Many diabetic foot amputations are preventable
- From: Kurt <kurtwheeling1965@xxxxxxxxxxx>
- Date: Tue, 25 Aug 2009 17:48:11 -0700 (PDT)
I'm posting the entire article because I feel it's that important for
all diabetics. If you have friends who have diabetes you should send
them the link to the article. I did mine. I found myself applauding
this comment in the article:
"Obama's larger argument: Better payment for early-stage diabetes
treatment, or even care to prevent diabetes, could save the nation
money."
Kurt
http://www.diabetes.org/diabetesnewsarticle.jsp?storyId=20763783&filename=20090825/ap20090825aponlineallD9A9OOR80newsaporganpaewEDIT.xml
or
http://tinyurl.com/mc94ws
25-AUG-2009
WASHINGTON - It costs $1,400 to cover the oozing sore on the
diabetic's foot with a piece of artificial skin, helping it heal if
patients keep pressure off that spot. So when Medicare paid for the
treatment but not the extra $100 for a simple walking cast to protect
it, an artificial skin maker last year started giving free casts to
some needy patients.
Without the right cushioning, "the person will walk to the bus stop
and destroy it," fumes Dr. David G. Armstrong of the Southern Arizona
Limb Salvage Alliance.
Limb-salvage experts say many of the 80,000-plus amputations of toes,
feet and lower legs that diabetics undergo each year are preventable
if only patients got the right care for their feet. Yet they're
frustrated that so few do until they're already on what's called the
stairway to amputation, suffering escalating foot problems because of
a combination of ignorance - among patients and doctors - and payment
hassles.
"There's no magic medicine right now for the diabetic foot," says
specialist Dr. Lawrence Lavery of Texas A&M University, who bemoans
that simple-but-effective preventive care just isn't attention-
getting.
"People come in (saying), 'Hey, my wife noticed a bloody trail today
as I was walking across the linoleum in the kitchen. What should I
do?'"
President Barack Obama got a drubbing from surgeons this month after a
confusing comment about how they're paid for foot amputations that
cost $30,000 or more. That tab is the total cost, including
hospitalization; surgeon fees range from about $750 to $1,000.
Obama's larger argument: Better payment for early-stage diabetes
treatment, or even care to prevent diabetes, could save the nation
money.
The money part's hard to prove but it's a lot of misery saved if it's
your foot, and the spat highlights a huge problem. Some 24 million
Americans have diabetes, meaning their bodies can't properly regulate
blood sugar, or glucose. Over years, high glucose levels gradually
damage blood vessels and nerves.
One vicious result: About 600,000 diabetics get foot ulcers every
year. Poor blood flow in the lower legs makes those ulcers slow to
heal. And loss of sensation in the feet, called neuropathy, makes
patients slow to notice even small wounds that rapidly can turn
gangrenous.
A mere nick while clipping nails, or a blister from an ill-fitting
shoe, can begin the march toward amputation - and about half of
patients who do lose a foot die within five years.
Saving those feet isn't cheap. Treating a slow-to-heal diabetic foot
ulcer can cost up to $8,000. If it gets infected, $17,000. Worse, a
fraction of patients gets multiple slow-to-heal ulcers each year.
What helps?
-Routine foot checkups. There's great variability in how insurers pay
for foot screenings before someone's deemed at high risk, says Dr.
Harry Goldsmith, a consultant on podiatric reimbursement. Yet some
simple tests, like one that measures blood pressure at the ankle to
predict circulation clogs, can signal later risk of ulcers. Medicare
patients who do develop certain risk factors qualify for the next
step, regular clinic visits to have a technician trim nails or smooth
calluses, time that should include a quick check for any wounds,
Goldsmith says.
-Gadgets like $20 telescoping mirrors let diabetics who can't move
well check their numb soles for wounds between doctor visits, and
infrared foot thermometers that cost up to $100 can detect changes in
temperature that mean an ulcer's brewing before the skin breaks.
Again, insurance payment varies.
-Taking pressure off the foot is key, starting with supportive shoes
or insoles that target weak spots before an ulcer strikes. Medicare
will help pay for certain therapeutic shoes although paperwork limits
the diabetics who try them, says Lavery. He finds that an athletic
shoe checked by a foot specialist for proper fit can help many
patients.
When an ulcer demands more advanced care like grafting that artificial
skin, Armstrong says removable walking casts - to-the-calf Velcro
boots that injured athletes often wear - ease pressure best but seldom
are covered. Worried that doctors wouldn't prescribe its wound healer
Dermagraft if patients crushed it before it could work, Tennessee-
based Advanced BioHealing has provided nearly 1,900 of the boots
through a patient-assistance program since last year, said vice
president Dean Tozer.
-The "toe and flow" approach, diabetic limb-salvage teams that pair
specialists who otherwise seldom work side-by-side, like podiatrists
and vascular surgeons. Wound care won't work well until clogged leg
arteries are cleared to improve blood flow, notes Armstrong, whose
team at the University of Arizona, Tucson, documented a drop in
amputations in its first nine months. Such teams can eliminate some of
the time diabetics wait for appointments to treat a festering foot,
plus stress prevention.
.
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