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

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

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.

How to Check Your Diabetic Feet

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.

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?

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.

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

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

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.