Local Chapter Works To Prevent Amputations and Future Complications
Who is more likely to be alive five years from now—a patient undergoing treatment for breast cancer, or her neighbor who is having a leg removed due to a diabetic foot ulcer that wouldn’t heal?
If you’re surprised that the much more likely survivor is the cancer patient, you may find it hard to believe that well more than half the patients who lose a leg to a nonhealing wound will die within the next five years. Like the tip of an iceberg, slow-healing foot and leg wounds are often the first visible sign of greater problems going on beneath the surface.
When Desmond Bell, DPM, CWS, helped to launch the Save A Leg, Save A Life Foundation in Tampa, he didn’t realize it was the first meeting of what would soon grow to be a nationwide organization which now includes a chapter in Birmingham.
“It came out of frustration,” Bell said. “I was seeing so many cases that could have been prevented, and I was the one who had to tell patients it was too late. Their leg had to come off. There was such a disconnect in the understanding of how to care for diabetic foot ulcers and other nonhealing wounds. We brought together people from different disciplines—home health nurses, podiatrists, wound specialists, cardiovascular surgeons and diabetes experts. We talked about the latest advances in wound care and how to recognize underlying problems. We also exchanged ideas about how we could improve the appalling statistics.”
Within a couple of years after the foundation began a campaign of education and outreach, amputation statistics in the Tampa area improved significantly. Another bonus was the networking and professional relationships that developed.
“If we had a question or needed to make a referral, we could pick up the phone and know who to call,” Bell said. “I referred several patients to a cardiovascular surgeon I met through the group, especially patients I suspected were medical time bombs. He often called me back to say, ‘You were right—the workup shows they are in imminent danger of a stroke or a heart attack. Let’s take care of that first, then do the leg revascularization.’ ”
Alabama has one of the highest amputation rates in the country; and not coincidentally, it also has one of the highest rates of diabetes. Rodney Snow, MD, medical director of the Wound Care and Hyperbaric Medicine Department at Princeton Baptist Medical Center, sees the human consequences of that statistic every day. That’s why he made it a priority to organize a Save a Leg, Save a Life chapter in Birmingham.
“Nonhealing wounds aren’t glamorous. You don’t see as dramatic a result as you do with life-saving heart surgery or cancer treatment—but effective wound treatment and treating the underlying problems saves lives. It also protects quality of life and prevents the psychological pain of an amputation that doesn’t have to happen,” Snow said.
Unfortunately, some physicians aren’t always aware that a patient is developing a problem with wounds, or may not realize the greater implications for a patients overall health.
“So many healthcare providers don’t seem to realize the broader implications of nonhealing foot and leg ulcers,” Bell said. “Instead of giving them a prescription for three weeks of antibiotics, we need to give them referrals to determine why the wound is there so we don’t miss an opportunity to prevent a catastrophe.”
Another part of the challenge in healing wounds on the feet is patient education.
“From childhood we learn that if it hurts, don’t do it. If it doesn’t hurt, it’s okay,” Snow said. “The problem with that is neuropathy. There is often so much neuropathy that patients don’t feel the pain. They continue to walk on severe wounds without giving them a chance to heal, and sometimes they don’t even realize the wounds are there till they are advanced.”
Both Bell and Snow report that they frequently see patents who haven’t told their primary physicians about the ulcers on their feet and legs.
“Patients come to me with terrible wounds on their feet and say they just saw their doctor a couple of days ago,” Bell said. “I ask them what their doctor said about the wound, and they say they didn’t get around to mentioning it.”
Snow said, “Primary physicians are under so much time pressure. By the time they go over a dozen medications and labs and talk about the diabetes and other health issues, the visit is over. If someone with a history of diabetes or peripheral artery disease comes in your office, ask them to show you their feet. Feet tell you a lot about how the rest of their body is doing.”
Numerous advances in wound healing are dramatically reducing the need for amputations when appropriate care is received in time. Addressing the source of the problem speeds recovery, helps to prevent recurrences and protects other body systems from damage that might otherwise become lethal.
“We have living skin substitutes that function like grafts, hyperbaric oxygen chambers, negative pressure wound therapy and vascular procedures to open blocked blood vessels,” Bell said. “So many legs that we would have had to amputate in the past can now be saved.”
To make the latest information on healing wounds, preventing amputation and adding years to life more accessible, Save A Leg, Save A Life chapters offer outreach programs, screenings and symposiums.
“Our Birmingham chapter is for everyone in the area, not just those of us at Princeton,” Snow said. “We invite patients, care givers and the medical community to join us in our efforts to save limbs and lives.”
Weekly updates and discussions of related news are also available through the foundation’s online radio show.
“It’s every Sunday at 11:00 am, and the shows are archived so you can listen to previous broadcasts,” Bell said. The organization’s founder and executive director, Bell also hosts the show. “Just go to Savealegsavealife.org and click on the button to tune in.”