STAY WELL & SPARKLE – Too Many Amputations

AmputeeOscar Pistorius of South Africa is an outstanding Olympian – so much more!

Though he had both legs amputated when only 11 months old, he is strong and swift – unlike many of the amputees locally.

Why? A high percentage of amputations result from Diabetes. A world wide epidemic is raging. Dominica ranks 4th in the region for obesity – way too high. The Diabetes rate closely mirrors the obesity rate. So, excluding other causes such as trauma, the more Diabetes increases, the more the amputations. Diabetes is no respecter of persons. Rich or poor, town or country, educated or not, everyone should take note, especially if a close blood relative suffers from the condition.

Three top reasons for seeking medical attention:

  1. Blood
  2. Pain
  3. It looks bad

At first, Diabetes does none of these. Relatives and friends could be diabetic for years and you’d never know, unless they told you. Patients tend to have an alarminglycavalier attitude toward their blood sugar, checking it only once in a while. That is despite accessible clinics and numerous free health fairs at a location near you. Indeed, you can bring water to the horse, but you cannot make it drink. Many Dominicans boast two phones: a Lime and a Digi. Yet they don’t own a glucometer, a cheaper blood-checker that helps lives.

 

Too sweet

The supreme irony is that in everyday language, sugar is something so appealing. We describe nice, gentle people as having sweet personalities. We sing, ‘It’s so sweet to trust in Jesus.’ In the Southern United States, for instance, “Gimme some sugar” can mean different things. In fact, sugar in western culture is now being regarded as a toxin. To admit helplessly having a ‘sweet tooth’ may not be so funny after all. Out-of-control sugar silently wreaks havoc on human flesh. Elevated glucose attacks the nerves and damages blood vessels. It targets the eyes (blindness) and kidney (failure leading to dialysis). This makes Diabetes a very expensive and debilitating disease over the long run, both for families and for the country.

Once it leaps out of the barn, it takes off  like wildfire. It might look like an ordinary ‘bow-bow’ one day. Before you know it, the infection does not heal and it is down to the bone. Next thing, they are talking gangrene and amputation of a toe, foot or part of a leg. Like moving beyond only extractions in basic dentistry, Princess Margaret Hospital should utilize the capacity for surgical procedures to restore circulation (bypass) instead of automatic amputation.

In Dominica, amputees’ quality of  life plummets. They often end up dependent and incessant beggars – the bane of visitors, shoppers and vendors alike. Growing up, I knew a handful of amputees. Today, it seems as prevalent as in any of those strife-torn, hacking off, blowing up, God-forsaken countries we routinely see about on the World News. We have a problem. If you are close to a large hospital centre which may have artificial limbs not being used, let’s arrange to get some of these here to help restore mobility to our people.

 

Let’s turn things around

We place children at real risk bringing them up on over-sweetened juices, soft-drinks and sugary snacks.  This one thing is clear. We have to take diabetes management up a notch. The Dominica Diabetes Association and the Health Promotion Unit is doing a terrific job fostering a healthy diet, regular exercise and blood sugar monitoring. They provide important medical advice regarding taking of pills or insulin. No disrespect, but okra, cinnamon, coconut water and bush tea is not enough. Go by the numbers. Listen to those who have dedicated years of formal training to caring for this condition.

7 important reminders:

  1. Avoid the Cinderella Sister Complex.While growing up, some males feel bashful about having big feet. As working adults, they discover that is not such a bad thing after all. The price of  beauty: high-heeled females have a tougher time avoiding tight or narrow shoes. Confirmed diabetics should shop carefully or even special-order shoes that better cushion feet, support the arch and distribute weight evenly.
  2. Trim your nails carefully. Get help if you get cut. Check your feet once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. Any foot sore which that doesn’t begin healing within a few days needs medical attention. Ask someone to help if you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet.
  3. Wash your feet everyday. Dry them gently, especially between the toes. Sprinkle powder or cornstarch between your toes. Use coconut oil, Vaseline or lotion on the tops and bottoms of your feet to keep the skin soft.
  4. Don’t remove calluses or other foot lesions yourself. To avoid injury to your skin, don’t use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Don’t use chemical wart removers. See your medical professional for removal of any of these lesions.
  5. Don’t go barefoot. To prevent injury to your feet, don’t go barefoot, even around the house. Wear clean, dry socks.  Avoid socks with tight elastic bands that reduce circulation, as well as thick socks that often fit poorly and irritate your skin.
  6. Smoking is not an option. Some people will cork their ears and that’s their right. It’s their body. However, the evidence shows conclusively that any kind of smoking harms the circulation. It reduces delivery of  life-giving oxygen in the blood. The result: more severe wounds and poor healing. Your doctor can help you quit even if you just thinking about doing so.
  7. Schedule annual foot exams. Your visit cannot be the usual ‘brap, brap…next!’ Diabetics should make sure their nurse practitioner or doctor takes the time to inspect their feet properly – at least once a year. This should involve checking the pulses and use a bristle to evaluate changes in sensation.

Oscar Pistorius is not diabetic so expect to hear much more about his exploits. Amputation can happen to anyone, but certain medical conditions render us in the bulls-eye. Eat a more plant-based diet, exercise regularly and stay on top your blood sugar. Diabetic complications are designed to be avoided. People are not like crabs that can just drop a leg and carry on. The polls overwhelmingly show that all of you, and all of me, do better in one piece.

Dr. Sam Christian is a general surgeon who manages the Urgent Care at 137 Bath Road. It is a facility for general medical care, surgery and acupuncture at short notice. He is author of the faith and fitness book, ‘Mannafast Miracle’ and a former Major and Battalion Surgeon in the US Army Reserves. He serves as Medical Officer of the Dominica Cadet Corps and Medical Advisor of the Dominica Cancer Society. He can be reached anytime at 440-9314 / 613-8345 or [email protected]

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24 Comments

  1. Olivet Thomas
    September 7, 2014

    Dr Sam. Good information. Diabetes is a known killer of black people. Everyone should get checked yearly especially if there Is a history of diabetes in the family. Keep up the good work. God bless

  2. Francisco Telemaque
    July 30, 2014

    Diabetic Ketosis and Acidosis

    When inadequate quantities of carbohydrate are enviable for storage, and utilization, there is an overproduction of ketone acids from partial combustion of fat. The appearance of ketone acids with sugar in the urine of a diabetic patient usually indicates a dangerous reduction in carbohydrate reserves, and demands immediate treatment with insulin. Ketonuria without glycosuria can be produced by severe carbohydrate restrictions in normal or diabetic individuals.

    In the diabetic, Ketonuria without glycosuria is a rare occurrence except when caloric needs are increased by hyperthyroidism or infection. In this case, the appearance of ketone acids calls for the administration of more carbohydrate, with enough insulin to ensure its storage and utilization. Heave glycosuria, and ketonuria are accompanied by a decreasing body weight which reflects both the loss of necessary foodstuffs, and the loss of body water with its associated electrolytes-sodium, bicarbonate, and chloride from the blood plasma, and interstitial fluid, and potassium, phosphate, and protein from the cells.

    (I may add here by this time the patient will experience some serious halitosis, which is an offensive odor of the breath; ” bad breath).

    As the excretion of the strong ketone acids dangerously depletes the body’s reserves of sodium, potassium, and water, any slight upset may precipitate acidosis. In this malnourished and depleted state, this patient is easy prey to an infection, which is a frequent cause of acidosis.

    Symptoms

    The appearance of marked polyuria, weakness, and somnolence should warn the patient that the diabetes is dangerously out of control. As the acidosis becomes more marked, anorexia nausea, and vomiting appear, sometimes accompanied by diffuse abdominal pain. The odor of acetone on the on the breath becomes more obvious; breathing becomes deep, and slow as acidosis leads to the air hunger. That I will not touch on so as not to be too long. Nevertheless the patient shows a curious cutaneous flush in spite of the shock- like state of the circulation; and somonlence deepens to stupor, and finally coma. The blood shows hemoconcentration, leukocytes, hyperglycemia, and a profound reduction in the carbon-dioxide-combining power.

    I can go into the treatment at this point, nevertheless, I will leave it to idiots such as The Facts, to go on the internet, on a website and find the treatment. I did not have to write this one, but when people who has no name, nobody I term them opens their mouth on me, I have to prove to them that they are nothing more than fart, blowing for just a short second.

    Refute that, if you can or find it on your internet and present it verbatim.Make me look small! If you want more I can write a book on the subject.

    Francisco Etienne-Dods Telemaque

  3. Francisco Telemaque
    July 28, 2014

    If I read something, that is beyond my comprehension, or my educational background, I would simply shut up and not make an idiot of myself, none of the three who gave me the thumbs down can identify themselves and say why they disapprove, because they would not know what the heck they are talking about. Knowledge is power, and I am equip with medical and scientific knowledge which I can use to save any of the three idiots life if the time ever came: So, just read me and be quiet, your jealousy will not help you!

    Physiology:

    If glucose is not used because of lack of insulin, a chain of events occurs; first, a rise in blood sugar takes place above the normal limits of 80-120 mg. per 100 cc., due to inability of renal tubular phosphorylation to keep pace with the excess of sugar. In diabetes of long standing, however, adaptation apparently takes place, and glycosuria may not appear with blood levels up to 0.25-0.3 Gm. per 100 cc. The sugar available for excretion is first derived from ingested glucose. This normally would be oxidized, converted to liver, and muscle glycogen, or used in the synthesis of amino acids and fatty acids.

    Failure of utilization soon results in glycolysis of liver glycogen. By an unknown mechanism, a falling liver glycogen results in increased mobilization of fats as fatty acids to be brought to the liver. Similarly, failure of amino acid; and hence protein synthesis prevents correction of the breakdown of tissue proteins required to provide amino acids to the liver for gluconeogenesis. The excessive mobilization of fat has two consequences. The normal end products of fat metabolism in the liver are acetic acid and acetoacetic acid.

    These normally enter the blood and are burned primarily in the muscles, at a rate equal to that of their formation. In the presence of diabetes the formation of these products is in excess of that which can be handled. Interconversion of acetic acid excess than occurs in the liver to form ketone acids, and acetone. The unchecked breakdown of tissue proteins results in excessive deamination with the loss of nitrogen to the body as urea nitrogen, and of the glucose thus formed, as glycosuria. Glucose excretion carries with it body water. A negative potassium balance follows the breakdown of proteins and the loss of intracellular water as dehydration progresses.

    This potassium loss appears early. Note: The underutilization theory currently does not imply, as formerly, that glucose utilization stops completely; the brain and other tissues have an inherent, though limited, capacity to use sugar independently of insulin.

    Insulin:

    Insulin is secreted from the beta cells of the islets of Langerhans in the pancreas. It is an incomplete protein protein lacking in methionine, rich in cystine, and depending on the disulfide bonds of cystine for its activity. Its molecular weight is approximately 35,000; hence the immediate consequence of insulin lack is hyperglycemia, while an excess causes hypoglycemia. The mechanisms of action of the hormone are largely unknown. The main metabolic disorder for which insulin is used therapeutically is diabetes mellitus. Here also, the pathologic mechanism which results in the disorder are obscure. In general, insulin opposes those other endocrine secretion which serve to mobilize glucose or decrease its utilization.

    Finally the metabolism of carbohydrate, fat, and protein are highly interrelated. Hence, derangement in the metabolic pathway of one ultimately causes serious interference with the metabolism of the others.

    Francisco Etienne-Dods Telemaque

    • The Facts
      July 29, 2014

      We can get this over the Internet, on certain health Websites. I have read much about that and more..

    • Francisco Telemaque
      July 30, 2014

      If your comment is in regards to what I wrote, I challenge you here and now to go to your website, and copy, and post it here verbatim prove yourself smart.

      You can’t! Most of you are so damn lie, all you can do is critique, again I say to you and you kind, I am a health science major, my knowledge came out of medical school, even if I did not graduate as a medical doctor, I am certain I can save the stupid life!

      You all talk crap, prove me wrong, Go on your website and get it as I wrote and post it here word for word, if you do not understand the meaning of verbatim.

      Some of you are so damn sick, its not funny. I am not here to compete with people like you, or anyone, If I write something, and it helps someone, so be it.Your intelligence is beneath mines anyway, so what’s the point?

      Again I will say yours, and the jealousy of people like you will never give you the academic education that I possess, if you are an idiot, a computer cannot make you smart, and you can read all the rubbish on the Internet, unless you get it out an accredited institution, the information you may have might be bogus, mind you business. If you have something better to present than I have present it okay, you will be better of than talking fart about you read that and more on some dumb Internet.

      The Dominica mentality, if he is not down to my level, I will do something to bring him down that is not going to happen, because I have long discovered that you are not even educated at community college level, so how can you deal with someone who is college, and university educated; you will be dead, I will still be standing with my knowledge, until God calls me home!

      It is in my head you see, and you can’t take it away from me, all you can do is puff-up and wish you were me!

      Francisco Etienne-Dods Telemaque

  4. damian
    July 28, 2014

    One very simple fact to help preventing diabetes is to start
    walking as much as our elders used to . Don’t use the bus to get to church, go for walks in the evenings as our forefathers did . Don’t Don’t Don’t get glued to the TV.
    Blessings

    • The Facts
      July 29, 2014

      This is the problem with some people of today. They do very little walking. We also hear this on TV programs and during the news. There are still some people who will not go out for a walk.
      It is said when people sit for hours and do not utilize their fingers, the latter for those who have arthritis in their fingers, it will not be long that they will not have use of them. TV and computer have added to all sorts of ailments.

  5. conscious
    July 28, 2014

    Dr how can you use Pistorius as an example when this man is charged for shooting and killing his girlfriend in Africa.

    • derp
      July 28, 2014

      ‘an exampe’

  6. diasporan -D/can
    July 27, 2014

    DR SAM
    Take it to the rum shops too. Too much alcohol to much sewo. DA Pass time drinks

    • The Facts
      July 29, 2014

      The problem is when people drink a lot they do not eat and also drink milk, water and juice as orange juice.
      This is a joke from one of my book of jokes: A doctor said to a male patient, “Not enough blood in your alcohol stream.” :lol: :lol: :lol:

  7. For Real
    July 27, 2014

    Great piece Dr, Sam. Good info.

  8. longtong
    July 27, 2014

    Good stuff. Thanks for the info doc. Would love to read ur book some time.

  9. Francisco Telemaque
    July 26, 2014

    “Diabetes increases, the more the amputations.”

    In regards to the above we find that more prevalent in third world nations such as ours where people are less devoted to taking care of themselves, even when they are diagnosed with the disease, they tend not to believe the doctor, and since in the early stages of diabetes one feels no actual discomfort, by the time some symptom arises it is late.

    It is important to note that diabetes is a progressive disease, and no matter how much one exercise, and diet, the disease will continue to be progressive, insulin is the best treatment: these days it is fortunate to have actual human insulin which works better than the nonhuman type of insulin.

    One need to remember that the symptoms only appear when the problem begins to worsen! Amputations can be avoided, if the patient maintains a good diet, exercise, and is regimental about the proscribe medication there will be no need for amputation. Most patients prefer to remain on the sulfonylurea group of medication, nevertheless if I was asked, I would advise that the sooner they start treating their disease with insulin its the better they will manage and control their diabetes. Sulfonylurea medication works well for a short period of time before the body commenced resisting them all.

    At one time I detest taking insulin, at the moment I am insulin dependent, I actually take insulin four times per day, but my life is much more comfortable than when I only took some dumb pill.

    There are people who owns glucose monitors, and are about to die, the idea is not simply to monitor the volume of blood glucose, because whereas one may look at certain numbers, and conclude since it is within a certain level all is well. Not so at all, one need to also monitor their Hemoglobin A1c that is the key to control. A1c: hemoglobin A with a glucose moiety attached to the amino terminal valine of the beta chain. That type of hemoglobin is made at a slow constant rate during the 120 day life span of the erythrocyte.

    It accounts for 3 to 6 percent of the total hemoglobin in a normal person, and up to 12% in a person with diabetes mellitus. Increased levels of hemoglobin A1c correlate with glucose intolerance in diabetics; with good diabetic control the hemoglobin A1c level should return to normal range, that is why periodic A1c assays can be helpful in evaluating effective control of diabetes mellitus. Let it be known that normal glucose level should be between 80 and 120 milligrams plus or minus 5 milligrams ; meaning for a normal person their glucose level should not exceed 125mg, neither should it drop below 75mg. in the event it falls below 75 mg.. that is an indication the person is hypoglycemic, if it exceeds 125 mg., that is an indication that the individual is hyperglycemic.

    One need to understand also if they maintain a level of 7-8 hemoglobin A1c, it is actually the same as if they are walking around with almost 300mg, of glucose in their system. There are other body chemicals which should be monitored: i.e., triglyceride. I will not elaborate on that, but it is important to limit lipids intake. Although diabetes might be a heredity disease, one can live a long and productive life, yours truly is an living example, I now realize I was born a diabetic, that would make me type 1, I was diagnosed type2 but with my knowledge gained in health science impressed on me that I am type 1 (one). I can say at about age 49, I was basically completely blind by diabetes, nevertheless, this very day, I am enjoying a 20/20 vision. I was informed last week that the disease has now got into my eye, nevertheless, if it is going to cause me problems in the eye, by then I will be ninety years old; perhaps ready to die.

    So, those people who are loosing their legs, and appendages to diabetes it is all due to poor medical treatment in our country, and the lack of care they give to themselves. We, do not see many amputees in North America due to diabetes.

    Francisco Etienne-Dods Telemaque

  10. July 26, 2014

    Thank you Dr. Christian for this timely and informative article. When I say to people I have been Diabetic for 30 years, the response is always one of disbelief. Last year, on my way from my annual check up, I saw a huge billboard which said: “More people suffer and die each year from Diabetes, than from Breast Cancer and Aids combined”. World Diabets Day which is observed annually on November 14, is round the corner. The International Diabetes Association is calling for a Blue Breakfast to be celebrated on that day world wide, in an effort to promote Healthy Eating. One is also being planned in Dominica, and I would like to take this opportunity to appeal to all concerned to support and participate in this “BLUE BREAKFAST” carded for November 14, 2014.
    Once again thank you Dr. Christian for work among God’s people, especially our Youth.

  11. The Facts
    July 26, 2014

    Dr. Christian, as usual, this is an excellent article. You have said it all. I cannot add a thing to it. :) May those who read it take note and also inform others about it as each one reaches one.
    Health education, especially today should be taught from childhood as also in the schools. Today, there is a greater emphasis on health, taking care of oneself, eating and drinking nutritiously and maintaining good health that, with the help of God we may live healthier and longer.
    Some years ago I read in a local ethnic newspaper that “knee operations are a gigantic waste of money.” This article was written by an ethnic doctor. I kept a copy of it and inform others about it.
    I would assume that amputations should be avoided if at all possible. You are aware that proper nutrition is necessary to maintain good health.
    Last year a dear D/can friend passed on in Toronto. Her illness commenced with a toe problem which apparently led to other ailments. Her toe was healed. She had told me she has to be careful about injuring her toe.
    Her passing on was shocking. We really did not expect that she would have passed on then; never thought she was so sick. She was seeing a doctor who prescribed her medication.
    I was extremely distraught over her passing. To this day, I privately lament over her passing. However, I leave all in the hands of God whom we know, knows best.
    It is strange that you mentioned the name of this man, Oscar Pistorius of South Africa who is (was) an outstanding Olympian. You should know that he is charged with the murder of his girlfriend. He and his lawyer(s) are fighting this case so that he is not imprisoned probably for life. To my knowledge, the verdict has not yet been handed down.

    • Francisco Telemaque
      July 28, 2014

      “It is strange that you mentioned the name of this man, Oscar Pistorius of South Africa who is (was) an outstanding Olympian.”

      I suppose Dr. Christian may have simply mentioned him as a to capture the attention of his readers such as you, and I, and others. Nevertheless, Oscar’s situation has nothing to do with diabetes. In the first place he was born with some genetic defect; I can elaborate on that; however, that is not the topic of the conversation.

      He could have lived with his paralyzed legs, however, he would be subjected to crawl for the rest of his life. If you remember a guy from Point Mitchell they use to call Carapoo, he is dead now, I believe his condition was caused by polio, Pistorius may suffered a similar fate.

      Note also, diabetes is not the only cause of amputation, there are other medical causes, and that could be as simply as poor blood circulation. Sometimes you see people with toes, and fingers amputated, that has nothing to do with diabetes, as a matter of fact these patients are not diabetic at all!

      Francisco Etienne-Dods Telemaque

  12. Just a suggestion
    July 26, 2014

    Thank God for you.

  13. July 26, 2014

    Sorry Oscar Pistorious was amputated at 11 months old not 11 years as i mentioned above…

  14. July 26, 2014

    Never compare someone who is amputed during adulthood with someone who is amputed during childhood and worse again never compare them with Oscar Pistorious.
    Oscar pistorious is a healthy man .He was born without fibular;the fibular is the small bone next to the big long bone on your legs or what is normally called the tibia.His mother decided to amputate him at the age of 11 years old ,hense the reason why he is fully adapted to his amputation.
    Oscar is healthy,people with diabetes ,have kidney failure,heart desease ,eye problem,weight gain or loss etc and even you are amputated the damage is already done hence your ill health .

  15. Observer
    July 26, 2014

    I liked your article doctor. It is simple, straightforward and right on Q.

  16. Anonymous
    July 26, 2014

    beautiful as always sir!

  17. Kashimar
    July 26, 2014

    All of me want to spread all your advice, Doc. Where were you last weekend? Missed your article.

  18. CONCERN
    July 26, 2014

    Dominicans have become a nation of fast food the diet has changed over the years and the don’t want to walk. The health department in the USA is on a campaign to stop the eating of to much fast foods and doing more exercise. A simple walk from one village to the next is so healthy especially for our feet it keep the pulse in your feet alive. So my people if you don’t want to loose your feet keep moving and change your diet to freshly cook foods.

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