Thursday, March 25, 2010
Thursday, March 18, 2010
Preventing amputations in patients with diabetes and chronic kidney disease
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 ~
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 ~
Wednesday, March 17, 2010
Foot Care
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 ~
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 ~
Friday, March 12, 2010
Preventative Foot Care in Hemodialysis Patients
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.
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.
Monday, February 15, 2010
Hunterdon Medical Center among first to use artery cleaning device
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.
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.
Thursday, February 11, 2010
KDOQI To Update Diabetes Guideline
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.
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.
Monday, February 1, 2010
Men More Likely to Suffer from Diabetes Complications
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.
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.
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