Encompass Network Partners - Saving Lives and Limbs

LIMBS 4 LIFE Promotion

2011-06-08T17:26:00.000-05:00

It's that time again! Encompass Network Partners LIMBS 4 LIFE Promotion! Each year we offer one lucky Dialysis Clinic a six month FREE trial of our services. Encompass partners with dialysis clinics to secure complete diagnosis, care and treatment options for patients suffering from critical lower limb ischemia and foot wounds. It's simple, fast and we handle it all for you!

To be eligible to enter, email us at: Kburleson@encompassnetworkpartners.com. We will pick one lucky winner on July 1st.

For more information, go to our website Encompass Network Partners

Or follow us on Facebook

Good Luck and thanks for being part of our community!
Encompass Network Partners
Saving Limbs & Lives!

Many Kidney Disease Patients Unaware

2011-03-03T13:54:00.000-06:00

Many people diagnosed with chronic kidney disease do not know they have the disease, according to report published in the March issue of the American Journal of Kidney Diseases.

Researchers at Vanderbilt University Medical Center in Nashville, Tennessee, surveyed 401 people with kidney disease attending a nephrology clinic. More than 75 percent of participants had stage 3 chronic kidney disease or above. While 94 percent of patients surveyed were aware they had a kidney “problem,” more than 30 percent were unaware they had a serious, potentially life-threatening disease. All of the patients surveyed were under the care of a kidney specialist, or nephrologist.

“The lack of awareness of chronic kidney disease among those who are affected appears to be greater than other health conditions,” said study co-author Dr. Julie Anne Wright from Vanderbilt’s Division of Nephrology and Hypertension. “Even when patients are under the care of specialists, they frequently have a limited understanding of fundamental topics, including symptoms, the course of kidney disease and risk factors such as diabetes and hypertension. This study highlights the need for providers to ensure that communication is not only delivered but understood between all parties involved.”

Beyond diagnosis awareness, results of the 34-question survey also showed that 78 percent of participants did not know that the disease may progress with no symptoms. More than 34 percent were unaware that they were at increased risk for heart disease and 32 percent did not know that the kidneys make urine.

Read entire article at Renal Business Today

Kidney Patients Ask for More Information on Options

2011-02-18T14:56:00.000-06:00

Many kidney failure patients want more detailed information about their treatment choices, according to a new study.

More than 30 percent of the 1,000 U.S. patients who took part in an Internet survey said they felt that the different therapies -- in-center hemodialysis, peritoneal dialysis, home hemodialysis and kidney transplantation -- were not "equally or fairly presented to them."

Nearly 70 percent of the respondents told the researchers that they were not provided with specific education and training about home hemodialysis, a relatively new option that may offer some advantages -- including ease of treatment -- over in-center dialysis.

Overall, the participants were moderately to highly satisfied with their current treatment, but satisfaction was highest among transplant patients and home dialysis patients, and lowest among in-center dialysis patients.

Doctors had the most influence over people's choice of therapies, the survey found. And, what patients said they wanted most was more information on new treatment and improved medications.

The study was published online Feb. 17 in the Clinical Journal of the American Society of Nephrology.

"Dialysis patients should be provided with enough information to choose optimal therapies," Dr. Stephen Fadem, of Baylor College of Medicine in Houston, and lead author of the report, said in a news release from the American Society of Nephrology. "Our survey shows that dialysis patients do not always receive uniform, thorough information about all possible treatment methods and, as a result, are only moderately satisfied with their pre-treatment education."

~BusinessWeek.com~

Patients need wake-up call about link between kidney disease, diabetes

2011-02-16T10:54:00.000-06:00

A multicultural study that will appear in the March issue of the Journal of Renal Care underscored the relationship between kidney disease and diabetes, and the need for greater awareness of this link.

In this small study, 23 South Asian diabetes patients and 25 white diabetes patients between the ages of 34 years and 79 years — with an average age of just older than 70 years — were surveyed to note any differences in the experiences, knowledge and attitudes of the two groups.

The researchers, led by Gurch Randhawa, director of the Institute for Health Research at the University of Bedfordshire, and research fellow Emma Wilkinson, found that many of the patients studied were unaware of possible kidney problems before their referral to specialist services. Overall, patients felt that they had received limited information about possible complications when they were diagnosed with diabetes, the researchers noted.

"Our research shows that low awareness and lack of information about kidney problems are common in both the South Asian and white patients we spoke to," Randhawa said. "In some cases, this was exacerbated by language barriers. The findings also demonstrate that the long-term educational needs of patients who have had diabetes for many years are just as important as the need to make newly diagnosed patients aware of all the health risks they face."
~ Drug Store News ~

Foot Problems Common Among Dialysis Patients

2011-01-26T08:48:00.000-06:00

What is the problem and what is known about it so far?
Foot problems are common among people with diabetes. Most often, they occur because of nerve damage or poor blood circulation in the feet and legs. People with diabetes can develop serious ulcers (open sores) on their feet that are likely to get infected and are difficult to heal. As a result, people with diabetes are more likely than others to eventually need foot or leg amputations. Studies have shown that diabetic foot problems are more common among some ethnic groups than others. Studies have also found links between foot problems and other complications of diabetes, such as kidney disease. More study is needed to fully understand such links and how they may help to identify those in need of help to avoid foot problems and amputations.

Why did the researchers do this particular study?
The researchers wanted to learn more about how frequent foot problems are among people from different ethnic groups who have diabetes and advanced kidney disease.

Who was studied?
The study included 466 patients with diabetes from different ethnic backgrounds in the United States and the United Kingdom. The patients were receiving dialysis therapy for kidney failure.

Read entire article here

CMS issues final rule for dialysis facility quality incentive program

2010-12-31T09:10:00.000-06:00

The Centers for Medicare & Medicaid Services issued a final rule for the Quality Incentive Program that will establish performance standards for dialysis facilities and provide payment adjustments to individual End-Stage Renal Disease facilities based on how well they meet these standards.

The final rule establishes the ESRD QIP performance standards, sets out the scoring methodology CMS will use to rate providers quality of dialysis care, and establishes a sliding scale for payment adjustments based on the facilities performance. CMS will assess each dialysis facility on how well its performance meets the standard for each measure and will calculate each facilities Total Performance Score. The maximum Total Performance Score a facility can achieve is 30 (10 points per measure). Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to 2% depending on how far their performance deviates from the standards.

CMS finalized three measures as the initial measure set during the first program year. Two of these measures are designed to assess whether patients hemoglobin levels are maintained in an acceptable range, while the third measures the effectiveness of the dialysis treatment in removing waste products from patients blood.

In future years CMS may add quality measures and establish additional performance standards that facilities will need to meet to receive full payment for the services they furnish to Medicare beneficiaries.

Read entire article here

Dialysis Data, Once Confidential, Shines Light on Clinic Disparities

2010-12-28T15:43:00.000-06:00

For years, the government has collected a rich store of data about the performance of individual dialysis facilities. But it has kept nearly all the information secret from those it might benefit most: Patients.

Now ProPublica has obtained this data under the Freedom of Information Act. We are making a comprehensive set of clinic records publicly available for the first time on our website.

Patients and others can search for a clinic and see how it compares on 15 key measures, ranging from mortality and hospitalization to transplant rates and infection control. Also on the site are historical reports dating to 2002.

Release of the data is long overdue, patient advocates say.

"It gives you a snapshot of what a clinic is about," said Roberta Wager, a past president of the American Association of Kidney Patients who works as a nurse and patient educator at several dialysis clinics in Texas. "This is your life. Wouldn't you want to have everything in your favor?"

There are almost 400,000 Americans who depend on chronic dialysis to do what their failed kidneys cannot, a number that has grown swiftly over the past two decades, spurred by epidemics of obesity and diabetes.

More than 5,000 facilities have sprung up to provide them with care, stretching into the nation's most rural areas and competing for patients in urban and suburban areas.

Patients today have more choice than ever. Yet most pick centers based on convenience, or on what their doctors suggest, with little notion that even clinics within the same communities can have substantial disparities.

In more than 200 counties nationwide, the data show, the gap between facilities with the best and worst patient survival, adjusted for case-mix differences, is greater than 50 percent. In areas such as Allegheny County, Pa., or Franklin County, Ohio, each with upwards of two dozen clinics, the differences are even more substantial, exceeding 200 percent.

There is also wide variability in how often patients at different clinics are hospitalized for septicemia. Although septicemia cases can be unrelated to dialysis, it is a significant risk for patients, who typically have their blood cleaned of toxins three times a week. Nationally, the rate was about 12 percent a year for 2006 to 2008. But in dozens of counties, the spread between facilities with the highest and lowest rates was more than 25 percentage points.

Read entire article here

New York City to Start Organ Ambulances

2010-12-06T11:37:00.000-06:00

Renal Business Todays editor Keith Chartier

New York City will start sending out a second ambulance to scenes in which someone may be in danger of dying in order to quickly harvest organs that can be used for transplant.

The federally funded five-month trial will be limited to Manhattan between 4 pm and midnight to adults between 18 and 60 years old, and to people who die of cardiac arrest outside of a hospital.

The development of the program was fraught with ethical concerns, but those behind it felt that organs needed to be obtained sooner outside the hospital before the organ becomes unusable.

To read entire article on Renal Bizblog, click here

Making Sugar Count During The Holidays

2010-12-01T11:19:00.000-06:00

American Diabetes Association - If you like sweets, one of the most tempting parts of the holidays is the dessert. Even though you have diabetes, you can still fit sweets into your meal plan.

Eating high-sugar foods like cakes, candy, cookies, and pies will make blood glucose rise, so do not just add them to your diet. Instead, substitute small portions of these sweets for other carbohydrates already in your meal plan. For example, if you want a small serving of pumpkin pie, then pass on eating a dinner roll during the main course.

To view Desserts During the Holidays, click here

Cost of diabetes could be $3.35 trillion by 2020

2010-11-29T10:34:00.001-06:00

The number of Americans diagnosed with diabetes and the related costs of the disease could reach catastrophic proportions, according to new research by the UnitedHealth Group.

The new projections are alarming, as more than 50% of Americans could have prediabetes or diabetes by 2020, which could carry a healthcare price tag of $3.35 trillion over the decade. New estimates show diabetes and prediabetes will account for an estimated 10% of total healthcare spending by the end of the decade at an annual cost of almost $500 billion –– up from an estimated $194 billion this year, UnitedHealth said in its new report, “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead.”

Estimates in the report were calculated using the same model as the widely cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association, UnitedHealth noted.

Read more here

Survey: Most consumers turn to blogs, Facebook for health info

2010-11-22T09:51:00.000-06:00

A social media go-to-market strategy is fast becoming a must-have for companies these days, especially those companies operating in the healthcare arena. It’s no longer enough to push patient education out through a branded online page anymore, not with the growing prominence of social media sites. Today, companies need to seed that education across Facebook and Twitter and/or actively engage bloggers and heavy users to successfully get that education out to the masses online.

An Accenture survey released Tuesday found that U.S. consumers seeking medical advice are turning to medical websites, social media sites, online communities and informational websites in far greater numbers than the websites of pharmaceutical companies. According to the survey, of the more than two-thirds (68%) of consumers who go online for health information, slightly more than 1-in-10 regularly turn to a pharmaceutical company’s website to seek information about an illness or medical condition, compared with 92% who more frequently look to other online resources.

That patient traffic helps illustrate the fundamental shift from a predominantly one-way company-to-patient dialogue to enabling a patient-to-patient — and even a patient-to-healthcare-professional dialogue — through the evolution of social networks and online communities.

“Pharmaceutical companies that embrace innovations, such as social networking and communications via mobile devices, and integrate and align their communication strategy across multiple channels will be positioned to have a much greater influence on their patients’ choices and, consequently, realize significant increases in revenue, profitability and sustained competitive advantage,” stated Tom Schwenger, global managing director for Accenture’s Life Sciences Sales and Marketing practice.

Read more here

Dialysis: An Experiment In Universal Health Care

2010-11-09T14:39:00.000-06:00

Every year, more than 100,000 Americans start dialysis treatment, a form of chronic care given to people with failing kidneys. And for many, the cost is completely free. Since 1972, when Congress granted comprehensive coverage under Medicare to any patient diagnosed with kidney failure, both dialysis and kidney transplants have been covered for all renal patients.

But a new joint investigation between The Atlantic and ProPublica found many problems with dialysis in the U.S.: The cost of treatment is among the world's highest, while the U.S. mortality rate for dialysis patients is one of the world's worst. One in four patients will die within 12 months of starting treatment.

Investigative reporter Robin Fields, who spent the past year reviewing thousands of documents and interviewing more than 100 patients, doctors, policymakers and experts, found systematic failures in the way dialysis centers are set up in the United States.

"At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care," she writes in a piece that will be published in the December issue of The Atlantic. "Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. [And] the government withholds critical data about clinics' performance from patients, the very people who need it most."

Read more on A Growing Industry

Advocating for Patients with Diabetic Nephropathy

2010-11-04T08:43:00.001-05:00

Although no cure exists, pharmacologic and nonpharmacologic measures can help patients prevent onset or progression of diabetic nephropathy to preserve kidney function.

Diabetes is the seventh-leading cause of death in the United States and the primary cause of end-stage renal disease. Diabetic nephropathy is a longterm consequence of diabetes, estimated to affect 20% to 40% of patients with diabetes. Although there is no cure for diabetic nephropathy, by understanding the pathophysiology, preventative strategies, and interventions to slow the progression of this disease, the pharmacist can be better prepared to advocate for kidney function preservation.

Pathophysiology
Although the exact cause of diabetic nephropathy is unknown, several mechanisms have been hypothesized. Hyperglycemia, the formation of advanced glycosylation products, activation of the renin-angiotensin- aldosterone system, and activation of cytokines are all thought to be contributing factors to the progression of disease.

Hyperglycemia appears to cause expansion and injury of the glomerular basement membrane of the kidneys by increasing the renal mesangial cell glucose concentration. Initially, the glomerular mesangium expands by cell proliferation and later by cell hypertrophy. Transforming growth factor beta (TGF-beta) is particularly important in causing the expansion and later fibrosis by stimulating the production of both collagen and fibronectin. Other cytokines that are present in the kidney are also under investigation for their role in diabetic nephropathy.

Advanced glycosylation products are formed as glucose binds reversibly—and eventually irreversibly—to proteins in the kidneys. The glycosylation products can eventually form complex cross-links over time as the hyperglycemia continues and can contribute to renal damage by stimulation of growth and fibrotic factors.

In diabetic nephropathy, the local renin-angiotensin system is activated. Angiotensin II is stimulated and results in constriction of the efferent arteriole of the glomerulus, which results in increased glomerular capillary pressures. Angiotensin II also stimulates renal mesangium expansion and fibrosis through activation of angiotensin II type 1 receptors, and increases the expression of TGF-beta and other growth factors.

Microalbuminuria (30-300 mg/L) may contribute to renal injury associated with diabetic nephropathy. An increase in glomerular permeability causes plasma proteins such as albumin to be secreted into the urine. A portion of these proteins is absorbed by the proximal tubular cells, which can trigger an inflammatory response that contributes to kidney damage. Macroalbuminuria (>300 mg/L), nephrotic syndrome, and eventually renal failure may occur during the later stages of diabetic nephropathy.

Read entire article at Pharmacy Times

Most diabetics do not change oral health habits after diagnosis

2010-11-01T08:50:00.000-05:00

Many active diabetes managers have not changed their oral care habits since being diagnosed, despite the fact they are at higher risk for developing serious complications from poor oral hygiene, according to a study by dLife, a multimedia network serving the diabetes community, and market research firm SoundView Research.

Furthermore, more than half of active diabetes managers surveyed had not been advised by their dentists to take extra care to brush, floss or rinse daily.

"The results of this study show the gulf that exists between perceptions and the connections between diabetes and oral health. Your dental health absolutely affects the control of your diabetes," stated Charles Martin, a dentist, author and founder of DentistryForDiabetics.com. "Inflammation in the mouth coming from gum disease spreads to the whole body. This inflammation increases insulin resistance, cholesterol levels and C-reactive protein levels. So, uncontrolled oral disease can be the hidden factor working against those trying to maintain good control over their diabetes."

Click here to read entire article

Kidney Transplant Numbers Increase for Elderly Patients

2010-10-31T20:23:00.001-05:00

Elderly patients with kidney failure get kidney transplants more often than they did a decade ago, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The results suggest that the chances of receiving a kidney transplant are better than ever for an older patient who needs one.

Kidney failure afflicts nearly half a million individuals in the United States, and 48% of sufferers are 60 years of age or older. Kidney disease patients who obtain a transplant live longer than those that remain on dialysis. Fortunately, living and deceased organ donations are on the rise; however, transplant waiting lists have become increasingly long as more and more people develop kidney dysfunction.

Elke Schaeffner, MD (Charité University Medicine, in Berlin, Germany), along with Caren Rose and John Gill, MD (St. Paul's Hospital, University of British Columbia, in Vancouver, Canada) examined whether elderly patients with kidney failure have better or worse access to transplants now than they did in the past. The study included patients with kidney failure in the United States aged 60 to 75 years listed in the United States Renal Data System between 1995 and 2006.

The study revealed that elderly patients rarely receive a transplant, but they were twice as likely to get one in 2006 as in 1995. (In 2006, they had a 7.3% likelihood of getting a transplant within three years of their first treatment for kidney failure.) Elderly patients now benefit from greater access to organs from living donors and older deceased donors compared to a decade ago. They also die less frequently while waiting for a kidney than they did in the past.

To read entire article click here

Diabetes prevalence among Americans may increase to 33%

2010-10-25T09:35:00.000-05:00

The rate of diabetes among Americans is on an upswing and likely will reach epic proportions by 2050, costing the government millions.

A new study by the Centers for Disease Control and Prevention and published in Population Health Metrics found that annual diagnosed diabetes incidence (new cases) will increase from about eight cases per 1,000 people in 2008 to about 15 in 2050. The authors also projected that — assuming low incidence and relatively high diabetes mortality — total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the U.S. adult population by 2050, but noted that if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050.

Read entire article here

History of diabetes treatment chronicled in New York Historical Society exhibition

2010-10-12T12:52:00.000-05:00

Recalling the desperate fight for life that once was waged by juvenile diabetes patients and commemorating the events of the 1921 discovery by Toronto physician Frederick Banting that inaugurated a new era of hope for them and their families, the New York Historical Society will present the exhibition "Breakthrough: The Dramatic Story of the Discovery of Insulin" from October 5, 2010 through January 31, 2011.

Highlighting the roles of science, government, higher education, and industry in the development and distribution of a life-saving drug, the exhibition will bring to life the personalities who discovered insulin and raced to bring it to the world, and will tell the story of one extraordinary girl — Elizabeth Evans Hughes, daughter of statesman and Supreme Court Justice Charles Evans Hughes — who was among the very first patients to be saved.

"This is a powerful story that deals with type 1 diabetes and the discovery of insulin in that very early period. You can imagine the number of desperate people all over the world who wanted [an effective treatment]," said Stephen Edidin, chief curator of the Society's Museum Division.

Read entire article here

Gestational diabetes test may predict Type 2 diabetes among women

2010-10-12T09:32:00.000-05:00

A new Tel Aviv University study found a test used to diagnose gestational diabetes in women could be a key indicator to diagnosing Type 2 diabetes.

The study -- led by Gabriel Chodick of Tel Aviv University's department of epidemiology and preventive medicine at the Sackler faculty of medicine -- found that women who "failed" the glucose challenge test, a series of four blood tests conducted over a single four-hour period, have a higher chance of developing adult onset diabetes later in life. Chodick and colleagues collected data on more than 185,000 women in Israel who took the glucose challenge test, then acquired information from the nation's health registry as to what percentage of these women contracted diabetes later in life.

Read more here

Diabetes and Kidney Disease

2010-10-08T08:57:00.000-05:00

Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body.

Are there different types of diabetes?

The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life.

Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans and Asian Americans.

Read entire article here

Air pollution may be linked to diabetes, study finds

2010-10-04T09:18:00.000-05:00

Diabetes could partially be related to air pollution, according to a new study.

The study, conducted by researchers at Children’s Hospital Boston and published in this month’s issue of the journal Diabetes Care, found that diabetes in adults was consistently correlated with particulate air pollution even after adjusting for known risk factors, such as obesity and ethnicity.

The researchers based the study on fine particulates of between 0.1 and 2.5 nanometers, known as PM2.5, a component of haze, smoke and car exhaust, obtaining county-by-county data from the Environmental Protection Agency for 2004 and 2005. They then combined that data with diabetes data from the Centers for Disease Control and Prevention and the Census Bureau to find the prevalence of adult diabetes and adjust for such risk factors as obesity, exercise, geography, ethnicity and population density.

Read entire article here

5 Reasons That May Explain Why Type 1 Diabetes Is on the Rise

2010-09-28T17:40:00.000-05:00

Type 1 diabetes rates are increasing in children. Here are possible reasons why...

It's no secret that type 1 diabetes is on the rise in children. If current trends continue, new cases in kids younger than 5 could double by 2020, according to a study published last year in The Lancet. What's up for debate are the reasons for this increase. Is it environmental? Genetic? Something preventable? Scientists aren't sure just yet, but a book published in January, called Diabetes Rising: How a Rare Disease Became a Modern Pandemic, and What to Do About It (Kaplan Publishing), by freelance medical journalist Dan Hurley, explores the possibilities.

"Type 1 diabetes seems to be going up at a level of 3 percent a year in the United States," says Hurley, himself a longtime type 1 diabetes sufferer. "If we can find out what is causing that, we can prevent a lot of people from getting it." Clearly, he says, there is something going on in the environment—in the way people live—that is partly responsible. U.S. News asked Hurley, of Montclair, N.J., to discuss the leading theories scientists have for explaining why more kids are falling prey to type 1 diabetes and why more are expected to in the future. Below are 5 hypotheses he includes in the book. All of them presume that the person has some genetic tendency towards developing type 1 diabetes, Hurley says. "Think of these things—growth, sunlight, cow's milk in infancy, etc.—as fertilizers. With them, the underlying genetic risk is boosted."

Read entire article here

Price Chopper expands Diabetes AdvantEdge program with free offerings

2010-09-27T10:16:00.000-05:00

Insulin-dependent diabetics will be eligible to receive free syringes and pen needles from Price Chopper, the Northeast supermarket chain said.

Price Chopper said the expansion of its Diabetes AdvantEdge program meant that it could serve 100% of the population that manages diabetes with increased access to medication, supplies, support and information, as well as education on food, nutrition and diabetes management.

Read more here

National Limb Loss Information Center - Fact Sheet

2010-09-24T08:14:00.000-05:00

In the United States, there are approximately 1.7 million people living with limb loss. It is estimated that one out of every 200 people in the U.S. has had an amputation.
Each year, the majority of new amputations occur due to complications of the vascular system (of or pertaining to the blood vessels), especially from diabetes. These types of amputations are known as dysvascular. Although rates of cancer and trauma-related amputations are decreasing, rates for dysvascular amputations are on the rise. Incidence of congenital (present at birth) limb difference has seen little or no change.

Incidence data represents the occurrence or number of people who become an amputee each year. This fact sheet represents this type of data. Prevalence data represents the total estimated number of people living with limb loss, both new cases of amputation and those living with the limb loss for many years.

To view recent trends and read the entire article, click here

Peripheral Arterial Disease/ABI Screening

2010-09-22T22:28:00.000-05:00

Peripheral arterial disease (PAD) is more commonly known as hardening of the arteries. Peripheral arterial disease screening is done by using the ankle-brachial index (ABI). This ABI screening is painless, quick, and non-invasive. It will identify most cases of peripheral arterial disease.

What you can learn

The ankle-brachial index measures the ratio between the pressure in your arms and that in your legs. This ratio indicates how well blood flows to the legs. A ratio of less than 0.90 indicates plaque buildup and possible peripheral arterial disease. A ratio of 0.90 or greater is considered normal.

The ABI screening is simple and painless. After removing your socks and shoes, you will have pressure cuffs placed around your upper arms and ankles. A small ultrasound device will then measure the systolic blood pressures in your limbs.

The Ischemic Foot

2010-09-21T09:44:00.000-05:00

Description

The term "ischemic foot" refers to a lack of adequate arterial blood flow from the heart to the foot. There are a wide variety of possible causes for poor arterial circulation into the foot including arterial blockage from cholesterol deposits, arterial blood clots, arterial spasm, or arterial injury. The ischemic foot is also referred to as having arterial insufficiency, meaning there is not enough blood reaching the foot to provide the oxygen and nutrient needs required for the cells to continue to function.

Diagnosis

The result of insufficient blood supply to the foot can manifest itself in a variety of ways depending upon how severe the impairment to circulation. Early symptoms may include cold feet, purple or red discoloration of the toes, or muscle cramping after walking short distances (intermittent claudication). Later findings may include a sore that won't heal (ischemic ulcer), pain at night while resting in bed, or tissue death to part of the foot (gangrene).

The diagnosis of ischemia is made by reviewing the patient's symptoms, examination of the foot, and special testing to evaluate the circulation. The examination should reveal cold skin temperature, and skin atrophy that causes the skin to appear shiny or paper thin with loss of normal hair on tops of the toes and on the lower leg. There is often a color change associated with ischemic feet. This may show as a purple discoloration of the toes, white blanching of the toes when the foot is elevated, and red discoloration when the foot is hanging down. Additionally the two arterial pulses in the foot will not be as strong as normal, or may be entirely absent. Certainly the presence of a pale looking ulcer, or black gangrenous toes would be an ominous sign of poor circulation.

Learn more about The Ischemic Foot here

What is P.A.D.?

2010-09-20T15:28:00.000-05:00

P.A.D. is short for Peripheral Arterial Disease. People have P.A.D. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation.

P.A.D. occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

The good news is that like other diseases related to the arteries, P.A.D. can be treated by making lifestyle changes, by taking medicines, or by having endovascular or surgical procedures, if needed.

Is P.A.D. serious? Read more here

American Diabetes Association teams up with HearPO

2010-09-20T08:09:00.000-05:00

A national strategic partnership between the American Diabetes Association and HearPO will provide additional resources to educate people with diabetes, medical practitioners and the general public about the connection between diabetes and hearing loss.

Read more here

Green Leafy Vegetables Can Cut Risk of Diabetes

2010-09-18T08:59:00.002-05:00

Eating more green leafy vegetables can significantly cut the risk of developing diabetes, British scientists have confirmed. The researchers reviewed six earlier studies on links between diabetes and the consumption of fruits and vegetables and found eating an extra serving a day of vegetables like spinach, cabbage, and broccoli reduced adults’ risk of getting type 2 diabetes by 14 percent. The findings don’t prove that the veggies themselves prevent type 2 diabetes which is often linked to poor diet and lack of exercise and is reaching epidemic levels as obesity rates rise.

People who eat more green leafy vegetables may also have a healthier diet overall, exercise more, or may be better off financially and any of those factors could affect how likely they are to get diabetes. But, "the data suggest that green leafy vegetables are key," said researcher Patrice Carter of the diabetes research unit at Leicester University. The review, published in the British Medical Journal, looked at six studies, which covered more than 200,000 people between 30 and 74 years old, in the United States, China and Finland. "Fruit and vegetables are all good, but the data significantly show that green leafy vegetables are particularly interesting, so further investigation is warranted," Carter said in a telephone interview. Green leafy vegetables contain antioxidants, magnesium and omega 3 fatty acids – all of which have been shown to have health benefits, she added. Each of the studies that Carter and her colleagues analyzed followed a group of adults over periods of 4-and-a-half to 23 years, recording how many servings of fruits and vegetables each participant ate on a daily basis then examining who was diagnosed with type 2 diabetes.

Read entire article here

Symptoms and Diagnosis of PAD

2010-09-17T10:27:00.003-05:00

The most common symptom of PAD is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.

The pain of PAD usually goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less. If there's a blood-flow blockage due to plaque buildup, the muscles won't get enough blood during exercise to meet the needs. The "crampy" pain (called "intermittent claudication"), when caused by PAD, is the muscles' way of warning the body that it isn't receiving enough blood during exercise to meet the increased demand.

Many people with PAD have no symptoms or mistake their symptoms for something else.

To see the symptoms of severe PAD, click here

Are the days of kidney dialysis numbered?

2010-09-13T12:25:00.001-05:00

There's no gentle way to put it. Chronic kidney failure is ugly and often deadly, and more people in the States are suffering from it every year, with increasing rates of diabetes and hypertension contributing to the problem.

What's more, the treatment that keeps many waiting for kidney transplants alive--dialysis--involves several sessions per week, at several hours per session, during which blood pumps through an external circuit for filtration to replace just 13 percent of kidney function, leaving many patients exhausted both physically and financially.

View entire article here

Study Finds Differences in Care for Patients Beginning on Dialysis

2010-09-10T14:58:00.003-05:00

A study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN)says that kidney disease patients
insured by some federally sponsored national health care organizations are more likely to undergo an important predialysis procedure than patients with other types of insurance.

The results may provide insights into ways to improve kidney-related care for patients before they go on dialysis.

To read entire article, click here

Daily Hemodialysis Improves Depression and Recovery Time

2010-09-06T09:35:00.003-05:00

Hemodialysis patients who transitioned from in-center to daily home dialysis regimens experienced significant improvements in depressive symptoms and post-dialysis recovery times, according to a new report published today in the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.

Patients who made the switch from the normal, thrice weekly in-center treatment regimen to a daily schedule, defined as six times per week, reported more than a 30% decline in depressive symptoms and an 87% drop in post-dialysis recovery time over a 12 month period.

The research team assessed 128 patients making the treatment regimen switch. Patients were assessed upon enrollment and then again four months and 12 months afterward. The average training period to complete the transition was 27 days.

Click here to read entire article

Dialysis 101

2010-08-30T17:04:00.003-05:00

Definition

Dialysis is a treatment that performs the functions of natural kidneys when the they fail (kidney failure). Most patients begin dialysis when their kidneys have lost 85%-90% of their ability to function, and will continue dialysis for the rest of their lives (or until they receive a kidney transplant). This is called end-stage renal disease (ESRD).

ESRD may be caused by a variety of conditions that can impair kidney function, including diabetes, kidney cancer, drug use, high blood pressure, or other kidney problems. Dialysis is not a cure for ESRD, but helps you feel better and live longer.

There are two types of dialysis:

* Hemodialysis
* Peritoneal dialysis

Parts of the Body Involved

Hemodialysis—veins in the arm, leg, or neck

Peritoneal dialysis—abdomen
Reasons for Procedure

The purpose of dialysis is to help keep the body's chemicals in balance, which the kidneys do when they are healthy. The main functions of dialysis are to:

* Remove waste and excess fluid from the blood to prevent build-up
* Control blood pressure
* Keep a safe level of chemicals in the body, such as potassium, sodium, and chloride

Dialysis may also be done to quickly remove toxins from the bloodstream, in cases of poisoning or drug overdose.

To read more, click on: Dialysis/Lifescript

Type 2 diabetes may have links to Alzheimer’s, study reveals

2010-08-30T09:34:00.002-05:00

Those with Type 2 diabetes may be at greater risk of developing the brain plaques associated with Alzheimer’s disease, new research suggested.

According to a Japanese study, which appeared in the Aug. 25 online issue of the journal Neurology, those individuals with the highest levels of insulin resistance had nearly six times the odds of developing plaque deposits between the nerves in the brain, after adjusting for other risk factors, compared with those with the lowest levels of fasting insulin.

To read entire article, click here

JDRF wants Denver residents to be 'T1D Aware'

2010-08-23T10:36:00.001-05:00

The Juvenile Diabetes Research Foundation launched an awareness campaign in the Denver area to shed light on key signs of Type 1 diabetes.

To view complete article, click here

Diabetes-related hospitalizations on the rise

2010-08-20T11:29:00.001-05:00

Nearly 1-in-5 hospitalizations in 2008 were related to diabetes, according to a recent report by the Agency for Healthcare Research and Quality.

That means a total of more than 7.7 million hospital stays and $83 million in hospital costs, of which Medicare covered 60%, the report found. On average, diabetes patients paid $10,937 for hospitalization, while those without the disease paid $8,746.

To read the entire article, click here.

Fistula Placement More Likely with Federal Insurance Programs

2010-08-19T09:43:00.002-05:00

Kidney disease patients insured by some federally sponsored national healthcare organizations are more likely to receive a fistula for vascular access during dialysis than patients with other types of insurance, according to a study appearing online Aug. 12 in the Journal of the American Society Nephrology (JASN).

The results may provide insights into ways to improve kidney-related care for patients before they go on dialysis, according to the study’s authors.

Experts recommend creating an arteriovenous fistula (AVF), to connect a vein and artery and allow access to the vascular system during dialysis. An AVF provides a long-lasting site through which blood can be removed and returned during the dialysis procedure, which patients must undergo three to four times per week.

To view entire article, click here

As diabetes rates grow, R&D pipelines flow

2010-08-16T08:27:00.001-05:00

Research and development pipelines are flowing with a record number of drugs for treating diabetes and related conditions, according to a report from the Pharmaceutical Research and Manufacturers of America released in late May, which showed 235 medicines in development to treat the disease.

According to the American Diabetes Association, 24 million Americans are living with diabetes, up from 21 million in 2005. The most rapidly growing incidence of the disease, Type 2, has increased along with the incidence of obesity in the United States.

To read the entire article, click here.

Many diabetic foot amputations are preventable

2010-08-10T09:11:00.003-05:00

Diabetes an independent risk factor for vascular disease

2010-06-28T22:59:00.000-05:00

New data suggest that although diabetes doubles the risk of vascular disease, elevated fasting glucose has little effect on the risk of coronary heart disease (CHD) or major ischemic events. The results of a meta-analysis of 1.2 million patients in 120 randomized, controlled trials were presented Saturday morning at a special symposium cosponsored by ADA and The Lancet, which published the study in their June 26 issue.
“We’ve known for decades that diabetes is a risk for vascular disease,” said lead author Nadeem Sarwar, PhD, University of Cambridge, United Kingdom. “But how the risk varies by age, sex, and levels of other risk factors remains unknown.”
Sarwar represented the Emerging Risk Factors Collaboration, which designed and conducted the study. The collaboration represents more than 12 million person-years of risk, he said, with a mean follow-up of 10 years.
Analysis of contributed studies showed that diabetes roughly doubles the risk of cardiovascular events regardless of other factors. Having diabetes increases the risk of coronary death by 2.31 times and increases the risk of a nonfatal myocardial infarction (MI) by 1.82 times.
The presence of diabetes also increases the risk for ischemic stroke by 2.27 times, for hemorrhagic stroke by 1.56 times, and for other vascular deaths by 1.73 times.
Overall, the hazard ratios (HRs) for CHD were higher for women than for men and higher in younger (40-59 years) patients than in those 70 years old and older. The HRs were also higher for fatal events compared with nonfatal MIs.
Why diabetes produces a greater risk in groups that would be expected to be at lower risk is not clear, Sarwar said. Diabetes may be associated with more severe vascular lesions, but further study is needed.
“We did not see a linear relationship between fasting glucose and cardiovascular disease,” Sarwar continued. “The risk is essentially flat for serum glucose between 3.9% and 5.6%, then increases sharply.”
The analysis suggests that diabetes is responsible for about 10% of all vascular deaths, roughly 325,000 people annually in the developed world.
“Diabetes doubles the risk for vascular diseases independent of other factors,” Sarwar concluded. “In people who do not have diabetes, fasting glucose is not a useful predictor of vascular disease.”
~ Drug Topics ~

Diabetes exposure in utero increases risk of early ESRD

2010-06-27T21:40:00.000-05:00

Being exposed to diabetes in utero substantially increases the risk of premature end-stage renal disease (ESRD), found Robert G Nelson, MD (left).
The finding comes from a study of Pima Indians 5 to 44 years old with type 2 diabetes, 102 of whom were the offspring of diabetic mothers and 1,748 without diabetes exposure in utero.
“Pima Indians have the highest rate of type 2 diabetes in the world. We’ve been studying the population since 1965, so we have extensive longitudinal data that allows us to look not only at disease in the parents, but in the offspring, and follow them into adulthood,” said Nelson.
An earlier study by Nelson and colleagues showed that exposure to diabetes in utero caused a dramatic increase in the development of diabetes in youth. About one-third of cases of diabetes in young adulthood are attributable to diabetes exposure in utero, he said.
Genetic susceptibility from the mother can partially explain the early onset of diabetes in the offspring, Nelson said. Intrauterine exposure also is associated with higher birth weight and higher weight in childhood and adolescence compared with persons without such exposure.
In the current study, the participants were followed for a maximum of 40 years, from their onset of diabetes until either death, onset of ESRD, or age 45 years.
Fifty-seven of the participants who were exposed to diabetes in utero developed ESRD before age 45, which was 4 times the rate of ESRD compared with controls who were not exposed to diabetes in utero.
Twenty percent of ESRD that occurs in the population before age 45 is attributable to exposure to diabetes in utero,” said Nelson. Assuming this relationship is causal, “if you delayed the development of diabetes until after the onset of childbearing years, you would reduce the incidence of diabetic ESRD by about 20%,” he said.
If the offspring are exposed to diabetes in utero, diabetes prevention efforts in the form of lifestyle modifications (diet and exercise) are needed to slow or prevent the development of diabetes and its complications, Nelson said.
~ Drug Topics ~

Diabetes-related leg amputations could be prevented and need not be costly: IDF

2010-06-14T12:14:00.000-05:00

By BOBBY RAMAKANT | CNS
Published: Apr 12, 2010 17:28

Of more than one million lower extremity amputations performed each year worldwide, 70 percent happen to people with diabetes. In India alone, almost 40,000 legs are amputated every year as a consequence of diabetes.

These figures were mentioned by Prof. Jean Claude Mbanya, president of International Diabetes Federation (IDF), in his message to the mid-term continuing medical education (CME) meeting on "high-risk diabetic foot" organized by the Association of Surgeons of India (ASI), UP Chapter and Indian Podiatry Association (IPA) in Kanpur last Sunday.

Mbanya's message, which was also handed out to the media, said the latest data from the IDF indicates that “diabetes affects 285 million people around the world, and is increasingly on the rise.”

“Of the many serious complications that can affect individuals with diabetes, it is the complications of the foot that take the greatest toll," Mbanya said.

On a positive note, he said, amputations could be prevented and need not be expensive.

"Many of these amputations can be prevented. Better education and improved management of foot care can be performed at relatively low costs and have been shown to reduce the number of lower extremity amputations by 50-85%," he said.

And this can be done through a concerted effort involving members of the global diabetes community to increase awareness in levels of health care services worldwide, Mbanya said.

"It is time to reduce the unnecessary suffering that foot complications can bring. With relatively low investment, it is possible to advance education and prevention that will result in lower rates of amputation, and better quality of life for people with diabetes. The time to act is now!" he said.

Mbanya is a professor of medicine and endocrinology at the University of Yaoundé I in Cameroon. He is also the director of the National Obesity Centre University of Yaounde, Cameroon, and chief of the Endocrinology and Metabolic Diseases Unit of Hospital Central in Yaoundé

The Diabetic Foot in End Stage Renal Disease

2010-05-11T16:48:00.001-05:00

Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5–10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies—neuropathy, ischemia, and infection—are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.
~ informahealthcare.com ~

Prevent diabetes problems: Keep your feet and skin healthy

2010-05-04T16:42:00.002-05:00

What are diabetes problems?

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

This information is about feet and skin problems caused by diabetes. You will learn the things you can do each day and during each year to stay healthy and prevent diabetes problems.

How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your feet:

* Nerve damage. One problem is damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection.
* Poor blood flow. The second problem happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease, also called PVD.

Smoking when you have diabetes makes blood flow problems much worse. For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Once in a while a bad infection never heals. The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. The area becomes black and smelly.

To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot, or part of a leg. Cutting off a body part is called an amputation.

What can I do to take care of my feet?

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. ~ NDIC ~

Foot Complications

2010-04-28T14:46:00.000-05:00

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems.
Neuropathy

Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.
Skin Changes

Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.

After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products.

Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don't soak your feet — that can dry your skin.
Calluses

Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts.

Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself - this can lead to ulcers and infection. Let your health care provider cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.

Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone.
Foot Ulcers

Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best.

Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace, or cast on your foot to protect it.

If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infecton.

After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.
Poor Circulation

Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don't smoke; smoking makes arteries harden faster. Also, follow your health care provider's advice for keeping your blood pressure and cholesterol under control.

If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.

Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation.

Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes, but don't walk when you have open sores.
Amputation

People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footware.

For these reasons, take good care of your feet and see your health care provider right away about foot problems. Ask about prescription shoes that are covered by Medicare and other insurance. Always follow your health care provider's advice when caring for ulcers or other foot problems.

One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.

~ American Diabetes Association ~

Monthly Poll

2010-04-12T12:53:00.001-05:00

Foot Screenings...How important are they?

2010-04-06T10:32:00.000-05:00

There are no screening protocols in hemodialysis centers to identify the problem earlier on. As a result preventive strategies to reduce morbidity and mortality related to this issue remains unaddressed. The magnitude of this problem is unrealized until you add to the equation that majority of hemodilaysis patients are diabetics as well. As a result there remains a significant issue of lower extremity amputations in hemodialysis patients. Overall 40% of patients in United States starting chronic dialysis count diabetes mellitus as the primary cause of renal failure, making it the number one cause of CKD (Berman et al, 2001). Patients with diabetes and chronic renal disease frequently present with a combination of the devastations of diabetes including: nephropathy, retinopathy, and vasculopathy. The main focus of the care of these patients has been on the target organs like heart and kidneys. Therefore, early risk factors for diabetic foot complications may be disregarded, and this may lead to amputation--a failure for both the patient and physician. Diabetic foot complications, including amputation, add significantly to the morbidity and mortality of the patient with diabetes and CKD. However, of all the long-term complications of diabetes, foot complications may be the most preventable. In the United States, diabetes is the cause of 50% of nontraumatic lower extremity amputations and is increasing annually (Levin, 2002). The prevalence of lower extremity amputation for patients with diabetes and CKD is much greater than those without CKD. The rate of lower limb amputation for the population at large increased during a recent 4-year period from 4.8 to 6.2 /100 persons. During the same time frame, this rate of lower extremity amputation rose from 11.8 to 13.8/100 among persons with CKD attributed to diabetic nephropathy. The rate for patients with diabetes and CKD was 10 times greater than the diabetic population at large (Eggers, Gohdes, & Pugh et al, 1999). The cost of treating patients with diabetes is astronomical both financially and in terms of quality of life. The loss of a lower extremity or even part of a lower extremity greatly impacts quality of life.

by Zahid Ahmad, M.D.
University of Oklahoma
Asst. Professor of Medicine – Interventional Nephrology
Section of Nephrology & Hypertention

Amputation and diabetes: How to protect your feet

2010-04-01T12:21:00.000-05:00

Foot care is especially important if you have diabetes. Diabetes can impair blood flow to your feet and cause nerve damage. Without proper attention and care, a small injury can develop into an open sore (ulcer) that can be difficult to treat. Sometimes amputation is necessary if an infection severely damages the tissue and bone.

The good news is that with proper diabetes management and careful foot care, amputation may be preventable. Here's what you need to know about the link between amputation and diabetes — and how to keep your feet healthy.
Why does diabetes pose a risk of amputation?

Diabetes can cause two potentially dangerous threats to your feet.

* Nerve damage (diabetic neuropathy). When the network of nerves in your feet is damaged the sensation of pain in your feet is reduced. Because of this, you can develop a blister or cut your foot without realizing it.
* Reduced blood flow. Diabetes can also narrow your arteries, reducing blood flow to your feet. With less blood to nourish tissues in your feet, it's harder for sores to heal. An unnoticed cut or sore hidden beneath your socks and shoes can quickly develop into a larger problem.

Left untreated, a minor foot injury could become a serious infection — even leading to tissue death (gangrene). Severe damage might require toe, foot or even leg amputation.

~ MayoClinic.com ~

Monthly Poll

2010-03-25T18:05:00.000-05:00

Preventing amputations in patients with diabetes and chronic kidney disease

2010-03-18T09:25:00.001-05:00

Foot lesions are the single most frequently mismanaged problem of patients with diabetes mellitus and chronic kidney disease (CKD). Foot problems are often viewed as a minor problem, yet frequently impact patient survival (Schomig, Ritz, Standl, & Allenberg, 2000). Recommendations for improving the survival of patients with diabetes and CKD include improvement in the foot care and education of both patients and nephrology health care providers regarding diabetic foot complications (Ritz, Koch, Fliser, & Schwenger, 1999).

Over 40% of patients in United States starting chronic dialysis count diabetes mellitus as the primary cause of renal failure, making it the number one cause of CKD (Berman, 2001). Patients with diabetes and chronic renal disease frequently present with a combination of the devastations of diabetes including: nephropathy, retinopathy, and vasculopathy. Diabetic foot complications, including amputation, add significantly to the morbidity and mortality of the patient with diabetes and CKD. The main focus of the care of this patient has been on the target organs of the heart and kidneys. Therefore, early risk factors for diabetic foot complications may be disregarded, and this may lead to amputation--a failure for both the patient and clinician. However, of all the long-term complications of diabetes, foot complications may be the most preventable.

In the United States, diabetes is the cause of 50% of nontraumatic lower extremity amputations and is increasing annually (Levin, 2002). The cost of treating patients with diabetes is astronomical both financially and in terms of quality of life. The loss of a lower extremity or even part of a lower extremity greatly impacts quality of life. Depression is common after amputation. Leisure activities as well as employment status are altered. The mortality rate after amputation in patients with diabetes is 11%-41% at 1 year, 20%-50% at 3 years, and 39%-68% at 5 years (Fritschi, 2001).

~ BNET ~

Foot Care

2010-03-17T14:54:00.000-05:00

Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a year - more often if you have foot problems. Your health care provider should also give you a list and explain the do's and don'ts of foot care.

Most people can prevent any serious foot problem by following some simple steps. So let's begin taking care of your feet today.
Prevention

Your health care provider should perform a complete foot exam at least annually - more often if you have foot problems.

Remember to take off your socks and shoes while you wait for your physical examination.

Call or see your health care provider if you have cuts or breaks in the skin, or have an ingrown nail. Also, tell your health care provider if your foot changes color, shape, or just feels different (for example, becomes less sensitive or hurts).

If you have corns or calluses, your health care provider can trim them for you. Your health care provider can also trim your toenails if you cannot do so safely.

Because people with diabetes are more prone to foot problems, a foot care specialist may be on your health care team.
Caring for Your Feet

There are many things you can do to keep your feet healthy.

* Take care of your diabetes. Work with your health care team to keep your blood glucose in your target range.
* Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
* Be more active. Plan your physical activity program with your health team.
* Ask your doctor about Medicare coverage for special shoes.
* Wash your feet every day. Dry them carefully, especially between the toes.
* Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. Read more about skin care.
* If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.
* Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.
* Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
* Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.
* Get started now. Begin taking good care of your feet today. Set a time every day to check your feet.

~ American Diabetes Association ~

Preventative Foot Care in Hemodialysis Patients

2010-03-12T17:55:00.000-06:00

Comprehensive care of hemodialysis patients poses a significant challenge for nephrologists. Although protocol driven approaches by hemodialysis centers have significantly improved standardized care, significant gaps remain in overall medical care provided to hemodialysis patients. Admittedly, with improvement in care, mortality rate for dialysis patients has decreased by 10 percent from its peak in 1988; however, it still stands at a disturbing figure of 248 deaths per 1,000 patient-years. The life expectancy of ESRD patients is one-fourth to one-sixth of the age-matched general population, with cardiovascular disease being the most likely cause of death.

Diabetics on hemodialysis have even worse prognosis than other patients. Patients with diabetes and ESRD are admitted to the hospital on average 2.3 times per year, and only 27 percent of these patients will survive five years on hemodialysis. With improvement in overall care, mortality has improved in hemodialysis patient population, but perhaps not to the expected level for multiple reasons. One likely explanation is that although mortality may be less with improvement in one area of care, mortality in other neglected areas of care may negate these potential gains. It therefore remains imperative that the nephrology community does not lose sight of the fact that only comprehensive care of these patients will realize the goal of improvement in mortality and morbidity in this hemodialysis population.
Focus on Foot Care

One such area of care which remains under the radar is morbidity and mortality related to peripheral vascular disease and foot care. For the most part, at this stage, foot care attracts attention only after a problem has already arisen. There are no screening protocols in hemodialysis centers to identify the problem earlier on. As a result, preventive strategies to reduce morbidity and mortality related to this issue remain unaddressed. The magnitude of this problem is unrealized until you add to the equation that the majority of hemodialysis patients are diabetics as well. As a result, there remains a significant issue of lower extremity amputations in hemodialysis patients. Overall, 40 percent of patients in the United States starting chronic dialysis count diabetes mellitus as the primary cause of renal failure, making it the number one cause of CKD (Berman et al., 2001).

Patients with diabetes and chronic renal disease frequently present with a combination of the devastations of diabetes including: nephropathy, retinopathy and vasculopathy. The main focus of the care of these patients has been on the target organs like heart and kidneys. Therefore, early risk factors for diabetic foot complications may be disregarded, and this may lead to amputation—a failure for both the patient and physician. Diabetic foot complications, including amputation, add significantly to the morbidity and mortality of the patient with diabetes and CKD. However, of all the long-term complications of diabetes, foot complications may be the most preventable. In the United States, diabetes is the cause of 50 percent of nontraumatic lower extremity amputations and is increasing annually (Levin, 2002). The prevalence of lower extremity amputation for patients with diabetes and CKD is much greater than those without CKD. The rate of lower limb amputation for the population at large increased during a recent four-year period from 4.8 to 6.2/100 persons. During the same time frame, this rate of lower extremity amputation rose from 11.8 to 13.8/100 among persons with CKD attributed to diabetic nephropathy. The rate for patients with diabetes and CKD was 10 times greater than the diabetic population at large (Eggers, Gohdes, & Pugh et al., 1999). The cost of treating patients with diabetes is astronomical both financially and in terms of quality of life. The loss of a lower extremity or even part of a lower extremity greatly impacts quality of life. Depression after amputation is common. Leisure activities as well as employment status are altered. The mortality rate after amputation in patients with diabetes is 11 percent to 4 percent at one year, 20 percent to 50 percent at three years, and 39 percent to 68 percent at five years (Fritschi, 2001). The impact of disorganized foot care on overall morbidity and mortality in hemodialysis patients therefore can no longer be ignored. One could always argue the benefit of putting resources into such an endeavor.

Do diabetic foot examinations reduce the risk of amputation? For two decades, the United States Department of Health and Human Services (HHS) has used health promotion and disease prevention objectives to improve the health of the American people. The overall goal for diabetes in the Healthy People 2010 objective is, “Through prevention programs, reduce the disease and economic burden of diabetes and improve the quality of life for all persons who have or are at risk for diabetes” (HHS, 2000). A specific objective contained within this goal targets a 55 percent reduction in the rate of lower extremity amputations in persons with diabetes. This would amount to 1.8 lower extremity amputations per 1,000 patients with diabetes per year, down from 4.1 per 1,000 patients that occurred in 1997 (HHS, 2000). Several clinical studies in the nondialysis diabetic population have shown that coordinated programs to screen for high-risk feet and to provide regular foot care decreased lower extremity amputation rates. In a controlled study, 45 hemodialysis patients were assigned to intensive education and care management that included preventive foot care and 38 HD patients were assigned to usual care. Over the 12-month follow-up period, there were no amputations in the study group while there were five lower extremity amputations and two finger amputations in the control group. Mortality was unaffected over the short time of the study, but the morbidity benefit was obvious. Benefit from aggressive preventive care is therefore very likely if not proven through prospective randomized controlled trials.

Nobody would disagree that regular foot care is standard care for every diabetic, and diabetic patients on dialysis are no exception to this standard of care. The American Diabetic Association recommends, “All individuals with diabetes should receive a thorough foot examination at least once yearly to identify high-risk foot conditions.” The ADA goes on to recommend more frequent evaluation for people with one or more risk factors and a visual foot inspection at every visit with a healthcare professional for diabetic patients with neuropathy. “Examination of the foot is an obvious, fundamental step to identifying certain foot risk factors that can be modified, thus reducing the risk of ulceration and amputation” (Mayfield, Reiber et al. 1998). Foot lesions are the single most frequently mismanaged problem of patients with diabetes mellitus and chronic kidney disease (CKD). Recommendations for improving the survival of patients with diabetes and CKD include improvement in the foot care and education of both patients and nephrology healthcare providers regarding diabetic foot complications (Ritz, Koch et al. 1999).
Improving Foot Care

The real question is: Why is it so difficult to provide much needed foot care and how best to do it? One has to take into account the fact that it is not easy for a hemodialysis patient to keep multiple subspecialty appointments. Once-a-year visits for foot examination are not very likely to identify and trigger an early referral. Yet three times a week they are available to a hemodialysis nurse for simple inspection and basic exam of feet. It is logical to think that foot care protocols would be part of patient care. It is possible that it poses some legal and monetary issues for the hemodialysis companies in an era of shrinking reimbursements for hemodialysis patients. These concerns, for the most part, are not true. Legally, it is always safer to prevent than treat an issue after it has been allowed to manifest in medical care set up. Improving care of hemodialysis patients with foot care should theoretically keep patients out of hospitals and on a hemodialysis chair for monetary gains of the hemodialysis center.

Finally, of course one cannot put cost on saving a patients from morbidity and mortality associated with poor foot care. However, planning this care would require careful insight into all practical aspects of care and caregivers. To begin with, the screening process should be very basic level, which hemodialysis nurses are comfortable with. Time spent and protocol has to be very straightforward. It should simply identify and focus on confirming a “NORMAL” exam from “NOT NORMAL” requires physician evaluation. Hemodialysis nurses should then be able to pass that information in a quick computerized manner to nephrologists triggering referrals to podiatrist, interventional cardiologist/interventional radiologists committed to his/her group preferably again by the same computerized network. Unnecessary time spent on telephone calls have to be avoided using protocol driven care and computerized network. Information then would have to be exchanged seamlessly between hemodialysis centre nursing staff, nephrologists, interventionalist and podiatrist. The whole network would have to be HIPAA compliant and be easy to learn and adapt to the needs to dialysis facility and physician groups involved. Ideally the network should be able to blend in with existing networks involved in hemodialysis care as well as communicate with subspecialty groups.

In summary, preventive foot care for hemodialysis patients is lost in efforts and time spent to provide care in other much politicized areas of care. But ignoring prevention in this area leads to significant morbidity and mortality. There are no randomized controlled trials of intensive education and care management versus usual care of feet in diabetic dialysis patients. Nonetheless, diabetic dialysis patients are likely to benefit from examination of the foot as part of the routine dialysis care. Given the fact that prevention can be easily done in hemodialysis center by hemodialysis nursing staff, there is little reason not to introduce it. Three times a week contact between hemodialysis nurses and patient is a potential opportunity to assess risks, educate and provide early intervention for foot issues in CKD population. Simple measures such as routine foot screening and education for this high risk population can prevent ulcer-initiating events and detect small ulcers when they may heal with proper intervention. Preventive strategies should include protocol based strategy for referral to specialist. Computerized network should allow this to happen seamlessly and effortlessly to benefit all involved in hemodialysis care. In this regard, all involved in medical care of hemodialysis patients can no longer afford to ignore the importance of preventive care of hemodialysis patients.

~ Renal Business Today ~

Zahid Ahmad, MD.
Dr. Ahmad is an assistant professor of medicine of interventional nephrology at the University of Oklahoma’s Section of Nephrology & Hypertension. For more information visit www.encompassnetworkpartners.com.

Hunterdon Medical Center among first to use artery cleaning device

2010-02-15T11:36:00.001-06:00

By: Hunterdon County Democrat

February 14, 2010, 11:06AM

Scott Collins, 45, of Lambertville visited Dr. Andrey Espinoza, interventional cardiologist at Hunterdon Medical Center, last summer in an act of desperation. After suffering from peripheral arterial disease for the past seven years, Collins had grown accustomed to the pain and numbness in his legs that prevented him from walking more than 50 yards without having to take a rest.
Once his legs reached 100% arterial blockage, Collins began to accept the idea that he would likely be a candidate for amputation.
Peripheral arterial disease occurs when plaque builds up on the inside walls of blood vessels, causing a blockage of blood flow to the extremities, and is often associated with high blood pressure, diabetes, heart disease, stroke and aging.
After a short visit with Espinoza, Collins learned that a new device, Pathway Medical Technologie’s Jetstream, could fix his problem. Interventional Cardiologists at Hunterdon Medical Center is now treating patients using a newly FDA cleared device that clears away and removes potentially deadly artery clogging plaque in leg arteries for those suffering from peripheral arterial disease, a chronic condition that affects nearly 12 million Americans.
Collins came back for his procedure and the moment they finished their work, he knew that they had changed his life.
“I was still lying on the table, but I knew the procedure had worked,” Collins said. “My leg began to itch. I hadn’t felt anything in that leg for years.”
Working from his three-story home as an antique reseller is enjoyable again, Collins said, adding he has found freedom in what he deems his “new legs.”
“This treatment represents an innovative and minimally invasive solution to clear blockages in the peripheral arteries, restoring blood flow and effectively treating the disease without surgery,” explained Espinoza, who is the first physician to treat a patient using the device at Hunterdon Medical Center.
The Jetstream Atherectomy System is the first on the market capable of treating an entire spectrum of disease found in the PAD patient, including hard and soft plaque, calcium, thrombus and fibrotic lesions with consistent clinical results. The Jetstream catheter is equipped with tiny rotating blades and a vacuum that cuts through accumulated plaque in the legs and then vacuums away the debris left behind.
This treatment has the potential to reduce procedure time and minimize vessel trauma, which can mean fewer complications for patients. Removing the plaque that has been cut loose also minimizes the potential for that plaque to travel back through the leg’s arteries and cause another blockage.
PAD usually affects adults from age 60 to 80, but patients can be younger. Further, while people with elevated cholesterol, smokers or those with a history of heart disease can develop PAD, many people do not realize they have blocked arteries. Unfortunately, despite the large number of sufferers, traditionally invasive treatments for PAD, such as bypass surgery, coupled with a lack of consumer education, means that PAD is responsible for more than 150,000 leg amputations each year and only about 400,000 patients receive the endovascular intervention they need. In addition, many patients are poor surgical candidates for whom surgery can be life threatening.
Jetstream is now in use at more than 100 centers across the country, including New York-Presbyterian Hospital in New York, St. John Hospital and Medical Center in Detroit, Cardiovascular Consultants of Washington in Seattle, Wellstar Kennestone Hospital in Atlanta and Leesburg Regional Hospital in Leesburg, Florida, and has been used to successfully treat more than 600 patients suffering from PAD to date.
Jetstream offers renewed hope for patients and the benefits of a minimally invasive treatment option, including faster recovery and decreased systemic complications.
For more information on cardiac services at Hunterdon Medical Center call Registered Nurse Nicole Camporeale, heart and vascular care coordinator at Hunterdon Medical Center, at 908-237-5440 or visit hunterdonhealthcare.org.

KDOQI To Update Diabetes Guideline

2010-02-11T10:11:00.000-06:00

From: Renal Business Today

Draft of Updated Guideline Expected by January 2011
02/09/2010
NEW YORK—The National Kidney Foundation announced Feb. 9 plans to update its KDOQI Clinical Practice Guideline for Diabetes and Chronic Kidney Disease, which were first published in 2007.

“A revised diabetes and chronic kidney disease guideline will include recent studies focusing on the management of hyperglycemia such as the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial; we are aiming to complete the update process within a year, to ensure that practitioners and patients benefit from new knowledge as soon as possible,” said KDOQI Chair, Michael Rocco, MD of Wake Forest School of Medicine in North Carolina. “A draft is expected to be available for public review by January 2011.”

The work group is currently being assembled by Co-Chairs, Drs. Katherine Tuttle and Robert Nelson, who will return to their leadership positions.

“Our understanding of the diagnosis and management of diabetic kidney disease (DKD) is evolving rapidly and we want to ensure that the KDOQI guidelines reflect current knowledge. Moreover, findings from several recent trials suggest that certain drug treatment strategies widely believed to be beneficial for diabetic patients may in fact offer little benefit and may, in some settings, even be harmful,” said Tuttle, who is Medical and Scientific Director of Research at Providence Medical Research Center in Spokane, Wash.

“Emphasis on DKD prevention is reinforced by current evidence demonstrating long-term benefits of healthy lifestyle changes to reduce risk of type 2 diabetes, the root cause of most DKD,” said Nelson, who Staff Clinician at the National Institute of Diabetes and Digestive and Kidney Diseases. “By updating the guidelines to incorporate such new information, we seek to ensure that KDOQI remains an essential resource to clinicians in the management of their patients with and at risk for diabetic kidney disease.”

The KDOQI Evidence Review Team is currently assessing the literature before the work group begins writing. This process will be followed by a public review of the draft before its final publication next year.

“A thorough review of current literature inevitably identifies new questions that need to be addressed. Since investigators pay close attention to the research recommendations published with KDOQI guidelines, an update of these recommendations is fundamental to the guidelines update process. Guideline development and research data generation are iterative processes that should feedback to inform and update one another on an ongoing basis,” said Jeffrey Berns, MD of University of Pennsylvania School of Medicine and KDOQI’s Vice Chairs for guidelines.

Men More Likely to Suffer from Diabetes Complications

2010-02-01T10:11:00.000-06:00

From: Diabetes News Hound

Men are more likely to suffer from diabetes-related health problems, according to the American Diabetes Association. That’s due, in part, to the fact that a third of men with Type 2 diabetes, the more common form of the disease, don’t even know they have it, according to a recent article from TodaysTHV.com.

Type 2 diabetes is commonly referred to as “adult onset diabetes” even though it can affect people of all ages. People who have Type 2 diabetes become insulin resistant, meaning their body produces insulin, but doesn’t use it properly. Therefore, many with this form of the disease take pills or even inject extra insulin in order to regulate the amount of sugar in their blood.

Some of the side-effects or complications that men may suffer from include retinopathy, a problem in the eyes that can lead to blindness if left untreated, impotence and amputations. They can also experience peripheral vascular disorder, or PVD, which is a pain in the thigh, calf or butt during exercise that is linked to a dramatic increased risk for heart disease and stroke.

Peripheral Vascular Disease (PVD) / Peripheral Arterial Disease (PAD)

2010-01-28T09:09:00.002-06:00

What is peripheral vascular disease (PVD)?
Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Conditions associated with PVD that affect the veins include deep vein thrombosis (DVT), varicose veins, and chronic venous insufficiency. Lymphedema is an example of PVD that affects the lymphatic vessels.

When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD). However, the terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. In the US, 10 million people have peripheral artery disease. PAD occurs in 5 percent of adults older than 50 and in 20 percent of adults older than 70. It is frequently found in people with coronary artery disease, because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

Conditions associated with PAD may be occlusive (occurs because the artery becomes blocked in some manner) or functional (the artery either constricts due to a spasm or expands). Examples of occlusive PAD include peripheral arterial occlusion and Buerger's disease (thromboangiitis obliterans). Examples of functional PAD include Raynaud's disease and phenomenon and acrocyanosis.

What causes peripheral vascular disease?
PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include trauma to the arms or legs, irregular anatomy of muscles or ligaments, or infection. Persons with coronary artery (arteries that supply blood to the heart muscle) disease are frequently found to also have peripheral vascular disease.

What are conditions associated with peripheral vascular disease?
The term "peripheral vascular disease" encompasses several different conditions. Some of these conditions include, but are not limited to, the following:

atherosclerosis - the build-up of plaque inside the artery wall. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. The artery wall then becomes thickened and loses its elasticity. Symptoms may develop gradually, and may be few, as the plaque builds up in the artery. However, when a major artery is blocked, a heart attack, stroke, aneurysm, or blood clot may occur, depending on where the blockage occurs.

Buerger's disease (thromboangiitis obliterans) - a chronic inflammatory disease in the peripheral arteries of the extremities leading to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries. Buerger's disease most commonly occurs in men between the ages of 20 and 40 who smoke cigarettes. Symptoms include pain in the legs or feet, clammy cool skin, and a diminished sense of heat and cold.

chronic venous insufficiency - a prolonged condition in which one or more veins do not adequately return blood from the lower extremities back to the heart due to damaged venous valves. Symptoms include discoloration of the skin and ankles, swelling of the legs, and feelings of dull aching pain, heaviness, or cramping in the extremities.

deep vein thrombosis (DVT) - a clot that occurs in a deep vein, and has the potential to dislodge, travel to the lungs, occlude a lung artery (pulmonary embolism), and cause a potentially life-threatening event. It is found most commonly in those who have undergone extended periods of inactivity, such as from sitting while traveling or prolonged bed rest after surgery. Symptoms may be absent or subtle, but include swelling and tenderness in the affected extremity, pain at rest and with compression, and raised vein pattern.

Raynaud's phenomenon - a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset. Raynaud's most commonly occurs in women between the ages of 18 and 30. Symptoms include coldness, pain, and pallor (paleness) of the fingertips or toes.

thrombophlebitis - a blood clot in an inflamed vein, most commonly in the legs, but it can also occur in the arms. The clot can either be close to the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis). It may result from pooling of blood, venous wall injury, and altered blood coagulation. Symptoms in the affected extremity include swelling, pain, tenderness, redness, and warmth.
varicose veins - dilated, twisted veins caused by incompetent valves (valves that allow backward flow of blood) allowing blood to pool. It is most commonly found in the legs or lower trunk. Symptoms include bruising and sensations of burning or aching. Pregnancy, obesity, and extended periods of standing intensify the symptoms.

What are the risk factors for peripheral vascular disease?
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that cannot be changed include the following:

age (especially older than 50)
history of heart disease
male gender
diabetes mellitus (type 1 diabetes)
postmenopausal women
family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral vascular disease

Risk factors that may be changed or treated include:

coronary artery disease
impaired glucose tolerance
dyslipidemia
hypertension (high blood pressure)
obesity
physical inactivity
smoking or use of tobacco products
Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.

What are the symptoms of peripheral vascular disease?

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral vascular disease may include:

changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
diminished pulses in the legs and the feet
gangrene (dead tissue due to lack of blood flow)
hair loss on the legs
impotence
non-healing wounds over pressure points, such as heels or ankles
numbness, weakness, or heaviness in muscles
pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
pallor (paleness) when the legs are elevated
reddish-blue discoloration of the extremities
restricted mobility
severe pain
thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis.

How is peripheral vascular disease diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for peripheral vascular disease may include any, or a combination, of the following:

angiogram - an x-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the x-ray.

ankle-brachial index (ABI) - a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.

blood lipid profile - a blood test to measure the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others.

Doppler ultrasound flow studies - uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.

magnetic resonance angiography (MRA) - a noninvasive diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the heart and other soft tissues and to assess blood flow.

treadmill exercise test - a test that is given while a patient walks on a treadmill to monitor the heart during exercise.

photoplethysmography (PPG) - an examination comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. These measurements are then compared to the systolic blood pressure in the arm.

pulse volume recording (PVR) waveform analysis - a technique used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.

reactive hyperemia test - a test similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites.

segmental blood pressure measurements - a means of comparing blood pressure measurements using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.

What is the treatment for peripheral vascular disease?

There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke, and other complications.

Specific treatment will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your signs and symptoms
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment may include:

lifestyle modifications to control risk factors, including regular exercise, proper nutrition, and smoking cessation
aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)

medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls

angioplasty - a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be performed in many of the arteries in the body. There are several types of angioplasty procedures, including:
balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area
atherectomy - the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter
laser angioplasty - a laser used to "vaporize" the blockage in the artery
stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open
vascular surgery - a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow
With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.

What are the complications of peripheral vascular disease?
Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:

amputation (loss of a limb)
heart attack
poor wound healing
restricted mobility due to pain or discomfort with exertion
severe pain in the affected extremity
stroke (three times more likely in persons with PVD)
By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.

Prevention of peripheral vascular disease:
Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

smoking cessation, including avoidance of second hand smoke and use of tobacco products
dietary modifications including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables
treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your physician
weight reduction
moderation in alcohol intake
medications as determined by your physician to reduce your risk of blood clot formation
exercise plan of a minimum of 30 minutes daily
control of diabetes mellitus
control of hypertension (high blood pressure)

A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your physician for diagnosis and treatment.

The National Kidney Foundation Opens New Office at Saint Mary’s Regional Medical Center

2010-01-27T08:38:00.002-06:00

-Facility to educate northern Nevada residents about kidney disease-

RENO, Nev.– In an effort to expand patient services and provide greater resources to the local community, the National Kidney Foundation will open a new office in Reno, Nev. at Saint Mary’s Regional Medical Center. The new office, opening on Aug. 28 will provide northern Nevada patients, caregivers, medical professionals, and the public with programs on kidney disease and its two leading causes, diabetes and high blood pressure. The priority of the foundation and Saint Mary’s is to educate the public about kidney disease and organ donation, health screenings for those at risk, patient services, and policy initiatives; all in an effort to combat rising levels of chronic kidney disease in Nevada.

“Saint Mary’s is dedicated to providing the best possible care to those suffering from kidney disease and with the recent opening of our Saint Mary’s Center for Kidney Care, it is a natural fit have the National Kidney Foundation on our campus,” said Mike Uboldi, president and CEO of Saint Mary’s Regional Medical Center. “Having Nevada’s office of the National Kidney Foundation at Saint Mary’s enables us to offer those suffering from kidney disease yet another resource.”

Approximately 26 million Americans have some level of kidney disease and more than 425,000 Americans are currently undergoing treatment for kidney failure. In northern Nevada, more than 65,000 people have chronic kidney disease and more than 560 patients are receiving dialysis treatment, which is expected to double within ten years. In addition to these growing numbers, northern Nevada currently does not have a transplant center, making it difficult for patients to receive lifesaving transplants.

“One in eight people in northern Nevada have chronic kidney disease though a majority do not know it and over 200 await a lifesaving kidney transplant,” said Christopher Kelly, division president of the National Kidney Foundation. “From our new partnership with Saint Mary’s we look forward to helping those suffering from kidney disease by educating them about programs and other resources available.”

The northern Nevada Kidney Foundation office will be located on the fourth floor of Saint Mary’s Regional Medical Center and opens on Aug. 28. Those interested in learning more about the National Kidney Foundation and its programs can call 775-770- 6530 or visit www.kidneynca.org.

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About Saint Mary’s
In 2009 Saint Mary’s celebrates 101 years of delivering compassionate, high-quality, affordable health services to northern Nevada. Founded in 1908 by the Dominican Sisters of San Rafael, Saint Mary's is a member of the Catholic Healthcare West family of hospitals and medical centers in Arizona, California, and Nevada. As a fully integrated, faith-based healthcare system with 380 licensed beds, approximately 2,300 employees, 850 affiliated physicians, and 300 volunteers, Saint Mary’s provides a wide variety of inpatient, outpatient, and community services to go Well Beyond for the community we serve. For more information, please visit www.saintmarysreno.org.

About Catholic Healthcare West
Catholic Healthcare West (CHW) is the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California. Founded in 1986, the CHW network of more than 10,000 physicians and approximately 53,000 employees serves a population spanning 22 million people at 41 hospitals across California, Arizona, and Nevada. CHW is committed to delivering compassionate, high-quality, affordable health care services with special attention to the poor and underserved. In 2008, CHW provided $967 million in charity care, community benefits, and unreimbursed patient care. For more information, please visit our website at www.chwHEALTH.org.

Contacts:

Gary Aldax
(775) 770-3038
gary.aldax@chw.edu

Frankie Vigil
(775) 287-5924
frankie.vigil@rrpartners.com

Christopher Kelley
(415) 902-8115
chris.kelley@kidney.org

Renown offering PVD/PAD screenings as part of American Heart Month

2010-01-26T09:47:00.000-06:00

Renown Regional Medical Center announced today that they will offer Life Line Screening as part of February's "American Heart Month."

Life Line Screening is designed to help people identify their risk of stroke, vascular disease and osteoporosis before they suffer catastrophic illness.

The screenings will be held Wednesday, Feb. 10 from 9 a.m. to 5 p.m. in the Mack Auditorium at Renown. The cost is $129.

To pre-register, go to www.lifelinescreening.com, or call 1-800-690-4100 to make an appointment. Call 982-4100 for directions.

The screening will provide:

Carotid Artery Screening – painless, non-invasive Doppler ultrasound used to visualize the carotid arteries, the arteries that bring blood to the brain. The majority of strokes are caused by plaque build up in these arteries.

Abdominal Aortic Aneurysm Screening – Ultrasound is used to visualize the abdominal aorta, the largest artery in the body, to measure the diameter of the aorta. This measurement can indicate if there is a weakening in the aortic wall which can cause a ballooning effect known as an aneurysm. Abdominal aortic aneurysms can burst. When they do, it is usually fatal.

Peripheral Arterial Disease Screening – PAD is also known as “hardening of the arteries.” Individuals with PAD have a 4 to 6 fold increased risk of cardiovascular disease. Risk is evaluated through a measurement called the “Ankle-Brachial Index,” which is obtained by reading the systolic pressure in the ankle and arm.

Osteoporosis Screening – Ultrasound is used to estimate the bone density of the heel. This can indicate if there is a reduction in bone density, which may indicate the presence of osteoporosis. The heel is used because it is similar in composition to the hip, where disabling fractures often occur.

Atrial Fibrillation is an abnormal heart beat (arrhythmia) that affects the atria - the upper chambers of the heart - and is the most common form of sustained arrhythmia. 2.5 million Americans have been diagnosed with atrial fibrillation, and for those over age 40, there is a one in four chance of developing the condition.

Vascular Screenings Check for Silent Problems

2010-01-22T14:20:00.000-06:00

From: Keeping in Circulation

Most of us know something about heart disease, but many do not know that we need to take care of our arteries as well. These vessels create a "superhighway" of blood flow that takes oxygen-rich blood from the heart to every area of our bodies. It is the buildup of plaque (which is a combination of fat, cholesterol, calcium and other materials) in the arteries, which can lead to more serious health issues such as peripheral arterial disease (PAD), heart attack or stroke.

One way to monitor what is going on with your arteries is to have a vascular screening, which can aid in the early detection of vascular disease. This can be helpful, as many vascular diseases do not have noticeable symptoms as warning signs.

Vascular screenings check for a variety of issues related to the arteries, are painless, non-invasive and involve no radiation. The screenings typically check the:

Carotid arteries – This test uses Doppler ultrasound to check for plaque and assess the rate of blood flow in the arteries of the neck which bring blood to the brain.
Abdominal aorta – This test checks for an enlargement of the abdominal aorta, the largest artery in the body.
Peripheral arteries – This is a non-invasive blood pressure test called the ankle-brachial index (ABI) that looks at the systolic pressure (upper number of your blood pressure) in your arms and legs to check for diminished blood flow.
The screenings are most appropriate for those over age 50 with specific risk factors such as smoking, high blood pressure, high cholesterol, or a family history of heart attack, aortic aneurysm or stroke. If you have diabetes, you are at a particularly increased risk for PAD. The American Diabetes Association recommends that every person with diabetes age 50 and older have a screening for PAD.

Screenings are generally not offered as part of a regular physical examination and most health insurance companies will not cover the costs unless you have symptoms.

As the conditions for which these tests screen tend to be silent in the early stages, there can be benefits to screening when you are at risk. The good news is that there are hospitals and private companies that offer the screenings in the community at low cost and sometimes for free.

Look for a screening event provided in conjunction with your local hospital. Or, look for an event conducted by a private company that has a solid reputation and clearly explains the screenings offered and provides background information on its clinical team.

No screening for any disease is 100 percent accurate all the time. There is always a chance for a false finding. That is why it is important that you share your screening results with your health care provider, who can discuss the findings of the screening with you and make sure you have all of the follow-up that you need.

Dance for Diabetes: Podiatry School Gives Back

2010-01-22T11:14:00.001-06:00

From: The Official Blog of Houston Podiatrist, Dr. Andrew Schneider

On January 16, 2010, Scholl College of Podiatric Medicine (SCPM) in conjunction with Rosalind Franklin University of Medicine and Science (RFUMS) hosted the 23rd Annual Dance for Diabetes at the Millennium Knickerbocker Hotel in Chicago, Illinois. This annual event helps raise money to donate to the American Diabetes Association (ADA) to help fund research on preventative medicine and education on Diabetes.

Scholl College of Podiatric medicine has been dedicated to raising money for the American Diabetes Association for the past 23 years due to its close professional tie to diabetes. Ask any podiatrist out there about diabetes link to their profession and they will go on for hours about how diabetes affects the lives of many of their patients.

In the past 20 years diabetes has become an epidemic in American society. Currently affecting more then 24 million people in the United States, Diabetes is projected to keep increasing in prevalence over the next decade if the Americans do not change their lifestyles. The reason for the huge increase in the number of people diagnosed with diabetes is strongly correlated to obesity rate of this country.

Diabetes is a disease that really affects the entire body but has special effects on the lower extremities which is why diabetics are frequent visitors to Podiatry offices. Diabetes leads to peripheral neuropathy which causes diabetics to lose sensation in their extremities. Peripheral neuropathy can lead to ulcerations of the feet which can lead to further complications such as infection.

Due to the fact that podiatrists see the devastating side effects of diabetes in their patients many of them become very passionate about raising awareness for Diabetes prevention and research. Undoubtedly this is why SCPM students and faculty work so hard every year to raise money through Dance for Diabetes to donate to the ADA. This year the college was pleased to announce that they donated $21,278 to the American Diabetes Association which is the second largest amount raised by the college in the last 23 years and the most donated since SCPM merged with RFUMS. Congratulations to the all the students and faculty at Scholl College of Podiatric Medicine for raising awareness for a cause that they feel so passionate about. Hopefully Dance for Diabetes will be a tradition that lives on for many years to come.

PERIPHERAL ARTERIAL DISEASE EXAMINED

2010-01-21T11:02:00.001-06:00

From: The Clinical Services Journal

January 2010
Dr ROBERT MORGAN, consultant vascular and interventional radiologist at St George’s Vascular Unit, provides an overview of the burden of PAD, guidance on how to diagnose the condition, relevant risk factors, risk-factor modification and treatment options available.

Today, one in five in the 65 to 75-year-old age group in the UK1 has peripheral arterial disease (PAD), also known as peripheral vascular disease, on clinical examination. Healthcare professionals have a significant role to play in preventing the escalation of this disease by ensuring early diagnosis, providing patients with advice on risk-factor modification and managing patients with an appropriate treatment. Although prevalence of PAD in primary care practices is high, it is commonly under-diagnosed. This is due to many doctors not obtaining a relevant history for PAD and frequently overlooking subtle signs of the condition on physical examination.2

What are the symptoms?

Today, only a quarter of the one in five 65 to 75-year-olds have any symptoms at all. The “silent” nature of this condition, along with the overall increasing age of the population and the escalating incidence of risk factors for PAD, lead to concern that PAD may become one of the leading diseases of this century. One of the more common indicators of PAD is extreme leg pain caused by walking or exercising, as many as 40% of people with PAD never complain of this symptom2 – and those who do often mistake the discomfort for ageing pains and fail to seek treatment, allowing the condition to worsen. PAD is highly treatable in its early stages, but as the disease remains undiagnosed, the likelihood of facing complications greatly increases, as does the probability of suffering from a heart attack or stroke. Symptoms to look for and discuss with patients when making a diagnosis of PAD include:

• Fatigue or cramping in the leg muscles (claudication) when walking.
• Pain in the legs and/or feet that disturbs sleep.
• Ischaemic tissue ulceration (punched-out, painful, with little bleeding), gangrene.
• Pallor with leg elevation after one minute at 60 degrees (normal colour should return in 10 to 15 seconds; longer than 40 seconds indicates severe ischaemia).
• Absent or diminished femoral or pedal pulses (especially after exercising the limb).
• A lower temperature in one leg compared to the other
• Hair loss and/or poor nail growth (brittle nails).
• Dry, scaly, atrophic skin.

What is the cause?

The underlying cause of PAD is atherosclerosis – a common, progressive disease that involves the hardening and narrowing of the arteries. This is a result of fat, cholesterol and other substances building up in the walls of arteries and forming plaque (atheroma or fatty deposits). As the plaque deposits intensify, the arteries narrow and become less flexible, restricting blood flow. Narrowing of the coronary arteries due to atherosclerosis can result in angina, shortness of breath, heart attack and other symptoms. In PAD, the lower extremities are affected. When blood flow to the legs becomes limited or restricted, the propensity for developing infections, chronic foot ulcers, gangrene and leg lesions dramatically increases. In severe cases, amputation of the affected limb is required if other available treatments fail.

Risk factors

The most common risk factors for PAD include: diabetes, high blood pressure, high cholesterol levels, obesity, smoking and being older than 50.3 All of which are also risk factors for cardiovascular disease. People with diabetes are at the greatest risk for developing severe PAD and experiencing complications from the disease. In fact, people with diabetes are up to fifteen times more likely to endure lower-limb amputation than those without diabetes and problems with the feet are one of the most common causes of diabetes-related hospitalisation.4

Simple test for PAD

General practitioners can quickly and easily test for PAD. The most common test is the ankle/brachial pressure index (ABPI) at rest, a non-invasive process that compares blood pressure in the ankles with the blood pressure in the arms. Although an ABPI can help determine if someone has PAD, it cannot identify the location and degree of the obstruction in the artery. The non-invasive “Doppler Test” is also available and checks a specific artery for blockage. The test uses ultrasound waves to measure blood flow in arteries within the lower extremities. A physical examination and listening to the heart and lungs with a stethoscope will help detect early atherosclerosis. In patients with PAD, a whooshing or blowing sound (“bruit”) is heard over an artery. In complicated or difficult to diagnoses cases, patients should be referred to secondary care where other tests may be carried out to diagnose atherosclerosis or complications. These tests include:

• Arteriography.
• Cardiac stress testing.
• CT scan.
• Intravascular ultrasound (IVUS).
• Magnetic resonance arteriography (MRA).

Managing PAD in primary care

Non-surgical therapy for intermittent claudication involves risk-factor modification, exercise and pharmacological therapy. Details on each of these can be found below.

• Dietary modification, including eating a low-fat, low-cholesterol, and low-salt diet.
• Weight reduction if the patient is overweight.
• Stop smoking. There is a higher correlation between smoking and developing PAD than any other risk factor. All available strategies to help patients quit smoking, such as counselling and nicotine replacement, should be used. Stopping smoking reduces the severity of claudication, the progression of disease and the risk of heart attack and death from vascular causes. Studies have demonstrated lower rates of amputation in patients who stop smoking.5
• Hypertension is a significant risk factor for PAD. Antihypertensives should be prescribed to patients with PAD to reduce morbidity from cardiovascular and cerebrovascular disease.
• Diabetes. Controlling blood sugar levels could not only decrease the incidence of cardiovascular disease and heart attack, but also reduce the occurrence of PAD and PAD outcomes (claudication, peripheral revascularisation, or critical limb ischaemia and amputation).6
• Hyperlipidemia. Studies have demonstrated the benefits of lipidlowering therapy in patients with PAD. Controlling lipids has been shown to reduce disease progression and the severity of claudication.7
• Exercise. PAD can be effectively treated with a formal exercise programme. Research has shown that the greatest improvements in walking ability occur when the following occur: each exercise session is continued for more than 30 minutes, at least three sessions are undertaken per week, the patient walks until near-maximal pain is reached and the exercise regime is continued for at least six months.8
• Pharmacological therapy. Effective drug therapies for PAD include aspirin (with or without dipyridamole), clopidogrel, cilostazol and pentoxifylline. Aspirin and dipyridamole increase the pain-free walking distance and blood flow.9

Management in secondary care

In patients with severe PAD whose condition is not improving with riskfactor modification, exercise programmes and pharmacological therapy, invasive procedures may need to be carried out in the hospital setting. These procedures include angioplasty, stenting or surgery. Angioplasty is a non-surgical procedure that is used to widen arteries. During this procedure, a catheter with a balloon on its tip is inserted into the narrowed artery and inflated. Once the artery widens, the balloon is deflated and the catheter is withdrawn, often restoring blood flow. Until recently, there was uncertainty around the efficacy of angioplasty in combination with supervised exercise and best pharmacological therapy in the treatment of intermittent claudication. A recent study demonstrated that angioplasty in combination with exercise and pharmacological therapy improved walking distances and ABPI 24 months after the procedure compared with exercise and drug therapy alone in patients with stable mild to moderate intermittent claudication.10 Stenting can also be performed to help widen arteries. The stent is inserted into the artery, where it is expanded to hold the artery open and allow blood flow to resume. The procedure is minimally invasive, as the stent is guided into the restricted artery with a catheter that is inserted through a small opening in the artery. Drug-eluting stents have been developed to prevent plaque from growing around the stent due to inflammation and forming scar tissue (restenosis). In patients where large sections of an artery are narrowed, arterial bypass surgery may be required. Bypass surgery is usually successful, but can be risky for patients who suffer from co-morbidities such as diabetes or high blood pressure. With increased awareness of PAD among both patients and healthcare professionals, and proactive testing in primary care for those at risk, we can hope to reduce the significant burden PAD may place on the health system and prevent it from becoming a leading cause of hospitalisation during this century.

References

1 Fowkes F.G.R., Housley E., Cawood E.H.H., MacIntyre C.A.A., Ruckley C.V., Prescott R.J. Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991;20:384-91. 2 Hirsch A.T. et al. Peripheral arterial disease, detection, awareness, and treatment in primary care. JAMA 2001;286:1317-24. 3 PAD Risk Factors and Possible Complications. American Heart Association. www.americanheart.org/ presenter.jhtml?identifier=3020256 (accessed Jan 09). 4 von Wartburg L. Diabetes Health: “The Double Whammy: When Peripheral Artery Disease Complicates Peripheral Neuropathy” May 8, 2007. www.diabeteshealth.com/read/2007/ 05/08/5175.html (accessed Jan 09). 5 Girolami B. et al. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl: a meta- analysis. Arch Intern Med 1999;159:337-45. 6 Adler A.I. et al. UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes. Diabetes Care 2002;25:894-99. 7 LaRosa J.C., He J., Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999;282:2340-6. 8 Stewart K.J. et al. Exercise training for claudication. N Engl J Med 2002;347:1941-51. 9 Regensteiner J.G., Hiatt W.R. Current medical therapies for patients with peripheral arterial disease: a critical review. Am J Med 2002;112:49-57. 10Greenhalgh R.M. et al. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Eur J Vasc Endovasc Surg. 2008 Dec;36(6):680-8.

Boston Scientific, Abbott, Johnson & Johnson embroiled in off-label stents case

2010-01-20T09:12:00.000-06:00

January 19, 2010 by MassDevice staff

Some of the biggest names in medical devices are embroiled in a whistleblower lawsuit accusing them of deliberately promoting the off-label use of biliary stents to treat cardiovascular conditions in hundreds of thousands of patients.

A few of the biggest players in the medical devices arena are accused in a whistleblowers lawsuit of promoting the off-label use of biliary stents to treat cardiovascular disease in hundreds of thousands of patients.

Former Guidant Corp. regional sales director Kevin Colquitt filed a "qui tam" lawsuit accusing Boston Scientific Corp. (NYSE:BSX), Johnson & Johnson (NYSE:JNJ) and its Cordis Corp. subsidiary and Abbott (NYSE:ABT) of encouraging physicians to use the biliary stents to treat blocked blood vessels. The stents are designed to treat bile duct cancers and are not approved or cleared for other uses by the Food & Drug Administration. The whistleblower lawsuit allows Colquitt to file suit on behalf of the government and to collect a third of any monetary judgment resulting from the case.

The lawsuit, filed in the U.S. District Court for Northern Texas and unsealed Jan. 18, alleges that Abbott (which acquired Guidant's stents business in 2006 as part of Guidant's acquisition by Boston Scientific), alleges that the companies promoted the use of the biliary stents to treat obstructions in peripheral blood vessels. The biliary stents faced a lower regulatory hurdle because they're designed for use in cancer patients who are not expected to survive for long. Although physicians are allowed to use devices for off-label treatments, the companies that make them are barred from promoting or encouraging such practices.

Colquitt, who joined Guidant in 2004, filed the lawsuit on behalf of the U.S. government and eight states (California, Florida, Illinois, Louisiana, Massachusetts, Tennessee, Texas and Virginia). The suit accuses the companies of Medicare fraud and filing fraudulent clearance applications with the FDA. The firms allegedly counseled sales reps to target doctors specializing in peripheral vascular disease, sponsored studies of the off-label use of the stents, actively marketed the devices to peripheral vascular specialists (largely ignoring the gastroenterologists and hepatologists who would use the devices for their approved applications), gave sales reps mandatory quotas and bonuses for off-label sales and instructed healthcare providers to falsely code reimbursement claims using codes for vascular stents, according to court documents.

"Indeed, virtually all of the approximate [sic] 150,000 stents implanted in patients each year to treat vascular disease are adulterated and misbranded biliary stents whose investigational use is not authorized by Federal standards based on Defendants' failure to establish that the devices are safe and effective under Federal law," according to the lawsuit. "The impact on beneficiaries' health and safety cannot be overstated as reflected in adverse events reported by healthcare providers. ... The adverse events reported include death, fractures of the devices after implantation, migration and dislodgement of the devices after implantation, arterial dissection and occlusion, arterial and stent embolizations, aneurysms, acute renal insufficiency, amputations, air embolisms, fistulization, strokes, late restenosis, allergic reactions, infections, clots, internal bleeding, and persistent vessel spasms."

Rise in Endovascular Therapy for PAD Parallels Improved Outcomes

2010-01-15T13:44:00.002-06:00

Key Points:
Endovascular treatment for PAD has waxed as surgery has waned
Contemporary PAD patients tend to be sicker
Nonetheless, decreases seen in major amputations, mortality

From: TCTMD - The Source for Interventional Cardiovascular News and Education
By Kim Dalton
Wednesday, January 13, 2010

Over the past decade, as angioplasty increasingly displaced surgery for revascularization of peripheral arterial disease (PAD), rates of major amputation as well as mortality and other complications declined. The shift occurred despite patients presenting with more comorbidities, according to a study published online January 4, 2010, ahead of print in the Journal of Vascular Surgery.
To evaluate the shift in treatment of lower-extremity PAD and the impact of this trend on different patient groups, investigators led by Roman Nowygrod, MD, of Columbia University Medical Center (New York, NY), analyzed data from the National Inpatient Sample as well as New York State inpatient and outpatient databases on patients at least 40 years old who underwent either surgical or endovascular lower leg procedures or major amputations from 1998 to 2007.
Comparing 2007 with 1998, hospitalizations for invasive treatment of lower-extremity PAD decreased slightly, from 192 to 183 per 100,000 people aged ≥ 40 years. However, the proportion of open vs. endovascular revascularizations changed substantially, with the former declining 67% while the latter almost doubled. Meanwhile, the per capita volume of major amputations decreased by 38%.
Although most procedures were performed for critical limb ischemia, the overall rate of lower-extremity revascularizations in this group declined by 20%, from 93 per 100,000 in 1998 to 75 per 100,000 in 2007. Likewise, the incidence of interventions (endovascular or open surgical) for other PAD diagnoses decreased slightly, from 78 to 70 per 100,000. On the other hand, after a stable period from 1998 to 2002, interventions for claudication increased by almost 50% from 2003 to 2007.
The rate of procedures for critical limb ischemia declined steeply for octogenarians (from 317 to 240 per 100,000) and more moderately for patients aged 65 to 79 years (199 to 160 per 100,000), while interventions for claudication increased for all age groups (≥ 40 years). Meanwhile, outpatient interventions increased for all PAD diagnoses in all age groups.
Differing Fortunes of Open vs. Endovascular Intervention

While the proportion of open procedures decreased, use of endovascular revascularization increased substantially, quadrupling for critical limb ischemia and doubling for claudication.

Over the same period, rates of major amputations declined from 42% to 30% for critical limb ischemia, from 0.9% to 0.3% for claudication, and from 18% to 14% for other PAD diagnoses. Importantly, the improvement in patients with critical limb ischemia occurred despite the fact that they were twice as likely to have diabetes and 3 times more likely to have renal disease as those with claudication. In fact, comparable reductions in major amputations were seen in both diabetics (27%) and nondiabetics (32%).
Complications Decline for Both Revascularization Strategies
Over the study period, even as the prevalence of comorbidities such as CAD, COPD, renal disease, and (among claudicants) diabetes increased, operative mortality rates decreased for both revascularization procedures, as did postoperative cardiac complications, bleeding, and stroke. In addition, the incidence of infection declined with endovascular revascularization.

The mean length of hospital stay also declined over the decade, from 9.5 days in 1998 to 7.6 days in 2007. In addition, 35% of patients were discharged within 1 to 2 days in 2007, compared to only about 16% in 1998.
“Our analysis of national inpatient and outpatient state data supports the trend toward increasing treatment of PAD by endovascular intervention,” the authors write, predicting that given the safety of the minimally invasive approach, the percentage of outpatient procedures is likely to continue to grow.
The investigators caution that “although the decline in amputation rates seems likely due in large part to the increased use of endovascular interventions, other variables are clearly operative, including improved endovascular technology, better diabetes management and foot care, and improving and more ubiquitous application of medical therapies.”
In addition, the study findings are based on administrative data and thus subject to certain limitations, the authors note. For example, the absence of anatomic characteristics and condition variables precluded a careful analysis of treatment groups. Also, the inability to track patients over time meant they could not distinguish primary from secondary interventions, readmission, or complications.
Endovascular Trend Justified
“This is a very important paper,” William A. Gray, MD, of Columbia University Medical Center (New York, NY), told TCTMD in a telephone interview. “It both validates trends that we have perceived in the [vascular] community and justifies the increased use [of the endovascular approach] that it documents.”
“It’s not surprising that an easier, more accessible procedure is increasing,” Dr. Gray observed. “But that is nicely balanced by the fact that outcomes appear to be improving too—fewer mortalities, morbidities, shorter length of hospital stay. There are also fewer admissions for critical limb ischemia—likely because claudicants are being treated earlier. And treatment of claudicants may be leading to fewer patients with end-stage PAD.”
Though the study only reports hospitalization trends, “it speaks to the improvement in surveillance and care that these patients have been getting over the past decade, which is quite striking. This translates into a lot of saved limbs and lives,” Dr. Gray said, adding that it also reflects changes in the training of vascular surgeons, who are increasingly receiving instruction in endovascular techniques from fellow surgeons, as documented in a recent study in the Journal of Vascular Surgery.

Source:
Egorova NN, Guillerme S, Gelijns A, et al. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety. J Vasc Surg. 2010;Epub ahead of print.

Disclosures:
Drs. Nowygrod and Gray report no relevant conflicts of interest.

Pathway Medical Technologies Receives FDA 510(k) Clearance For JETSTREAM G3™ Atherectomy System

2010-01-15T11:21:00.001-06:00

From: Medical News Today

Pathway Medical Technologies, Inc., an innovator of endovascular treatments for peripheral vascular disease (PVD), announced that the U.S. Food & Drug Administration (FDA) has granted the company 510(k) clearance to market JETSTREAM G3™, its newest peripheral revascularization catheter for the treatment of PVD. With a new distal cutter and enhanced aspiration efficiency, JETSTREAM G3 offers a significant improvement in cutting and removing disease as compared to previous versions. JETSTREAM G3 is used for treating the entire spectrum of disease found in the PVD patient, including hard and soft plaque, calcium, thrombus and fibrotic lesions.

"JETSTREAM G3 is the next step in atherectomy treatment for peripheral vascular disease. These enhancements incorporate a new state-of-the-art cutter that will enable physicians to treat PVD more quickly, safely and effectively than any of the existing technologies," said Pathway Medical Technologies President and CEO Paul Buckman. "Over the past twelve months Pathway has made significant advances to our atherectomy system. We believe that JETSTREAM G3 now represents the definitive treatment for all lesion morphologies, including calcium and total occlusions. We are fully committed to the continued development of innovative medical devices for the treatment of vascular disease."

"The JETSTREAM device is a highly effective technology for the treatment of occlusive and thrombotic peripheral arterial disease," stated Tom Shimshak MD, an interventional cardiologist and Director of the Cardiovascular Laboratory and Medical Director of the Cardiovascular Institute, Wheaton Franciscan Healthcare, All Saints, Racine, Wisconsin. "The advances in the cutting tip and increased power in the JETSTREAM G3 device will be particularly desirable for long, diffusely diseased segments, including calcification, chronic total occlusions and traditional 'no-stent' zones."

JETSTREAM is a peripheral revascularization catheter designed to remove all kinds of artery-clogging plaque in the lower limbs of patients. This innovative and minimally invasive solution clears blockages in the peripheral vasculature, restores blood flow and effectively treats PVD. JETSTREAM consists of a sterile, single-use catheter and control pod and a reusable, compact console that mounts to a standard I.V. stand. The catheter has an expandable cutting tip that safely debulks and preemptively removes both hard and soft plaque, as well as calcium, thrombus and fibrotic lesions. Excised tissue and thrombus are continually aspirated from the peripheral treatment site through ports in the catheter tip to a collection bag located on the console. The distal portion of the catheter also possesses infusion ports that provide continuous infusion of sterile saline during the atherectomy procedure. Active aspiration is a safety feature that minimizes the risk of distal embolization.

With simple set up and an ergonomic design for easy operation by trained clinicians, JETSTREAM maximizes treatment effectiveness and offers renewed hope for non-surgical candidates and the benefits of a minimally invasive treatment option, including faster recovery and decreased systemic complications.

Leg cramps could indicate peripheral arterial disease

2010-01-12T13:57:00.001-06:00

Saturday, January 09, 2010

From dcourier.com

Has this happened to you? A distinct pain or cramp strikes your legs when you walk. When you stop for a few minutes, the pain goes away. But when you start walking again, it comes back.

You might chalk it up to getting older and respond by cutting back on walking. But that would be the wrong reaction. Instead, you should see your doctor, because your pain may be claudication, which is often a symptom of peripheral arterial disease (PAD). It's a potentially serious but treatable circulation problem.

When someone develops PAD, the extremities - usually a person's legs - don't get enough blood flow to keep up with demand from the muscles. The result can be pain that develops when the demand increases, such as when walking or exercising. The arteries that supply blood to the limbs are damaged, usually by a buildup of plaque that blocks or narrows them.

Treatment restores blood flow

Treating peripheral arterial disease with angioplasty and stenting is often effective for patients who have moderate to severe narrowing or blockage in one or more blood vessels.

Angioplasty involves inserting a catheter (a small, hollow tube) with a tiny balloon on its tip into an artery. Using a type of X-ray that projects moving pictures on a screen, the catheter is guided through the blood vessel to the area that's narrowed or blocked.

When the catheter is in place, the balloon is inflated to flatten the blockage into the blood vessel wall, while at the same time stretching the artery open to increase blood flow.

Following angioplasty, there's a risk that the artery will become narrowed or blocked again at the same site. To help prevent this, a stent is usually put in place after the balloon is deflated and withdrawn. A stent is a tiny mesh tube that remains in the artery to prop it open. The artery wall grows over the stent to keep it in place.

Treating pain and reducing risk

Treatment of PAD has two major goals. One is to reduce symptoms, such as leg pain, so that physical activities can be resumed. The other is to stop the progression of atherosclerosis (buildup of plaque in arteries) to reduce the risk of heart attack and stroke.

PAD patients should control their cholesterol, blood pressure and blood sugar, if they also have diabetes. Lifestyle changes are important, too. If you smoke, quitting is the single most effective way to reduce risk. Exercise helps condition muscles to use oxygen more efficiently, and a healthy diet can help to control other risk factors, such as cholesterol and blood pressure levels.

If you think you may have PAD, see your doctor for an evaluation.

Deficiencies in foot care of diabetic patients on renal replacement therapy

2010-01-10T16:24:00.002-06:00

Diabetic patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) are known to be at very high risk of foot ulceration causing significant morbidity and mortality. We surveyed the foot care of all diabetic patients in our area having RRT for ESRD over a three-month period. Of the 55 patients included, 36 (65.5%) had not been seen in a diabetes clinic and 32 (58.2%) had not been seen by a podiatrist in the preceding year. Of all patients, 36 had previous documented evidence of high-risk feet yet only 21 (58.3%) of this group had been seen by a podiatrist in the year before. Active ulceration was known to be present in seven patients. Ulcer duration was between 16 and 66 (mean 33) weeks. Three patients with active ulceration had not been seen by a podiatrist and four had not been seen in diabetes clinic in the previous year. In view of the worrying deficiencies in foot care in this group, we suggest increasing podiatry and diabetes team access for RRT patients at the site of their dialysis and advocate early multidisciplinary foot clinic referral for patients with ulceration.

~Practical Diabetes International~

Angina In The Legs? Time To Alert Patients And Physicians

2010-01-08T16:21:00.003-06:00

ScienceDaily (Jan. 4, 2010) — Edmonton researchers recommend that people over age 40 be screened for peripheral artery disease (PAD), which puts people at high risk for serious medical complications including heart disease, stroke, and possible lower limb amputation.

It contributes to thousands of deaths every year yet nobody knows for sure how many Canadians have PAD.
"PAD is under diagnosed and under treated," Heart and Stroke Foundation researcher Dr. Ross Tsuyuki told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
"PAD is caused by a narrowing of the arteries that supply blood to the legs. The pain some PAD patients experience is the lower limb equivalent of the chest pain from the heart," says Dr. Tsuyuki. Since the leg artery narrowings seen in PAD usually imply similar narrowings in heart and brain arteries, PAD is a strong marker for heart disease and stroke.
"PAD is as serious as heart disease and its prevention and treatment is similar," says Dr. Tsuyuki. "It's unique in that it manifests in the legs but is just as urgent."
He warns that the index of suspicion for family doctors should be high, however often it's not. Many people with PAD have no, or very mild, symptoms. Only about half of people experience pain walking. Once the diagnosis of PAD has been made, physicians should also consider if significant artery narrowings are present in the heart and brain.
Dr. Tsuyuki and his team at the University of Alberta sought answers by studying 362 volunteers over age 50, chosen from 10 pharmacies in Central and Northern Alberta and in physician offices. After extensive screening and testing, the results found 17 PAD cases, a prevalence of five per cent.
Importantly, 80 per cent of the people diagnosed with PAD were previously unaware they had this condition. This is important because knowledge of the presence of PAD mandates more aggressive treatment, not only to treat leg symptoms, but also prevent heart attacks and strokes.
"These figures emphasize the importance of PAD screening to detect disease and guide treatment," says Dr. Tsuyuki. "The study also points to the value of community pharmacies as an efficient way to screen for this condition."
The researchers followed up with the people diagnosed with PAD three months after the screening and found that 88 per cent visited their family physician following the screening and half then received lifestyle or pharmacologic interventions.
Screening for PAD is a simple procedure that compares the blood pressure in the leg to that of the arm. A ratio of leg pressure to arm is less than 0.90 indicates the presence of PAD.
Heart and Stroke Foundation spokesperson Dr. Beth Abramson says that physicians should aggressively treat any high blood pressure and cholesterol in their patients with PAD and manage diabetes if it is present. "People don't recognize that leg cramps while walking may be due to circulation problems that put them at risk for heart disease and stroke," she says.
Dr. Abramson says people should talk to their doctor if they have difficulty with walking and develop pain or discomfort in the calves or legs that get better with rest. "This symptom -- called claudication -- is angina in the legs and puts you at risk of heart attack."
She says that heart attacks are often due to disease resulting from narrowing of arteries of the heart and that people should be aware that this disease can be widespread throughout the body. "If we see narrowing of the arteries in the legs, it's often in the heart as well, hence the heart/leg connection."
While PAD may have no symptoms, here are some signs and symptoms to look for:
Leg pain during exercise (most common symptom).
Open sores that don't heal.
Feeling of coldness or numbness in one or both legs.
Pain in the toes at night.
You are at higher risk of developing PAD if you:
Smoke or previously smoked.
Have diabetes.
Have high blood pressure.
Have high blood cholesterol.
Have heart disease or have had a stroke.
By being physically active and smoke-free, PAD patients can reduce their symptoms, improve their mobility and quality of life, and potentially prevent heart disease and stroke

Screening the Legs for a Serious Condition

2010-01-08T15:48:00.001-06:00

January 8, 2010
Screening the Legs for a Serious Condition
Diane Fennell
From: www.diabetesselfmanagement.com/Blog/Diane-Fennell

Researchers in Canada are recommending that people over age 40 be screened for peripheral arterial disease, or PAD, a condition of the legs and feet that is associated with a higher risk of complications such as heart disease, stroke, and lower limb amputations. People with diabetes are more likely than those in the general population to develop PAD, which affects roughly 8–12 million Americans.

The condition, which is characterized by a narrowing of the arteries that supply blood to the legs, typically causes cramping, pain, or tiredness in the legs, particularly when walking or exercising; numbness, tingling, or coldness in the lower legs or feet; and infections in the legs or feet that heal slowly. In some people, however, symptoms are very mild, and in others there may be no symptoms at all.

Ross Tsuyuki, PharmD, MSc, and his colleagues at the University of Alberta looked at 362 people over age 50 who had visited pharmacies and doctors’ offices in Central and Northern Alberta. After extensive screening, 17 people, or 5% of the participants, were diagnosed with PAD. Significantly, 80% of those diagnosed had not previously been aware that they had the condition.

According Dr. Tsuyuki, “The pain some PAD patients experience is the lower limb equivalent of the chest pain from the heart. PAD is as serious as heart disease and its prevention and treatment is similar. It’s unique in that it manifests in the legs but is just as urgent.”

Screening for PAD is a painless and relatively simple procedure that involves comparing the blood pressure in the leg to that in the arm. The American Diabetes Association (ADA) recommends that people who are over 50 and have diabetes be screened for PAD even if they have no symptoms and that people under 50 who have risk factors such as smoking, high blood pressure, high cholesterol, or a history of diabetes longer than 10 years also receive screening.

To learn more about Dr. Tsuyuki’s research, read the article “Angina In The Legs? Time To Alert Patients And Physicians.” And for more information about PAD, see “When Your Legs Ache: Peripheral Arterial Disease and Diabetes.”

Online Community for Dialysis Patients

2010-01-07T13:13:00.001-06:00

My Access Site is an online community to bring together dialysis patients and their supporting friends and families. It takes on a bird’s eye view of a city that features a "Soap Box" to voice your opinions and rate your dialysis clinic/staff members, "Cafe" to meet others out there and start discussions on various topics, and the "Art Gallery" to share your creations, among other features like education and community resources.

Visit us at www.myaccesssite.com

Lower Leg Amputation

2010-01-04T12:28:00.001-06:00

Statistics show in the United States, infected foot ulcers are the most frequent admitting diagnosis for hospitalization of patients with diabetes. In 2003, there were about 111,000 hospital discharges for lower extremity ulcers. There are more than 90,000 lower extremity amputation procedures performed on patients with diabetes in the U.S. annually, which equates to one every six minutes. The mortality rate after amputations is about 40% at one year and 80% at five years. Five-year mortality rates after new-onset diabetic ulceration are between 43% and 55% and up to 74% for patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin’s disease.
By Mark Hinkes, DPM

Many diabetic foot amputations are preventable

2009-12-30T12:30:00.000-06:00

It costs $1,400 to cover the oozing sore on the diabetic's foot with a piece of artificial skin, helping it heal if patients keep pressure off that spot. So when Medicare paid for the treatment but not the extra $100 for a simple walking cast to protect it, an artificial skin maker last year started giving free casts to some needy patients.

Without the right cushioning, "the person will walk to the bus stop and destroy it," fumes Dr. David G. Armstrong of the Southern Arizona Limb Salvage Alliance.

Limb-salvage experts say many of the 80,000-plus amputations of toes, feet and lower legs that diabetics undergo each year are preventable if only patients got the right care for their feet. Yet they're frustrated that so few do until they're already on what's called the stairway to amputation, suffering escalating foot problems because of a combination of ignorance -- among patients and doctors -- and payment hassles.

"There's no magic medicine right now for the diabetic foot," says specialist Dr. Lawrence Lavery of Texas A&M University, who bemoans that simple-but-effective preventive care just isn't attention-getting.

"People come in (saying), 'Hey, my wife noticed a bloody trail today as I was walking across the linoleum in the kitchen. What should I do?'"

President Barack Obama got a drubbing from surgeons this month after a confusing comment about how they're paid for foot amputations that cost $30,000 or more. That tab is the total cost, including hospitalization; surgeon fees range from about $750 to $1,000.

Obama's larger argument: Better payment for early-stage diabetes treatment, or even care to prevent diabetes, could save the nation money.

The money part's hard to prove but it's a lot of misery saved if it's your foot, and the spat highlights a huge problem. Some 24 million Americans have diabetes, meaning their bodies can't properly regulate blood sugar, or glucose. Over years, high glucose levels gradually damage blood vessels and nerves.

One vicious result: About 600,000 diabetics get foot ulcers every year. Poor blood flow in the lower legs makes those ulcers slow to heal. And loss of sensation in the feet, called neuropathy, makes patients slow to notice even small wounds that rapidly can turn gangrenous.

A mere nick while clipping nails, or a blister from an ill-fitting shoe, can begin the march toward amputation -- and about half of patients who do lose a foot die within five years.

Saving those feet isn't cheap. Treating a slow-to-heal diabetic foot ulcer can cost up to $8,000. If it gets infected, $17,000. Worse, a fraction of patients gets multiple slow-to-heal ulcers each year.

What helps?

--Routine foot checkups. There's great variability in how insurers pay for foot screenings before someone's deemed at high risk, says Dr. Harry Goldsmith, a consultant on podiatric reimbursement. Yet some simple tests, like one that measures blood pressure at the ankle to predict circulation clogs, can signal later risk of ulcers. Medicare patients who do develop certain risk factors qualify for the next step, regular clinic visits to have a technician trim nails or smooth calluses, time that should include a quick check for any wounds, Goldsmith says.

--Gadgets like $20 telescoping mirrors let diabetics who can't move well check their numb soles for wounds between doctor visits, and infrared foot thermometers that cost up to $100 can detect changes in temperature that mean an ulcer's brewing before the skin breaks. Again, insurance payment varies.

--Taking pressure off the foot is key, starting with supportive shoes or insoles that target weak spots before an ulcer strikes. Medicare will help pay for certain therapeutic shoes although paperwork limits the diabetics who try them, says Lavery. He finds that an athletic shoe checked by a foot specialist for proper fit can help many patients.

When an ulcer demands more advanced care like grafting that artificial skin, Armstrong says removable walking casts -- to-the-calf Velcro boots that injured athletes often wear -- ease pressure best but seldom are covered. Worried that doctors wouldn't prescribe its wound healer Dermagraft if patients crushed it before it could work, Tennessee-based Advanced BioHealing has provided nearly 1,900 of the boots through a patient-assistance program since last year, said vice president Dean Tozer.

--The "toe and flow" approach, diabetic limb-salvage teams that pair specialists who otherwise seldom work side-by-side, like podiatrists and vascular surgeons. Wound care won't work well until clogged leg arteries are cleared to improve blood flow, notes Armstrong, whose team at the University of Arizona, Tucson, documented a drop in amputations in its first nine months. Such teams can eliminate some of the time diabetics wait for appointments to treat a festering foot, plus stress prevention.

By LAURAN NEERGAARD
AP Online delivered by Newstex

Chronic Critical Limb Ischemia

2009-12-14T16:43:00.002-06:00

Chronic critical limb ischemia is manifested by pain at rest, non-healing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.

Atherosclerosis underlies most peripheral arterial disease. Narrowed vessels that cannot supply sufficient blood flow to exercising leg muscles may cause claudication, which is brought on by exercise and relieved by rest. (For a review of the diagnosis and management of claudication, see the article by Santilli, et al., in the March 1996 issue of American Family Physician.1) As vessel narrowing increases, critical limb ischemia can develop when the blood flow does not meet the metabolic demands of tissue at rest. While critical limb ischemia may be due to an acute condition such as an embolus or thrombosis, most cases are the progressive result of a chronic condition, most commonly atherosclerosis.
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An ankle systolic pressure of 50 mm Hg or less or a toe systolic pressure of 30 mm Hg or less suggests the presence of critical limb ischemia.
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Chronic critical limb ischemia is defined not only by the clinical presentation but also by an objective measurement of impaired blood flow. Criteria for diagnosis include either one of the following (1) more than two weeks of recurrent foot pain at rest that requires regular use of analgesics and is associated with an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less, or (2) a nonhealing wound or gangrene of the foot or toes, with similar hemodynamic measurements.2 The hemodynamic parameters may be less reliable in patients with diabetes because arterial wall calcification can impair compression by a blood pressure cuff and produce systolic pressure measurements that are greater than the actual levels.

Risk Factors:
Chronic critical limb ischemia is the end result of arterial occlusive disease, most commonly atherosclerosis. In addition to atherosclerosis in association with hypertension, hypercholesterolemia, cigarette smoking and diabetes,3,4 less frequent causes of chronic critical limb ischemia include Buerger's disease, or thromboangiitis obliterans, and some forms of arteritis.5
Figure 1a
FIGURE 1A. Right heel ulcer in a 56-year-old patient with diabetes. The ulcer failed to heal after three months of conservative treatment.

Diabetes is a particularly important risk factor because it is frequently associated with severe peripheral arterial disease. Atherosclerosis develops at a younger age in patients with diabetes and progresses rapidly. Moreover, atherosclerosis affects more distal vessels in patients with diabetes; the profunda femoris, popliteal and tibial arteries are frequently affected, while the aorta and iliac arteries are minimally narrowed. These distal lesions are less amenable to revascularization. Atherosclerosis in distal arteries in combination with diabetic neuropathy contributes to the higher rates of limb loss in diabetic patients compared with nondiabetic patients.6,7

Clinical Presentation:
The development of chronic critical limb ischemia usually requires multiple sites of arterial obstruction that severely reduce blood flow to the tissues.7,8 Critical tissue ischemia is manifested clinically as rest pain, nonhealing wounds (because of the increased metabolic requirements of wound healing) or tissue necrosis (gangrene).

Ischemic rest pain is classically described as a burning pain in the ball of the foot and toes that is worse at night when the patient is in bed. The pain is exacerbated by the recumbent position because of the loss of gravity-assisted flow to the foot. Ischemic rest pain is located in the foot, where tissue is farthest from the heart and distal to the arterial occlusions.1 Patients with ischemic rest pain often need to dangle their legs over the side of the bed or sleep in a recliner to regain gravity-augmented blood flow and relieve the pain. Patients who keep their legs in a dependent position for comfort often present with considerable edema of the feet and ankles.

Non-healing wounds are usually found in areas of foot trauma caused by improperly fitting shoes or an injury. A wound is generally considered to be nonhealing if it fails to respond to a four- to 12-week trial of conservative therapy such as regular dressing changes, avoidance of trauma, treatment of infection and debridement of necrotic tissue.

Gangrene is usually found on the toes. It develops when the blood supply is so low that spontaneous necrosis occurs in the most poorly perfused tissues.

Diagnosis:
Patients with diabetes develop atherosclerotic lesions in the more distal leg vessels, which are less amenable to revascularization.
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The presence of rest pain can sometimes be difficult to discern in patients with other chronic leg pain, such as that caused by peripheral neuropathy. Labeling a wound as non-healing can also be a subjective assessment. However, a number of physical findings and objective hemodynamic parameters can be used to substantiate a diagnosis of chronic critical limb ischemia. Typical physical findings include absent or diminished pedal pulses, shiny smooth skin of the feet and legs, and muscle wasting of the calves.

An objective measurement of blood flow is easily accomplished with the use of a hand-held Doppler probe and a blood pressure cuff.1 The cuff is inflated until the pulse distal to the cuff is no longer heard by Doppler. The cuff is then slowly deflated until the pulse is again detected. This measurement is recorded as the systolic pressure. As previously mentioned, an ankle systolic pressure of 50 mm Hg or less or a toe systolic pressure of 30 mm Hg or less suggests the presence of critical limb ischemia.

JAMIE D. SANTILLI, M.D., and STEVEN M. SANTILLI, M.D., PH.D.
University of Minnesota School of Medicine
Minneapolis, Minnesota

Peripheral Arterial Disease

2009-12-14T16:25:00.002-06:00

Your arteries carry blood rich in oxygen and nutrients from your heart to the rest of your body. When the arteries in your legs become blocked, your legs do not receive enough blood or oxygen, and you may have a condition called peripheral artery disease (PAD), sometimes called leg artery disease.

PAD can cause discomfort or pain when you walk. The pain can occur in your hips, buttocks, thighs, knees, shins, or upper feet. Leg artery disease is considered a type of peripheral arterial disease because it affects the arteries, blood vessels that carry blood away from your heart to your limbs. You are more likely to develop PAD as you age. One in 3 people age 70 or older has PAD. Smoking or having diabetes increases your chances of developing the disease sooner.

The aorta is the largest artery in your body, and it carries blood pumped out of your heart to the rest of your body. Just beneath your belly button in your abdomen, the aorta splits into the two iliac arteries, which carry blood into each leg. When the iliac arteries reach your groin, they split again to become the femoral arteries. Many smaller arteries branch from your femoral arteries to take blood down to your toes.

Your arteries are normally smooth and unobstructed on the inside but, as you age, they can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, your arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow to your leg arteries. When this happens, your leg does not receive the oxygen it needs. Physicians call this leg artery disease. You may feel well and still have leg artery disease or sometimes similar blockages in other arteries, such as those leading to the heart or brain. It is important to treat this disease not only because it may place you at a greater risk for limb loss but also for having a heart attack or stroke.

What are the symptoms?
You may not feel any symptoms from peripheral artery disease at first. The most common early symptom is intermittent claudication (IC). IC is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel a tightness, heaviness, cramping, or weakness in your leg with activity. IC often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may begin to feel IC at shorter walking distances. Only about 50 percent of the people with leg artery disease have blockages severe enough to experience IC.

Critical limb ischemia is a symptom that you may experience if you have advanced peripheral artery disease. This occurs when your legs do not get enough oxygen even when you are resting. With critical limb ischemia, you may experience pain in your feet or in your toes even when you are not walking.

In severe peripheral artery disease, you may develop painful sores on your toes or feet. If the circulation in your leg does not improve, these ulcers can start as dry, gray, or black sores, and eventually become dead tissue (called gangrene).

Amputation:
In extreme cases, especially if your leg has gangrene and is not salvageable, your surgeon may recommend amputating your lower leg or foot. Amputation is a treatment of last resort. Vascular surgeons usually only perform it when the circulation in your leg is severely reduced and cannot be improved by the methods discussed already. More than 90 percent of patients with gangrene who are seen by vascular specialists can avoid amputation or have it limited to a small portion of the foot or toes.

~ VascularWeb ~

Amputation and diabetes: How to protect your feet

2009-10-14T21:17:00.002-05:00

The diabetic foot: amputations are preventable

2009-10-14T21:14:00.001-05:00

People with diabetes are at risk of nerve damage (neuropathy) and problems with the blood supply to their feet (ischaemia). Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they get infected, may result in amputation.

In 2000 the International Diabetes Federation endorsed the International Working on the Diabetic Foot as a Consultative Section on the Diabetic Foot. Together the organizations established goals for the future of diabetic foot care worldwide.

Goals

* to inform people of the extent of diabetic foot problems worldwide
* to raise awareness of the diabetic foot among those at risk and those in a position to take action
* to persuade healthcare decision makers that action is both possible and affordable
* to warn healthcare decision makers of the consequences of not taking action
* to inform people with diabetes of the measures they can take to prevent foot complications

Diabetes is a serious chronic disease. In 2003 the global prevalence of diabetes was estimated at 194 million. This figure is predicted to reach 333 million by 2025 as a consequence of longer life expectancy, sedentary lifestyle and changing dietary patterns. This rise is likely to bring a proportional increase in the numbers of people with diabetes complications, including problems of the foot.

Most amputations begin with a foot ulcer

Diabetic foot ulcers as a result of neuropathy or ischaemia are common. In developed countries, up to five per cent of people with diabetes have foot ulcers, and one in every six people with diabetes will have an ulcer during their lifetime. Foot problems are the most common cause of admission to hospital for people with diabetes. In developing countries, foot problems related to diabetes are thought to be even more common. Without action, global amputations rates will continue to rise.

Every 30 seconds a leg is lost to diabetes somewhere in the world

Extensive epidemiological surveys have indicated that between 40% and 70% of all lower extremity amputations are related to diabetes. This means that every 30 seconds a lower limb is lost to diabetes. The vast majority (85%) of all diabetes-related amputations are preceded by foot ulcers.

For most people who have lost a leg, life will never return to normal. Amputation may involve life-long dependence upon the help of others, inability to work and much misery. Aggressive management of the diabetic foot can prevent amputations in most cases. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team.

In developed countries diabetic foot care accounts for up to 20% of total healthcare resources available for diabetes. In developing countries, it has been estimated that foot problems may account for as much as 40% of the resources available. In western countries, the economic cost of a diabetic foot ulcer is thought to be between US$7,000 and US$10,000. Where healing is complicated and amputation required, this cost may increase to as much as US$65,000 per person.

Up to 85% of amputations can be prevented

In most cases, however, diabetic foot ulcers and amputations can be prevented. Researchers have established that between 49% and 85% of all amputations can be prevented. It is imperative, therefore, that healthcare professionals, policymakers and diabetes representative organizations undertake concerted action to ensure that diabetic foot care is structured as effectively as local resources will allow. This will facilitate improvements in foot care for people with diabetes throughout the world and bring about a reduction in diabetic-foot-related morbidity and mortality.

Significant reductions in amputations can be achieved by well-organized diabetic foot care teams, good diabetes control and well-informed self care

There is strong evidence to indicate that foot care is best delivered when it is provided by a multidisciplinary team. This should closely involve the person with diabetes and his or her family, along with healthcare professionals from different specialties. Ideally the team will include a physician, a nurse, a specialist educator, a podiatrist, a surgeon, an orthotist (shoemaker) and an administrator. The podiatrist is a key member of the multidisciplinary diabetic foot team. At present there is a lack of trained podiatrists working in diabetic foot care. Mandatory minimal skills and equipment for those offering a podiatry service should be controlled to ensure that people with diabetes are not put at increased risk by unregulated, unqualified and poorly equipped practitioners.

IDF’s position is that management in the prevention and treatment of diabetic foot problems includes the following:

* Annual inspection of the foot
* Identification of the foot at risk
* Education of people with diabetes and healthcare professionals
* Appropriate foot wear
* Rapid treatment of all foot problems

Only through a multidisciplinary approach addressing the diversity of possible foot problems in people with diabetes can the desired reduction in amputation rates be achieved.

Conclusion

It is now time to take appropriate action to ensure that people with diabetes everywhere receive the quality of care that they deserve. It is hoped that global awareness of diabetes and its complications will be raised and that the necessary attention will be paid to the need for improved foot care for people with diabetes throughout the world.

IDF recommends that every individual with diabetes receive the best possible foot care. At the organizational level, diabetic foot care should be structured in such a way as to optimize treatment and prevention possibilities. For this to be feasible all parties involved (i.e. healthcare providers, policymakers and patient organizations) should recognize the need for combined action.

~ International Diabetes Federation ~

Prevalence of risk factors predisposing to foot problems in patients on hemodialysis

2009-10-14T21:10:00.002-05:00

The prevalence of peripheral arterial occlusive disease (PAOD) in the general public is estimated at 3.5% to 23% (O'Hare & Johansen, 2001). Among individuals with diabetes, the prevalence of PAOD is four to seven times greater than in those without diabetes (Armstrong, Lavery, & Harkless, 1998). The most common cause of chronic renal failure is diabetes, accounting for 44.3% of new end stage renal disease (ESRD) patients annually in the United States (U.S.) and 33% of new ESRD patients in Canada (U.S. Renal Data Systems [USRDS], 2003).

Annually more than 125,000 people in the U.S. undergo lower extremity amputations (Armstrong et al., 1998). Of these, between 50% and 80% are attributable to diabetes (Lavery et al., 1996; Spollett, 1998). There is some evidence to suggest that the prevalence of foot problems among patients with diabetes who also have ESRD is even greater than in patients with diabetes without ESRD (Eggers, Gohdes, & Pugh, 1999; Hill et al., 1996; Rith-Najariah & Gohdes, 2000). Thus, the potential burden of illness in a dialysis population is a costly one. According to some sources, however, between 50% and 85% of lower extremity amputations associated with diabetes could be avoided or delayed through appropriate educational and treatment programs (Edmonds, 1987; Halpin-Landry & Goldsmith, 1999).

~ BNET ~

Preventive Foot Care in Hemodialysis Patients

2009-10-14T21:00:00.006-05:00

How Do I Know if I Have Leg Ischemia?

2009-10-14T21:00:00.005-05:00

Ischemia of the lower extremities will manifest itself in many different ways ranging from asymptomatic (simply the presence of a blockage) to gangrene of the leg or a part of it. Quite often a patient will have an asymptomatic blockage (one that they do not know is there) that is manifested simply by an absent pulse in the foot, behind the knee or in the groin or an abnormal angiogram that is usually done at the time that a cardiac catheterization (heart catheterization) is performed. A person will have no symptoms referable to this blockage and will only know of the abnormality because their physician informs them of such! This is generally referred to as Fontaine’s Class I.

The next “level” of ischemia is that of claudication. This is manifest by cramping pain that occurs with walking. It most often affects the calf muscles and generally occurs at a rather fixed distance (usually measured in blocks.) Depending on the severity of the ischemia—either by its level of lifestyle interference or by distance at which symptoms begin—it is referred to as Fontaine’s Class IIa or IIb.

Rest Pain is the next Stage (III) in the Fontaine classification of leg ischemia. This is typified by pain that occurs even in the absence of significant stress on the legs. It often occurs in the evenings awakening the patient from sleep. Quite often, hanging the leg from the side of the bed will improve the painful symptoms that are experienced. The foot will often turn a light purple or deep red-violet color as it is held in a dependent condition—often referred to as “dependent rubor.” This is a sign of significant leg ischemia and warrants aggressive intervention.

The final stage of leg ischemia (Fontaine Level IV) is tissue loss—seen as a non-healing sore or gangrene. This level (along with rest pain) is appropriately referred to as “limb-threatening ischemia” and must be evaluated appropriately by those with expertise in this area. Ignoring this degree of ischemia will very likely lead to limb loss (amputation) at some point in the future!

~ The Cardiovascular Care Group ~

PAD

2009-10-14T20:57:00.002-05:00

Peripheral vascular disease (PVD) can affect the arteries, the veins or the lymph vessels. The most common and important type of PVD is peripheral arterial disease, or PAD, which affects about 8 million Americans. It becomes more common as one gets older, and by age 65, about 12 to 20 percent of the population has it. Diagnosis is critical, as people with PAD have a four to five times higher risk of heart attack or stroke.
~ American Heart Association ~

Peripheral Vascular Disease

2009-10-14T20:54:00.004-05:00

What is peripheral vascular disease?

This refers to diseases of blood vessels outside the heart and brain. It's often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. There are two types of these circulation disorders:

* Functional peripheral vascular diseases don't have an organic cause. They don't involve defects in blood vessels' structure. They're usually short-term effects related to "spasm" that may come and go. Raynaud's disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.

* Organic peripheral vascular diseases are caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It's caused by fatty buildups in arteries that block normal blood flow.

What is peripheral artery disease?

Peripheral artery disease (PAD) is a condition similar to coronary artery disease and carotid artery disease. In PAD, fatty deposits build up in the inner linings of the artery walls. These blockages restrict blood circulation, mainly in arteries leading to the kidneys, stomach, arms, legs and feet. In its early stages a common symptom is cramping or fatigue in the legs and buttocks during activity. Such cramping subsides when the person stands still. This is called "intermittent claudication." People with PAD often have fatty buildup in the arteries of the heart and brain. Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.

How is peripheral artery disease diagnosed and treated?

Techniques used to diagnose PAD include a medical history, physical exam, ultrasound, X-ray angiography and magnetic resonance imaging angiography (MRA).

Most people with PAD can be treated with lifestyle changes, medications or both. Lifestyle changes to lower your risk include:

*
Stop smoking (smokers have a particularly strong risk of PAD).
*
Control diabetes.
*
Control blood pressure.
*
Be physically active (including a supervised exercise program).
*
Eat a low-saturated-fat, low-cholesterol diet.

PAD may require drug treatment, too. Drugs include:

*
medicines to help improve walking distance (cilostazol and pentoxifylline).
*
antiplatelet agents.
*
cholesterol-lowering agents (statins).

In a minority of patients, lifestyle modifications alone aren't sufficient. In these cases, angioplasty or surgery may be necessary.

Angioplasty is a non-surgical procedure that can be used to dilate (widen) narrowed or blocked peripheral arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery segment. The balloon is then inflated, compressing the plaque and dilating the narrowed artery so that blood can flow more easily. Then the balloon is deflated and the catheter is withdrawn.

Often a stent — a cylindrical, wire mesh tube — is placed in the narrowed artery with a catheter. There the stent expands and locks open. It stays in that spot, keeping the diseased artery open.

If the narrowing involves a long portion of an artery, surgery may be necessary. A vein from another part of the body or a synthetic blood vessel is used. It's attached above and below the blocked area to detour blood around the blocked spot.

~ American Heart Association ~

Foot Pain and Diabetes

2009-10-14T18:56:00.003-05:00

Foot pain can certainly be caused by any number of reasons. However, foot pain resulting from diabetes is both painful and very common for those living with diabetes.

Diabetes and foot pain is generally defined by four different types.

A nerve problem (where the nerves themselves are affected by the disease) called peripheral neuropathy is the most common source of foot pain tied to diabetes. Peripheral neuropathy comes in the form of sensory, motor, and autonomic neuropathy.

Sensory neuropathy is the most common and is defined by symptoms where the amount of pain is much greater than the source that is causing the pain. As an example, just touching, or lightly pulling on your socks triggers a painful reaction. Also, with sensory neuropathy you may experience some numbness along with tingling, burning, or even stabbing type pain symptoms.

Because blood sugar can be a player in this type of pain, check your blood sugar levels for the past several weeks to see if perhaps there is an upward trend toward high levels.

Relief is of the utmost importance in these cases and can come from various applications. Massaging your feet or using a foot roller can sometimes drop the level of pain. Anything you can do from a shoe perspective such as cushioned supports and inserts can assist as well. Anything to help mitigate the pressure and pounding of daily activities on the foot and/or any rubbing or chaffing is beneficial. There are also prescription drugs that your doctor can recommend that will often times work.

When the nerves to the muscles become affected by diabetes (motor neuropathy), your muscles will begin to feel weak and achy. Although the smaller muscles of the feet aren't usually the first to be affected, your balance can eventually become affected which may cause alignment problems and/or rubbing on the feet which ultimately results in pain. Support, exercise, stretching, and massage are your best weapon against motor neuropathy. Keeping your muscles healthy and flexible is a key element in relieving this type of foot pain.

Autonomic neuropathy affects the nerves that we don't consciously control, hence the 'auto' of autonomic. With this condition existing your sweating triggers are altered and as such you may suffer from dry or cracked skin. For your feet this may result in a build up of foot calluses, thickened nails and such that lead to foot pain. The daily use of conditioning agents formulated specifically for diabetes can aid or prevent this problem.

With diabetic people proper circulation is a primary concern. Circulation problems in the feet can cause severe pain. Addressing circulation problems should always be done in conjunction with your medical doctor. Various approaches may include an exercise program, physical therapy, medication, or even surgical procedures, but again, consult with your physician before considering any strategy that involves addressing a circulation issue.

With diabetic people muscle and joint pain is not uncommon. If tendons and joints begin to stiffen coupled with imbalances associated with peripheral neuropathy and walking alignment occurs, the foot and the joints become painful. In fact, if the walking misalignments continue, this can lead to other foot disorders such as corns, bunions, and hammertoe.

People living with diabetes are more susceptible to infections within their body because of the changes that have taken place in their body. If a bacterial infection attacks the foot, the foot can become red, experience swelling, feel warm, and be painful. Keeping the immune system as healthy as possible by controlling your blood sugar, proper nutrition, and exercise, should be a top priority in your defense against infections.

If you are afflicted with diabetes, in addition to being mindful of the above information, work closely with your primary care physician to ensure that you receive proper information and care for your personal situation.

~Ezine Articles ~

Diabetes: PAD and Limb Loss

2009-10-06T15:47:00.002-05:00

Peripheral Arterial Disease (PAD) and Limb Loss

Peripheral arterial disease (PAD) is a form of artheroscelorisis (hardening of the arteries). In PAD, fat builds up inside the artery (blood vessel) walls. Over time, this causes a blockage that can keep your blood from flowing properly. PAD may result in blockages in the brain, arms, kidneys, and legs.

Diabetes is a major cause of PAD. People with diabetes are unable to properly digest the sugar they eat. This sugar builds up and causes changes in their blood vessels. These changes lead to circulation problems. PAD is a risk factor for foot ulcers that can lead to amputation in diabetic patients.

How many people have PAD?

* As many as 10 million people in the United States have PAD.
* In 1996, an estimated 128,588 individuals lost a limb because of PAD.

What are the risk factors?

* Diabetes. People with diabetes are at greater risk for severe PAD. People with diabetes are five times more likely to have an amputation due to PAD.
* Age. The risk of limb loss due to PAD increases with age. People 65 or older are two to three times more likely to have an amputation.
* Gender. Men with PAD are twice as likely to undergo an amputation as women.
* Race/ethnicity. Some racial and ethnic groups have a higher risk of amputation (i.e., African Americans, Latino Americans, and Native Americans). This is because they are at increased risk for diabetes and cardiovascular disease.

~ dLife ~

Diabetes & Feet

2009-09-22T12:14:00.003-05:00

Diabetes affects the body's blood circulation which in turn affects the feet. Extreme cases of nerve and foot disorders (neuropathy) may lead to foot/leg amputations also known as lower extremity amputations or LEAs.

Why do people with diabetes have to take care of their feet more than those with no diabetes? According to the American Diabetes Association by the time type 2 diabetes is diagnosed, 50% of patients already show early signs of foot complications. People with diabetes are 5 times more likely to develop "peripheral neuropathy" (nerve damage in extremities) than the general population. Checking feet daily and having a doctor examine the feet can help prevent serious complications.

What are some symptoms of peripheral neuropathy "complications"?
Loss of feeling in feet. Foot sores that do not heal. Numbness, tingling or burning sensation in feet.

How can these "complications" be prevented?
Keep blood sugar (glucose) close to your goal. Don't smoke.

Get blood pressure checked regularly. Continue taking medication for blood pressure if prescribed by your doctor.

Check feet thoroughly ever day.

Report any problems to your health care provider.

How to Care for Your Feet:
Check feet daily for cuts, sores, red spots, swelling, and infected toenails.

Keep the top and bottom of feet's skin soft and smooth by using skin cream, lotion, or petroleum jelly.

Smooth corns and calluses gently -- check with your healthcare provider for proper care.

Trim toenails each week or as needed -- Cut nails straight across and file the edges. if you cannot see well, or if your toenails are thick or yellowed, have a foot care doctor trim them.

Never walk barefoot -- wear shoes and socks (preferably cotton or wool) at all times to protect feet from injury. Remember to shake out your shoes before putting them on since a small pebble or glass can lead to foot problems.

Wear shoes that fit well. Shape of feet may change due to poor fitting shoes. If you have lost feeling in your feet ask your health care provider for advice on proper shoes.

Protect feet from extreme heat or cold

(Adapted from ADA diabetes educational material)

Diabetes and P.A.D.

2009-09-21T08:26:00.002-05:00

What is the link between Diabetes and P.A.D.?

People with diabetes are at higher risk for having P.A.D. Some studies have found that one out of three people with diabetes over age 50 has P.A.D., and P.A.D. is even more common in African Americans and Hispanics who have diabetes.

Having P.A.D. and diabetes can be a very serious problem. People who have both diseases are much more likely to have a heart attack or stroke than those who just have P.A.D., and they are more likely to die at a younger age.

Because many people with diabetes do not have feeling in their feet or legs due to nerve disease, they may have P.A.D. but cannot feel any symptoms. As a result, they do not know they have P.A.D., or they may have it for a long time before it is diagnosed. Further, when blood flow to your feet and legs is narrowed or blocked due to P.A.D., it takes longer for cuts or wounds to heal, which may increase the risk for amputation (or losing a foot or leg).

If you have diabetes, talk with your health care provider right away if you have any of these P.A.D. warning signs:

* Fatigue, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest.
* Foot or toe pain at rest that often disturbs your sleep.
* Skin sores or wounds on your feet or toes that are slow to heal.

Most people with P.A.D. do not have any symptoms. Guidelines released by leading vascular organizations recommend that people with diabetes over the age of 50 be tested for P.A.D. Testing is also recommended for people with diabetes under the age of 50 with other risk factors, such as smoking, high blood pressure or cholesterol problems. ~P.A.D. Coalition~

Encompass partners with Dialysis Clinics to secure complete diagnosis, care and treatment options for patients suffering from critical lower limb ischemia and foot wounds. The Encompass Network is a web base application that provides clinics with the tools for a thorough screening, systematic refereeing, and complete patient follow through from diagnosis to healing. Our user friendly system requires minimal staff time and the automated referring systems allow the attending physicians to review data and refer patient to a specialist based upon the patient assessment profile and easy “refer now” option. The assessment profile will keep the clinic informed with patient diagnosis, treatments and updates that go on outside of the clinic. You will see the results.

For questions, or to partner with Encompass Network Partners, contact:
Kelly Burleson, Director of Client Relations, kburleson@encompassnetworkpartners.com

Stop PAD Petition Drive to Expand Medicare Coverage to Test Patients for Peripheral Arterial Disease

2009-09-16T09:10:00.001-05:00

September 15, 2009 10:05 AM Eastern Daylight Time

THE SAGE GROUP Supports the “Stop P.A.D.” Petition Drive to Expand Medicare Coverage to Test Patients for Peripheral Arterial Disease

ATLANTA--(BUSINESS WIRE)--In recognition of National P.A.D. Awareness Month, Mary L. Yost, President of THE SAGE GROUP recommends that patients, relatives, and the medical community join the campaign to increase access to a simple noninvasive test to diagnose peripheral arterial disease (abbreviated P.A.D. or PAD).

This inexpensive test known as the ankle-brachial index (ABI) is a cost-effective method to detect disease in asymptomatic patients. Although Medicare currently offers testing for patients with symptoms, PAD is most commonly asymptomatic.

“Asymptomatic does not mean that the disease is benign. PAD is not just a leg problem,” declared Ms. Yost. Within 5 years, 50% of patients will experience a heart attack or stroke; 30% will be fatal.

PAD, also known as peripheral vascular disease (PVD), is characterized by a reduction of blood flow to the lower limbs due to atherosclerosis.

In the severe stages of PAD (critical limb ischemia or CLI) blood flow is so inadequate that ulcerations and gangrene occur. Once PAD has progressed to CLI, the risks of limb loss and mortality increase. At six months, approximately 20% of those with CLI will die; another 35% will experience amputation.

THE SAGE GROUP estimates that approximately 160,000 PAD-related amputations are performed annually in the U.S. “The tragedy is that early diagnosis and treatment could eliminate many of these amputations,” declared Yost.

Ms. Yost noted, “As the nation debates healthcare reform, it is important to keep in mind that early diagnosis is a key factor in reducing the costs of chronic diseases, such as PAD.”

If diagnosed in the early stages, PAD patients can be treated with the appropriate lifestyle modifications and drug therapies to reduce the risks of heart attack and stroke; exercise therapy to reduce the pain of claudication; or if blockages are more severe with minimally invasive revascularization technologies.

“However, if the disease is not diagnosed until critical ischemia occurs, interventional therapy is more costly. If gangrene is so severe that the limb cannot be salvaged the patient must undergo amputation, the most costly procedure,” Yost elaborated.

“Amputation is not only extremely undesirable from the patient’s viewpoint it is socially undesirable in terms of costs. The inability of a large percentage of these amputees to live independently adds significantly to the total cost burden,” stated Yost.

“Since the ABI test is generally not performed on asymptomatic PAD patients, significant numbers remain undiagnosed until they suffer a heart attack or develop ulcers and gangrene. In our opinion this needlessly increases overall costs,” Ms. Yost observed. “We have estimated that a 25% reduction in the number of amputations could save $2.9 billion in healthcare expenditures. Based on today’s procedure costs and long term care costs this is probably a conservative number,” she continued.

THE SAGE GROUP estimates that 16-17 million U.S. citizens currently have PAD and 2.2 to 2.7 million of them suffer from critical limb ischemia.

Additional information about PAD and vascular diseases can be found at the nonprofit Vascular Disease Foundation site at www.vdf.org.

To sign the petition, go to www.padcoalition.org/petition and complete the online form.

THE SAGE GROUP, an independent market research and consulting company, specializes in atherosclerotic disease in the lower limbs, specifically PAD (Peripheral Arterial Disease), CLI (Critical Limb Ischemia) and ALI (Acute Limb Ischemia).

Doctors aim to increase awareness of peripheral arterial disease

2009-09-09T10:54:00.001-05:00

Peripheral arterial disease is one of the most common types of cardiovascular disease - and also one of the least publicized, health officials say.

According to Dr. Robert Wilkins, a board-certified cardiovascular specialist with Southern Heart Center, a service of Hattiesburg Clinic, this lack of awareness could be deadly.

During September, which is "National P.A.D. Awareness Month," Wilkins and his colleagues Drs. Craig Thieling, Ben Rester and Randel Smith, are committed to increasing the public's knowledge of this disease.

P.A.D. affects about 10 million Americans and occurs when the arteries in the legs or other non-heart arteries become narrowed or clogged by fatty deposits or plaque. The buildup of plaque causes arteries to harden and narrow, a process called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced.

The most common type of P.A.D. is the extertional leg pain, burning or tightness known as "claudication."

When not diagnosed and treated early, this may lead to a severe decrease in leg blood flow, a condition known as "critical leg ischemia," a condition that can result in a possible amputation.

P.A.D. is a warning sign that other arteries in the body, including those in the heart and brain, may also be blocked.

This condition is associated with a high risk of heart attack, stroke and death.

Unfortunately, many people may not recognize their leg pain symptoms as P.A.D.

"People were not aware of the risk factors for this disease, the increased risk for heart attack and stroke associated with this disease, or simple diagnostic tests which can identify this disease," Wilkins said. "In addition, many people are not aware of the numerous non-surgical, minimally invasive treatment options for this disease."

Southern Heart Center has now developed a special P.A.D. treatment team including: cardiovascular medicine physicians and endovascular specialists, acute care nurse practitioners, physician assistants and nurses.

Southern Heart Center also has a number of events scheduled throughout September to increase public awareness of P.A.D.

These events include speaking to senior and civic organizations, presenting at Forrest General Hospital's Spirit of Women luncheon, and working with primary care providers in this region.

The center also will sponsor three vascular disease screening events. The screenings will be provided in Hattiesburg, Picayune and Magee.

"Our cardiovascular physicians have made themselves available to speak to any organization which wants to learn more about this very serious but often treatable disease" said Ken Smith, Southern Heart Center's administrator. "They are very passionate about the need to increase public awareness of the diagnosis and treatment of peripheral arterial disease."

For more information, visit www.hattiesburgclinic.com or call Southern Heart Center at 268-5800.

Top Warning Signs and Symptoms of Diabetes

2009-09-08T19:35:00.002-05:00

Many of the signs of Type 1 and Type 2 diabetes are similar. In both, there is too much glucose in the blood and not enough in the cells of your body. High glucose levels in Type I are due to a lack of insulin because the insulin producing cells have been destroyed. Type 2 diabetes occurs when the body's cells become resistant to insulin that is being produced. Either way, your cells aren't getting the glucose that they need, and your body lets you know by giving you these signs and symptoms.

Frequent trips to the bathroom:
Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can't filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom.

Unquenchable Thirst:
If it feels like you can't get enough water and you're drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you're running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.

Losing Weight Without Trying:
This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren't getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.

Weakness and Fatigue:
It's that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn't there or if the cells don't react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.

Tingling or Numbness in Your Hands, Legs or Feet:
This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.

Other Signs and Symptoms That Can Occur:
Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.

~By Debra Manzella, R.N., About.com~

Critical Limb Ischemia - Potential Solution and Treatment?

2009-08-20T08:42:00.001-05:00

Medical Quarterly
Metro Magazine
August 2009
Duke Testing New Stem Cell Therapy
By Rick Smith

The name is not commonly known and is difficult to pronounce, but the disease afflicts an estimated 12 million Americans. It’s called critical limb ischemia. Treatments are lacking and often require amputation, but help may be on the way: A potential solution for people afflicted with diabetes and obesity who are facing amputation of a limb due to circulatory problems caused by ischemia is soon to begin clinical testing at Duke Uni versity.
The disease causes narrowing and hardening of arteries, thus reducing blood flow. If not treated, victims can suffer nerve and tissue damage. The disease can also trigger gangrene, which often requires amputation.
In lab tests on animals, the use of stem cells not only improved blood flow, but also grew new blood vessels. Dr. Chris Kontos, co-director of the Duke Heart and Vascular Group, will be coordinating the trial that focuses on the stem cell regime developed by Pluristem Thera peutics.
But these are not embryonic stem cells, which have created so much controversy within the medical community. Rather, Pluristem, an Israeli biotherapeutics company whose stock is traded on the Nasdaq, is pioneering the use of stem cells derived from the placenta.
“There is no good medical therapy for critical ischemia,” said Dr. William Prather, who is a consultant with Pluri stem and helped pick Duke as one of the sites for the test. “There are surgical therapies that can clean out the vessels, but there is no medication or procedure to grow new blood vessels around the obstruction. That is what we have proved in animals.”
Duke is currently enrolling subjects for the trials for the Phase I tests of Pluristem’s PLX-PAD solution. A similar trial will take place in Alabama. “Both locations have used other companies’ cells in the past, so they are familiar with stem cell therapy,” Prather said.
Allogeneic Method
Pluristem is working on a variety of products that would enable stem cell transplants between unrelated donors and patients. The concept is called allogeneic, or “taken from different individuals.” The company wants to treat both severe ischemic and autoimmune disorders; it recently received funding support from the Israeli government.
The Pluristem method is not the first to use stem cells as a potential treatment for ischemia, Prather pointed out. How ever, the other choice is stem cells taken from bone marrow. Placenta cells are much more widely available, less expensive and don’t require donors to go through the surgical process to extract cells from the hip.
“We don’t have to do any of that with our cells,” Prather explained. “Our cells come off the shelf, they are one size fit all, they come from material that is thrown away, and outpatients can be injected in a process that takes 30 minutes. They are observed for six hours and then sent home.”
In late July, the first patient was injected with the proposed treatment in a clinical trial in Germany being run in parallel with the US tests. As many as 12 patients will be injected, with a mix of smokers, diabetics and obese subjects to be tested in the US.
Phase I trials focus on safety. If the treatment is found to be safe, Phase II trials would begin. The US Food and Drug Administration granted Pluristem approval for the Phase I trials earlier this year.
The treatment is intended for victims of “late stage” ischemia who have not responded to other treatments or surgery and face the prospect of amputation. People selected for the trial will already have a condition related to ischemia, such as an ulcer or nerve pain.
All test patients will receive one injection and half will receive a second, Prather said. There will be no placebos. Pluristem will track both safety and efficacy data over a three-month period following the injections. Although the primary “end point,” or goal of the Phase I trial, is safety, Prather said doctors also will be able to track whether the patients show improvement.
“In animal trials, we saw improvement in blood flow in about three weeks,” Prather explained. “I’m not sure we can equate that to three weeks in humans, though. We could get efficacy in blood flow within a month or two months of injection.”
Even if the treatment proves safe and ultimately is granted FDA approval for sale, Prather pointed out the healing process would not be a quick one. “If these cells are going to be effective, blood flow improvement will be a matter of weeks and months, not inject today and improve tomorrow,” he said. “It just takes time for a new blood vessel to grow.”
Duke and Pluristem agreed to partner on the trial after Pluristem came in contact with Dr. Brian Annex, a former physician at Duke. “He is a world-renowned leader in angiogenesis (the growth of new blood vessels),” Prather said. “He was in transition at the time when we talked last year, and he recommended that we work with Dr. Kontos. Annex later joined the Pluristem Scientific Advisory Board.
“We are very excited about the possibilities,” said Kontos, who hopes for the first patient injections to be made by the end of August.

Peripheral Vascular Disease

2009-08-12T14:29:00.001-05:00

There has to be knowledge in order to bring awareness...

From Wikipedia, the free encyclopedia

Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD) or peripheral artery occlusive disease (PAOD), includes all diseases caused by the obstruction of large arteries in the arms and legs. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. It causes either acute or chronic ischemia (lack of blood supply), typically of the legs.

Shammi Kapoor speaks about his battle with the little-known disease

2009-08-07T08:32:00.001-05:00

By: Hemal Ashar Date: 2009-08-06 Place: Mumbai

Celebrities are notorious for keeping their guard up, not letting the world see that their star (literally) has dimmed, that they are human after all. So former star Shammi Kapoor deserves a double yahoo for letting his defences down and giving the world a peek into his frailties.

The actor was at the Breach Candy hospital on Tuesday afternoon, along with a clutch of doctors to raise awareness about peripheral vascular disease. The relatively little known disease occurs when there is a blockage of blood flow from the artery to organs other than the heart.

In familiar territory

The SoBo hospital is familiar territory for the actor, (also a kidney patient) who takes regular dialysis at the hospital. Shammi is also a Chronic Obstructive Pulmonary Disorder (COPD) sufferer, where his lungs have been compromised. He arrived in a wheelchair; and ribbed the docs at the press conference, "Ah, you all are wearing ties today." He then asked in jest, "What do you want me to talk about? The last time I winked at a girl? Okay, okay, I will tell you about my experience with vascular disease."

Lost toes

The flamboyant Kapoor was afflicted with the disease last year. He said, "I lost a toe on each of my feet to vascular disease. I was saved from losing my limbs by timely medical treatment." He then revealed how he heard the doctors who were operating on him in the operation theatre. "I was given local anaesthesia, so I could hear the docs speaking: "Here I found it, hey milaa vein, oh artery.

The pain was so bad, I started shrieking, an anaesthetist clamped my mouth shut." He said gesticulating wildly to laughter by the docs. The docs admitted that Shammi started bleeding while the operation was on and his thigh had swelled to twice the size, underlining the gravity of this disease.

Finally, Shammi when urged to give a message to mark Vascular Awareness Day on August 6, told people to take timely medical help, with the same flourish he delivered lines like Chahe koi mujhe jungli kahe on screen.

What is peripheral vascular disease?

2009-08-03T09:02:00.001-05:00

Peripheral artery disease (PAD) is a heart condition similar to that of coronary artery disease and carotid artery disease. In PAD, the fatty deposits build up in the inner linings of the artery walls. These blockages restrict the blood flow circulation, mainly in arteries leading to the kidneys, stomach, arms, legs and feet.
In its early stages, a common symptom is cramping, or fatigue in the legs and buttocks during activity. Such cramping subsides when the person stands still. This is called “intermittent claudication.” People with PAD often have fatty buildup in the arteries of the heart and brain. Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.
There are two types of these circulation disorders:
Functional peripheral vascular diseases don’t have an organic cause. They don’t involve defects in blood vessels’ structure. They’re usually short-term effects related to “spasm” that may come and go. Raynaud’s disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
Organic peripheral vascular diseases are caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It’s caused by fatty buildups in arteries that block normal blood flow.
How is peripheral artery disease diagnosed and treated?
Techniques used to diagnose PAD include a medical history, physical exam, ultrasound, X-ray angiography and magnetic resonance imaging angiography (MRA).
Most people with PAD can be treated with lifestyle changes, medications or both. Lifestyle changes to lower your risk include stopping smoking, diabetes control and blood pressure. Become physically active; eat a low-saturated-fat, low-cholesterol diet.
PAD may require drug treatment, too. Drugs include medicines to help improve walking distance, antiplatelet agents and cholesterol-lowering agents (statins).

Alternatives to Amputation

2009-07-29T09:45:00.000-05:00

Amputation of an arm or leg should always be a last resort. That’s why Florence Davis of Hillside, NJ sought the help of a talented team of doctors at Newark Beth Israel Medical Center in an effort to save her leg.

For over a year, Davis struggled with a persistent foot wound that restricted blood circulation in her leg. The problem became so severe that doctors were considering amputating the leg. However, the vascular specialists at Beth Israel had other plans for their 81 year-old patient. Doctors applied a new ultra-cold catheter technique to open several blockages in the arteries—a technique that would save her leg without any surgery.

If you’ve ever sough medical advice for the treatment of a wound, you know that wound care can be a tricky ailment that can often spiral into other diseases due to complications and infections. Davis suffered from peripheral artery disease (PAD), but wasn’t aware that the condition could be life-threatening and seriously debilitating. If left untreated, people who exhibit symptoms of PAD are four to five times more likely to get a heart attack or stroke. The pain in Ms. Davis’ foot became so severe that she could barely walk. To make matters worse, she got a cut on her toe that refused to heal, so she turned to the Advanced Wound Care and Hyperbaric Institute at Newark Beth Israel Medical Center for help.

Doctors began aggressive wound treatment, but tests show that she had three blockages in the artery that runs from her hip to her toe. Circulation had to be restored, but Davis was not a candidate for the traditional vascular bypass surgery that transplants blood vessels from a healthy limb to replace blocked vessels. The wound care specialists at Beth Israel referred Davis to Madhu Salvaji, DO, one of a handful of New Jersey doctors who uses the Polarcath system to treat patients. This sophisticated form of treatment combines cold therapy and angioplasty (a procedure that involves using a balloon to open clogged arteries) to help prevent future blockages.

“Cooling the blood vessel down to -10 degrees Celsius as the balloon is inserted in the clogged artery, causes targeted cell death and alters the new cells that will replace them, greatly reducing the chances of a future blockage,” explained Dr. Salvaji. Altogether, Dr. Salvaji opened three blockages using a combination of cold catheter, stent placement and artherectomy, a delicate process of removing plaque from the artery walls.

“All I had to do was lie still,” said Mrs. Davis about the three minimally invasive procedures that were performed in stages. Within two weeks, the swelling in her foot disappeared, her toe was healed and she was back to her daily walking, shopping, and gardening.

For more information about advanced wound care or treatment for peripheral artery disease at Newark Beth Israel Medical Center, please call 1-888-SBHS-123.

Peripheral Arterial Disease (PAD)

2009-07-23T10:43:00.001-05:00

Peripheral Arterial Disease (PAD) is also known as atherosclerosis, poor circulation, or hardening of the arteries. PAD progresses over time at variable rates in each individual depending on the area of circulation effected and one's health and family history. The signs and symptoms of PAD may not arise until later in life. For many, the outward indications will not appear until the artery has narrowed by 60 percent or more.

One method the body uses to adapt to the narrowed arteries is the development of smaller peripheral arteries that allow blood flow around the narrowed area. This process is known as collateral circulation and may help explain why many can have PAD without feeling any symptoms.

When a piece of cholesterol, calcium or blood clot abruptly breaks from the lining of the artery or a narrowed artery blocks off completely, blood flow will be totally obstructed and the organ supplied by that artery will suffer damage. The organs in PAD most commonly affected and researched are the legs.

What happens if the disease worsens?

The severity of PAD depends on when it is detected and any pre-existing health factors; especially smoking, high cholesterol, heart disease or diabetes. In the later stages, leg circulation may be so poor that pain occurs in the toes and feet during periods of inactivity or rest. This is especially true at night. This is known as rest pain, which usually worsens when the legs are elevated and is often relieved by lowering the legs (due to the effects of gravity on the blood flow).

Critical Limb Ischemia

The most advanced stages of PAD can lead to Critical Limb Ischemia (CLI) . Here the legs and feet have such severe blockage that they do not receive the oxygen rich blood required for growth and repair of painful sores and even gangrene (dead tissue). This condition, if left untreated, may require amputation.

Workshop on Surgery cure for Peripheral Vascular Disease organised by Ruby Hall

2009-07-22T08:10:00.000-05:00

(I-Newswire) - Workshop on Surgery cure for Peripheral Vascular Disease organised by
Ruby Hall
- Surgeries performed on five patients -
Pune, Tuesday 20th July 2009: In a bid to spread awareness about breakthrough treatments of Peripheral Vascular Disease ( PVD ), also known as Peripheral Arterial Disease, Ruby Hall had organised a day-long workshop recently.
The workshop, conducted under the supervision of Dr Bhagat Reddy from Georgia, USA. Dr Shirish ( M.S ) Hiremath, Dr Dhanesh Kamerkar and Dr Chandrashekhar Makhale actually performed Endo vascular procedures on five patients, who were suffering from PVD.
For cases of PAD, someone requiring surgery the newly developed device called the Frontrunner is now available which works in a similar way like an excavator, which bore through the mud and sludge causing the blockage. “It is like an angioplasty and a by-pass surgery performed on the leg,” says Dr Kamerkar.
Dr. Shirish ( M.S. ) Hiremath, Director, Ruby Hall Clinic said, “Lower limb PVD is a serious threat to the Indian population especially because of our susceptibility to Diabetes. Since people with diabetes frequently have high blood pressure and high cholesterol levels, it further accelerates the development of atherosclerosis. Given that PVD in diabetes is largely asymptomatic, patient education plays a key role in preventing major complications later. While 82,000 people have diabetes-related leg and foot amputations each year in India, timely treatment can significantly reduce this number”.

The new technique of surgery, prevalent in the West for a couple of years has now been brought to India to help patients who have a high risk of surgery. By the use of a Frontrunner, surgeons can avoid major cuts and incisions on the patient’s body and open up the blockage with just a puncture, as in conventional Coronary Angioplasty.
The workshop, which has already been held at major cities like Bengaluru, Hyderabad etc. aimed to instruct doctors about new tools and techniques that they can learn to deal effectively with the threat of PVD .
PVD, a widely prevalent, progressive atherosclerotic disease that carries a high risk of limb loss, stroke, and premature death, which can affect anyone. It occurs when the arteries ( blood vessels ) that supply blood to various parts of the body become narrow because of the buildup of fatty deposits on the inside walls of the blood vessels of the heart ( coronary artery disease ), brain ( cerebrovascular disease ) and kidney ( renal artery disease ). Because of this, people with PVD have a higher risk of heart attack, stroke or kidney failure.
Dr. Shirish ( M.S. ) Hiremath who has the largest volume of Angioplasties, explained how cardiologists have got involved in managing leg issues.” Basically the process of atherosclerosis ( aging of the arteries ) is same all over the body. Measures taken to avoid atherosclerosis help both “Heart and Health.” Also, with enormous expertise in Heart arteries, Dr. Shirish ( M.S. ) Hiremath, feels they are very adapt to performing leg Angioplasties.
The doctors warn that people with PVD, if not treated are likely to undergo amputation of the limbs. “If people have better tools available to them, the results in treating patients can improve drastically. Thus, the workshop is beneficial not just to doctors and a boon to patients suffering from PVD, but to the whole society at large,” acts Dr Kamerkar.
One of the patients, Suhas Patil, who got operated said, “ I was suffering from daibetes from a very long time but I was not aware of PVD. When the doctors informed me about it, I had lost all hopes. There are many such people like me who are not aware of such consequences Such kind of workshops should be organized on a regular basis to make people aware about the disease. I would like to thank all the doctors who helped me in understanding the effects of the disease and guided in the right direction.”

PAD | Are You at Risk for Peripheral Arterial Disease?

2009-07-21T11:32:00.000-05:00

PAD | Are You at Risk for Peripheral Arterial Disease?
Tuesday, July 21, 2009
From: thebpmonitor.com

You walk a block, then clutch your leg with what feels like a charley horse. You stop, and the pain does too. The discomfort may be a warning of a common yet serious condition called peripheral arterial disease (PAD).
In PAD, the same fatty material that can clog heart arteries builds up in the arteries of the legs, blocking blood flow. The risk for death from heart attack or stroke is six to seven times greater in people with PAD is equivalent to the risk of someone who has had a heart attack or stroke. Without prompt treatment, one in four people with the condition will suffer a heart attack, stroke or amputation or die within five years.
PAD is most often recognized when it causes claudication and fatigue, cramps, tiredness or pain in the leg or buttock muscles that goes away when you stop walking. Less frequently, it can cause ulcers or slow-healing wounds on the feet or toes, or pain in the feet or toes that disturbs sleep. However, as many as half to two thirds of those with the condition have no symptoms.
As with coronary heart disease, key risk factors for PAD are having diabetes, smoking or having smoked, and being over age 50. “If you have no other risk factors, age alone will increase risk and yet risk rapidly increases even in younger people who smoke or have diabetes,” says Alan T. Hirsch, M.D., professor of epidemiology at the University of Minnesota School of Public Health in Minneapolis. “We want people to recognize that if you are over 50 and have any other risk factor, you have a one in four chance of having this disease.”
Also at risk are African Americans and anyone with chronic kidney disease, high blood pressure, high blood cholesterol or a personal or family history of vascular disease, heart attack or stroke. An estimated 8 to 12 million people in this country have PAD.
If you have risk factors, talk to your doctor, whether or not you have symptoms. The PAD Coalition, a consortium of health organizations and government agencies, recommends that those at risk get a quick, painless, accurate and inexpensive diagnostic test called an ABI (ankle-brachial index).
The good news: PAD is both preventable and is very treatable. “PAD is a common and serious disease, which merits immediate and lifelong attention,” says Dr. Hirsch. “Become informed and take actions to protect your health.” Arms for Legs While exercise is helpful for people with PAD, walking is a typical workout for sufferers but can also be painful. Diane Treat-Jacobson, R.N., Ph.D., assistant professor at the University of Minnesota in Minneapolis, has done studies on the effects of exercise on people with this disease.
She recently discovered that supervised training using aerobic arm exercise was as beneficial as treadmill walking in improving walking distance. Treat-Jacobson notes that while results are preliminary, arm exercise might be a pain-free option that can “help break the cycle of disability or enable patients to start exercising sooner after a surgical procedure.”
Remember that peripheral arterial disease is both preventable and very treatable, but it is a a common and serious disease which merits your attention if you have any of the symptoms addressed in this article.
It is up to you to become informed about this disease and take active action to protect your health.

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2009-07-20T17:11:00.003-05:00

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HEART TO HEART: Understanding PVD

2009-07-20T09:29:00.000-05:00

HEART TO HEART: Understanding PVD
DR HAIZAL HARON KAMAR
Monday, July 20th, 2009 02:52:00

STAND up. Feel the ground beneath you. Is it firm? Walk around and jump up and down. Go kick a ball. Now look at your feet. Look at them hard.
Why have I asked you to do this? What is my point?

For most people, this is not something that we think of consciously. The ability to stand and walk is what all of us learned to do months after birth. It is a natural part of our everyday life.
Unfortunately, the same cannot be said of Ibrahim (not his real name). He had his left leg amputated above the knee in March this year. His right leg followed two weeks ago. His life will never be the same again.

Ibrahim is a 60-year-old man with peripheral vascular disease (PVD). It is an occlusive arteriosclerotic disease affecting the arteries to his legs.

He also has diabetes, hypertension and high cholesterol.

Although he does not smoke, he has the other risk factors for severe PVD.

His problem started in the middle of last year. He complained of cramp-like feeling at the back of both calves when walking. The medical term for this symptom is intermittent claudication.

After a few weeks, he began to notice the walking distance it took for the claudication pain to come on was becoming less.

In late November, he noticed a small wound on the sole of his left foot. He had no recollection of how he sustained it. He had been having numbness in his feet for some time before that and he attributed it to his longstanding diabetes. When he sustained the wound to his foot, he had no knowledge of it till later.

Ibrahim has had diabetes, hypertension and high cholesterol for more than 10 years. He was not diligent in taking his medications or clinic follow-up appointments.

Instead, he resorted to traditional treatment to help heal the wound. By the middle of February, the wound had become worse. It was bigger and the whole foot was in pain even at rest.

When he eventually came to the hospital two weeks later, all his left toes were black and gangrenous. Infection had already spread to the bones of his foot. He had osteomyelitis.

He initially refused medical advice to have a below-knee amputation. He insisted on the medical team to perform a miracle to save his leg. Unfortunately, despite aggressive treatment with intravenous antibiotics and regular wound care, his leg could not be saved. As I am writing this, Ibrahim is recovering in the hospital from his second amputation. Sadly, his case is not isolated.

He is just 1 of about 10,000 diabetics whose legs are amputated in Malaysia every year, where 40 to 50 per cent of these cases are preventable.

Did you know that patients with PVD have a four-fold risk of death from heart attack and heart-related diseases, and a two to three times greater risk of stroke?

Diabetics are two to four times more likely to get PVD and for those who also smoke, the risk of having an amputation is 30 per cent in the next five years. With the rising number of diabetic patients, which currently stands at 14.9 per cent in Malaysia for those above 30 years of age, PVD is fast becoming an epidemic.

As a clinical condition, PVD is grossly neglected, vastly underdiagnosed and badly managed. As with Ibrahim
and thousands others, severe PVD leading to critical limb ischaemia (painful leg at rest, non-healing wounds and gangrene) is the first presentation to the doctor. Chances of a good recovery will be smaller at this stage.

For some, it may even be too late.

Ignorance is the main cause of the rising number of PVD cases worldwide. Perhaps we place too much concentration on the symptoms and signs of heart attack and stroke that we tend to neglect PVD, the third commonest manifestation of cardiovascular disease.

To halt the growth of this serious disease, drastic measures need to be instituted before the situation gets out of hand.

Early identification of patients at risk of PVD, aggressive risk factor modification and timely referral to the vascular surgeon in severe cases is vital.

If you are diabetic or at high risk of getting PVD, please consider the following:
● Watch your diet. It has to be low in sugar and fat.
● Take your medicines as prescribed. Follow the advice of your doctor.
● Stop smoking.
● Exercise regularly.
● Take care of your feet. Make sure they are clean and dry at all times, especially in the spaces between
the toes.
● If numbness develops on the soles of your feet, take appropriate measures to protect your feet from accidentally having a cut.
● If you have any of the PVD symptoms and signs (claudication or critical limb ischaemia), see a doctor straight away.

Once you see a doctor, he may order an ankle-brachial pressure index (ABPI) test. It is a measure of the fall in blood pressure in the arteries supplying the legs compared to the pressure in the arms. A reduced ABPI (less than 0.9) is consistent with PVD. Values of ABPI below 0.8 indicate moderate disease and below 0.5 severe disease.

These days, CT angiogram which is a non-invasive imaging test, is being used on a wider basis to visualise the extent of the disease. Based on this and the clinical picture, the vascular surgeon will advise on the best treatment from the available options which are:

● Conservative measures with medicines and life style modification only.
● Angioplasty, which is the opening up of narrowed arteries using special balloons inserted through the groin. This is the preferred option in certain cases especially in those at high risk of surgery.
● Bypass surgery using either the saphenous vein from the leg or an artificial graft to circumvent the blockage in the artery.

If you have any questions or comments, feel free to write to me at haizal@tropicanamedicalcentre.com. See you next Monday.

Saving limbs with drug-eluting stents

2009-07-19T10:48:00.002-05:00

July 16, 2009
Saving limbs with drug-eluting stents
Filed under: Uncategorized — reducedapmiami @ 1:55 pm

Attempts to explore deprecatory limb ischemia in peripheral arterial disorder (PAD) patients with unworthy of-the-knee angioplasty are still thwarted by restenosis (the re-narrowing of the artery at the situate of angioplasty or stenting), the extremity due to the fact that replay treatments and the continued progression of atherosclerotic complaint, leading to tissue death (gangrene) and amputation.

Interventional radiologists have been studying a potential solution - the use of drug-eluting stents - and have found that these types of stents lessened the rate of repeat procedures to open these small arteries, according to results presented at the Society of Interventional Radiology’s 34th Annual Scientific Meeting.

“This is encouraging news for PAD patients with critical limb ischemia. The smaller blood vessels below the knee are more difficult to treat due to their size (3 millimeters) and are more prone to reclog than larger vessels. The use of drug-eluting stents in the tiny infrapopliteal arteries of the leg may significantly impact their care,” said Dimitris Karnabatidis, M.D., assistant professor of interventional radiology at Patras University Hospital in Rion, Greece. “Drug-eluting (or drug-coated) stents have emerged as a potential solution to the limitations of endovascular treatment of PAD patients with critical limb ischemia,” he added. An interventional radiologist performs a balloon angioplasty to open a clogged blood vessel and then places a drug-eluting stent in that artery. The stent acts as scaffolding to hold the narrowed artery open. Drug-eluting stents slowly release a drug for several weeks to block cell proliferation or regrowth, thus inhibiting restenosis.

Researchers from a single center studied 103 patients in a double-arm prospective registry who had critical limb ischemia and who underwent infrapopliteal revascularization with angioplasty and placement of either a drug-eluting stent (with sirolimus, an immunosuppressant drug) or a bare-metal stent (without a drug coating). The patients had regular follow-ups up to three years, and researchers studied how they did by stent type. In the first group, 41 patients (75.6 percent diabetics) were treated with bare-metal stents, and in the second group 62 patients (87.1 percent diabetics) were treated with drug-eluting stents.

At three years, those patients with drug-eluting stents had “significantly higher patency” (length of time the blood vessels stayed open and moved blood flow efficiently); reduced restenosis of the vessels; and consequently less clinical recurrence requiring repeat angioplasty, said Karnabatidis. “In the drug-eluting stent group, an estimated 60 percent of the treated arteries remained open at three years. This is significantly longer than the bare-metal stent group, where the arteries remained open only approximately 10 percent at 3 years,” said Karnabatidis. “This corresponds to a more than 5 times increased risk of vessel reclogging when bare metal stents were used,” he added. “Because of the reduced vessel restenosis, repeat angioplasties were necessary in only 15 percent of the patients in the drug-eluting stent group versus almost 35 percent in the bare-metal stent group up to 3 years - this being the equivalent to an almost 2.5-fold risk of repeat procedures in the case of bare metal stents,” noted Karnabatidis. “These statistical results are based on three-year adjusted survival analysis after application of a Cox model for multivariable analysis,” he explained.

If a person has critical limb ischemia, it means he or she is at great risk for tissue death due to lack of blood flow, which carries oxygen and nutrients to the cells. The severely restricted blood flow results in severe pain in the feet or toes, even while resting, and sores and wounds that will not heal. Tissue death (gangrene) and amputation are imminent at this advanced stage of PAD, which is caused by atherosclerosis, the hardening and narrowing of the arteries over time due to the buildup of fatty deposits called plaque.

“Multicenter randomized trials are necessary to support these promising results and build on the level of clinical evidence supporting the integral value of infrapopliteal drug-eluting stents in critical limb ischemia treatment,” he added. In the United States, drug-eluting stents are FDA-approved for the coronary arteries but not for infrapopliteal arteries. In Europe, drug-eluting stents have CE Mark approval for below-the-knee use.

http://www.sirweb.org/

Critical Limb Ischemia

2009-07-16T16:08:00.002-05:00

From Woundresearch.com

Critical Limb Ischemia
PUBLICATION DATE: Aug 01 2008
Issue:
8

author:
Laura Bolton, PhD, FAPWCA

Dear Readers:
Critical limb ischemia (CLI), the most severe stage of peripheral arterial disease, affects 250,000 new patients annually in the United States with an estimated 40% requiring amputation within 12 months of a CLI episode, in addition to an annual mortality rate of more than 20%.1,2 Distal bypass surgery prompts healing of lower extremity ulcers associated with CLI if resulting arterial patency supports skin perfusion pressure of at least 35 mmHg.3 Surgical bypass of the occluded arterial segment improves3,4 and extends primary arterial patency, though there is insufficient evidence to support improved amputation rates or mortality compared to most other modalities.4 What options are available to the individual for whom bypass surgery is no longer feasible? This month’s Evidence Corner reviews two studies evaluating efficacy of modalities for treating CLI in patients without further vascular surgery options, as the search for an effective treatment of CLI continues.
Critical Limb Ischemia
Reference: Kavros SJ, Delis KT, Turner NS, et al. Improving limb salvage in critical ischemia with intermittent pneumatic compression: a controlled study with 18-month follow-up. J Vasc Surg. 2008;47(3):543–549.
Rationale: Intermittent pneumatic compression (IPC) is a noninvasive method of increasing arterial circulation and ameliorating intermittent claudication in patients with peripheral arterial disease (PAD).
Objective: Evaluate clinical efficacy of IPC in patients with chronic CLI, nonhealing foot ulcers, and minor toe or transmetatarsal amputation after further options for arterial revascularization had been exhausted.
Methods: This retrospective cohort study compared two similar groups, each consisting of 24 consecutive patients, for whom further surgical bypass was not an option, and were cared for in a multidisciplinary community clinic from 1998–2004. Resting ankle-to-brachial ratios of systolic blood pressure (ABI), sitting transcutaneous oximetry (TcPO2) duplex graft surveillance, and foot radiography confirmed vascular status. Both groups received weekly debridement and biologic dressings for tissue loss and nonhealing amputation wounds of the foot due to CLI. Intermittent pneumatic compression allocation was based solely on a patient’s willingness to use it. The IPC inflation pressure was 85 mmHg to 95 mmHg and was applied for 2 seconds with a 0.2-second rise, 3 cycles per minute, for three 2-hour daily sessions. Adherence was monitored closely. Healing outcomes were “favorable” if complete healing with limb salvage occurred during 18 months. Outcomes were considered “adverse” if nonhealing caused below-knee amputation during that time.
Results: Groups were comparable at baseline on all arterial and wound parameters; prior amputation and comorbid factors were assessed. Four patients (17%) in the control group and 14 IPC (58%) patients healed (P < 0.01). The likelihood of limb loss in the control group was 7 times that of IPC subjects who also increased in TcPO2 (P = 0.0038).
Authors’ Conclusions: When used within a protocol of standard wound care, IPC significantly improves clinical healing and below-knee amputation outcomes of patients with inoperable CLI. This research sets the stage for rigorous prospective, multicenter, randomized, controlled trials (RCTs) of IPC to establish its role in healing while clarifying its indications for use.
FGF-1 Gene Therapy Decreases Amputation Rates in Patients With CLI
Reference: Nikol S, Baumgartner I, Van Belle E, et al. Therapeutic angiogenesis with intramuscular NV1FGF improves amputation-free survival in patients with critical limb ischemia. Mol Ther. 2008;16(5):972–978.
Rationale: Although controversial, with its long-term effects under scrutiny, angiogenic growth factor therapy has been proposed for treatment of critical limb ischemia in end-stage PAD. Acidic fibroblast growth factor (FGF-1) is a potent mitogen for vascular endothelial cells, inducing blood vessel formation in vitro and in vivo. A plasmid-based gene transfer delivery system for FGF-1, NV1FGF with “Conditional Origin of Replication” (pCOR), reduces the potential for propagation in the host environment while sustaining local FGF-1 production permitting less frequent treatment.
Objective: A Phase 2b, double blind, randomized, placebo-controlled clinical trial investigated the efficacy and safety of intramuscular NV1FGF versus placebo in subjects with CLI at high risk of amputation.
Methods: A European multicenter trial screened 125 patients with CLI ineligible for revascularization as confirmed by a vascular surgeon. Each patient had at least 1 nonhealing ulcer, a TcPO2 £ 20 mmHg, ankle pressure
£ 70 mmHg, and toe pressure £ 50 mmHg. Patients were randomly assigned to receive 8 intramuscular injections of 2.5 mL NV1FGF in a 0.2 mg/mL solution (n = 59) or similar placebo injections (n = 56) on study days 1, 15, 30, and 45. Percent of patients with at least 1 ulcer completely healed at week 26 was the primary outcome. Secondary outcomes TcPO2, ABI, amputation, and death were evaluated at week 52.
Results: Among 107 subjects evaluated for healing, 19.4% of NV1FGF-treated and 14.3% of control patients healed during 26 weeks (P = 0.514; not significant). Likelihood of amputation or of major amputation was reduced in the NV1FGF group (P = 0.011), which also experienced improvement in time to death or major amputation. No other secondary outcomes were statistically significant. Adverse events were comparable in both groups, supporting the safety of NV1FGF.
Authors’ Conclusions: This was the first double blind, prospective RCT in patients ineligible for bypass surgery. Despite the fact that no improvement in wound healing was seen it showed the potential for NV1FGF to significantly reduce amputation risk, potentially lowering mortality rates in these high-risk patients.

Clinical Perspective
Both publications aim to improve the lot of patients with serious vascular impairment, using either biochemical or physical modalities. Plasmid gene transfer of NV1FGF administered once every 2–3 weeks for the first 7.5 weeks of care appears to save limbs, though its effect on ischemic ulcer healing remains uncertain. Other plasmid growth factors either lack healing and amputation effects5 or heal wounds without reducing amputation.6 The capacity to save limbs in high-risk patients for whom surgery is no longer an option is equally compelling for NV1FGF and IPC. Limb salvage plus the healing benefits of properly applied IPC are unprecedented, although it was a small retrospective study and was potentially biased by selection of IPC-willing patients. Larger prospective RCTs on patients with CLI, perhaps comparing IPC with and without NV1FGF, would seem necessary. As a physical modality, IPC may be compatible with gene or biochemical therapy. These studies open potential care options for patients with CLI who are faced with possible amputation.

References:
1. Dormandy J, Heeck L, Vig S. The fate of patients with critical leg ischemia. Semin Vasc Surg. 1999;12(2):142–147.
2. Dormandy J, Mahir M, Ascady G, et al. Fate of the patient with chronic leg ischaemia: A review article. J Cardiovasc Surg. 1989;30(1):50–57.
3. Tsuji Y, Hiroto T, Kitano I, Tahara S, Sugiyama D. Importance of skin perfusion pressure in treatment of critical limb ischemia. WOUNDS. 2008;20(4):95–100.
4. Fowkes F, Leng GC. Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD002000.
5. Powell RJ, Simons M, Mendelsohn FO, et al. Results of a double-blind, placebo-controlled study to assess the safety of intramuscular injection of hepatocyte growth factor plasmid to improve limb perfusion in patients with critical limb ischemia. Circulation. 2008;118(1):58–65.
6. Kusumanto YH, van Weel V, Mulder NH, et al. Treatment with intramuscular vascular endothelial growth factor gene compared with placebo for patients with diabetes mellitus and critical limb ischemia: a double-blind randomized trial. Hum Gene Ther. 2006;17(6):683–691.

Diabetic Footwear

2009-07-16T11:13:00.002-05:00

From: Living and Coping with Diabetes

Diabetic Footwear
Jul 16th, 2009 by diabetes-blog
Foot pain affects many diabetics…

We received a tweet a from someone who wanted to recommend a brand of diabetic socks and foot wear that was very helpful in alleviating foot pain for his dad. We have not tried this brand personally… however, we wanted to share this information with you all in case someone may find a benefit from this type of product. Below you will find a brief synopsis of information along with the website.

Celliant/Health Sport socks and support braces, elbow sleeves are a newly created product. The Celliant yarn is patented and has been clinically proven to increase oxygen in the body, reduce pain, and help regulate body temperature.

Increased oxygen is known to promote quicker muscle recovery and healing. Increased circulation is a great thing for DIABETICS. My father is a Type II diabetic and he swears by the socks. Our product increases oxygen levels by up to 12%. You can look at the test and research results on our site www.clinicalcloset.com.

-Nick Lyle

http://twitter.com/nelyle

If you find this information helpful or if you know someone that may benefit from this type of service please pass this link on.

Here 2 Serve U

@DiabetesSupport

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