CONSULTANT SURGEON at the Queen Elizabeth Hospital, Selwyn Ferdinand, has dismissed claims that Barbados is the amputation capital of the world, noting that the data did not support that claim.
He however concedes that the incidence of diabetes-related amputations in the island is too high, and he urges patients to become more involved in understanding the disease and what is involved in their care.
According to Ferdinand, behaviour modification in diabetic patients is one of the biggest challenges facing medical practitioners. “How to get persons with diabetes to understand that if you’re sitting down by the door and the rain starts to fall, you shouldn’t just rush out there to pick up the clothes off the line, because if you sustain a nail puncture, you’re going to be in some trouble. You therefore need to develop the habit of making sure that when you’re going outside, you put on your slippers or footwear that is going to be protective.”
He says that while doctors advise patients and give them all the information, it is still proving very difficult to motivate them enough to make the changes in their lifestyles. And he stresses that “this is not a stubborn, old people problem. In fact, the majority of people that we see with nail punctures are fit, healthy people who just have not made the changes that are necessary in their behaviours as a result of their diabetes to minimise these problems.”
The medical practitioner says it is extremely important for diabetics to check their feet daily for any abnormalities because one of the consequences of the disease is neuropathy or lack of sensation, so people may not be immediately aware that they have injured their foot.
“We have dramatic stories of people walking around in their house and hearing a sound of ‘tac, tac, tac’ and wondering where is this coming from, only to realise that there is a tack stuck in the sole of their foot and they didn’t feel when it occurred. If it weren’t for the sound, they wouldn’t have known.”
In examining the feet, the diabetic is therefore looking for injuries; changes in the shape of the toes; the development of corns or calluses; extremely dry skin; and whether or not the feet are fitting into footwear properly. Special attention must also be paid to cutting toenails and this should preferably be done by a podiatrist, a primary care practitioner or a trusted partner, Mr. Ferdinand advised.
Also of vital importance to the diabetic is wearing proper fitting footwear. The surgeon notes: “Fashion tends to prevail and that’s unfortunate. The principle is to try to get proper fitting footwear that is not going to cause any injury to the feet. The more fashionable shoes are not able to do that.”
He further advised that diabetics shop for shoes in the afternoon and not in the morning. “They go early in the morning before the stores are crowded but you should actually buy shoes in the afternoon when your feet are at maximum size because the size then is going to be more accurate than when your feet are not swollen in the morning.”
The QEH Consultant said that one of the most troubling myths doctors at the hospital encountered was that once a diabetic patient came into the hospital for care, they would lose a limb.
“We in the public sector struggle when we have to deal with patients who come to us with preconceived stories…
Amputation is the worst case scenario when we are not able to control a situation, usually because the infection has gotten so bad and is spreading and is becoming life threatening, or the limb has no circulation for it to be sustained and remain alive.”
But Ferdinand stressed that amputations were never done without significant efforts to save limbs “A lot of our activity is spent in dealing with infections in persons who have sustained injuries, either from nail ‘jucks’, bruises, scrapes or blisters, which for one reason or another have not improved in the care that they would have received from their primary doctor and they are now at the hospital for care in a more expert setting.”
He said that when most people heard the word amputation, they immediately thought in terms of major amputations such as those done above the knee or just below the knee.
He explained, however: “Lots of amputations are done because the toe is now dead and we can’t get any circulation to it, or the infection has destroyed it and we have to control the infection so we have to take the toe off. So, lots of little bits of surgery are done to control infections which may result in minor amputations but our goal is always to try and preserve as many functional feet as possible.” (BGIS)
