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  Chat Transcript
Maintaining Healthy Skin and Feet/Open Q&A – Toufic Rizk, M.D., January 26, 2013
 Sharon@Unity:
Welcome to the Unity Diabetes Online Community! I’m Sharon Spear, a certified diabetes educator, and I’ll be hosting today’s chat. We’re glad you could join us. I’d like to introduce our special guest, Dr. Rizk. Dr. Rizk is the Medical Director of Unity Vascaular Surgery and the Unity Wound Care Center. We’ll be taking about maintaining healthy skin and feet and answering all of your diabetes-related questions.
 Sharon@Unity:
Before we get started let me just tell you how we’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question. It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat. 
 Dr. Rizk@Unity:
Sharon thank you for your kind introduction. I will be glad to answer any questions related to diabetes as it relates to wounds, foot infections and prevention, among other questions, to the best of my knowledge.
 juanitajolley:
How often would you recommend visiting a podiatrist or having a pedicure, if at all?
Dr. Rizk @ Unity:
My recommendation for visiting a podiatrist would be once every few months if you have healthy feet and for nail clipping, if you are old and have difficulty reaching your feet to cut the nails safely. If you have a wound, you should see the podiatrist ASAP. With pedicures, you want to be careful not to get injured. 
Sharon@Unity: 
 Good question juanita, your health care provider should check your feet at least once a year, if you are having foot problems , such as pain in feet or difficulty cutting toenails, see a podiatrist every three months. Be careful about pedicures and bring your own clean equipment.
 Sharon@Unity: 
Dr. Rizk, could you tell us a little about Unity's Wound Care Center? 
 sassy35:
I have numbess in my feet and I was wondering if there are there any special precautions I should take or concerns I should have? 
Dr. Rizk@Unity: 
The Wound Care Center is open to any patient with difficult to heal wounds after a trial of 30 days has failed to heal the wound. The wounds referred to us are usually complex and demand constant attention. Typically a patient referred would have to commit to the Center until healed. Often times the patients are frustrated enough to want to heal and are at the end of their rope? Diabetic foot ulcers are a frequent referral to our center. 
 lucyblue:
Hi Dr. Rizk, What are some treatment options for healing foot ulcers that the Wound Center uses?
 Sharon@Unity:  
Sassy, you should check your feet daily and wear shoes and socks. 
 Jane@Unity:
I am an instructor for the Managing Diabetes classes at Unity. I have currently have 16 people in my class. A participant asked the question. 
Dr. Rizk@Unity:
Options for healing foot ulcers at the Wound Care Center include a full evaluation, laboratory evaluation including Hemoglobin A1C levels and tight BS control, X rays to make sure there is no bone infection, culture of wounds and antibiotic treatment, and appropriate wound care that include proper dressings and minor surgical cleaning while offloading the wound. 
Jane@Unity: 
Joyce from my class asked, "What is the difference between a foot cream that said is specifically for diabetes. Can I use a less expensive brand?" 
lucyblue: 
Sounds pretty comprehensive - thanks for the info, Dr. Rizk! 
Sharon@Unity:
You can use less expensive brands - there is one called Diabetic. 
Sharon@Unity: 
Dr.Rizk, I understand you have some specialized equipment at the Wound Center, can you elaborate on that? 
Jane@Unity:  
Hi Sharon, thanks for your answer. Please expand on your answer.
Dr. Rizk@Unity:
In addition to what I have mentioned above, we also do skin grafts at the Wound Center. For difficult to heal wounds, where everything else has been tried first and failed, we have the option of using hyperbaric oxygen therapy as well, but as a last resort only. 
juanitajolley: 
Dr. Rizk, does committing to the Center mean becoming an inpatient? 
sassy35: 
Dr. Rizk - What kinds of doctors see patients at the Wound Care Center? 
 Sharon@Unity:
 Jane , I have some samples of the foot cream Diabetic skin care, I will drop them off to you tomorrow for your class.
 Jane@Unity:
What do you think about putting Vaseline on the feet and put socks on feet or gloves on hands, to help with dry skin?
Jane@Unity: 
Alicia said, "thanks for the samples!” 
 Dr. Rizk@Unity:
Very good question, Juanita. What I mean by commitment is a mutual understanding that we are going to help you to the best of our ability until you heal. You have to be willing to reciprocate and take responsibility for your actions. The biggest frustration we have is non-compliant patients. The Center is an outpatient facility and you are not an inpatient, but typically we see our patients weekly until healed. 
 Sharon@Unity:
Just make sure the socks are not cutting off the circulation to the leg. 
Jane@Unity:  
 O.K., thanks Sharon!
juanitajolley:  
Thank you so much Dr. Rizk and Sharon for your time and responses. You've been very helpful. 
 Dr. Rizk@Unity:
The providers working at the Center are podiatrists, general and vascular surgeons, geritricians and primary care doctors. All of us have taken a week-long courses about wound care and are all trained to provide evidence-based medicine.
 Sharon@Unity:
 That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat Tuesday, February 12 at 8 p.m. – Colleen Gladstone, C.D.E. will focus on heart health and answer all of your diabetes questions.
sassy35: 
 Thanks, Dr. Rizk!
 Sharon@Unity:
 Thank you, Dr. Rizk.
 
 
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