Many Diabetic Foot Amputations Preventable With Simple Care, Experts Say
By Lauran Neergaard
The Associated Press and Reprinted in LV Review Journal Tuesday August 25th 2009
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 the U.S. health care plan for the elderly 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. Armstron of the Southern Arizona Limb Salvage Alliance.Limb salvage experts say many of the 80,000 plus amputations of the toes, feet, and lower legs that diabetics in the U.S. undergo each year are preventable if only patients got the right care for their feet.Yet they are frustrated that so few do until they are already on whats 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 notice 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 are paid for foot amputations that cost $30,000 or more. That tab is the total cost, including hospitalization;surgeon fees range from around $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 is hard to prove but it is a lot of misery saved if it is your foot, and the spat highlights a huge problem. Some 24 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels gradually damage blood vessels and nerves. One result : About 600,000 diabetics get foot ulcers every year. Poor blood flow in the lower legs make 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 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 is not 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 get multiple slow-to-heal ulcers each year.
