"It’s quite a luxury for doctors and patients to go to a wound center located in a hospital."
As the owner of Brynmore Farm in New Egypt, Andy is on his feet from dawn to dusk. A morning spent milking the cows quickly slides into an afternoon of field work, feedings and rounding up calves. Then it’s early to bed and back to the same routine the next morning.
“It’s non-stop,” Andy admits. “Seven days a week. Sometimes 18 hours a day.”
But Andy’s job almost came to a permanent stop when a stubborn cut blossomed into a serious infection threatening not only his livelihood, but his life as well.
Hidden Dangers
Andy isn’t sure when he go the cut on the outside of his foot, behind his smallest toe. Not one to put off work for doctor’s appointments, he continued about his routine on the farm. But as a diabetic, that was the worst course of action he could have taken.
It was finally a case of pneumonia that brought Andy to RWJ Hamilton’s emergency room. After he was admitted, his care team realized pneumonia wasn’t Andy’s only problem, and called podiatrist Jason Levy, DPM, to do a consult. The foot had become seriously infected, leading to a severe case of sepsis. A bedside X-ray showed a subcutaneous emphysema, or gas in the tissues.
“That was very concerning,” says Levy. “Because it leads you to believe it’s a gas-producing organism, almost like a flesh-eating bacteria, which is a life and limb-threatening emergency.”
Within the hour, Levy performed a procedure at the bedside to open up the wound and drain out the infection. Andy was later taken to the operating room where Dr. Levy performed a formal debridement procedure to clean out the infected area.
Hard to Heal
While a cut or blister may not seem like something to lose sleep over, for a diabetic, it can be life threatening. Diabetics can’t attack infections as a non diabetic would, says Levy, because the increase in their sugar directly affects their immune system. In fact, a common condition associated with diabetes is peripheral vascular disease, which also hinders wound healing, especially in feet, hands and other extremities.
Diabetics also often suffer from neuropathy, where the nerves that are supposed to carry signals back and forth from the brain to the rest of the body are damaged. This makes it difficult for the sufferer to feel pain in their extremities.
“Unfortunately these people often can’t feel their toes or their feet,” says Levy. “So when they put pressure in a sore spot on their foot, where a person without diabetes would feel that pressure and alter the way they walk, a diabetic is just not getting the signal to their brain that says, ‘Hey this hurts.’”
Though Andy had been managing his diabetes for some time, he wasn’t very vigilant about checking his feet for cuts or scrapes that he might not be able to feel.
“I didn’t even know I had the wound,” Andy admits. “I wasn’t feeling anything.”
Wound Care
After he was discharged from the hospital, Andy began coming to RWJ Hamilton’s Wound Care Center once a week to receive weekly debridement procedures, advanced wound dressings and antibiotics.
“It’s quite a luxury for doctors and patients to go to a wound center located in a hospital,” says Dr. Levy. “All their labs and their studies can be done right there so it’s very convenient and efficient.”
Patients also have access to a multi-disciplinary team of specialists - including podiatrists, vascular surgeons and infectious disease specialists - all of whom can be brought in on the case depending on the patient’s unique needs.
“A patient may see one doctor at a time, but there’s a whole team working behind the scenes,” Dr. Levy says.
With the help of the wound care team, Andy’s wound healed quickly. And not surprisingly, as soon as Andy was able to start wearing shoes again, he was back out on the farm.
“When you’re so sick you don’t realize what’s going on, it doesn’t matter,” Andy said. “But then you feel better and you need to get back to your everyday life.”
Don’t Play the Waiting Game
According to the Centers for Disease Control, over half of the amputations in the United States each year are caused by diabetes and subsequent complications, mostly in the lower
extremities.
Too often, Dr. Levy sees patients, especially diabetics, who have let a slow-healing cut linger too long. Something that could have been treated easily at the start spirals out of control,
leading to trips to the emergency room, limb amputation and in the worst cases, loss of life.
The best way to avoid such situations is to be proactive. Diabetics in particular should check their feet and other extremities regularly for cuts or blisters. Any injury to the skin should be
checked by a physician immediately. If there is any hesitation, there are several common symptoms of infection to look out for, including:
- Redness
- Swelling
- Pus
- A bad odor
“I always tell my patient that I’d rather tell you it’s no big deal than for you to decide that yourself when it actually is a big deal,” says Levy.