'We just chop off people's legs too easily'

'We just chop off people's legs too easily'

Vascular surgeon says many amputations unnecessary

Executive editor — publications

Monday, December 23, 2019

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Michael Myrie was having a tough time with his legs. Both were swollen due to poor circulation caused by high cholesterol and diabetes.

“I had been going to doctors and they said it was [poor] circulation and inflammation,” Myrie told the Jamaica Observer last Saturday. “I went to a doctor in Montego Bay and he did an ultrasound and told me he couldn't help me, so he sent me to a vascular surgeon in Kingston. He sent me to do a CAT (computerised axial tomography) scan and when he looked at the scan he told me I'm not a surgery patient, all he can do is send me to walk.”

The doctor, Myrie said, told him to walk for six weeks and return to him. But at the end of the period the swelling was worse, particularly in the left leg, which the doctor had found was even more troublesome as the nerve in the sole had died.

In February this year, a friend told Myrie about Dr Mark Taylor, who operates Samaritan Cardiovascular Services at Gore Business Centre on Waterloo Road in St Andrew.

“I called him, and he told me to come in. When I went in he looked at the CAT scan and he said it is bad,” Myrie, who is diabetic, related.

A few days later, Dr Taylor performed surgery on Myrie's left leg, restoring blood flow, and now the hardware store employee is a happy man.

“The swelling has gone down now,” Myrie told the Observer. “If I didn't do the surgery I would have to amputate the leg. It's a blessing when he came into the picture.”

Myrie's surgery is just one of many that Dr Taylor has conducted since opening the medical facility earlier this year.

Taylor, a cardiac and vascular surgeon who has an impressive medical record in the United States over more than two decades, is adamant that amputation, in many cases, is unnecessary.

“I knew from before that there are too many amputations in Jamaica,” he said, referencing an Observer lead story on October 28 reporting University of the West Indies (UWI) Professor Dr Dalip Ragoobirsingh as saying that the Caribbean, led by Jamaica, is the amputation capital of the world, due to poor foot care.

Dr Ragoobirsingh, director of the university's Diabetes Education Programme, had told the newspaper that there is one amputation per 1,500 diabetic patients in Jamaica.

“There are two things going on with amputation,” said Dr Taylor. “One is that amputation or the rate of or incidence of amputation is actually an indicator, or in this case a bad indicator of the quality of our health care. But it's also more specific that we don't do enough to prevent amputations. To put it bluntly, we just chop off people's legs too easily.

“The sad thing is that amputation carries a very high mortality. Separate and apart from the underlying reason why you're having the amputation, if they cut your legs off, you die quicker,” he said.

Dr Taylor's argument was an amplification of a presentation made in 2014 by Dr Michael Boyne, consultant endocrinologist at The UWI's Tropical Medicine Research Institute, on the burden of Type 2 diabetes in Jamaica.

“If you amputated a toe you can see that by five years, 25 per cent of the people have died. By the time you end up with a below-knee amputation, more than half the population has died within five years. If you have an above-knee amputation, more than 80 per cent of the population have died within five years,” Dr Boyne stated at the inaugural Jamaica Advanced Laparoscopic Seminar. “So once you have had an amputation, I am telling you, you are marked for death.”

According to a 2012 Oxford Academic study, “Having a lower limb amputation is associated with a somehow high risk of not surviving within the first year from surgery, with perioperative mortality ranging from nine per cent to 16 per cent [1–5], and one-year survival rates ranging from 86 per cent to 53 per cent [1–10].”

Dr Taylor argued that the biggest issue might be awareness, not only among patients, but among doctors. “Patients are not referred early. I hardly see someone who's just having pain. By the time I see them they have ulceration, gangrene, and it goes from like a routine procedure to what we call a salvage procedure. We have to salvage the leg,” he lamented.

That, and the experience of his father who was diabetic, have driven his interest in preventing amputations.

To facilitate that, Dr Taylor has invested in state-of-the-art equipment which, he pointed out, are standard for such operations globally.

“We don't compete with the radiologists, but when I see somebody who has a critical problem a blocked blood vessel we can look at it. We do our own ultrasound, then we do a complete vascular testing. We measure all the blood flow in the legs and the arms. We analyse the wave form, we do the flow velocity so we know what's going on,” he explained.

He also has a group of specialists working as a team to treat patients. The team comprises himself as the vascular surgeon; Dr Lucien Tomlinson, general surgeon; Dr Suzette Robinson, endocrinologist; Latifah Hudson, physiotherapist; and Dr Angela Davis, podiatrist.

People with varicose veins are also treated by the team.

“It is good to focus on varicose veins because it means that there is incompetence, but the varicose vein by itself is not the problem. It is the secondary effects of the pooling of blood in the leg; the leg gets swollen, it turns dark, it gets hard, you get ulceration. What we do is what is called endovenus radio frequency ablation. We put the radio frequency catheter up the vein and we close it. Just close it, right here, done. No problem.

“We did one patient here who had it for 53 years and we told him, we're going to treat you and it's going to heal, because we pinpoint the problem,” said Dr Taylor, who has more then 4,000 successful surgeries under his belt.

Among the equipment in his practice is a hyperbaric chamber, which provides oxygen therapy and is used to treat patients with wounds that are difficult to treat.

“So when you go into this it helps with any type of chronic infection patients with chronic osteomyelitis, patients with venous ulcers, arterial ulcers. We have to make sure that they have good blood flow before we use this. After we do the surgery, we can put them in here and speed up the healing any ulcer— if it's not related to diabetes. Actually, the most popular use of the hyperbaric chamber in the USA is by athletes who want to speed up healing, and for conditioning. It's also called 'Hollywood Secrets', as the rich and famous use it for their skin,” he said.

“It helps with general healing, for example, sun damage, wrinkles, acne, general healing. It stimulate the stem cells to multiply and regenerate, but we focus on wound care,” Dr Taylor said.

“What I have identified is that most of the amputations in Jamaica are due to diabetes, and most of those cases are due to what we call peripheral arterial disease; that means the arteries going to the leg are obstructed,” he said.

“We have another group of people who have chronic venous disease the arteries are not obstructed but the veins are incompetent and the blood pools in the leg. Those people get chronic ulcers, their risk of amputation is not very high, but they end up with what Jamaicans call sore foot,” Dr Taylor said, pointing out that while diagnosis is important, his focus is on treatment.

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