Diabetic Amputation Rates Rising

Mary is a lady I have taken care of for several years.  Every time she comes in I check her heart and lungs.  Then, when I go to check for swelling in her legs, we have a good laugh.  See, the first time I saw her, I checked for swelling and only then realized something pretty important.

Mary’s lower left leg is missing.

She is diabetic and developed gangrene in her left leg some time before she started seeing me and had to have her left leg amputated below the knee.  She is a very sweet lady but now has some significant trouble getting around.

Why would Mary need to get her leg amputated?  There are a number of possible reasons.  Diabetics can lose feeling in their feet and if they hurt themselves they may not feel it.  They don’t generally have good circulation and wounds take longer to heal.  Diabetics also have immune systems that don’t work right and they have trouble fighting infections.

Unfortunately Mary is in good company.  The rates of diabetic amputation are risking across the country.  For instance, in California, the rate of diabetic amputation rose 31% between 2010 and 2016.  Some counties like San Diego and Riverside counties had over 60% increases.  Across the United States the rate of diabetic amputation rose 27% between 2010 and 2014.  Before 2009 the rates had been dropping.

Why is this happening?  Why are people losing toes and feet, ankles and legs to diabetic amputation?

There are a number of possible reasons.

  1. More diabetics.  The number of Americans with diabetes is on the rise.  This doesn’t explain it all, though, because even just looking at diabetic patients the rates are rising.
  2. Access to care.  Before the Medicaid expansion that came with the Affordable Care Act many low-income diabetics went without care for their illness.  Also, coverage for podiatric care (which includes care for foot wounds and chronic foot infections) is not consistent across the country and across insurers.  If you can’t afford medication and see the specialists you need, you’re at increased risk for complications like amputation.
  3. Health literacy.  Many diabetics don’t understand why they need to see the doctor regularly.  They don’t know all the bad things that can happen as a result of diabetes.  They don’t know they could lose their vision, have a heart attack, wind up on kidney dialysis, have a diabetic amputation.  Education is key.
  4. Lifestyle factors.  If you’ve ever tried to lose weight you know how hard it is to change your lifestyle.  Eating a healthy, mostly-plant-based fresh-food diet, exercising regularly and drinking water are critically important for diabetics but many patients seem to think as long as they take their pills or their shots that’s all they need to do.  NO medication can make up for a crappy lifestyle!

If you are a diabetic, please make sure to see your doctor regularly.  If your doctor wants you to check your blood sugar and blood pressure, PLEASE do it, and keep a written log.  (It’s really hard for us to scroll through your glucometer’s tiny screen, so please bring us an organized log.  It will save time for more important things!)

Don’t smoke.  Whatever you need to do to quit, do it.

Get.  Serious.  About your diet.  NOT kidding.  What we put in our mouths determines the majority of health for ALL of us, not just diabetics.  Even if you have a low income, you can make healthy choices in your diet.

Walk.  Get outside and walk.  Go to the mall and walk.  It doesn’t matter WHERE you walk, as long as you do it.  Research has shown that walking is an excellent intervention for those who have circulatory problems in their legs.  It actually helps grow new blood vessels around any blockages that are there.

Look at your feet every day.  If you can’t reach them, get a mirror on a stick or have a family member check your feet.  All parts of them, tops and bottoms and between the toes.  Report ANY wounds or cuts or scaly, red areas to your doctor, even if they’re not painful.  Remember, diabetics lose feeling in their feet and it can be subtle so that they don’t realize the sensation is not normal.  Wear sturdy protective shoes to keep from injuring your feet, especially if you know the sensation isn’t normal.  Cute little sandals and flip-flops will NOT protect your feet from injury.

A diabetic amputation is a huge deal.  Amputation affects independence, the ability to walk and drive and get done the things that we need to do every day.  We need to do a better job preventing the need for diabetic amputations. That means being aggressive about diabetes and blood pressure treatment, protecting our feet, staying active and being engaged with our doctor and an active member of the treatment team.

God gave you two legs, two feet and ten toes.  There’s a reason for that, and we need to do everything we can to keep all those parts in good working order!

QUESTION: Do you know anyone who has lost part of their foot or leg to diabetic amputation?

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What Is Physician Burnout?

Dr. Sadd is a colleague of mine that I’ve been worrying about for a while.  He comes to the office and constantly complains about EVERYTHING.  Dr. Sadd snaps at the office staff, makes negative comments about his patients, and has no tolerance at all when things don’t run smoothly.  He doesn’t really have “good days” and never seems to be happy.

Dr. Sadd is burned out.

What is physician burnout?  Burnout doesn’t just happen to doctors but is very prevalent in the medical field.  Because of this, research on burnout is often done on doctors and nurses and other medical professionals.

Physician burnout happens when the emotional and energetic toll of practicing medicine becomes overwhelming.  Burned out doctors and nurses are exhausted.  They are cynical and have a hard time connecting with others.  They doubt they are really making a difference.  Those of us in the health professions generally chose the field BECAUSE we want to make a difference.

If not addressed, burnout can drive doctors and nurses out of medicine.  Worse, burnout can cause depression and lead to suicide.  And physician burnout is very common.  Recent studies suggest that over half of American doctors are suffering from burnout.

What are the causes of physician burnout?  Recent changes in the American medical landscape with increased regulation and government reporting requirements are contributing to burnout.  We aren’t secretaries.  When we have to spend more and more time staring into the computer screen instead of interacting with patients, it adds more stress.

Doctors and nurses often feel they have less and less control over the way they practice medicine.  They often feel as though their training and expertise aren’t valued.   Checklists and paperwork, financial pressures and rules that don’t make sense all contribute.  If we don’t have enough support with the clerical side of things we can feel overwhelmed.

In addition, some doctors don’t have a good work-home integration.  Long work hours are hard on the family.  We neglect activities that we enjoy and put more and more energy into work.  Eventually the tank is empty and we have nothing more to give to our patients.

If you have lost the joy you used to take in your work, you might be burned out. You might be burned out if you are dreading going to work tomorrow,   If you find it really hard to finish tasks at work that used to be easy, or if you find yourself procrastinating, you might be burned out.

Unfortunately, if you are a doctor or nurse and you’re burned out, you might actually be dangerous.  Burnout increases the risk of medical errors.  In addition, patients who see a burned-out doctor are less satisfied with their care and may be more likely to sue if something goes wrong.  Interestingly, burned-out doctors seem to be more prone to car accidents.

What can you do about it if you are a doctor or nurse and you think you might be burned out?  First of all, be honest with yourself about the situation.  Talk with your supervisor and find out what resources are available at work.  Think about whether you’re taking steps to take care of yourself and enjoy your life NOW.  Too many of us focus on the future at the expense of the present!

After this process, it’s time to reconnect with the joy of your career.  Why did you choose a career in medicine in the first place?  What are the biggest stressors?  Are there ways to reduce the stress while maximizing the rewarding parts of your career?

Physician burnout (and nursing burnout) is a big problem in medicine and more and more organizations are recognizing it.  While your organization may offer tools to decrease burnout, it’s first up to you to recognize that you are losing your joy.

After all, the first step to fixing a problem is recognizing it exists in the first place.

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Toxoplasmosis

My family and I got some surprising news about our cat Domino this week.  You may remember I wrote a few weeks ago that she was sick with pneumonia.  The vet treated her with rounds of two different antibiotics and the pneumonia just wasn’t clearing up.

We were wondering if she might have a lung tumor causing the pneumonia not to get better as expected.  Then Dr. Kontur said “Let me do one more test.”

Turns out, the test came back “screaming” positive!

Domino has toxoplasmosis.

Toxoplasmosis is an intestinal infection with a parasite called Toxoplasma gondii that is found in some animals including cats.  Dr. Kontur tells me it usually affects young cats and older cats with asthma (like Domino) and can cause pneumonia.  Treating the infection requires antibiotics and hopefully it will clear up easily.

So why am I writing about toxoplasmosis today?  Because Toxoplasma can infect humans too.  Toxoplasmosis can be transmitted from animal feces, soil or sand contaminated with animal feces, and by eating raw or undercooked meat or seafood.

Most people who get toxoplasmosis from their cats or any other source have no symptoms at all.  In addition, those who do get sick generally just get flulike symptoms (headache, fever, body aches and fatigue).  Healthy people are at little or no risk of long-term harm from toxoplasmosis.

Who IS at risk?  Pregnant women and those whose immune systems are not normal are most at risk.  People with HIV infection, inherited immune deficiencies, or receiving chemotherapy for organ transplant, cancer or autoimmune diseases are at risk.

Pregnancy is definitely not much of a concern for me, my childbearing days are done.  However, I do have a cancer patient in my house.  As many of you know, my husband was diagnosed over 6 years ago with multiple myeloma.  As a result, we are very conscious of infection risk where he is concerned.

If you or someone you know is at risk for toxoplasmosis, there are a few things you should keep in mind.

  • Clean out your cat’s litter box every day.  It takes 1-5 days for Toxoplasma organisms to become contagious after passing in the cat’s stool.
  • If possible, have someone who is NOT pregnant and is NOT immune compromised clean the litter box.
  • Fully cook meats and seafoods before eating them.
  • Wash your hands thoroughly with soap and hot water after gardening and after cleaning a cat litter box.
  • If your kids have an outdoor sandbox, keep it securely covered to keep feral cats and other animals out of it.

For healthy people toxoplasmosis is not generally a serious health problem.  However, it can cause pregnant women to miscarry their babies and can cause infection in the unborn baby.  In additon, people with immune suppression can develop breathing problems, neurologic problems like seizures, and can affect the eyes and vision as well.

We are so blessed that Dr. Kontur discovered Domino’s toxoplasmosis infection!  Here’s hoping her infection clears up quickly and easily (although she HATES being force-fed pills).  And clearing up Domino’s infection will help protect Russ from any possibility of infection in the future.

If you’re looking for a new vet for your four-legged family member, please give Dr. Kontur a call at Summit Animal Hospital in Northfield.  She rocks!

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How To Be YOUR Healthiest You!

Have you ever had a salesperson try to sell you something you didn’t want?  Maybe you were shopping for a new TV and the salesperson tried to get you to buy something bigger or more expensive than what you were looking for?  Or you’re looking for a new lipstick and the salesperson tries to convince you that their entire line of cosmetics is Just perfect for you!

Even worse, have you been talked into buying something and got home and found it wasn’t what you thought?

When someone tries to sell you something without knowing what would make your life better, they are wasting their time and yours.

Since I can’t possibly know each and every one of you, I try to write about a variety of health topics and let you pick and choose what is helpful for you.  (And I hope you know that I LOVE suggestions for post topics.  If you want to read about something, please drop me an email and let me know!)

There is, however, a tool to help me to know exactly what would help YOU.  What would make YOUR life better.  How I can help you meet YOUR health goals.  What would help you be YOUR healthiest you!

That tool is Shaklee’s HealthPrint personalized health assessment. This assessment is a five-minute questionnaire that asks about diet and lifestyle and your individual health goals.  It then gives you suggestions to improve your diet and lifestyle, as well as adding nutritional supplementation, so that you can meet your health goals!

I realize I’ve written about the HealthPrint before, a little over a year ago, and some of you took advantage of the assessment then.  Many of you didn’t, or you subscribed to my blog since that time.

Why am I writing about it again? Because it is still true that in order to know how to help YOU, I have to know where you’re coming from.  I have to know what’s important to you.  In order to help you be your healthiest you, I have to know what your personal challenges and goals are.  And this is such a quick and easy way to learn about you!

This week I want to invite you to take Shaklee’s HealthPrint and let me learn a little about you.  In return, I can help YOU learn a little about you too!  Maybe you already know you don’t get enough sleep.  Maybe you DIDN’T know that you aren’t getting quite enough exercise.  Maybe you didn’t realize drinking that soda in the afternoon isn’t a good choice.

Yes, the HealthPrint makes suggestions for adding supplements.  If you’ve been reading my blog for any length of time, you’re aware that I’m a firm believer in nutritional supplementation.  Surveys show 95% of Americans don’t get all the nutrition they need from their diet.  I don’t think I eat healthier than 95% of Americans, do you think YOU do?  And going without essential nutrients just isn’t acceptable.

Nutrition therapy put my migraines in remission 8 years ago.  It helped my mother heal what SHOULD have been permanent neuropathy in her hands and feet from chemotherapy for breast cancer.  It helped my husband avoid serious adverse effects from HIS chemotherapy for multiple myeloma.  My boys are tall and healthy and strong with the highest quality nutritional support available on the market.

And it’s hard to argue with scientific proof that those who use Shaklee supplements are healthier than those who don’t use them.  Don’t believe me?  Click this link to see the research.  Want more?  Okey dokey, here’s more 🙂

Whether your health goals include weight loss, better physical fitness, stress relief, better sleep, healthy aging, or just good overall health, I can help.  Shaklee can help.  The first step is the 5-minute, 20-question HealthPrint questionnaire.

Don’t you have 5 minutes to spend, to learn how to be YOUR healthiest you?

Click this link and take the HealthPrint assessment now!

PS – Even if you took the HealthPrint last year, you can still take it again.  Maybe things have changed!  Maybe you’re eating better, or your goals are different 🙂

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Should Doctors Fire Patients?

“Just tell her to send in the f*@&ing prescription!”

Really?  This is how you talk to people?  Unfortunately, sometimes this is EXACTLY how patients talk to my staff.  The question is, how should a doctor handle a patient like this?

What if this is YOU speaking to my staff this way?  Should I fire you? Should doctors fire patients?

That is an important topic of discussion among medical personnel especially in the outpatient setting.  Clearly, a patient who uses abusive language towards staff members should get the “You have 90 days to find a new doctor” letter.  But are there other reasons why patients should be dismissed from the practice?

Your relationship with your doctor is really not like your relationship with anyone else.  It’s a unique mix of cheerleader, parent, coach and cop.  There has to be mutual respect and trust.

Patients often talk about the trust they have in their doctor.  I agree, that trust is critical.  You have to be able to trust that I know my stuff, that I’ll be able to listen to your symptoms, ask the right questions, recognize the physical findings on exam, order the right tests, then put it all together to come to the right diagnosis.

What patients often don’t understand is that I have to be able to trust YOU.  For example, I have to know you’ll answer me truthfully when I ask you questions.

For instance, how much alcohol do you drink?  Do you use drugs?  Are you taking your medicine every day?  How many sex partners have you had in your life?  This year?  This week?  Did you really lose that prescription or did you sell it?  Are you seeing three other doctors who are prescribing the same medication I am?

The relationship we have is absolutely necessary for us to be able to work together as a team.  I’m not painting the walls in your living room, I’m guiding you to your healthiest and best self possible.  Are you listening to me and giving me honest feedback?  Are you helping me craft a good treatment plan that makes sense to us both?

If I were to poll friends of mine in the medical field I would guess these are the most common reasons we have to dismiss patients from our practices:

  • Repeated no-call/no-shows (lack of respect for the office and other patients)
  • Abusive language and behavior towards the doctor and/or staff
  • Failure to pay their bill (an unfortunate reality of business)

However, I would submit there are other valid reasons to dismiss a patient from the practice:

  • Dishonest behavior such as lying
  • Consistent failure to keep up their part of the treatment plan, such as a diabetic who neglects taking their medication, going to the dietitian or checking blood sugars
  • Failure to maintain appropriate boundaries

By the way, I’m dead serious about that last one.  I had a patient once who wanted to see me socially.  That is, he wanted to date me.  Never mind the fact that both of us were married (me very happily, him not so much).  Never mind that such a thing would violate my oath, State Medical Board regulations, and all the profession’s ethical standards.  He was very persistent.  His find-a-new-doctor letter got mailed out the next day!  What a nightmare…

My patients are awesome.  I absolutely love my practice and the vast majority of my patients are a pleasure to see.  However, I’m not shy about dismissing patients.  If they make me and my staff miserable, or if I’m not effective in motivating them to get their health conditions under control to the best of their ability, then it is in everyone’s best interest that they choose a new doctor.

QUESTION:  Do you work with the public in your job?  Do you have the ability to “fire” clients?  Would you add any reasons to fire patients to the ones I listed above?

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