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

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

LA Times Article on Diabetic Foot Amputations

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?

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?

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

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

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.

One Fourth of Diabetic Amputees Wish They Saw a Podiatrist Sooner

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.

UNC Basketball Player: Diabetic Foot Amputation?

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.

American Limb Preservation Society Site is Up!

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

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

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.

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.