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| BACKGROUND | DIAGNOSIS | TREATMENT | SURGERY |
GLOSSARY OF TERMS
Diabetes Mellitus encompasses the following three forms of the disease:
Type 1 Diabetes also known as Insulin-Dependent or Childhood-Onset is characterized by a lack of insulin production. Without daily administration of insulin, Type 1 diabetes is rapidly fatal.
Type 2 Diabetes also referred to as Non-Insulin-Dependent or Adult-Onset results from the body’s ineffective use of insulin. World-wide, Type 2 diabetes represents 90% of all people with diabetes.
Gestational Diabetesis hyperglycemia or raised blood sugar diagnosed during pregnancy through prenatal screening.
Atherosclerosis is commonly referred to as hardening of the arteries because it causes a loss of elasticity. This is caused by the accumulation of a fatty substance called atheromatous plaque on the inside of the walls of arteries. This plaque consists of macrophage white blood cells and low density lipoproteins (LDL).
Damage to the tissues include:
Cellulitis: subcutaneous (under the skin) inflammation of connective tissue--adipose tissue, tendons, ligaments, muscles, cartilage and bone
Septic Arthritis: the decomposition of organic matter in the joints
Abcess & Sinus Tract formation: a localized collection of pus surrounded by inflamed tissue
Osteomyelitis: an infectious usually painful inflammatory disease of bone that is often of bacterial origin and may result in death of bone tissue
Gangrene: local death of soft tissues due to loss of blood supply
Damage to the nerves is known as neuropathy. Common symptoms of diabetic neuropathy include tingling, pain, numbness, or weakness in the feet and hands.
Homocysteine is an amino acid found in the plasma of the blood, high levels are associated with vascular disease.
Erythrocytosis is a dramatic increase in the number of circulating red blood cells.
Thrombocytosis is an abnormal increase in the number of blood platelets.
Thrombosis is the formation of a blood clot (thrombus) within a blood vessel that remains attached to its place of origin on the vessel wall.
BACKGROUND
MECHANISM
Diabetes Mellitus represents several diseases in which high blood glucose levels over time damage the nerves, kidneys, eyes, and blood vessels. Foot problems commonly develop in people with diabetes and can quickly become serious/life-threatening.
Diabetic Foot includes all foot problems in patients with diabetes and accounts for more time spent by diabetics in hospitals than for all other aspects of their disease combined.
Diabetes tends to affect medium to small size arteries by causing progressive hardening of the vessel wall known as atherosclerosis.
The circulatory changes that occur diminish the blood supply to the extremities, particularly the lower extremities, leading to damage of the tissues and nerves of the feet. Such tissue and nerve damage in turn leads to skin ulceration, infection, and finally gangrene.
CAUSE
Diabetes is a disorder of metabolism -- the way the body breaks down food into glucose, the form of sugar in the body. Following digestion, glucose enters the bloodstream, where it is available for the cells of body. The pancreas, an organ near the stomach, produces a hormone called insulin to facilitate the transport of glucose into the body’s cells.
With diabetes, the pancreas either does not make enough insulin or the body can’t use the insulin properly. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body instead of being used by the cell.
Type 2 Diabetes is largely due to excess body weight and physical inactivity. Until recently, this type of diabetes was known only to occur in adults but it is now seen in obese children.
PATIENT PROFILE
Diabetic Foot complications most frequently affect elderly patients. Most diabetics have Type 2 diabetes or ‘adult diabetes’ rather than the insulin-requiring Type 1 diabetes which afflicts the young.
SYMPTOMS
With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot and cause sores to develop.
DIAGNOSIS
BLOOD ANALYSIS
Blood tests are performed to look at general health and to assess risk factors that affect the progression of the disease, including fasting blood cholesterol levels, blood sugar, kidney and liver function, and homocysteine levels.
DOPPLER/DUPLEX ULTRASOUND EXAMINATION
A measurement of blood flow and the identification of sites of vessel blockage is accomplished with the use of a hand-held Doppler probe. This allows the examiner to listen to the blood flow. The most accurate and detailed test, is a Duplex Ultrasound exam. This provides an ultrasound image of the vessel to determine whether there is any blockage or structural damage and is also able to record quality of blood flow as well as localised blood pressure.
TREATMENT
SMOKING CESSATION
Immediate and complete tobacco use cessation is absolutely essential. We require this not only of patients with Diabetic Foot, but of all patients with circulatory disorders. Individuals who smoke not only put themselves at risk for developing vascular disease but also undermine attempts at treatment.
Cigarette smoking in particular is known to cause erythrocytosis, plasma volume contraction, and thrombocytosis. These are all conditions which lead to dramatically increased risk of venous and arterial thrombosis.
We understand the difficulty many smokers face in quitting and we work with our patients to overcome this personal challenge. We offer several strategic methods to help them end their addiction and improve their vascular health.
MOST TREATMENTS TODAY
The primary goals of most treatments of circulatory disorders today are to attempt to relieve symptoms and prevent further complications. At present, the majority of treatments act superficially in treating a patient’s symptoms and avoid dealing with the root of the problem.
Standard therapies typically include exercise programmes to try to increase blood supply to the affected tissues and the use of antibiotics to help in treating non-healing ulcers. Such therapies alone do not deal with the underlying cause of a patient’s illness. This is the reason the vast majority of treatments do not succeed.
ACHIEVING NEW HEIGHTS IN VASCULAR CARE
At Vascular General, we have developed innovative therapeutic procedures for the treatment of all circulatory disorders of the lower extremities that have consistently produced dramatically successfully results.
Due to the long duration and frequent reoccurrence of open sores or ulcers in the lower extremities, the microorganisms involved in the infection expand exponentially in number and develop into colonies that have a type of protective shield or layer of armor which is resistant to antibiotics. This is why all too often ulcers appear to be non-healing and do not respond to antibiotic medication.
The finding that low dose electric current can disrupt the protective layer shielding microbial colonies is well documented in the scientific literature. Our application of low dose electrotherapy in combination with antibiotic medication has time and again yielded the knockout punch to the life-threatening microbial colonies infecting chronic wounds.
SAVING LIFE AND LIMB
Within a few weeks of our treatments, persistent open wounds that never seem to close and were for so long a constant danger to life and limb, are cleaned from infection, closed, and allowed to heal.
Our innovative use of low dose electrotherapy is not only a vital weapon in the battle against the spread of open wound infection but also a tool for the repair of such damages to the vascular system as inflammation of the vessel wall, ischemia, atherosclerosis, and thrombosis.
SURGERY
In more advanced stages of Diabetic Foot, surgery may be recommended to bypass the blocked artery or vein or to clean out the area of blockage.
Minimally invasive procedures are performed with an endoscope (a small, flexible tube with a light, optical lens, and probe, forceps, suction device, or other instrument for surgery on the end), they include:
ARTERIAL STENT PLACEMENT: a procedure in which a wire-reinforced stent is placed in the artery and left in to keep it open
BALLOON ANGIOPLASTY: dilation of an obstructed artery by the passage of a balloon catheter through the vessel to the area of disease, inflation of the catheter balloon tip compresses the plaque against the vessel wall
ENDARTERECTOMY: surgical removal of the inner layer of an artery when thickened and obstructed
THROMBOLYSIS: catheter-assisted administration of highly concentrated anticoagulant medication to remove or break up a clot
BYPASS SURGERY: If the disease is very advanced, or if it occurs in an artery or vein that is difficult to reach with a catheter, bypass surgery may be necessary. A bypass graft may be performed in such serious cases. This surgical procedure uses either an artificial tube or one of the patients own arteries or veins to bring improved blood flow to the affected area.
