KEEP YOUR FEET IN DIABETES!!!

THE DIABETIC FOOT

INTRODUCTION

Diabetes Mellitus is a fast growing pandemic afflicting people of all age groups. The disease affects all the systems of the body and all the tissues also. Numerous patients come to realize that they are suffering form this disease when the small ulcer on their foot does not heal and starts to make the foot look black (gangrene).Diabetic patients have 15– 40 times higher risk of under going amputation (cutting of the dead limb/foot) than normal population.

HOW DOES A DIABETIC FOOT OCCUR?

High blood glucose levels lead to nerve damage causing a significant decrease in the sensation of the feet. So any trauma, nail prick, ill fitting shoe, heat or cold; leads to formation of ulcers/ blisters on the feet which are ignored as the patient does not check the condition of his/her feet everyday. As the skin also becomes dry, the cracks that appear on the skin start harboring bacteria which increase the risk of ulceration.

Diabetics have a propensity to accelerated atherosclerosis (occlusion of blood vessels) of the limbs which reduces the blood flow and makes the foot susceptible to ulceration. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. High blood sugars also have a detrimental effect on the immune system leaving the body susceptible to infections.

WHAT SHOULD I DO EACH DAY TO STAY HEALTHY WITH DIABETES?

• Follow the healthy eating plan that you and your doctor or dietitian have worked out.
• Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
• Take your medicines as directed.
• Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Don't smoke.

HOW DO I KNOW THAT I HAVE A DIABETIC FOOT?

• Persistent pain.
• Redness.
• Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation.
• Other signs of poor circulation include the following:
• Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
• Hair no longer growing on the lower legs and feet
• Hard shiny skin on the legs
• Localized warmth.
• Any break in the skin is serious. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
• Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
• A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
• Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
• Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
• New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.

WHAT ARE COMMON DIABETES FOOT PROBLEMS?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

• Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.
• Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.
• A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.
• Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.
• Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.
• Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.
• Athlete's foot is a fungus that causes itchiness, redness, and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

TELL YOUR DOCTOR ABOUT ANY FOOT PROBLEM AS SOON AS YOU SEE IT.

WHAT CAN I DO TO TAKE CARE OF MY FEET?

Look at your feet every day to check for problems.

• Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.
• Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
• If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
• File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.
• Cut your toenails once a week or when needed. Cut toe nails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
• Always wear slippers or shoes to protect your feet from injuries.
• Always wear socks or stockings to avoid blisters.
• Wear shoes that fit well
• Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
• Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night - indoors and outdoors.
• Having a doctor examine the patient's feet at least once a month.

WHAT CAN I DO TO TAKE CARE OF MY SKIN?

• After you wash with a mild soap, make sure you rinse and dry yourself well especially between the toes.
• Keep your skin moist by washing with a mild soap and using lotion or cream after you wash.
• Check your skin after you wash. Make sure you have no dry, red, or sore spots that might lead to an infection.
• Tell your doctor about any skin problems.
• Prevention & good control of blood sugar level - remains the best way to prevent diabetic complications.

                      

HOW CAN SPECIAL SHOES HELP MY FEET?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Talk with your doctor about how and where to get them.

WHAT INVESTIGATIONS WILL I NEED?

Medical evaluation includes a thorough history and physical examination and may also include laboratory tests, x- rays (angiogram) studies of circulation in the legs, and consultation with specialists. Ideal Fasting blood glucose is <120 mg/dl and Ideal HbA1c <7% (which denotes the long term diabetic control).

WHICH DOCTOR SHOULD I CONSULT?

Management of a patient with a diabetic foot requires a team of doctors out of which any one can be the first contact:  

• Physician: Family doctor is usually the first referral.
• Endocrinologist: Medical management of Diabetes.
• Plastic Surgeon: Wound management, soft tissue coverage and microvascular bypass surgeries.
• Vascular Surgeon: Management of blocked major arteries.
• Physiotherapist: Rehabilitation of patients.
• Dietician: Proper diet is the backbone of management of diabetes.

THE PATIENT IS THE MOST IMPORTANT MEMBER OF THE TEAM. No matter how qualified the other members are, if the patient does not believe they can master the problem and keep their own two feet intact for the rest of their lives, everything else will be a failure.

      

BE SAFE THIS DIWALI

BE SAFE THIS DIWALI

Diwali, the festival of lights, imparts diverse meanings to the various elements of nature. The delight is in the exquisite beauty of the firecracker as it lights up the sky, the thunder of the firecrackers that give language to the diyas, the enchantment lies in the wall of sparkles thrown up by the flowerpots (annar), the ground smiles when the chakkri turns its hypnotizing circles.  

As the month of October rolls towards the cooler month of November; the fervor of festivals rises to a crescendo. With the festival of lights “Diwali” drawing near, the days start becoming darker and the nights become brighter, lit by the magnificent lights in the bazaars and homes. Even though the hysteria created behind excessive air pollution by firecrackers rises to a higher pitch every year, the number of burn injuries also keeps pace. The reasons are numerous; faulty firecrackers, faulty igniting techniques. But the real factor is IGNORANCE.

Kids get cracking with the crackers, mothers get busy in the kitchen for guests and treats, fathers’ are fumbling with the gift lists. With the festivities in the air, a few safety measures can keep you and your family safe and usher in the prosperous New Year with smiles.

SAFETY TIPS WHILE BURNING FIRE- CRACKERS:

1. Keep the pile crackers away from the area where they are being lit.
2. Keep a bucket full of mud and another full of water nearby.
3. Avoid wearing long dresses/ kurtas lest they catch fire from the ground chakkar
4. Avoid wearing synthetic clothing (they catch fire faster).
5. Discard used sparkles in a bucket.
6. Always look around before lighting up a fire cracker; the other person may not know what you are up to.
7. Light the Annar (flower-pot) with a sparkle (phooljhari) keeping it at an arms length. Do not bend over it while lighting it.
8. Do not hold the annar/ fire cracker in your hand to light it.
9. Let the flames die out completely before you place another one in its vicinity.
10. While lighting a ground chakkar make sure your clothing is not touching the ground.
11. Let the fuse of the bombs be long so you have enough time to move away.
12. Light the firecrackers with a candle or sparkle as it increases the distance between the firecracker and your hand.
13. Avoid putting boxes over lit bombs they become projectiles when the bomb goes off.
14. Always keep the rockets in a tall bottle with wide base so that it doesn’t topple over when you light it.
15. Wear footwear while lighting fireworks
16. Light only one firework at a time, by one person. Others should watch from a safe distance.
17. An adult should always supervise the use of fireworks by children
18. Never carry fireworks in your pocket.

WHAT TO DO IN CASE OF BURN INJURY:

1. Remove burnt clothing as it stops the burning process.
2. Remove all constricting clothing/ jewelry immediately.
3. Place the burnt part under running tap water for 10min.
4. Avoid putting a blanket to stop the burning.
5. Avoid putting ice over the burnt part.
6. Eat a pain killer
7. Consult your doctor/ plastic surgeon

            Don’t let ignorance rule your actions; Be aware, Be safe and Enjoy a prosperous new year.

                                                                       Happy Diwali!!!!

DR. ASHISH GUPTA

ASSOCIATE CONSULTANT

DEPT. OF PLASTIC & MICROVASCULAR SURGERY

S.P.S. APOLLO HOSPITAL,

LUDHIANA

DO YOU KNOW A PLASTIC SURGEON..........

DO YOU KNOW A PLASTIC SURGEON..........

When a doctor introduces himself as a plastic surgeon, momentarily beautiful faces of Bollywood starlets flash in front of one’s eyes and the image of a jet setting doctor sets in. Over the last few decades the plastic surgeon has become synonymous with a cosmetic surgeon. My kid had a fall and sustained a cut wound over the eye; I would rush to the nearest hospital and ask for a Plastic Surgeon! My belief, there is no scarring in the hands of the plastic surgeon. You may be able to relate to many such parents. My friend is overweight and wants to go figure size zero; who do we consult, the Plastic Surgeon. My mother spilt scalding hot milk on her hand; whom to consult, the Plastic Surgeon.

                Is the speciality of Plastic Surgery limited to making scars disappear or make people look young and beautiful? Is this field limited to slowing the natural process of ageing? Is this field limited to the glamorous world of actors and models? Is this field affordable only by the super- rich? Hair Transplant found the fancy of the masses seeing their on screen balding actors suddenly supporting wavy locks of hair. Face transplant has been a fantasy of many since Poonam Dhillon changed to Tina Munim in a blockbuster Bollywood movie in the 1980s. Skin rejuvenation and tightening with botox & lasers has vaporized a decade of wrinkles. This brings us to the core issue of DO YOU KNOW A PLASTIC SURGEON.... does much more than just hair transplants, nose jobs, tummy tucks.........

                The locale of a plastic surgeon is not limited by anatomical barriers on the human body, nor is confined to one single organ system; but encompasses all medical and surgical specialities.  It was in 300BC, when Sushruta laid down the foundation of Plastic Surgery in India by performing forehead flaps for reconstructing the nose. His techniques are embalmed in his literature entitled, “Sushruta Samhita” and are still followed around the globe. Rhinoplasty commonly known as Nose Job, both as a cosmetic and reconstructive procedure has been our heritage.

                It was Dr. Capt. Balakrishnan, in India who brought the services of the Plastic Surgeon to the masses by envisaging the first Dept. of Plastic and Reconstructive Surgery in Nagpur and PGIMER, Chandigarh in India. It was his ideology that a child should not grow up with the deformity of a cleft lip & palate, a child should not be disabled due to birth defects of hands and feet, a labourer not left in the lurch to fend for himself with burns contractures, a skilled labourer left impoverished due to hand injury involving tendon and nerve, a housewife facing a decision to have her limb amputated due to crush injury, a youngster be left with terrifying scars of faciomaxillary injury sustained in a road traffic accident. He was a teacher of teachers and his ideologies still reverberate through those hallowed halls.

                The words Trauma and Trauma Surgeon are synonymous with a Plastic Surgeon. It may be a small laceration on the face or a gaping hole in the leg with multiple fractures and bleeding vessels; No wound, be it small or big is out of the preview of the Plastic Surgeon. According to a survey there are 14 deaths per hour due to road traffic accidents involving trucks and two wheelers on Indian Roads. Shattering the myths, the maximum number of accidents occur in the afternoons and evenings. In the absence of stringent laws and non- cooperative drivers who shun the protective equipment like helmets and safety belts, these numbers continue to grow. Split open faces with shattered facial bones are a common sight in the casualty being examined by a Plastic Surgeon.  The neurosurgeon and the plastic surgeon are usually the first ones to operate on such a patient as these injuries are in >45% of times associated with head injury.

Glass cut injuries over the wrist or hand by suicidal or homicidal intent not only cuts the arteries as is glorified in the movies but also disrupts the tendons moving the fingers, the nerves providing sensation to the hand.  Such gashes though look docile on the outside are amongst the most challenging for the plastic surgeon to restore the structures to their functional state. Repairing the tendon, the nerve and the blood vessel requires skill, patience and persistence for desired results.

                In patients who sustain fractures of limbs due to violent accidents with bone ends jutting out of the skin usually require a team of orthopedicians and plastic surgeons to fix the bone and cover the splintered bone with healthy skin, so that the person may be able to walk at the earliest. Many a times this bone becomes non viable and requires transplant of healthy bone from other parts of the body to be placed in the fracture site to help close the fracture. Many times these fractures have associated injury to the blood vessel which may lead to fatal blood loss or loss of the limb if not repaired within 6-8 hours. This repair of the peripheral vessels is a component of the armamentarium of the plastic surgeon.

                Human rage respects no boundaries and sometimes we are faced with a sword wielding felon intent on chopping off one’s head or limb; and unfortunately do succeed in some instances. In the 80’s & 90’s when the Toka machines were in vogue in the heartlands of Punjab and Harayana, trauma surgeons were faced with the unique dilemma of witnessing numerous amputations on hands, arms even avulsion injury of scalp which got caught in the wheel of the infamous Toka Machine. It was during those times the Plastic Surgeons took upon themselves to restore these limbs by reimplanting them. Surgical techniques and equipment has seen revolutionary change since the turn of the century with the Plastic Surgeon at the helm of all affairs. State of the art equipment is available in the premier institutes like S.P.S. Apollo Hospital, Ludhiana and other tertiary care centres along with availability of Plastic Surgeons trained to perform these surgeries akin to heroic acts seen on the silver screen.

                This all brings us back to the same pertinent question; “DO YOU KNOW A PLASTIC SURGEON...........” does much more than just trauma surgery?

DR. ASHISH GUPTA (ASSOCIATE CONSULTANT)

DEPT. OF PLASTIC & MICROVASCULAR SURGERY

S.P.S. APOLLO HOSPITAL, LUDHIANA

EMAIL: docashish2001@gmail.com

DO THOSE DARK SPOTS ON YOUR FACE BOTHER YOU???

Melasma Treatment and Cure

(MASK OF PREGNANCY)

         Melasma is a common ailment affecting females causing brown discolouration of skin of the face. It is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain anti-epilepsy drugs. Sun exposure would appear to be a stimulating factor in predisposed individuals. Although a few cases within families have been described, melasma should not be considered a heritable disorder.

        Melasma is common, especially in women of child-bearing age. Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking. Melasma is the most common pigmentary disorder among Indians.

        Melasma most commonly presents itself over the cheeks, forehead, upper lip, nose, and chin. Melasma also occurs on the forearms, but this is rare.

        Melasma is curable. Persistence on the part of the plastic surgeon and patience on the part of the patient is a sure remedy for cure. Successful treatment of melasma involves three pronged approach: SUNBLOCKS, BLEACH AND TIME.

1.       Sunscreen, however, is the most important factor. Without daily use of opaque sunscreen, treatment will fail (a broad-spectrum formulation with an SPF over 30 plus cover up is necessary).

2.       Bleaching preparations include 2 or 4% hydroqyinone containing creams or gels and 3% hydroquinone solution hasten the recovery of skin.

3.       Time for your body to adjust to the treatment and trust on your doctor are as vital as the other two modalities.

4.       Laser therapy with Intense Pulsed Light and to some extent Nd:YAG lasers are helpful in early return of normal colour of skin..

        It takes approximately 2 months to initiate response and up to 6 months to complete the process. Once epidermal melasma is cleared, the hydroquinone and tretinoin should be discontinued; But the  sunscreen should be continued through at least one summer season to reduce the risk of recurrence. Often, melasma will slowly resolve following childbirth or upon discontinued use of oral contraceptives.

        In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

FOR FURTHER DETAILS CONTACT:

DR. ASHISH GUPTA
ASSOCIATE CONSULTANT
SPS APOLLO HOSPITAL,
LUDHIANA
(M): +91-9779771111