An article from the Spring 2012 issue of MyGeorgetownMD.
Fifty-seven-year-old Chester Hines of Arlington, Va., has had type 2 diabetes since he was 29.
The disease forced the drafting and woodworking vocational teacher into early retirement, robbed him of his sight, caused his kidneys to fail and led to partial amputations on both of his feet. Still, Chester remained hopeful because experts at MedStar Georgetown’s Center for Wound Healing helped him preserve something very important—his mobility.
It started in 2008 when Chester developed a sore on his left foot that would not heal. Surgeons at MedStar Georgetown amputated Chester’s big toe to remove the infected tissue and stop the infection from spreading.
However, Chester’s 25 years with diabetes had reduced his blood circulation, making it difficult for the surgical wound to heal. To control the infection, MedStar Georgetown surgeons removed Chester’s toes on his left foot, preserving the rest of his foot and his overall mobility.
Then, last winter, poor circulation led to gangrene on the little toe of Chester’s right foot. Although he had angioplasty at another area hospital that successfully provided a new blood supply to the area, the wound would not heal, so he returned to MedStar Georgetown. “The doctors at Georgetown took such good care of me last time, there was no question where I was going,” says Chester.
It took several trips to the operating room to remove the infected area, which included all of his toes and about half of his foot. Then, it took three grafts to close the skin over what was left of his foot. “I have never seen a patient more motivated to avoid a limb amputation. Together, we prevailed,” says Dr. John Steinberg, DPM, podiatrist and diabetic limb salvaging expert.
“Dr. Steinberg asked me more than once if I was willing to keep fighting, to try to save my foot. He told me as long as I was, he would fight, too,” adds Chester. “I told him that as long as we still had options, I wanted to try them.”
“We used numerous advanced wound healing technologies to help Chester, including a negative pressure wound vacuum and hyperbaric oxygen,” says Dr. Steinberg. (See chart below.) Now, Chester will be able to walk with no prosthesis and keep active. Not only is it a big deal to Chester that he have some level of independence, but his ability to walk and be active will be a boost to his cardiovascular system, which can help him maintain his relative health.
Sadly, Chester’s experience is not typical. When people with diabetes go to the emergency room for an ulcer, statistics show that they have a 23 percent chance of their limbs being amputated.
As such, it is crucial that people who have complex medical issues that lead to non-healing wounds get treatment at a wound care program that offers the full range of specialists who can address the wound itself and its underlying causes. That’s what Chester received at MedStar Georgetown.
Whether caused by chemotherapy burns, open fractures, surgical incisions, bed sores or diabetic ulcers, the process of healing these wounds is complex and often requires many disciplines to achieve the best outcomes. At MedStar Georgetown, patients have access to a multidisciplinary team of experts that includes specialists in orthopaedics, endocrinology, vascular surgery, infectious disease, rheumatology, neurology, dermatology, podiatry, hyperbaric medicine and physiatry.
“Our program is a truly multidisciplinary program that can address any cause of challenging wounds,” says Christopher Attinger, MD, chief, Division of Wound Healing and director of the program. With a team of experts under one roof, many patients can have multiple appointments with different specialists during the same visit.
“Dr. Steinberg was the man of the hour,” says Chester, an upbeat man who looks forward to receiving the special shoe that will get him back on his feet soon.
Chester’s advice to others is simple: Be patient, follow your doctor’s instructions, don’t give up, and go to MedStar Georgetown.