February 25, 2018

Family ties!

By Anu Dev

“To put the world right in order, we must first put the nation in order; to put the nation in order, we must first put the family in order; to put the family in order, we must first cultivate our personal life; we must first set our hearts right.” – Confucius

“Family”– a word that’s casually thrown about; taken for granted really, used flippantly without knowing the exact meaning. It’s not given the importance it deserves; and by extension, the family members are probably not getting enough importance either. Being away almost five years has certainly focused my mind on family and what it means!!
How many of you parents take the time to connect with your children and find out how their day went? How many of you parents take the time to find out about all of those little things in your daughter or son’s life? And how many kids take the time to find out how was their mom or dad’s day at work?
The values we learn from our families are the ones that mould us; the ones that shape us as individuals. In high school, when our teacher taught us the proverb “The hand that rocks the cradle rules the World”, I always used to think it was terribly clichéd, and so I disregarded it. But I realise now that, hackneyed though the adage may be, it still holds a simple truth: the institution of the family — in which the mother is the touchstone — has great power. But with that great power comes great responsibility. And it is not just the mother’s hand that should ‘rock’ the cradle; fathers, we know, are just as important.
I have noticed a strange phenomenon developing in our society: Parents are refusing to be parents; they want to be “friends” with their children. My parents have a rule: they are friendly with their children, but they’re not our friends! I commend that rule to parents out there. It works. Children don’t take too kindly to their friends telling them what to do, so “friend-parents” shouldn’t be surprised when they’re ignored!!
Parents also need to make sure that they are fulfilling their responsibility to their children by ensuring that they’re a part of their childhood. If you’ve ever had those moments when you look at your kid and you realise you don’t really know your own child, you’re clearly doing something wrong. And you can connect only when you share experiences with them. If your child is expected to learn their key values from you, what do you expect them to learn if you’re not interested in teaching them anything? And remember: you teach values by doing, not just speaking! If you don’t do that, don’t be surprised that while you’re connected by the strongest bond ever – blood — you’re further apart than if you were just, say, co-workers.
The family, then, needs to go back to what it was intended to be — an institution to provide care and teaching of the fundamental values to the next generation. If those values are not set when young, little change can be expected later.
Of course that’s not to say all families are ‘dysfunctional’, and that all family members are strangers. It’s just that we might be headed for that, with everyone getting more and more caught up in their own busy lifestyles, and each person looking out only for #1.
So, friends, take the time to connect with your family members. Don’t lock yourself away in your room all day, while you’re on Facebook connecting with people from across the world, when you can’t connect with family in your own house. They can’t “unfriend” you!

Cervical Cancer is beatable

By Anu Dev

“Prevention is better than cure.” – Desiderius Erasmus
January is “Cervical Cancer Awareness Month”!

In my gynecology rotation, one of the questions we got asked by different doctors was, “What’s one of the most preventable types of cancer?” And the answer was always the same, “cervical cancer”.
Cervical cancer is one of the most preventable types of cancer. That’s because there is both a sensitive test for detecting pre-cancerous lesions — the pap smear — and there’s an effective method of dealing with HPV, one of the most prominent risk factors for the disease.
But before I go into that, perhaps an anatomy refresher might be necessary. Where exactly is the cervix? Well it’s actually the lower part of the uterus (womb), and it connects the cavity of the uterus to the vagina. In non-pregnant women, it’s about an inch long and is roughly cylindrical. And during labour, it dilates to allow the baby to pass through. It’s the body part that people are usually dramatically shouting about in movies when they’re yelling, “She’s 10 centimetres dilated! She’s gonna have this baby right now, on the subway!” Or you know, wherever the plot needs the woman to give birth.
In all types of cancer, the problem begins when cells deviate from their fixed growth patterns and appointed job descriptions and start growing uncontrollably. This can happen in the lungs, in the colon, and in the cervix.
In cervical cancer, the cells don’t suddenly make the switch from normal to cancerous growth; there’s a stage in between. This in-between stage can be picked up on a pap smear, and intervention can be made before the cells have a chance to progress to the cancerous stage.
We’re all well aware about the link between smoking cigarettes and lung cancer, but do we know what factors can increase your risk of cervical cancer? Well, for starters, cigarette smoking also increases your risk of getting cervical cancer. It’s a twofold risk increase compared with nonsmokers, actually. As an aside, smoking also increases your risk of developing bladder, stomach, mouth, throat, and a whole host of other cancers. Yeah, as far as vices go, that’s a pretty bad one to have.
The other risk factor I’d like to mention is HPV infection. Certain strains of the HPV virus, HPV 16 and HPV 18, are associated with the development of cervical cancer.
In fact, it is believed that a woman must be infected with HPV in order to develop cervical cancer.
There currently are vaccines like Gardasil and Cervarix that are available to prevent infection by HPV; and, by extension, prevent cervical cancer.
Current recommendation for screening for cervical cancer via pap smear are for women aged between 21 and 65 years to be tested every 3 years. So if you’re due for a pap smear, make sure you get one. If you’re not vaccinated against HPV, talk to your doctor about getting vaccinated. This is one type of cancer against which we have the tools and the know-how to try to prevent before it even gets a foot in the door.

Don’t go breaking your heart

By Anu Dev

“Fast food is popular because it’s convenient, it’s cheap, and it tastes good. But the real cost of eating fast food never appears on the menu.” -Eric Schlosser

When I first arrived in Trinidad, I was amazed at all the different types of fast food places they had: McDonalds, Burger King, KFC, Pizza Hut, Pappa John’s, Wendy’s and a whole host of others. At the time, Guyana only had a couple.
And then I came across a 2013 report that Trinidad was the number 1 obese nation in the Caribbean and the 6th most obese nation in the world. Guyana was way, way below them.
Was there a connection between the two facts? There sure was! And the connection wasn’t just a matter of correlation – it was causation. What had happened was that the First World countries – especially the leader, USA — had wised up to the connection between fast food and obesity, and had started to regulate them. That, of course, meant paying more attention to any number of factors – which in turn meant less profits.
Just as the cigarette manufacturers had done a few decades before, their fast food chains didn’t waste any time moving down to the Third World. In only the last two years, surely, you’ve noticed so many of these joints coming here to Guyana?
In the First World countries, the fast food industry’s being pressured to offer “healthy” options on their menus, and it’s mandatory to display the number of calories in each item of food. Like McDonalds in the States now also offers salads and wraps — never mind that the dressings for the salads probably have more calories than the burgers.
Now, don’t get me wrong: I get the allure of fast food. Who doesn’t? It’s tasty; a high fat- and-sodium content pretty much guarantees that. And of course it’s fast. Lying in my dorm room too tired (and lazy…mostly lazy), to cook, sometimes I give in to the urge to pick up my phone and order pizza.
And fast food’s so much cheaper than healthy food. When I’m ordering pizza, the person at the end of the line usually talks me into upgrading from a medium to a large pizza “for just $5 more” through some ongoing deal. I usually end up with a rather unhealthy amount of pizza, most of which I end up having to freeze for later.
I once had to turn down a free large pizza when I ordered a medium one. The Papa John’s worker seemed to think I was quite daft to turn down a free pizza, but as I tried to explain to her, I really had no need for both a medium and large pizza.
There’re always deals and promotions going on in these fast food places. I’ve never been offered a free larger head of broccoli when I buy broccoli. And I guess that’s why a lot of people prefer to go the fast food route, even knowing how unhealthy it is. And it’s incredibly unhealthy. One piece of chicken thigh from KFC has 290 calories, with 190 of those calories coming from fat; and it has 850mg of sodium — that’s 35% of your daily value. And many people don’t just get one piece of chicken; they get fries, soda, biscuits and more chicken.
In school, we’ve covered the systems of the human body and the type of strain your body goes through when you charge up on these fast foods. Your arteries get clogged, your heart has to strain to pump blood through those clogged arteries, and you’re more susceptible to developing diabetes, hypertension, or suffering a heart attack.
According to the UN Food and Agriculture Organization, the prevalence of obesity among adults in Guyana is 16.9%; and that’s pretty low, especially compared with Trinidad’s whopping 30%.
But if we keep on welcoming fast food chains into our country, and boast about it as “development”, we may well end up going the route of Trinidad; or even passing them.
Do your heart a favour and choose wisely when planning your meals. As with anything, moderation is key. A bit of pizza once in a while won’t hurt, but if it becomes habit, that when it’s a problem.

Happy New Year

By Anu Dev

“Hope smiles from the threshold of the year to come, whispering, ‘It will be happier’.” – Alfred Lord Tennyson

New Year’s Eve and New Year’s Day are two of my favourite days of the year. It’s probably because of that feeling of freshness that accompanies the thought of a new year. Rather weirdly (I now realise), I also used to be excited about the start of a new school year or term. I think I just really like fresh starts.
Interestingly, though the “New Year” was celebrated more than 4000 years ago, it was celebrated in Western cultures only from about four hundred years ago. For instance, in India, the New Year is celebrated in the Hindu month of Chaithra (Mid-April), and it’s been observed for many millennia. For instance, the Yuddhistir Shaka started around 5500BC!! I guess before New Year’s, life must have been one long drag. No wonder they called it the “Dark Ages”!
In fact, even the current date celebrated as “New Year’s Day” in the West was chosen in 153 BC by Julius Caesar. If you’re a fan of Roman and Greek mythology, you’ll be interested to know that the month January was named after the God of Doorways — Janus. He was given 2 faces — one which looked ahead to see what the New Year would bring, and the other looked backward to see what happened during the past year. You really can’t move forward if you completely ignore what happened in your past. In fact, didn’t that writer William Faulkner say, “The past is never dead. It’s not even past”?
New Year’s Day is that day wherein we can all pat ourselves on the back for making it through yet another year. Some of us may still be resting on our laurels if it was a successful year. And some may still be battle-scarred if it was a tough year. Survival is a victory! But we all have something in common: we’ve pulled through it all, to be here to ring in the New Year.
The New Year represents a new beginning; a chance to start afresh with new resolutions for the New Year. Unfortunately, I’m as guilty as anyone else of conveniently forgetting those resolutions by the next week! But we’ll still make them, won’t we? Hope beats eternal, doesn’t it?
Everyone has their traditions for the new year. When we were very young, my father insisted that we be up and outside to see the “Old Year Clouds” move over and be replaced by the “New Year Clouds”. This year-end, however, we can be sure there will be dark clouds — and I’m not just referring to the monsoon-type clouds that gather every night to dump their torrents over us the next morning.
Still, there’s a special joy in counting down those last few seconds until you light off the fireworks to usher in the New Year. And then the invariable hugs, shouting and general pandemonium as everyone celebrates making it through yet another year to another year full of possibilities.
For me, I’m looking forward to finishing up Med School in Trinidad, and starting a new chapter right here in Guyana.
Have a safe and happy New Year!

There’s no place like home

“Oh, but anyway Toto, we’re home! Home! And this is my room – and you’re all here! And I’m not going to leave here ever, ever again, because I love you all! And – Oh, Auntie Em, there’s no place like home!” – Dorothy, “The Wizard of Oz”

By Anu Dev

Over the past couple of weeks I’ve been wishing I had Dorothy’s red slippers so I could just click my heels and wake up in my own room. Since reading about Dorothy’s adventures in “The Wizard of Oz” I’ve gone through Tom Wolfe’s supposed more profound on the theme in his book which summarises his conclusion: “You can’t go home again”. And for what it’s worth, I still agree with Dorothy!
So now I’m finally home after three of the most gruelling weeks of my life. Heading into the final stretch towards my final MBBS exams in May, it seems that I’m being propelled forward by some mysterious force as things increasing get more hectic and fast-paced.
But I’m getting ahead of myself. For now I’m home. And I’ll be home for the next two weeks. Two glorious weeks of being home. I’ll be using that time to consume copious amounts of dhall, pickled mango, cook-up, and all of the other things I’ve been missing out on while I’ve been away.
But being away has also given me a greater appreciation of home. I used to sigh exasperatedly when we had to sing national songs in school but I’ve caught myself on more than a few occasions randomly belting out “Born in the land of the mighty Roraima…” in my apartment. That’s a catchy one, that.
And I relish the moments when I encounter someone with some link to Guyana: no matter how tenuous that link, we’re going to get along just famously. And then there are the even better moments when I meet someone actually from Guyana. It’s all I can do to maintain my composure.
For me, one of those times ended up being something that I’ll keep with me for the rest of my life. I was still in paediatrics and I was interviewing this mother about why her son had to be brought to the hospital. We got to the part of the interview where we were discussing her pregnancy and the birth of her son when she mentioned that her son was actually born in Guyana. And then she went on to say that she was actually from Guyana and that she had emigrated some years ago.
I’m sure at that point my expression was one of unbridled and unbounded joy. Another Guyanese? We ended up spending a long time talking. As another Guyanese living in Trinidad she also had to deal with all of the stereotypes Trinidadians have of Guyanese. They have so many negative stereotypes about us: about the way we’re SUPPOSED to speak, or how they EXPECT us to behave. I remember quite vividly we were on the wards one day and this patient was speaking in such broken English that she was almost incoherent. And somehow that seemed to make my house officer reflexively assume that the patient had to be Guyanese! So she asked the patient if she was Guyanese. The patient was Trinidadian, born, bred and raised. I’d be lying if I didn’t feel the tiniest bit vindicated. So when I met this Guyanese mother, it was so nice talking to someone else who has to deal with the same things on a day-to-day basis and how she copes with it and with being away from home. The conversation ended up being exactly what I needed to hear at the time.
Interestingly, during the past couple of months, I’ve noticed a shift in the way people in Trinidad talk about Guyana. There aren’t the usual snide comments about the Guyanese accent and questions about whether or not we have to use a wheelbarrow when we’re doing transactions at the bank. Now, it’s, “Guyana will be thriving. Guyana really has a bright future ahead. Guyana will really develop with all of that oil money.” Of course, the assumption is that they, the Trinis, will be “helping” us develop!
But anyway, I digress. I’m just so happy to be home, even if it’s just for a little while. There really is no place like home!

Brutal honesty

“Honesty is the first chapter in the book of wisdom.” – Thomas Jefferson

By Anu Dev

Anu Dev

I’ve noticed that there are some people who seem to think that the only way to be honest to someone is to be brutal about it. And that’s quite confusing for me. But I’ve realised that those people just use ‘brutal honesty’ as an excuse to say something mean and take someone down a few pegs.
And those people seem to really pride themselves on their brutal honesty. They think it’s a virtue! They’re like, “Oh that’s who I am, I tell it straight. I’m brutally honest. If people don’t like it then that’s their problem.” But there’s a difference between speaking honestly to someone and being a jerk about it…
There’s nothing dishonest about delivering a truth in a kind manner, taking the person’s feelings into consideration. Even when you’re being firm – you should respect the person you’re being honest to. I’ve written before of the philosopher Immanuel Kant’s exhortation that we must not treat people as means but rather as ends. Each person is an autonomous being… not there for you to spew your frustrations or insecurities on.
That old nursery rhyme “Sticks and stones will break my bones; but words will never harm me” is waaaaay off base, in my opinion. Words are capable of quite a lot of damage; they can harm the psyche and corrode the soul. Why do we teach kids that rhyme? Especially at that age when they have no filter, kids can say some of the cruelest things to each other. So why’re we telling them it’s okay to say whatever they like to each other but just don’t have a go at each other with sticks?
People also quite like to begin their sentences with “No offence, but…” and then continue to utter some incredibly offensive language. Sure, ordinarily I would’ve gotten offended by that, but since you said that you didn’t mean to offend, I guess it’s a-okay!
I think there’s a difference between being blunt and being brutal that some people seem to miss. It’s the difference in treating the “other” as an object or a subject. You can be blunt or straightforward without it having that sort or sharp-edged meanness of being brutal. There is the quality of empathy that each one of us should cultivate: just put yourself in that person’s shoes and ask whether you would want to be spoken to like that. And if you do, then you are a certified masochist…and you need help!!
The truth can be a difficult thing to hear and even more difficult to accept, so why make it even harder for that person by being mean about it? Man is a social being – we have to live with each other. There’s no need to be like porcupines with their needles always raised when someone gets close.

Informed consent

Informed consent is required for every invasive medical procedure, from getting your ears pierced to having an abortion – Bob McDonnell

By Anu Dev

Every day, at some point, we usually have to make decisions: whether it’s a decision about what we’ll wear, or what we’ll eat, or what TV show we should start binge-watching. And despite those being seemingly not very ‘serious’ decisions, most of us still take time to weigh our options and make a decision based on all of the facts we have at our disposal.

Anu Dev

Basically, what I’m getting at is that we all like to have all of the facts before we make a decision or commit to something; that’s just being rational. But there’s one area in our lives that, many times, we’re kind of shoe-horned into making decisions without having all the facts, or understanding all of the facts. And those are decisions that we make when we come into contact with the medical profession — when the question might literally be one of life and death.
One of the things that I’ve noticed when I’ve gone to hospitals (as a patient) is that there are some doctors who often don’t take the time to explain fully to their patients exactly what’s wrong with them, and precisely why they’re suggesting a particular method of treatment.
And it’s extremely ironic that it’s the area of our life that’s the most “life-or-death” that we’re the least informed about when making decisions. Can we still call them “consent”? I wonder: are we just going along with what the doctor decides? For consent to be valid, it must be “informed consent”, and we have a big role to play in “informed consent” also.
Think about it: “informed consent” must be given voluntarily (with no coercion or deceit) by an individual who has capacity, and by an individual who has been fully informed about the issue.
Interestingly, what we’re being taught at school is that obtaining informed consent is a legal and ethical necessity before treating a patient. It derives from the principle of autonomy — one of the 4 pillars of medical ethics: Autonomy, Beneficence, Non-maleficence and Equality. The ethical principle of autonomy requires that patients should accept or reject treatment based on a true understanding of their situation and on their personal philosophy.
But numerous studies have suggested that patients are giving consent based on misconceptions. There is a failure of communication: doctors are not doing a good job of providing accurate information, and/or patients are failing to process that information. I suspect it is a combination of both. While “informed consent” is great…how many of us can digest what the doctor might be talking about?
So it’s important to trust your doctors. They’ve take an oath to ‘do no harm’ (Principle of Non-maleficence) to their patient; so their decisions aren’t made to hurt patients, but rather to help them. But at the same time, many times there’s more than one way to go about helping the patient. A surgeon might be more likely to recommend a surgical intervention not because he/she wants to cut you open and make money off of you, but because that’s his/her specialty and those interventions are what he/she knows work. A medical doctor would probably suggest going a more medical route, treating the patient with drugs. Second opinions can help in this area.
As a patient, you have the right to ‘informed consent’, which means that if you need treatment, your healthcare provider must give you the information you need to make a decision. You shouldn’t have to blindly go along with treatment; you have a right to know exactly what it is you are agreeing to.
Consent means nothing if the patient doesn’t know what they’re giving permission for. It’s like those times kids try to get their parents to sign a blank piece of paper so that they can write an excuse to their teacher for missing school.

Health Behaviour

By Anu Dev

“Rest when you’re weary. Refresh and renew yourself, your body, your mind, your spirit. Then get back to work.” – Ralph Marston

Back when I was rotating through Family Medicine, we had a lecture on the concepts of “Heath behaviour” and “illness behaviour”, which I believe may be useful to the general reader. Heath behaviour refers to any action a person undertakes to promote, maintain, or protect health. And illness behaviour refers to the actions taken when sick to get better.
It made me remember that, at the beginning of med school, I was struck by how finely balanced all our regulatory systems are, ensuring that all of the processes in our body are in sync. Makes you sympathetic with those who believe there had to be a “master watchmaker”!! And think how elaborate our immune system is, to prevent us from getting sick all of the time. There are an awful lot of bacteria and viruses out there launching attacks on us, but we don’t spend every waking moment sick, warding them off, do we? That’s because our immune system is fighting off the invaders all the time.
And I realised how much we take these things for granted. We eat what we want when we want, not caring about what the nutritional content of the food or our irregular eating times might be doing to our bodies. Or we adopt a sedentary, couch potato lifestyle with nary a thought as to what is happening to our body that evolved over hundreds of thousands of years being quite active. And while we take in the car every 3000 miles for the oil and filter change, we don’t make regular check-ups with our doctor just to check if the systems are OK. Until we get sick, that is. We place more importance on our illness behaviour than our health behaviour.
But being healthy isn’t just about being physically healthy. The WHO thus defines health: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” And you’d be surprised as to how many “physical” illnesses are cause by “mental” disequilibrium. One medical expert, in the book, “Lives of a cell”, hazarded a guess that it might be as high as 50%!
There might be interminable arguments by philosophers about where the mind might be located, but there’s no question mental health is as important for normal-functioning as any of the other aspects of health. Mental health is defined as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” (OK…that one’s from the text! But it’s pretty complete.)
What about social health…we are social beings, aren’t we? Well that deals with your lifestyle choices. Do you want to die early from lung cancer? Then by all means keep chain-smoking those cigarettes. But secondary smoking is even deadlier to those around. So just quit! Smoking and drinking excessive amounts of alcohol are all lifestyle choices that you should say no to if you (or those around you) want to stay healthy. Remember: alcohol and domestic violence are highly correlated in our culture.
Other decisions you can make about your lifestyle are about the food you eat. Eat smarter, eat healthier. In Guyana, we’re at high risk for diseases like hypertension and diabetes. These diseases don’t have absolute cures, just ways to manage the illness. So let’s take preventative measures to prevent ourselves from getting these diseases.
Let’s try adjusting our health behaviour, because prevention is always better than cure!

MEDICAL TOURISM

By Anu Dev

Medical tourism can be considered a kind of import: instead of the product coming to the consumer, as it does with cars or sneakers, the consumer is going to the product – James Suroweicki

It’s November, which means that it’s Tourism Month again. This year, the theme is “Sustainable tourism – A Tool for Development”
I was a bit surprised; however, that medical tourism wasn’t touted at the launch of the Month, since this is one of the most lucrative and growing areas of tourism. A few years back, when I was still at Queen’s, medical tourism was in the air in conjunction with the proposed “Specialty Hospital”. But even if the latter has been shelved, it doesn’t mean the former has to die. Just like other types of tourism, “medical tourism” — as the quote above reminds us — is a special reverse type of import; here, the import (the medical tourist) actually comes to buy the product (medical treatment), and leaves the foreign funds in Guyana, rather than sending it abroad!
And those “foreign funds” are astronomical. According to the World Travel & Tourism Council (WTTC), medical tourism contributed 9 per cent of global GDP (more than US$6 trillion) and accounted for 255 million jobs in 2011. So, while our regular tourist numbers are inching ever upwards, I believe we should keep on in that area; especially since we have several medical schools in Guyana, and another is slated to open next year — which I understand will have an adjunct hospital.
Medical tourism brings in more than twice the spending of foreign tourists; so while we’re not going to be exactly overrun by tourists in downtown Georgetown, you’d be surprised how many relatives, friends and ‘significant others’ of patients will fill up the Marriott, Pegasus, Ramada Princess, and all the other smaller hotels that now dot our – dare I say it – once and future Garden City.
With angioplasties (for instance) going for $100,000 in the United States (and we are talking about US greenbacks here!) versus the $11,000 that India charges — even if we go to $15,000 — there’s still a lot of wriggle room for the surgery to be done in Guyana, and rake in all the side benefits of regular tourism.
And what the studies on the major players in medical medicine – India, Thailand — have shown is that, having come for the medical treatment, the foreign patients do get an opportunity to see the country and its attractions. And why shouldn’t they come to see our dear land of Guyana? We have so many beautiful sights to behold and places to visit. The land itself has done half of the work, all we Guyanese have to do is to market the beauty! And medical tourism can be another arrow in our marketing quiver to do this. Brazil is also a big player in medical tourism.
Another type of medical tourists that we can attract would be our Guyanese diaspora in the United States and Canada, which is fighting socialised medicine tooth and nail. For some reason, not many officials talk about the number of these “foreigners” who return to Guyana to have their dentures replaced. They cost at least ten times less than in the United States. Maybe our Specialty Hospital can also do dental surgery, as for instance Costa Rica does.
In the latter country, dental care can cost as much as 70 per cent less than in the United States. More than 40,000 medical tourists visited Costa Rica in 2011, a third for dental care. Guyana, like Costa Rica, is but a short trip from the United States, and it offers orthopedics, cardiology, spine, cosmetic and bariatric (obesity) surgery.
So let’s think – and act – outside the box and watch our tourism revenues swell! And not so incidentally provide higher paid employment to our swelling number of doctors!

Diabetes: Prevention is always better than cure

“Diabetes taught me discipline.” – Sonia Sotomayor

By Anu Dev

I’m rotating through general surgery again, and I’m seeing a lot of the same types of patients I saw last year, especially patients coming in with “diabetic feet”.
“Diabetic feet” refers to the characteristic changes seen in the feet of people with diabetes. Diabetes affects the blood vessels and nerves of the feet (and everywhere else in the body) and inhibits your body’s innate capacity to heal; which to a large extent depends on blood being supplied to the wound.
Because of the nerve damage, diabetics don’t really detect pain as readily as non-diabetics. So if, for example, they stepped on something sharp and injured their foot, they mightn’t even notice the injury. And because of the reduced blood flow and the consequent reduced ability to heal, there’s a greater risk of the wound staying open and becoming infected.
Diabetes also affects your ability to fight off infections, so the infection might spread to the entire leg, and to the bone. The infection could also spread to the blood, leading to a life-threatening condition called sepsis. Since diabetes affects the blood vessels of the feet, the blood supply to the feet is compromised. And if the tissues aren’t getting enough blood, they’ll eventually die. Some people end up having to have an amputation of a toe, a foot, or even an entire leg.
People with wounds to “diabetic feet” need specialist care from doctors and nurses who are experienced with this condition. When I was in Guyana, I was happy to learn that there is a specialised unit in Guyana to deal with “diabetic feet”, since there has been an upsurge in diabetes worldwide, which I am sure has increased our already historically high rate.
So if you know that you’re diabetic, you should take care of your feet, to prevent injury and infection. You should inspect your feet daily. Check for cuts, blisters, redness, swelling, or if your nails are getting brittle and thicker. Keep your feet clean. Use a moisturizer to keep dry skin from itching or cracking. Try to avoid walking barefooted, even indoors, to avoid stepping on anything that could cause a cut or a bruise.
And one of the most important things is to keep your diabetes under control.
Prevention is always better than cure, so it’s important to take care of your feet, to prevent injury and infection. And if your foot does get injured, or if you notice an ulcer forming, you should see your doctor.
I’ve seen so many patients who come in so late with the infection spread so far that the only solution was amputation.