Hello!
During the past two weeks, my advisor at iCAMP left town and so I turned my focus toward shadowing in the SALSA (Southern Arizona Limb Salvage Association) clinic and in the Operating Room as well as my work with the tribe. I did keep working on data analysis for the controls on the gait and BMI study and on the dialysis systematic review at iCAMP but mostly they have taken the back burner for the time being.
At clinic I have been assigned to shadow the main podiatry fellow on his rounds and attend his scheduled surgeries.
The first day was intense and gory. The second I came in, I was ushered into a room where a woman sat waiting. She had a very severe type of fungal foot infection that caused her toe nails to become thick (about an inch) and yellow-green. She had been treating them to no avail with anti-fungal cream that was causing severe irritation around her toes. She had not been able to get the insurance company to pay for the oral anti-fungal medication because they claimed to need proof that it was fungal. We took samples of her nails for the lab and sent her on her way. The next person we saw was a man whose toe was gangrenous. He was also diabetic and blood flow to the little toe had been cut off, leaving the toe to die. Because of this, his little toe was pitch black and a red infection was apparent moving up his leg. He was immediately admitted and prepped for amputation surgery. While he was being prepped, I got to go to the OR and observe another surgery. This one involved a diabetic man who had undergone an amputation of his first two toes several years earlier. He had developed arthritis and had excess bone growth on the ball of his foot due to the abnormal pressure distribution caused by losing his toes. Beneath the bone growth, a massive bursa had developed that was causing additional complications to his walking. The surgery involved cutting open the bottom of the foot, cutting out the bursa (about the size of a closed fist) and then using a male and chisel to break off the extra bone. After this was finished the foot was sown back up.
Over the course of the following days I continued to attend clinic. A majority of people there were diabetic and were coming in for treatment of ulcer or amputation related concerns. Some had underwent treatment for ulcers and had to come in for cleaning, some came to get new cleaning vacs. There were also the occasional bunion or young man with mysterious open leg wounds that seemed to have no obvious cause but for the most part diabetes was at the root of everyone's foot crises.
I don't get phased much by blood and guts but I must admit that some of the wounds were pretty gnarly. One even had maggots involved...I don't want to shock you with the images, but if you are curious I can send you photos (or just type diabetic foot ulcer into google images and you will get the idea). I have also gotten to attend two more surgeries recently. One was a simple 45 minute surgery that involved cutting out a piece of infected bone in a woman index toe and cutting the tendon so that the toe would remain straight (one result of diabetes is reduced muscle control which can cause toes to curl permanently. This can lead to ulcers on the toes). The other surgery I attended was in vascular surgery rather than podiatry. One of our family friends is a vascular surgeon and he got me in touch with one of the surgeons in his department. The surgery I watched was a femoral potliteal bypass surgery. The man was diabetic and had reduced blood flow to his feet. He had developed a wound on the top of his foot that was unable to heal due to the reduced blood supply. Because of this, the wound just got worse and worse (at the time of the surgery he had exposed bone and blackened, infected issue). The surgery lasted for about 6 hours. The man was put under general anesthesia and received a catheter. His leg was shaved and then opened to reveal a portion of vein. Carefully a portion was removed and then grafted on to the artery to reroute blood and help flow to the feet. The surgery went well and an angiogram taken at the end revealed enhanced blood flow.
Overall one thing I found frustrating in clinic was seeing patients who needed certain treatments but had to be denied for insurance reasons. There were a number of these patients (who would have benefitted extraordinarily from a certain therapy but could not afford it and thus were left to suffer).
With the tribe I have begun shadowing the dietitian and one of the outreach workers. In this way I have gotten to see some of the challenges individuals face on the side of preventing diabetes. Some of these challenges can be as devastating as the disease itself.
Music of the week: 1. Brahms Double Concerto (I fell in love with the last movement of this piece at the Tucson Symphony Orchestra performance last week), and 2. This awesomeness (in honor of my robotics team's awesome performance at the AZ East Regional).
