected while it is trying to heal. If you blood sugar is high, all of those sharks are wandering around in the dark, mouths wired shut, and the infection spreads.

If it spread enough, one of the bones gets infected. And a bone infection is the kiss of death for the diabetic foot. The only reliable way to heal a bone infection in an adult diabetic is to remove the infected bone. And that is where the amputation begins.

The moral of the story is watch your blood sugar, and your nerve damage will never get any worse. If you walk 30 minutes a day, fives days a week, your blood flow will never get any worse. If you have any nerve damage, you need close monitoring by a diabetic foot expert. If you ever get an any open sore, blister or ingrown toenail it is an emergency...no joke. Get that foot checked out or it might chopped off!

Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Harvard Study Shows Diabetic Testing Is Not Great

2008-11-20T03:27:00.000-08:00

A new study published by the New England Journal of Medicine today says that genetic testing is not much better than the low cost method of looking at traditional risk factors when trying to determine if a person will develop type-2 diabetes.

Doctors and scientists already know that a person's risk of developing diabetes increases significantly if they have diabetic relatives. The researches said that they have always thought inherited genes might be responsible, but acknowledged that family associations and learned behaviors such as a poor diet and sedentary lifestyle might also play a role.

One of the Harvard investigators who conducted the research explained "With the current state of knowledge, the genotype score doesn't help us sort out who is at elevated risk any better than measures like weight. We may eventually find out that those individuals without known risk factors who still develop type 2 diabetes have more diabetes-risk genes, once we know what more of those genes are," he added.

One new possibility is to study genetic markers in those people who make lifestyle changes to reduce risk, and then see of genetic testing becomes more reliable. Based on the study, it would appear that at present the standard prevention and lifestyle strategies are still most effective in determining who will be at risk from diabetes.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

at http://www.ineedmyfeet.com.

$218 Billion: The Cost of Diabetes Care in the U.S.

2008-11-19T12:53:00.000-08:00

On November 18, 2008 the Associated Press released a new study that shoes the totl cost for diabetes in America to be $218 billion. This is the first time a comprehensive estimate of the total financial cost diabetes takes, according to Danish pharmaceutical company Novo Nordisk A/S, which paid for the study.

The $218 Billion figure includes direct medical care costs, including amputations, hospitalization, medicines including insulin and pills for controlling patients' blood sugar, plus indirect costs such as disability due to amputation, lost productivity, disability, and forced early retirement.

The study, conducted by the Lewin Group consultants conducted the study, estimated that it costs to society society for people known to have Type 1 or Type 2 diabetes are estimated at $174.4 billion.

The firm explain that part of that $174 billion included an estimated $10.5 billion in medical costs and $4.4 billion in indirect costs, or a total of $14.9 billion, for people with Type 1 diabetes. This is the type of diabetes, which begins much earlier in life and was previously called childhood or juvenile diabetes. It’s been estimated that about 6 percent of the 17.5 million Americans diagnosed with diabetes actually have Type 1.

The study demonstrated that the vast majority of cost, which was estimated at $105.7 billion in direct costs and another $53.8 billion in indirect costs, for a whopping total of $159.5 billion, for people with Type 2 diabetes. This shows that Nearly 10 times the amount of health care dollars are spent on type 2 diabetes as opposed to type 1 diabetes. Type 2 diabetes has previously been referred to as adult-onset diabetes because of the average age at diagnosis is typically much later in life. This type of diabetes is also directly correlated with obesity and sedentary lifestyles.

This study does also add in estimates for people who have not yet been diagnosed ($18 billion), women who develop , gestational diabetes (diabetes which is only temporary and occurs during pregnancy) ($636 million), and those who exhibit characteristics of diabetes, and maybe in the process of developing the condition which is now frequently referred to as pre-diabetes ($25 billion).

These findings were recently presented at a healthcare conference for corporate executives. The firm that produced and funded the study does plan to publish a full report in a medical journal soon. These figures were produced based on numbers from sources including databases on treatment of people with Medicare, Medicaid, private and commercial insurance, federally funded public health surveys, and other sources.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

"I Need My Feet!"

2008-11-18T17:43:00.000-08:00

Today I saw one of my favorite patients. He is a true success story. He has diabetes. He has neuropathy. He cannot feel pain in his feet. He cannot feel a new sore starting. He has had Charcot Foot (where the bones get weak, the whole foot breaks down and collapses). He has been hospitalized. He had surgery for this that healed in a position that actually puts him at risk for more problems.

But he still does great!

Today he said that since we met, he has had several episodes where a little sore started to appear, yet he hasn't been able to tell in 50% of cases if it is serious or not. He comes in, gets treated and all is well. Last week he just noticed a "red spot" on the big toe. He came in and we saw he actually had a nasty infection.

We treated him and he is again on his way to recovery. He always seems to bounce back.

It isn't just that he checks his feet, or watches his blood sugar, or calls when he gets a problem. It seems that he has a real appreciation for life, a positive outlook, and gratitude for what he has. Today he said "I need my feet!" What a remarkable statement. It so clearly defines the obvious challenge faced by diabetics that others take for granted.

I will continue to enjoy being his foot doctor. He will continue to enjoy his feet.

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

“No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Amputation is Preventable

2008-11-18T16:43:00.000-08:00

It seems fitting that the official launch of the Diabetes Amputation Prevention Blog should fall in line with Diabetes Awareness Month and World Diabetes Day.

As a foot surgeon who has a particular interest in diabetes, I have amputated many toes, feet and legs.

This is preventable.

My wife's grandfather actually had several amputations related to diabetes, but died anyway.

This is preventable.

All of the information about diabetes you find here will help to educate, inform and prevent one of the worst, yet most preventable complications of diabetes...amputation.

Take the right steps, and you too can stay on your feet for the rest of your life.

Don't let diabetes get you down. I have seen how it happens. It is my mission to spread the word about healthy hopeful strategies that will keep diabetics out enjoying their favorite activities.

Stay active, Live long.

All the Best!

Dr. Christopher Segler

Diabetic Clinical Researcher

Award Winning Foot Surgeon

“No Leg Left To Stand On:

The Secrets Insurance Companies Don’t Want You To Know

About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.