August 26th, 2015
A patient of mine was a woman age about 70 years old. She was quite heavy, weighing around 70 kg, and she had had a bypass surgery because she had a narrowed artery in her 60’s.
Last year, she came to see me because she felt tired and tight in the chest when doing heavy activities. About 4-5 years after the bypass surgery, she did not watch her diet and did not exercise, thinking that everything would be fine forever after the surgery, like an appendix removal. The person who took care of her did not emphasize the importance of exercise and controlling risk factors after the surgery.
After examination, I found that parts of her heart muscle were dead, which could have happened since the operation. She only felt the symptoms lately because the treated artery was clogged again, and other ones were getting narrowed too.
Her condition did not allow for another bypass surgery, so I decided to widen her artery at some points to reduce her symptoms. I also used leg massaging device (EECP or Enhance External Counter Pulsation) to help increase capillaries to the heart muscles. After that, her symptoms improved and she could walk without feeling tired or tight.
I asked her to exercise and watch her weight, as well as keep her diabetes in check. However, she could not come see me often because she lived out of town.
About a year later, she came to see me for chronic wounds at her toes and shins, which had been there for a few months, starting from a small scrape at the toe and a burn from a motorcycle’s exhaust pipe. Her wounds got infected and started to hurt more, so she had to come to the hospital. Her heart was healthy, but she did not watch her food intake. Her weight increased by 5 kilos.
I examined her feet and found that the pulse at her both feet were very weak, especially on the left side, which was almost not palpable. The left foot was also darker and colder than the left. The wound on the left foot was about a centimeter wide and infected.
These are the signs of clogged arteries caused by diabetes. This will cause the wounds to get insufficient blood for healing. Her feet were also numb at the end because the nerves were damaged. Small wounds could not be felt, so she did not take care of them properly. Before she knew it, the feet were already very infected.
Diabetic patients are at risk for coronary diseases and other arteries are also in danger. It is the reason why so many patients lose their legs.
People with diabetes have to take a good care of their feet and keep checking whether there are scrapes or wounds, since some people would feel numb in the feet. If there is any wound, clean it well with antiseptic and keep your feet dry. If the wound doesn’t get better in a few days, consult your doctor.
Shoes should also be close-toed and soft to prevent injuries. Stay away from damp places, and the bathroom floor should be kept clean and dry at all times.
Diabetic patients should also have their eyes checked annually because it can affect the eyes as well.
This patient was given medication through the vein because her wounds did not get enough blood and were infected. I also found that the blood vessels in her legs were also extremely narrowed, especially on the left.
I told her that apart from medication, the wounds would have to be cleaned by scraping the dead tissue off, which could be quite painful. I gave her painkillers, but it was still a lot of pain. I could only calm her by saying that the legs were in pain but she was not. She didn’t seem to buy that.
Other than that, I used balloon angioplasty to widen the narrowed arteries at her legs, or she might need another bypass surgery of the leg. If the two methods failed, she could lose her legs. Upon hearing that, she was not scared at all. She smiled!
Patient: It would be great to cut my legs. Maybe it would be cheaper?
Doctor: Why is that?
Patient: Oh! Well, you get my legs, so I assumed they would be worth something? And I wouldn’t take them home!
Fortunately, her legs did not have to be amputated, because the balloon angioplasty worked. Soon she could go home happily.
Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.
ข้อคิดเห็นทั้งหมดนี้เป็นความคิดเห็นส่วนบุคคลของผู้อ่าน ไม่เกี่ยวข้องกับเจ้าของเว็บไซต์แต่อย่างใด โปรดแสดงความเห็นด้วยความสุภาพ ถ้าเป็นครั้งแรกที่คุณโพสต์แสดงความเห็น อาจจะมีการคัดกรองเนื้อหาได้ การแสดงความคิดเห็นควรอยู่ในประเด็น ห้ามโจมตีใส่ร้ายบุคคลอื่น หรือทำลิงค์ไปยังเว็บไซต์ที่มีเนื้อหาไม่เกี่ยวข้องกัน ผู้ดูแลเว็บไซต์สามารถแก้ไขหรือลบความคิดเห็นได้ทุกกรณี
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