Eye On Physical Therapy
As a health care provider, I am often exposed to many stories of heartache as well as stories of triumph over physical ailments. One of the more memorable stories that was told to me by a patient was also one of the most heart wrenching. She had her right lower leg amputated secondary to complications with diabetes.
She had not had her temporary prosthesis made yet and I was there to help keep the remaining musculature strong until the temporary leg was ready. She was young (late forties) and had always been in an upbeat mood. When her temporary leg was ready, we were to begin training her to walk on it. The stump was very painful, sore, red and inflamed. As she tried to put weight on it, she began to cry. I am somewhat used to a patient crying because of severe pain so we took a break. She explained to me that she wasn’t crying because of pain. She was crying because the amputation was all her fault. Because of the diabetes, she had diabetic peripheral neuropathy. With this condition, the nerves of the feet and legs are compromised and the patient experiences decreased sensation and feeling. This condition continued to worsen over time because she was not following through in taking her medications properly. She bought them and had them in her medicine cabinet, but did not take them on a regular basis.
In addition to her non-compliance with her medications, she was not inspecting her feet on a daily basis. Diabetics with peripheral neuropathy have decreased sensation in their feet. A small pebble in the shoe or an incorrectly fitting shoe can cause skin to break down and blister. The decreased blood flow, also caused by diabetes, prevents the blister or wound from properly healing. Soon this diabetic ulcer gets larger and larger. More often than not, infection is the next step in the process. Again decreased blood flow does not allow the immune system to fight the infection effectively; white blood cells cannot reach the site. Skin around the wound can turn black and die. Finally the limb can get gangrene. Amputation is the only answer to save the remaining leg.
She knew what needed to be done. She was educated about all the potential complications of diabetes. She knew she should have inspected her feet for wounds. She knew she should have seen her doctor when she discovered the wounds on her feet. Aggressive wound care may have prevented her from losing her leg. When I asked her why she ignored all of the signs and symptoms she replied that she didn’t know. After a few moments of silence she admitted she had been in denial. That by seeking medical attention for her feet and taking her medications she was admitting that she had diabetes. Because she didn’t believe that she had diabetes she had no reason to take her meds. She had hoped it would go away on its own.
Today she uses her prosthetic leg with a cane to get to and from work and wishes for a way to turn back the hands of time and fix the biggest mistake she had ever made.