The statistics is scary indeed. But
what is the way out? It is one thing to pontificate and another to take simple
action at preventive and curative stages. The best option obviously is to try
to avoid the disease by avoiding processed /high fat foods and a sedentary
lifestyle. But still the disease may creep upon one stealthily with no obvious
external symptoms, and one may have it before one knows it. So, coupled with
leading a healthy life style, it is also important to go for routine medical
checkups, including the blood sugar test, — which, sadly, is not happening even
in the urban populace of India, forget about the rural areas where medical
facilities and personnel are woefully lacking, despite numerous welfare schemes
of the government.
All said and done, if at any stage the
disease is diagnosed then, neither the treating physician nor the patient
should remain complacent toward this silent killer. The two main components of
diabetes are blood vessel damage and nerve damage (neuropathy). Blockage of the
blood vessels results in lack of blood supply. The first symptom of neuropathy
is numbness in the feet and sensation block. Loss of protective sensation of
pain is a major cause of creating what is called the ‘diabetic foot’.
So apart from diet/sugar control, one
needs to take extra care of the feet. Any person, who has been living with
diabetes for 5 years or more, should go for foot examination once every six
months. Very often even the doctors may miss out on the initial symptoms of a
tiny abrasion/wound in the feet which, if left untreated, develops into an
ulcer. These ulcers act as portals for the entry for bacteria leading to serious
infections, which, in the immuno-compromised diabetic patient, can result in
amputations or even death. Frequent and thorough foot examinations on part of
the doctor, as well as the patient are a must.
According to Dr. Arun Bal, one of the
legendary diabetic foot surgeons of India, associated with Raheja Hospital,
Fortis Hospital and Hinduja Hospital, “Doctors are taught that every infection
will have fever and every ulcer will have swelling. But this is absent in
diabetic foot lesions, which are like 'silent' icebergs — we see only a small
part of them. They are often missed because the usual signs of infection are
absent, and patients don't complain of pain. So, unless people living with
diabetes take very good care of their feet, it is likely that they will end up
with ulcers in their feet which can trigger the disease to take a completely
different progression path and even become unmanageable.”
He aptly quotes JA Lindsay — "For
one mistake made for not knowing, ten mistakes are made for not looking" —
and advises strongly that health care providers must properly examine patients’
feet at every visit.
Dr. Miranpuri, a reconstructive foot
surgeon from Detroit, argues for collaborative and comprehensive care of people
with diabetic foot with the goal to save the limb. He emphasizes that, “Both
doctors and patients need to be aware of the risk factors in diabetes and be
trained to handle them. There is a need for some ancillary support (in the form
of medical educators) in the hospitals to interact with the patients, as very
often the physicians do not have enough time and patience with the patient. This
becomes all the more important in India where patients, very often, may be poor
and uneducated and lack proper knowledge of the consequences of not following
the doctors’ instructions. This is especially true of Indian women, who are
programmed not to care for themselves, and hence tend to neglect themselves
completely.”
Professor (Dr.) Rama Kant, a noted
surgeon and president-elect of Association of Surgeons of India (ASI), also
feels that awareness should reach the masses through doctors. He laments that, “Primitive
and modern methods co exist in India. As far as control and management of
diabetic wound infection is concerned, there is not much difference between
19th and 21st century rural India. Infection control and meticulous examination
of foot as well as footwear is very important. There have to be preventive
societal programs. People need to be aware to understand the earliest symptoms
of ulceration and see a specialist. We need to innovate and try to save the
patient’s heel, even if it looks ugly and bad.”
Dr. Rajesh Kesavan, diabetic foot
specialist from Chennai, rues that time is ticking fast. With a view to improve
the existing situation he suggests: “Diabetic foot problems and diabetic
neuropathy should be made a compulsory part of medical curriculum; more medical
professionals should be trained in quality wound care management; and research
should be encouraged for developing cheaper and better wound care products and
therapeutic footwear.”
So, cost effective methods, coupled
with doctor’s ability to diagnose correctly and timely, is the need of the
hour. At present patients are ignorant and indulge in negative socio cultural
practices — like walking barefoot, wearing foot jewelry (especially toe rings),
wearing Hawaii slippers, which, though popular in India, are very harmful.
Sometimes even doctors and surgeons are not aware of diabetic foot problems
themselves, and may not even do routine examination of the foot, in a proper
way. It should be remembered that “many wounds look innocuous but may not be
inert. So, all wounds need to be probed.”
There is also a need for patients and
general public to know about the importance of correct footwear. Faulty
footwear and/or walking bare foot, which is so very common in India, are an
invitation to infected ulcers and eventually amputation. According to Dr. David
Nielson of USA, a patient should be well aware of the consequences of noncompliance
of doctors’ suggestions. This is especially true in patients who have to wear a
diabetic shoe, which should not be taken off at any time of walking, even for a
small distance. Very often patients do not realize the seriousness of this
instruction and tend to under comply. This prolongs the treatment without
yielding purposeful results.
Experts also stress upon counseling by
trained personnel. Depression therapy is a must, so that the patient not only
learns to manage diabetes but also feel happy with life in general.
Let us hope that everything will be
fine one day. To think that everything is fine today is an illusion.
