A multispecialty facility like White Plains Hospital’s Center for Advanced Medicine & Surgery not only offers patients the opportunity to see numerous providers under one roof; it also allows those providers to consult with and refer to other specialists with appropriate patients.
For patients with diabetes, this team approach can be essential to preventive and/or curative care. It is important to note, however, that people with diabetes should be seeing their podiatrist at least once a year. They should check their feet daily for any changes (including but not limited to cuts, sores, blisters, calluses, and skin or toenail problems). They should, as doctors nearly always advise, get regular exercise.
Unfortunately, “should” does not always translate into doing so. As a result, a diabetic person’s foot health could spin out of control and ultimately lead to foot or leg surgery that, if severe enough, is overseen by a vascular surgeon.
The issue is that high blood sugar can damage your feet’s nerves and lead to diabetic neuropathy, which is the presence of numbness or loss of all feeling in the foot. This can fool a less-than-diligent patient into thinking their feet are fine – but without a daily self-examination, and faithful adherence to a podiatrist’s recommendations, complications can easily arise and lead to a referral to a vascular surgeon.
I should point out that just because you’re seeing a vascular surgeon does not necessarily mean you will be getting surgery. Our primary mission is to provide care for those with diseases that affect their blood vessels, including the creation of treatment plans that can include medical treatments, diet and exercise programs, and other lifestyle modifications like quitting smoking and limiting alcohol consumption.
We typically consult with diabetic patients after their podiatrist has determined that the healing of cuts on the feet is inadequate or non-existent. One of our first tasks is to look for palpable pulses in their feet, the absence of which is a potential sign of diabetic arterial disease, also called peripheral arterial disease (PAD). This condition occurs when the arteries that supply blood to the legs are narrowed or blocked by a buildup of plaque, cholesterol and other substances. This can also lead to such serious problems as a heart attack, stroke, and kidney disease.
A series of tests to determine the presence of PAD follows, after which we can then classify the patient’s condition using the Wound, Ischemia and foot Infection (WIfI) system. If the WIfI score warrants it, we then go forward with a minimally invasive revascularization procedure to improve the blood flow; such procedures include angioplasty, lithotripsy, and the minimally invasive atherectomy, which uses a catheter to break down plaque or by placing a stent in the leg artery.
Patients often will find relief with these minimally invasive procedures, but if the patient’s PAD is too advanced bypass surgery may be necessary. This involves making incisions in the leg(s) to redirect blood flow around a blocked artery segment with a graft. Unfortunately, amputation may ultimately be called for, but that is always a last resort.
A regular regimen of daily self-examinations, lifestyle changes, and seeing a podiatrist at least once a year can usually help a patient avoid such a dire situation. In addition, as described above, diabetes can ultimately affect other parts of your body, including your heart. Living with diabetes can be tough – but all of us are tougher.
Dr. Ronak Patel is a vascular surgeon who practices at Vascular & Thoracic Associates in White Plains and at WPHPA of Nyack. To make an appointment, call 914-849-7175.