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Teamwork in care aims to prevent amputation Saving lower limbs tied to speed, coordination

Michael Kasprzak watched his toe turn black-and-blue, and knew that what he saw meant trouble.

To diabetics such as Kasprzak, ordinary sores on the feet serve as an early warning system for a simple reason: Skin ulcers are the most common foot sores that lead to amputations.

Kasprzak let it go for just a little while and learned how quickly the condition can spiral out of control.

Five years ago, doctors amputated the toe.

About a year later, another problem led him to lose the big toe and part of the foot.

"I don't hesitate anymore to get even a blister checked," said Kasprzak, now 35, of Cheektowaga. "I could have saved my toe if I had been more proactive."

Research suggests that as many as 85 percent of amputations may be preventable with earlier recognition and more aggressive treatment. As a result, a movement in the medical community has gained traction in recent years to change the strategy for wound care, including in Buffalo.

"We used to practice in silos," Dr. Lee C. Ruotsi said, referring to a lack of communication among the different competing specialists who treat patients for tough-to-heal sores and wounds.

"We're moving away from that and, instead, trying to share patients to provide the right care in the right sequence," he said.

Ruotsi, medical director of the Advanced Wound Healing Centers at Catholic Health, belongs to a group of Buffalo-area physicians trying to raise awareness among doctors and patients of the local chapter of the Save a Leg, Save a Life Foundation. The national organization was founded several years ago to advance a team approach to treating wounds that brings together specialists such as podiatrists, vascular surgeons and wound-care experts.

About 65,700 lower-limb amputations were performed in 2006 on people with diabetes alone, most of them preceded by a sore on the foot. In many cases, diabetics and others at high risk of limb loss fall into a pattern of one amputation followed by another, increasing their chance of death.

It doesn't have to be that way.

"Doctors were quick to amputate in years past. You'd see a whittling away of patients," said Michele C. Fisher, clinical coordinator for Vascular-Interventional Associates. "Now we try to start treatment by looking for the source of the problem."

The issue has grown in importance with the epidemic rise in diabetes, a disease of above-normal blood sugar levels. The number of Americans with diabetes has increased to 26 million, and as many as one-third of American adults could have diabetes by 2050 if current trends continue, according to the federal Centers for Disease Control and Prevention.

The prevalence of diabetes among adults in Erie County is 10.5 percent of the population, compared with 8.3 percent in the United States, according to the state Health Department.

"There has been an explosive growth in the number of high-risk people -- the elderly, diabetics and the obese," said Dr. David Davidson, a podiatrist involved in Save a Leg, Save a Life.

About 15 percent of diabetics experience a sore on their foot and, like others who suffer from other conditions that interfere with blood supply, their sores can become infected, gangrenous and, ultimately, almost impossible to heal.

The concept pushed by Davidson and others is to act quickly to deal with underlying medical issues, such as having a vascular surgeon open up narrowed arteries first to improve blood flow or having podiatrists attend to structural problems of the feet. A few weeks' delay can make the difference between losing or saving a limb.

They also see the local chapter as the best way to educate other physicians on best practices, collect data on the outcomes of treatments and reduce duplicative medical services.

The idea sounds sensible but requires cooperation rather than competition for patients. For it to work, they said, primary care physicians need to refer patients to the appropriate specialists before a patient's problems grow too big to repair.

"Doctors need to know there is a team out there and see us as a resource," Fisher said.

With the proportion of elderly in the population growing and the prevalence of diabetes, heart disease and obesity increasing, experts say, the demand for care of chronic wounds is on the rise.

The potential pool of patients who might benefit includes an estimated 64,000 Western New Yorkers who suffer from such chronic wounds as diabetic ulcers, pressure sores and surgical wounds, said Elizabeth A. Ciszak, program director of the Erie County Medical Center's Center for Wound Care and Hyperbaric Medicine.

"We only see a small portion of that population," she said.

Davidson said that there also is a financial argument for breaking down the barriers that divide many physicians. Studies suggest that the team approach requires expensive treatments but is less costly than amputating limbs.


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