What are the Facts?
Amputations…Just the Facts
In my years working as a foot and ankle surgeon I have seen many preventable amputations related to diabetes. I have seen lives destroyed and literally lost due to complications from diabetic foot ulcerations that have led to amputation and death. It is my heartfelt belief that this is all entirely preventable and avoidable. Hard to believe when you see the numbers.
Shocking statistics
In Scotland, there are 10 amputation each week due to diabetes.
In the U.K, there are 100 amputations per week.
Every 30 seconds a limb somewhere is amputated
as a consequence of diabetes.
Having diabetes makes you 46 times more likely
you will have an amputation.
1 year after a diabetic amputation,
26.7% will have another amputation.
3 years after a diabetic amputation,
48.3% will have another amputation.
5 years after a diabetic amputation,
60.7% will have another amputation.
Diabetics with amputations don’t live very long.
50% of all diabetics with an amputation are dead 3 years after the amputation.
65% of all diabetics with an amputation are dead 5 years after the amputation.
Amputations are expensive
The cost of an amputation is $60,000.
Nearly one fourth of all Diabetic Americans will be hospitalized for a foot problem.
The cost of diabetic foot problems in America is well over 1 billion dollars annually.
Amputation is preventable
Implementation of a diabetic foot care team with appropriate screening, risk assessment and timely referral has been shown to reduce the major amputation rate.
I have health insurance through a corporate self-insurance plan. Do you accept these health insurnace coverage arrangements? The American limb preservation Society does not accept any insurance assignments at all. However we can still provide consultation services for you. You (and we) are not bound by the stipulations of your employer provided health insurance. You are free to choose any expert you wish. Why doesn't the American Limb Preservation Society accept insurance?
Frequently Asked Questions (FAQs)
Are amputations really preventable?
Yes. Although the number of diabetic patients who will require an amputation is growing in the United States , this is highly predictable. Every amputation results from a number of lifestyle choices and neglect. Provided that precautionary measures are taken at an early enough stage every amputation is preventable. Even in the very worst of cases, the patient who has neglected themselves and developed a number of medical problems can still avoid a diabetic foot or leg amputation given the right amount of medical guidance and care. The earlier the intervention is undertaken, the higher the chances of success and a long healthy, active life for the diabetic.
What is the cost of diabteic foot amputation prevention?
Determining the actual financial cost of a diabetic foot or leg amputation amputation is easy. Statistics are collected by Medicare and clearly show that a diabetic leg amputation costs about $60,000. This of course is a large sum of money, but only tells part of the story. Worse yet is the uncaluable losses such as the forced changes in lifestyle following an amputation. No more walks on the beach, dancing on your anniversary or chasing the grandkids around. There is an undeniable emotional toll that likely far exceed the financial loss. But again, diabetes related amputations can be prevented. In this short video clip, we dicuss the cost of preventing a diabetic foot amputation.
Why doesn't the American Limb Preservation Society accept clients who smoke?
Smoking is nothing less than an elective medical catastrophe in the diabetic patient. Smoking has a number of disastrous effects on the foot and leg. For example, we know that a patient who smokes is 2.7 times more likely of having difficulty healing a fracture or rearfoot surgical procedure. Not only does smoking affect foot surgery, but in the diabetic smoking also affects circulation (blood flow), diabetic wound healing and tissue repair. A diabetic patient who chooses to smoke and refuses to quit is analogous to a person stubbornly sitting on the railroad tracks when a train is clearly headed down the line. Even in the director's former private practice, he flatly refused to perform elective bone surgery on the foot of any patient who smoked. This is not a moral issue, it is a biological one. Any diabetic who smokes will need to seek assistance elsewhere.
What if I have, a diabetic ulcer or foot infection and need expert advice immediately?
The American Limb Preservation Society offers direct access to the director for personlized consultation and advice regarding negotiating the health care system when a potential limb threatening event is unfolding. We realize that once the leg is amputated, is simply too late. You will never get your leg back. You are also likely to die within a few years. During these expert consultations, advice is provided regarding the current circumstances of a your condition and ways to make sure that you receive the best care. This includes discussions regarding ways to ensure that your insurance company approves certain tests and evaluations. You must realize that your insurance company is actually in the business of saving money by withholding test and treatments...and not really in the business of helping you at all. In addition, discussion is undertaken regarding the most likely course of action that your current treatment team will consider and what you need to know about these treatment options. During these consultations, we provide more thorough explanations about the different treatment options irrespective of the guidance of your treatment team. With these one-time expert consultations, you have the director of the American limb preservation Society acting as your personal patient advocate.
The American limb preservation Society does not accept any insurance assignments at all. We believe that medical decision-making should be between the patient and the doctor. We do not believe that an insurance company should be allowed to tell a patient that the cheapest treatment is the only choice. Because the cheapest treatment is rarely the best treatment. The cheapest treatment is also almost never the only choice. To get the full story on why we don't accept insurance you can read more here.
What is a wound culture?
A wound culture is a simple and effective way to determine what exactly what bacteria is growing in an infected area of tissue. This is one of the 7 critical skills that any diabetic foot treatment team must possess. It is well-known that taking wound cultures prior to starting antibiotics can dramatically reduce the severity of a diabetic foot infection. It can also decrease the amount of antibiotics that a diabetic will need to take in order to successfully resolve the infection. This is critical given the antibiotics used to fight an infection can cause kidney damage. Diabetics are already at high risk of developing damage to their kidneys. Antibiotics given for extended periods times may push them over the edge leading to kidney failure. When a diabetic has kidney failure, they must be on dialysis in order to survive. To learn more about the importance of obtaining a wound culture as well as the other critical skills that your diabetes treatment team should possess visit the 7 Essential Skills articles. You can find them on the Diabetes Amputation Prevention page.
Is it possible to find an expert diabetes doctor?
Diabetes is a complicated disease. Improper management can lead to catastrophe. But there is hope... you just need to make sure your are being cared for by an expert. It is possible to find a true diabetes expert to manage your diabetes. We have prepared a series of articles which provide tips on finding your very own diabetes expert. In the 7 Essential Skills articles we discuss the skills required for your diabetes treatment team to help you avoid the worst complications of diabetes. You can find it on the Diabetes Amputation Prevention page.
I just had diabetic foot surgery. How often should my diabetic foot doctor see me?
Diabetes related foot surgery and diabetic foot amputations place you at higher risk for future problems. You must keep in mind one year after the diabetic foot amputation, about 25% of people to have another amputation. Within three years, about 50% have had another amputation. Because the patient who has diabetes bit more prone to developing infections and has a much harder time healing wounds including surgery, your doctor should follow you very closely after diabetic foot surgery. There is no set schedule for anyone patient. But if you have any concerns or doctor should evaluate you immediately. Keep in mind bit any problem that begins after surgery is much easier to treat when evaluated right away when the problem begins. It is my personal preference to see patients on a weekly basisuntil they are completely healed if they have diabetic foot surgery. Even , if the surgery is completely healed, I believe it is still appropriate to continue to follow the patient closely and frequently for several months In order to assure that they don't develop another preventable diabetic foot ulceration, diabetic foot infection, or end up with a diabetic foot amputation. to learn more about the expectations you should have your doctor and their ability to continue to reevaluate you after a diabetic foot problem, see the 7 Essential Skills articles. You can find them on the Diabetes Amputation Prevention page.
My doctor said that my diabetic foot ulcer needs debridement. What is diabetes wound debridement? A person with diabetes and an open wound on the foot is said to have a diabetic foot ulceration. because diabetic peripheral neuropathy is so common, these open sores on the feet often start without the patient feeling anything at all. Under these circumstances, the patient can walk on the foot for a long period of time before they even notice that they have a diabetic sore. As a result of this continued pressure and friction from walking, most diabetic patients will develop a lot of thick callused skin at the edges of the ulcer. This actually causes greater pressure around the border of the sore and can prevent wound healing. In addition, this tissue can become so moist that it starts to break down or disintegrate. In order for the wound to heal in anyone with diabetes, it becomes necessary to remove all of the tissue that has been damaged by excessive moisture, pressure or friction. The medical term for removal of all of this unhealthy tissue is débridement. When performing a débridement of the diabetic foot ulcer, your doctor will typically use a scalpel or other instruments in order to trim away all of this diseased tissue. Typically, this causes no pain whatsoever. It is very rare that a diabetic patient who has a diabetic foot ulcer has enough feeling remaining in their feet to feel pain during a diabetic foot débridement. The débridement procedure is typically performed in the doctor's office. It is not necessary in most cases to go to the operating room for this procedure. If however the wound is grossly infected, it may become necessary to do more exploration and drainage in a surgical setting. Havivg the ablity to determine when surgery is necessary is one of the 7 Essential Skills you should require of your diabetes treatment team to help you avoid the worst complications (such as a leg amputation) of diabetes. To learn more aboutthe situationsin which diabetic foot surgery becomes necessary, see the Diabetes Amputation Prevention page.
I have a diabteic foot infection. My doctor started me on antibiotic pills a few days ago. I have read about MRSA and other scary bacteria. How do I know if I am taking the best antibiotics?
One of the 7 Essential Skills that your diabetic treatment team must possess is the willingness to evaluate your wound cultures and change your antibiotics if necessary. This is not comlicated. You need to be taking the antibiotics that are most likely to kill the bacteria. This is determined by taking wound cultures from the infected diabetic foot and the re-assessing the antibiotics effectiveness at 48-72 hours after the wound cultures are onbtained. To learn more about how your doctor should determine that you have been given the correct antibiotics visit the Diabetic Amputation Prevention page.
I understand that neuropathy can lead to an amputation. If I can feel my feet do I really need to have this evaluated by a doctor if I can feel my feet?
Of the 7 Essential Skills that your diabetic treatment team must possess is the ability to determine whether or not you have lost any of the sensation in your feet that can put you at risk of a diabetic amputation. Loss of feeling in the feet due to chronically high blood sugar is called diabetic neuropathy. The reason you need to have this evaluated is that the process of nerve damage in the feet is deceptive. The nerves are all different sizes. Diabetes destroys different sized nerves at different rates. It is very common for a newly diagnosed diabetic to come into the office stating that they don’t think they have any problems with your feet. In many cases, they will have some damage to the nerves in the feet that puts them at risk for developing the type of open sore (known as an ulceration) that can lead to a diabetic foot amputation. That type of nerve damage is referred to as loss of protective sensation. There are many other sensations that nerves can sense in the feet. These include vibratory sensation, hot/cold discrimination, pressure, and positioning. The nerves that carry the signals for each of these different sensations can get destroyed at different rates. Typically vibratory sensation is one of the first to go. After that the diabetic will develop loss of protective sensation. This is the type of nerve damage that places the diabetic patient at highest risk of amputation. Some of the other sensations go, much later. Proprioception (which is the ability to feel the position of the foot) is one of the last to go. Just because someone can feel shoes and socks on their feet only means that they have pressure and stretch receptors that are still functioning. They can still feel these things often times and be at risk of developing an open sore that leads to an amputation. Because of this, it is extremely important to be thoroughly evaluated in order to ensure for this reason it is very important to have the type of screening that determine someone’s risk of diabetic foot ulceration related to any presence of diabetic peripheral sensory neuropathy. If your doctor determines that you have any of this type of nerve damage, appropriate steps can be taken to make sure that you don’t develop a complication that leads to an amputation. To learn more of the details, visit Diabetic Amputation Prevention.
I have diabetic foot ulcer that goes to all the way to the bone. How bad is this? Evaluating the depth and charactern of any diabetic foot wound is one of the Essential Skills your diabetic foot treatment team must utilize in order to help you prevent a diabetes amputation. The deeper the wound, the worse it is. When the bone becomes exposed, there is an 85% chance you will have a bone infection. In the diabetic foot a bone infection is one of the worst things that can happen. Any infected bone in the foot must be removed in order for the infected to be reliabely cured. And NO...antibiotics alone are not enough. A bone infection in an adult diabetic patient is a surgical disease. Without surgery to remove the infected bone, the infection will likely spread and lead to more extensive amputation. Get a second opinion immediately. You must have this addressed as quickly as possible. To learn more about the importance of diabetic foot ulcer depth evaluation, see the Diabetic Amputation Prevention.
Can Gene Therapy Help with Diabetes? 
A recently publicized study at a University on Tehran used a treatment protocol which included stem cell to treat patients with peripheral arterial disease (PAD) who had already been slated for below knee amputation. It is well know that cells from the bone marrow (BM-MNC) can stimulate the formation of additional back-up blood vessels that doctors refer to as "collateral vessel formation" in limbs with poor blood flow (PAD). In the study doctors used these stem cells (harvested from the patient's own bone marrow) to restore blood flow to legs through additional new blood vessel formation. Twelve patients patients scheduled to have leg amputation received the treatment. All of the 12 patients who had the stem cell treatment were able to avoid amputation. Although these results are very encouraging, This treatment is still in the experimental stages. Stem cell treatments like this are not yet available in the United States.
Does Medical Grade Honey really work as a wound dressing?
Honey has been used a dressing for open wounds for thousands of years. Only recently has Medical Grade Honey become popular. Recently research scientists have studied the many properties of honey (such as its ability to act as a physical protective barrier, antibacterial properties, and wound moisturizer). Medical Grade Honey (unlike supermarket honey) has been purified, sterilized, and optimized for the right concentrations of anti-bacterial agents. Medical Grade Honey is now widely available without a prescription. It has been FDA approved. There is a great deal of scientific evidence that it helps heal radiation wounds, burns, and diabetic foot ulcers. To learn more of the details, visit Diabetic Amputation Prevention.
What is the best wound dressing for diabetic foot ulcers?
coming soon...
What is hyperbaric oxygen therapy? Is it worth paying for?
coming soon...