December 6, 2019
Joe Coles, a CPA in Tinton Falls, New Jersey, experienced a rude awakening when he began developing redness, blisters and—when those blisters broke—open sores on his feet and lower legs. He’d been diagnosed with type 2 diabetes more than two decades ago, but treated it more as a nuisance than the serious health problem it is. Now
it was catching up to him.
“I didn’t behave properly,” Joe admits. He saw his primary care physician, Brendan Mulholland, M.D., who is affiliated with Bayshore Medical Center and Riverview Medical Center, in early 2018 because of a sore on his ankle that refused to heal. His feet and legs became red and inflamed. He and his doctor tried different treatments, but it was clear that something more aggressive was needed.
His wounds did not just happen. He admits that he had not been taking good care of his body. His A1C (a measure of blood sugar levels that reflects on the last two or three months of the patient’s diet) had reached levels more than twice normal, signaling that it could be damaging his kidneys and vision. He also had congestive heart failure, which occurs more frequently in people who have diabetes than in those who don’t. The congestive heart failure led to his body holding excess water that contributed to the fluids leaking from his wounds.
Since Joe didn’t pay much attention to his diabetes, his partner, Gail, had no idea how sick he was until the sores and blisters developed. When she realized how serious it was, she pitched right in and became his personal care partner. Every day she would gently remove the bandages that protected the tender blisters and open wounds, then gently recover them with fresh bandages. Every day she carefully kept track of the advancing problems.
The problems were getting worse. Gail remembers, “We were up to 17 wounds when I wrapped his legs and feet on a Monday night. When we changed the bandages the next day, two more blister wounds had formed.”
A Team Effort
Even with treatment, Joe’s wounds were getting worse, so Dr. Mulholland referred him to the Wound Care Center at Bayshore. Joe was nervous at his first meeting with Mark DeCotiis, D.P.M. After all, many treatments had been tried and had failed.
Dr. DeCotiis’ specialty is treating chronic ulcerations of the lower extremities. Unlike traditional M.D.s, D.P.M.s complete their training and then do a three-year residency focusing on foot care and surgery. “Dr. DeCotiis walked into the room, examined me and said what he was going to do. He gave me confidence,” Joe says.
First, vascular surgeon Owano Pennycooke, M.D., operated to open arteries in Joe’s lower legs to restore healthy blood flow. He did an angiogram on Joe’s left leg in his office clinic. Using X-rays, he identified the artery feeding the wound, then performed an atherectomy to reopen it. The angiogram on his right leg showed less serious arterial disease, but the venous disease is currently being treated with compression hose. Since the doctors could not use stents in the procedures to open his blood vessels (stents do not hold up in these small blood vessels), it will be something Joe has to be aware of and there will be times in the future when those procedures may need to be redone.
For many people in this scenario, the only option is to amputate the foot. But Dr. Pennycooke’s motto is “keep the foot in the shoe,” and his work on Joe’s feet was an important factor in preventing a possible amputation.
The poor blood flow had weakened Joe’s skin and kept it from healing. His doctors, including cardiologist Marcia Liu, M.D., consulted one another and revised his medications. The result helped the healing by removing 20 pounds of excess fluids. Once home, Joe would sit with his leg elevated to continue to reduce the stress on
his legs and enhance healing.
“It was amazing how the wounds kept getting better and better,” he says. “I felt such a relief!”
For the next step, Dr. DeCotiis took Joe into an operating room, cleaned the wounds and placed a bioengineered skin substitute graft on the area to expedite healing. It was a very deep wound, and after weeks of healing, a second graft was required to finish the healing.
Back to Living Life
Dr. DeCotiis says that anyone who has type 2 diabetes should be seeing a podiatrist regularly for evaluation and be educated in preventative foot care. A low-risk patient who has well-controlled diabetes, no signs of diabetic neuropathy, no peripheral vascular problems, and no ulcerations or infections might only need to be seen annually. A higher-risk patient may need to be seen bimonthly.
In Joe’s case, instead of being seriously disabled, he is back to living his life. He goes to the gym regularly and works out with a trainer. He recently managed a dog agility competition at the Lower Camden County Dog Training Club in Cherry Hill, New Jersey. Gail showed Joe’s border collie, Bullet, because he was too busy taking care of show details. He fully expects to run his dog himself by fall.
“I’m glad to be walking on two legs,” Joe says. “I didn’t realize before how serious my diabetes was. If it hadn’t been for my doctors and Gail, I might be in a wheelchair now.”
If you have diabetes, are at risk for diabetes, or have any skin problems on your feet or lower legs, learn how we help people enjoy an improved quality of life and avoid debilitating complications.
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