Health & Medicine

July 29, 2012

Some amputations preventable, center shows diabetic patients

The Amputation Prevention Center is run by a wry, veteran vascular surgeon and a baby-faced podiatrist who contend that their team approach has saved the limbs of some 94 percent of the patients they see with wounds, infections or related ailments.

VAN NUYS – Ehud Giladi thinks the Amputation Prevention Center saved his life.

Giladi, known as "Udi" to friends and family, knew he was in trouble in November 2010 when he summoned his son to help remove a sock from his foot.

Giladi is a diabetic and had been badly overweight for years. His left foot had developed neuropathy – the loss of feeling in extremities common to diabetics.

"I knew I was getting worse, but I just did not want to deal with it," the Warner Bros. studio guard said.

After his son helped remove the sock and took him to the emergency room, doctors told Giladi all five toes should be removed to save the infected foot. During the operation, though, surgeons couldn't stop the bleeding, and he was transferred to Valley Presbyterian Hospital's Amputation Prevention Center.

It was there that Giladi says his foot – and his existence – was saved. "I pretty much owe them my life," he said.

There are many stories like Udi's at the Amputation Prevention Center, the only one of its type in California. The unit, housed at Valley Presbyterian's campus in the San Fernando Valley, is run by a wry, veteran vascular surgeon and a baby-faced podiatrist who contend that their team approach has saved the limbs of some 94 percent of the patients they see with wounds, infections or related ailments.

Their strategy is simple: All the specialists needed to evaluate and treat a patient in danger of losing a foot or leg are in one place; there's no need for crucial weeks of delay as patients shuttle among doctors' offices, their conditions worsening.

"This is a unit where we all practice together," said Dr. Lee C. Rogers, a podiatrist and co-medical director of the APC. "We've often heard the shock from patients: 'I just saw six doctors in 30 minutes. I just can't believe that I saw that many doctors.' "

Collaboration also is vital, said vascular surgeon Dr. George Andros, APC's medical director.

"You know, a lot of doctors don't play well in the sandbox with other children. They just don't do it. So you (have) to have people who know how to cooperate on all levels," Andros said.

Nearly 26 million U.S. residents suffer from diabetes, according to 2010 statistics released early last year by the American Diabetes Association. That's 8.3 percent of the population. Another 79 million Americans are pre-diabetic, their blood glucose having reached abnormal but not diabetic levels.

Diabetes can lead to heart disease and strokes, blindness, kidney disease, neuropathy and amputations. According to diabetes association statistics, more than 60 percent of non-traumatic amputations of lower limbs occur in diabetes patients.

That's the direction Robert Winkler was headed. A part-time jewelry salesman from Sherman Oaks, Winkler had developed neuropathy and a condition known as Charcot foot, the degeneration of bones, joints and soft tissues that often afflicts diabetics. After metal plates were surgically implanted in Winkler's left foot, and after he had worn special shoes for a few years, an ulcer the size of a silver dollar developed on his foot. That led his then-doctor to recommend an amputation below the knee.

Winkler refused, and was referred in the spring of 2011 to the Amputation Prevention Center. Once there, Rogers set about healing the ulcers in part by using small skin grafts derived from the foreskins of infant circumcisions, Winkler said. Andros increased the foot's blood supply by performing an angioplasty on a blood vessel. Though he may have to wear a special boot for the remainder of his life, Winkler still has his leg and foot.

"In my prayers every night, I do bless those doctors," said Winkler, now 66. "If I were a millionaire, I'd give them a million bucks."

Giladi is just as grateful. When he arrived at APC, Andros told him his condition was so advanced that in another month, without treatment, he could be dead. But before he would operate, Andros demanded that his 54-year-old patient promise to lose weight.

The pledge was made, and in late 2010, Andros revascularized Giladi's left foot, leaving 100 stitches along his leg. Then Belczyk and Rogers covered portions of his leg with the $1,500-a-piece skin grafts. Giladi spent months in rehabilitation, but is now back at work, thinner and with both legs.

"The nice thing about Dr. Andros that I like is he's old school," Giladi said. "He just made me realize that if I don't do this, I'm not going to come out alive."

Rogers said APC is so focused on saving limbs because 68 percent of leg amputees die within five years, in part because of the sedentary lifestyle patients often are left with. And amputated limbs are a major factor in forcing many people to leave the independence of their own homes and live out their lives in institutions.

There are a few other facilities in the United States that more or less follow the same model as APC, such as Georgetown University Medical Center's Center for Wound Healing, Andros said. Labovitz said he's hoping to open a similar unit at Western University in Pomona later this year.

The dearth of such facilities doesn't surprise Andros.

"This is hard work," he said. "Nobody wants to take care of these sick old folks with stinky diabetic feet. So it's not sexy. It ain't got sizzle. But it's important.

The doctors insist their strategy of saving rather than excising limbs through professional collaboration, quick access to specialists and high-tech tools is successful, cost-effective and, in the end, best for the patient.

"We have a policy here if we can do it," Andros said: "Even if you didn't walk in, you're going to walk out."

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