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Local experts team up to reduce amputation due to diabetes

Wednesday, December 05, 2018

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DIABETES is the second leading cause of loss of limbs in the Caribbean, following car accidents, according to local experts.

Like high blood pressure, high blood glucose levels cause damage to the blood vessels of the heart, eyes, kidney, and brain, as well as affect the nerves and blood vessels of the extremities, especially the lower limbs. Amputation of a lower limb may be necessary if the extremity becomes badly damaged.

The Samaritan Cardiovascular Services (SCS) and Andrews Memorial Hospital have joined forces to offer a new Amputation Prevention Programme (APP), which is aimed at preservation of limb, particularly in diabetics.

This type of programme, while not new in some countries, is said to be a first for Jamaica. The multidisciplinary team approach to amputation prevention is a well-established best practice to reduce disability and mortality in diabetics.

It has been shown that outcomes are improved with a well-thought-out multidisciplinary approach in caring for diabetics with foot problems. This approach is recommended by the Society of Vascular Surgery (SVS), American Diabetes Association (ADA) and multiple organisations involved with the care of diabetic patients.

Diabetic patients are prone to severe peripheral arterial disease in the blood vessels below the knee. This, along with other factors, result in a high rate of amputation in diabetic patients, even though studies show that over 80 per cent of amputations are preventable.

The programme, therefore, places special emphasis on providing adequate blood flow to the leg.

The programme targets patients who present with non-healing ulcers, rest pain or gangrene, all symptoms of critical limb ischemia. After the identification of patients with critical limb ischemia clinically, further testing is done to confirm the diagnosis by taking segmental pressures and measuring the oxygen concentration in the foot.

Patients are then taken to the operating room where an angiogram is performed and a treatment decision is made based on the findings. The treatment options currently available are balloon angioplasty, peripheral stenting or surgical revascularisation, which are all done at the same sitting.

The amputation prevention programme is a part of the comprehensive vascular and endovascular programme being launched at Andrews Memorial Hospital, Hope Road, Kingston. All disorders of the arterial, venous and lymphatic systems can be evaluated and treated. Special emphasis is placed on the minimally invasive or endovascular approach to cardiovascular disorders.

The Samaritan cardiovascular team will be headed by Jamaican-born and recent returnee doctor Mark Taylor. Dr Taylor graduated from The University of the West Indies (UWI), after which he interned at the Cornwall Regional Hospital. He also completed a residency in general surgery at the Howard University Hospital, a fellowship in surgical critical care at Mayo Clinic Rochester Minnesota, and a cardiothoracic fellowship at Wayne State University in Detroit, Michigan.

Dr Taylor was also a clinical associate at Cleveland Clinic Foundation in Cleveland Ohio, and a cardiothoracic and vascular surgeon at Samaritan Health Services in Oregon.

He also is certified by the American Board of Surgery in General Surgery and by the American Board of Thoracic Surgery in cardiothoracic surgery.

— Balford Henry

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