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Open Q & A and Preventing Diabetic Foot Infections/Ulcers and Maintaining Healthy Feet - Marilyn Konezny, C.D.E. and Toufic Rizk, M.D., Medical Director, Unity Wound Care Center, April 22, 2014

Marilyn@Unity:
Welcome to the Unity Diabetes Online Community! I’m Marilyn Konezny, a certified diabetes educator at Unity Diabetes and Endocrinology Services, and I’ll be hosting tonight’s chat. I am glad you could join us! Our special guest this evening is Dr. Toufic Rizk, Medical Director of Unity Vascular Surgery and the Unity Wound Care Center. We’re excited to answer all of your questions.
Marilyn@Unity:
Before we get started let me just tell you how I’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 if you switch to another application on your computer.
sassy35:
What is the best way to prevent issues with your feet?
lucyblue:
Dr. Rizk, I was wondering how I would know if I had a foot infection or if it is just a bad sore?
Dr. Rizk @ Unity:
The best way to prevent problems with your feet is to be aware that as a diabetic, your feet are at higher risk of injury. Prevention is key in this situation. Also, you should get a podiatrist to take care of your feet regularly.
Marilyn@Unity:
Foot prevention: Check feet daily for any changes at all; keep blood sugar in control; wear good, supportive shoes; don't go barefoot. Keep skin in good condition - use cream but NOT between the toes!
Dr. Rizk @ Unity:
As far as when to know whether you have a bad sore or an infection, you should use common sense. But to be safe, always assume the worst and seek help as soon as you think you have a problem. Time is of the essence.
sassy35:
How often should you see a podiatrist?
Dr. Rizk @ Unity:
I would seek a podiatrist's help every 6-12 weeks and as soon as a problem develops. Even routine nail trimming can be the source of a bad infection. So let the podiatrist do it safely for you.
Marilyn@Unity:
Many patients tell me they see a Podiatrist every 1-3 months, depending on the condition of their feet, or maybe just to get their nails trimmed.
Dr. Rizk @ Unity:
Marilyn must be reading my mind!
Marilyn@Unity:
:)
Marilyn@Unity:
Can you tell us why blood sugar control is important to prevent infections/wounds?
Dr. Rizk @ Unity:
Foot infections in diabetics can be not only limb-threatening but may also be life-threatening if they get out of control. The worst case scenarios are seen in patients whose blood sugars exceed 250-300. That is when the sugar affects their immune systems in a negative way.
Dr. Rizk @ Unity:
Chronically elevated blood sugars also damage the nerves (neuropathy) and blood vessels, and this combination makes patients more susceptible to infections and poor healing when they develop foot sores.
lucyblue:
If someone does have a foot infection/sore, how would it be treated to prevent more serious issues?
Dr. Rizk @ Unity:
First I would recommend seeking immediate help and see a provider as soon as possible to help manage the problem. This may entail proper wound care, offloading the sore, taking cultures to know what bugs are growing in the wound and start antibiotics. If necessary, x-rays can be taken to make sure the bone is not involved as well.
lucyblue:
If by chance the bone is involved is there anything that can be done?
Marilyn@Unity:
Oxygen is necessary for wound healing. At what point do you consider hyperbaric treatment?
Dr. Rizk @ Unity:
If the bone is involved, the antibiotics by mouth are usually not sufficient and the patient may then need intravenous antibiotics for 6 weeks through a special IV line. The treatment is often started in the hospital setting and transitioned to an outpatient source via a visiting nurse service or be taught to the patient or family member.
Dr. Rizk @ Unity:
For "refractory or chronic osteomyelitis", that is osteomyelitis that has not responded to the 6-week course, hyperbaric oxygen therapy, offered at the Unity Wound Care Center, becomes an option. In this situation, the patient goes into a chamber at high oxygen levels to help bone penetration. This treatment is 5 days/week for 2.5 hrs, and may last 12 weeks!
Marilyn@Unity:
Wow! Prevention is the best route to go!
Dr. Rizk @ Unity:
The Wound Care Center also takes patients whose wounds have not healed for 30 days and treat them with alternative modalities that include frequent surgical cleaning of the wounds, the use of skin substitutes and other advanced wound care products.
Jane@Unity:
Thank you Dr. Rizk for the excellent information! Thanks Marilyn for being a great host!
Dr. Rizk @ Unity:
Prevention is definitely the key because it avoids all the complications associated with a wound once it develops.
Marilyn@Unity:
Many of our patients have had wonderful results with the treatments/care they have received at the Wound Center.
lucyblue:
Yes, thank you both for great information!
Marilyn@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 on Tuesday, May 6 at 8 p.m. with Joy Valvano, C.D.E. and Kelly Ligozio, Associate Director, Tour de Cure, American Diabetes Association.
Marilyn@Unity:
Thank you Dr. Rizk!
Dr. Rizk @ Unity:
It is my pleasure to participate in the diabetes chat room. Great info gets passed on. Keep up your great work!
 
 
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