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home : lifestyle : health   May 26, 2016

2/20/2014 10:26:00 AM
The agony of the feet: Leg and foot ulcers a dogged problem for diabetics


Tom Collins
NewsTribune Senior Reporter



Chad Bianchi thought he had the flu. Within three days of getting the chills, doctors had to amputate part of his foot.

Bianchi lives in Spring Valley and was diagnosed with type-II diabetes when he was about 25 years old. The diagnosis wasn’t a shock, as his family has a long history of diabetes.

The big shock came last year when he thought he’d caught influenza. While he shivered and shuddered, his foot unexpectedly turned colors and festered. Doctors diagnosed the flu-like symptoms as a MRSA infection that tore through his foot, already compromised by diabetes, costing him two toes.

“I got a diabetic ulcer on the bottom of my foot,” Bianchi said. “It turned my foot from red to black in three days and they had to take two toes off.”

Bianchi needs to be extra-vigilant with his skin because even minor cuts and abrasions bear watching. A tiny wound can take much longer to heal or mutate into an ulcer that could cost him more toes.

If you have diabetes, you not only need to watch your diet and your blood sugar. You also need to keep an eye on your skin, as diabetes can generate fast-spreading skin ailments and ulcers that are difficult to treat and, because of nerve damage, sometimes difficult to catch.

“The problem with diabetes is cuts down on the circulation of blood to the skin, obviously creating problems, and it cuts back on the way the nerves work,” explained David Coynik, a Peru dermatologist. “People can have problems with their skin and not even feel them, because the nerves are not sending a signal back to the brain.”

Dermatologists recognize a number of skin conditions that can result from obesity and diabetes that isn’t properly treated. The list includes diabetic bullas — blood-filled blisters that need to be lanced — to neuropathic ulcers that require more intensive treatments or else the patient could lose part of their extremities.

Wounds and ulcers are exploding as America grapples with an obesity problem and a resulting increase in diabetes. The Centers for Disease Control estimate that 25 million Americans or 8 percent of the population has diabetes — among senior citizens the figure escalates to 26 percent — resulting in 1.1 million to 1.8 million new cases of chronic wounds. The International Diabetes Federation estimates a lower limb is amputated every 30 seconds due to diabetic wounds.

The biggest problem spots for diabetics are the legs and feet, which are located furthest from the heart and therefore less likely to receive sufficient blood and oxygen. Coynik said he’s had patients come in with “horrible ulcers” on the bottom of their feet.

“You wonder how patients could have walked in on their own,” said Coynik, who’s informed more than one ulcer sufferer that he’d better get screened for diabetes.

As Bianchi can attest, some ulcers become gangrenous and doctors have little choice but to amputate and arrest the still-dying flesh by enhancing blood flow. The best tool for treating these wounds is with a hyperbaric chamber, which will increase the oxygen levels in the blood and gradually repair the damaged tissue.

Terry Near runs the wound and hyperbaric center at Illinois Valley Community Hospital in Peru. The center opened last summer and already an estimated 60 percent of patients are diabetics with stubborn lesions on the extremities.

Diabetic ulcers require 90-minute sessions inside a hyperbaric chamber, with up to 40 sessions per patient. The chamber works by lowering barometric pressure to a level experienced by deep-sea divers. The chambers require the patient to sit or lie within, sealed but completely visible through glass. During each two-hour pressurized oxygen treatment, patients can read or watch TV.

“When your body gets to that level your cells can absorb the highly oxygenated air,” Near explained. “The combination of weekly wound visits and hyperbaric chamber is the gold standard for treating these ulcers.”

Hyperbaric therapy is credited with a 91-percent heal rate within a median 31 days.

Coynik recommended regular trips to an attendant physician to keep an eye on the skin and to ensure the diabetes is properly managed, as management will preclude the appearance of lesions and ulcers.

Tom Collins can be reached at (815) 220-6930 or courtreporter@newstrib.com.












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