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

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

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.