Health & Fitness

Fighting foot ulcers — a very serious problem for diabetics

For the Miami Herald

Carolyn Moore is a woman of faith. Raised in Miami, she loves to bike and swim, although she has not been able to do either for some time.

She calls her best friend, roommate and caretaker, “Sister.” Moore says Sister, whose real name is June Stevens, has been like an angel since Moore lost her foot to a diabetic lesion three years ago.

Moore, now 60, was studying philosophy at Miami Dade College in October 2013 when she felt a sharp pain in her foot. She was rushed to the hospital and was devastated to learn that a small bump on her big toe was infected with gangrene. She says that within weeks, she had all of her toes and half of her foot amputated. Today, she walks occasionally with a walker but mostly uses a wheelchair.

“I got into a little depressed mood, but I am a religious person, and I believe in God, and God doesn’t make mistakes,” Moore says with boundless optimism. “And I had a very, very good doctor.”

Moore recovered from the operation only to have a lesion reappear in the same spot in August 2015. This time, she decided to see Dr. Robert Kirsner at UHeath — University of Miami Health System.

Of the estimated 29 million Americans with diabetes, Kirsner says that one in four will develop foot lesions, and of those who do, one in six will require an amputation.

“One of the things we’ve learned in the past decade is that if you have a diabetic foot ulcer, you are more likely to die,” Kirsner says. “It puts you in a dangerous category. It’s common, and it has significant medical complications.”

Since the lesion occurred in the same location, it was important to treat her aggressively to avoid further amputation, he said. He used an advanced treatment called skin substitution therapy, which involves replicating missing skin with cell or tissue-based products. These products can be made from living or non-living cells and include substances like collagen or cadaver skin.

Moore underwent several months of skin substitution therapy, riding the bus in her wheelchair an hour each way with Sister by her side. Moore says the treatment was relatively pain-free and helped her heal more quickly that previous therapies.

Dr. Dolores Sanchez-Cazau, medical director of wound care at Hialeah Hospital, says that it is important to understand that diabetic foot ulcers are not simply ulcers, but part of a comprehensive disease that can affect all organs of the body.

“Because of the diabetes, the arteries can be hard, they cannot extend, and they can be clogged with cholesterol deposits that can cause stenosis,” Sanchez-Cazau says, explaining that diabetics often exhibit a variety of related symptoms including high blood pressure and high cholesterol.

“You need to treat the lesion,” she says. “You need to check the cholesterol and keep the blood sugar under 120 or 110. Hemoglobin A1C should be between six and seven, and the patient needs to watch their cholesterol and sodium.”

Sanchez-Cazau says that modern treatments offer hope for patients with diabetic foot ulcers. “With new grafts and new technology in wound care, like hyperbaric oxygen therapy, we can save those legs that would have been amputated in the past.”

Dr. Francisco Oliva, a podiatrist at Baptist Health South Florida, says he has also seen positive results from oxygen therapy. With oxygen therapy, a patient is immersed in a hyperbaric oxygen chamber, where they breathe compressed, highly oxygenated air. Treatments usually last about an hour, and occur two or three times per week.

“It’s got incredible rates of healing, especially when you have patients who have poor vascularity,” says Oliva, explaining that oxygen therapy works well on slow-healing wounds in patients with restricted circulation.

Oliva wrote his senior thesis about oxygen therapy while in medical school. He says the therapy was developed by observing Native Americans, who identified oxygen as a natural healing agent.

“They saw that when Indians fought battles on these high plateaus they didn’t heal well, but when they brought them into the valleys they healed better,” Oliva says, citing the higher levels of oxygen at lower altitudes.

And while oxygen and skin substitution therapies are often successful in treating those with diabetic foot ulcers, Kirsner, Oliva and Sanchez-Cazau all agree that the best treatment is prevention.

“The most important factor is early detection — putting patients in diabetic shoes and encouraging them not to wait till there is an issue,” says Oliva, adding that patients and their caretakers should check feet daily for even the tiniest lesion.

Moore is not worried about a newly developed third ulcer, which, fortunately, was caught early. She says that she has been diligent with follow-up care and has the utmost faith in God and her doctors. With Sister by her side, Moore looks forward to walking again and re-enrolling in college next year.

“I want to get out of this wheelchair so bad and ride a bicycle,” she says. “I just want to be normal — that’s a big deal for me.”

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