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Surgeons too quick to amputate

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  #1  
Old 31st May 2006, 01:13 AM
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Default Surgeons too quick to amputate

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Medical News Today are reporting:
Epidemic Of Unneeded Amputations - Physicians Too Quick To Amputate Despite Medical Advances
31 May 2006
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Non-traumatic amputations - those caused by arterial blockages related to diabetes, smoking, obesity and vascular system complications - are occurring at an alarming rate. Yet physicians may be too quick to amputate as 85 percent of them may be preventable, according to the International Diabetes Foundation.

Amputations are not only disfiguring and life-threatening, but are more dangerous and more expensive than revascularization, which is the reestablishment of blood supply. Diabetics are especially at risk for non-traumatic amputations, accounting for 82,000 non-traumatic lower extremity amputations (LEAs) in the U.S. yearly, according to the American Diabetes Association. The Centers for Disease Control (CDC) reports more than 60 percent of LEAs occur in diabetics.

These statistics are telling, and have one of the country's leading clinical investigators and cardiologists astounded. "It is shocking that in this day and age, there is an epidemic of unnecessary amputations. Amputation is a drastic procedure that takes a great physical and emotional toll on patients and their families. But physicians often jump too quickly to amputation rather than exploring medical advances that can prevent limb loss," said Dr. Craig Walker, of the Cardiovascular Institute of the South, in Houma, La.

Walker is a pioneer in a medical procedure to combat these trends: Cool Laser Revascularization for Peripheral Artery Therapy, or "CLiRpath."

"In the U.S. alone, there are approximately 1.8 million people living with limb loss," Walker said, citing National Limb Loss Amputation Center statistics. "A good portion of these individuals could have salvaged their limbs. This is tragic." Of note:

--The number of diabetes-related LEA hospital discharges increased by 240 percent between 1980 (33,000) to 2002 (82,000), according to the CDC. --The CDC says the five-year survival rate for all lower extremity amputees is less than 50 percent. For diabetic amputees, the rate is less than 40 percent. --In a five-year study in medical journal Diabetes Care, 40 percent of diabetics and 29.8 percent of non-diabetics had a second amputation to the same or opposite limb at an average of 16.2 and 12.3 months, respectively, after the first amputation.

In advanced stages of peripheral vascular disease (PVD), common in diabetics, plaque blocks arteries, resulting in rest pain, development of foot ulcers and onset of limb loss. The CLiRpath procedure, using a "cool" excimer laser and catheter system developed by Spectranetics Corp. (NASDAQ: SPNC), vaporizes arterial blockages, restores blood flow, and this surgery promotes wound healing, often enabling patients to leave the hospital the next day. CLiRpath has been the subject of rigorous clinical trials, with limb salvage observed in 95 percent of patients surviving to six months(1). The procedure is now available in more than 300 hospitals across the U.S.

Amputation decisions greatly impact lives of many people, like Michael Sevante, of Houma, La. In 2002, Sevante had recurring leg cramps and was diagnosed with PVD. He developed a non-healing infection and underwent an amputation below his left knee. As a result, Sevante had to walk his daughter down the aisle on her wedding day with a walker and a prosthetic limb.

Six months after his first amputation, he experienced similar symptoms in his right leg and decided to aggressively pursue amputation alternatives to avoid having to live in a wheelchair. He was referred to Dr. Walker, who was able to save Sevante's leg with CLiRpath. Today, Sevante is virtually pain free.

"After my first amputation, I would have done anything to avoid a second," said Sevante. "Had I not asked for an alternative, I fear I was on track for the loss of another limb. This would have meant the beginning of the end for me."
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Old 12th June 2006, 10:57 PM
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The article above appears to be from America, and although I am based in WA I dont think there is much difference here.

I have patients with significant intermittant claudication symptoms, and partial arterial blockages, who are told by vascular surgeons that surgery is not necessary 'yet'. I have also seen a case where a podiatrist was contacting a public vascular clinic every week (in Perth) to have an ulcer patient seen- in the end they were only seen AFTER developing gangrene.


Our health system is simply too overcrowded to provide best practise health care.

If someone has an inspiring story to the contrary I would love to hear it.
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Old 13th June 2006, 04:34 PM
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Tully,

If the podiatrist had such concerns re a non-healing ischemic ulcer, why didn't they sent the patient to the ED with a well written letter? This would usually result in an urgent Vasc review.

At our hospital an urgent vasc OP Appt can be arranged within a week, and the vasc reg will often rv patients in the ED.
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Old 13th June 2006, 05:03 PM
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Hi Steven,

I am not sure why that was not done, as I was a student at the time and not prone to questioning senior podiatrists actions! Perhaps it was one of the many times the ED was on byspass that year.
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