Hi all
Members do not see these Ads. Sign Up.
Yesterday we went to the Foot in Diabetes UK Conference at Ibis Earls Court London. Many seminars focusing on Wound care, prevention and management and management of diabetic foot care service. I run a busy High street private practice seeing up to 80 customers a week. It kind of dawned on me at some point that despite have quite a high percentage of patients with diabetes type one and two, I have never had a single patient who has ever required surgical amputation of a limb, not even a toe. I see all types of risk classification but none presenting with wounds requiring surgery or extensive debridement because those types of cases are usually referred directly to the NHS podiatry dept.
Now the obvious reply to that is that I don't see the high risk cases with severe pathology so that those I see wouldn't have the sequela of limb loss.
But high risk cases are not a start point they are an end result and what I don't see are cases progressing to that end result that then require referral to a Multi Disciplinary Team for instance. It was interesting and surprising to note that there was a new term introduced " Foot Attack" and foot attack require rapid appropriate treatment on the premise that if some one with diabetes had presented with 3 of the following - neuro ischaemia, PAD, non palpable pulses, infection, ulceration, then they had a higher 5 year mortality rate than those suffering heart attack or CVA.
Now, if memory serves, the statistic given yesterday was something like that 60-70% of those with diabetes would progress to neuropathic limbs and if more sensitive tests were done it would more likely be close to 90%. Of those about 50% would have severe degeneration and amputation due to neuro-ischaemia and 20% would lose their life within 5 years and much more than this if they did not receive early well managed treatment programs.
So, why don't I see that sort of progression in my diabetic patient demographic?
Maybe they escape out of my care without noticing and are taken up by the NHS but I think that is unlikely since other patient groups that go to NHS care for other reasons usually return with their history noted and recorded. Even if they did not return as is more likely to be the case with high risk diabetics there would still be the trail of disease progression and referral for many patient but that is not seen.
I wonder if you would care to comment on why that might be? Also is this normal experience for other private clinics?
Regards Dave Smith
Loading...
- Similar Threads - incidence amputation
-
- Replies:
- 1
- Views:
- 660
-
- Replies:
- 1
- Views:
- 1,389
-
- Replies:
- 1
- Views:
- 1,087
-
- Replies:
- 0
- Views:
- 1,787
-
- Replies:
- 0
- Views:
- 2,321
-
- Replies:
- 2
- Views:
- 3,982
-
- Replies:
- 0
- Views:
- 3,140