Sunday, 20 June 2010

Amputation Adds to Pain of Diabetics

Amputation Adds to Pain of Diabetics

William Harris used to play ball with his grandchildren in the backyard, walk to the store with his wife, and every day he got behind the wheel of a big rig as a professional truck driver.

All that's changed now. The 54-year-old Simpsonville man had parts of both feet amputated as a result of diabetes. And there's no guarantee he won't have to endure more.

“It's devastating,” he said. “I went to the hospital on a Thursday and on Saturday I was having an amputation.”

Sadly, Harris's case isn't unusual. There is one major amputation in a diabetic every three days at Greenville Memorial Hospital, according to Dr. John York, a vascular surgeon who performs these operations.

“It's a cruel disease,” he said.

Diabetes is an illness that causes high blood glucose levels that can have serious complications, including blindness, kidney failure, heart attack, stroke and amputation, according to the state Department of Health and Environmental Control.

Nationally, South Carolina ranks 10th in diabetes, DHEC reports. It afflicts almost 10 percent of the population, or about 350,000 people, disproportionately affecting blacks. And it kills about 3,000 every year, reducing lifespan by five to 10 years.

Among the 25 million diabetics in the United States, there are a striking 80,000 amputations each year, York said.

This surgery is typically needed when a patient develops a foot sore that doesn't heal, he said.

Diabetics can develop nerve damage that limits sensation in their feet. They don't heal well either. So when they get a sore, they might not notice it until it's gone so far that it puts them at risk for systemic infection and even death, York said.

It can happen to anyone with the condition, but is most common in those with Type 2 diabetes who “walk a hole in their foot,” he said. And those with poorly controlled diabetes are more prone to develop infections, he said.

But controlling diabetes can be complicated and inconvenient, requiring frequent blood glucose testing, dietary changes, exercise, regular foot care and medications, which can include insulin injections. And DHEC reports that half of all diabetics in the state check their blood glucose less than once a day.

“It's hard to get people to really be compliant,” said York, medical director of GHS's Institute for Vascular Health wound care center. “It's very challenging and frustrating too.”

And treating diabetes can be costly, forcing some patients to go without regular doctor visits or expensive drugs.

Diabetes runs the nation $116 billion in health care costs a year, accounting for about $1 of every $10 health care dollars spent, according to the American Diabetes Association. Medicare pays for more than half the cost, DHEC reports.

Harris' problems started with a couple of bruised toes.

Knowing he had a strong family history of diabetes, he'd seen the doctor and was diagnosed as pre-diabetic and prescribed medication. But he'd never heard anything about amputation as a possible consequence of the disease, and was shocked when it happened to him.

“I never thought this would happen,” he says. “No one in my family had anything like this.”

His infection also spread quickly, causing so much pain he couldn't sleep, and changed the appearance of his toes. He showed them to his wife of 35 years, Juanita.

“They were hurting me,” he says. “Two days later, they kind of turned to jelly on both feet.”

Surgeons wound up amputating his right foot almost to the ankle and a good portion of his left foot as well. He spent three months in the hospital, including 38 days in a hyperbaric chamber to promote healing.

It's limited his mobility, affecting his ability to take care of basic needs. And not being able to work has been an emotional struggle.

“I worked 21 years in the textile industry and when that folded, I got into truck driving. I worked all my life. Now everything has changed,” says the father of three and grandfather of three.

Though he mainly uses a wheelchair, Harris can walk a bit with a cane and prosthetic shoes. He's on 17 different medications and doesn't think the pain will ever disappear.

While his condition is under control now, he says it could flare up at any time. And after what he's been through, he says the number of amputations at the hospital is no longer a shock.

“I've met a lot of people who are a lot worse off than I am,” he says. “I'll just continue on and do the best I can.”

York said the hospital hopes to open a new center within the next year that's aimed at averting these infections in patients, and consequently, the amputations.

“Across the county, this has led to a decrease in amputation rates of up to 60 percent annually,” he said. “The only way we're going to impact this is on the front end with preventive measures.”

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