December 23rd, 2015
One 70 year old female patient of mine, was diagnosed with diabetes, is overweight (70 kg), and already had one cardiac bypass surgery for narrowing of the arteries. She came to see me several years after her bypass, complaining of frequent fatigue and chest pains. Unfortunately, this patient was of the mindset that a bypass surgery was like removing an appendix, the problem would go away, and she would be able to continue on with the same imprudent lifestyle. After her stint in the hospital, she went back to old eating habits, and irregular to no exercise.
A thorough checking revealed the narrowing of many coronary arteries and their bypass vessels. As her condition wasn’t strong enough for a second bypass surgery, I suggested angioplasty to widen some arteries to lessen her chest pains and free up blood flow. She was able to walk comfortably without experiencing fatigue within a short period of time, and the chest pains lessened noticeably.
I impressed upon her the importance of a healthy lifestyle for someone with a heart condition and diabetes. However, I was unable to monitor her regularly as she lived outside of Bangkok.
A year later, she comes back with suppurating sores on her toes, as well as on her legs. The sores had been festering for the past few months, refusing to heal. After a checkup, I found that her heart was still stable; she had gained 5 kilos, and had made no attempt to eat a healthier diet. Furthermore, the circulation in her legs was extremely weak, particularly on the left where no pulse was felt at all. Her left foot was lacked feeling, and was noticeably cooler than the right one.
The conditions described above are common in people with diabetes. Blood vessels will narrow, preventing adequate blood flow, making these patients susceptible to infections and difficult wound healing. Nerve endings will also degenerate, meaning that those with diabetes will begin to lose feeling in their legs and feet. This is why diabetics should take care to notice that they haven’t unknowingly injured themselves in their feet. If such injuries do occur, it is important that the wounds be cleaned regularly to prevent infection. Many careless people with diabetes have had to amputate their legs and feet as a result of spreading infection.
Aside from minor injuries to the feet and legs, it is also important to avoid stepping on wet areas, and to keep such places as bathrooms free of fungus and bacteria.
Lastly, it is important to have regular eye checkups, as diabetics also have a tendency to have problems in this area.
To counter the infection, this patient had to have a course of antibiotics. She also had to have her sores cleaned regularly. This process can be quite unpleasant, as the infected area has to be removed everyday by peeling of the dead flesh.
Furthermore, I had to open up her arteries in the left leg through angioplasty. Luckily the procedure was successful. If it had failed to bring back circulation to the leg, it would have to be amputated.
Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.
ข้อคิดเห็นทั้งหมดนี้เป็นความคิดเห็นส่วนบุคคลของผู้อ่าน ไม่เกี่ยวข้องกับเจ้าของเว็บไซต์แต่อย่างใด โปรดแสดงความเห็นด้วยความสุภาพ ถ้าเป็นครั้งแรกที่คุณโพสต์แสดงความเห็น อาจจะมีการคัดกรองเนื้อหาได้ การแสดงความคิดเห็นควรอยู่ในประเด็น ห้ามโจมตีใส่ร้ายบุคคลอื่น หรือทำลิงค์ไปยังเว็บไซต์ที่มีเนื้อหาไม่เกี่ยวข้องกัน ผู้ดูแลเว็บไซต์สามารถแก้ไขหรือลบความคิดเห็นได้ทุกกรณี
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