2007-07-06 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

Commentary By Dr. Tim Rohrs, DPT

For most of my 12 years as a physical therapist I have worked in an outpatient orthopedic setting. For a short period of time I worked as a home care therapist. Physical therapists who do home care generally treat patients that have recently been discharged from either a rehabilitation unit or directly from a hospital. Most have had some type of surgery or have had a stroke or similar central nervous system pathology. My most memorable patient was a woman in her mid-to-late fifties; not "old" by any stretch of the imagination.

This woman had undergone a below the knee amputation. She explained that she suffered from Type II diabetes and that due to complications from the disease, she had to have her leg amputated. Without any explanation from the patient, I knew the course of events that led to the amputation.

Diabetics suffer from decreased sensation and blood flow to many parts of the body, including the legs and feet. Because of this, any abrasion to the foot can be a problem. It can be a pebble in the shoe, the heel or toes rubbing from ill-fitting footwear, or just a simple blister. The diabetic foot, already suffering from sensation and circulation issues, does not feel these insults as a normal foot would. The skin thus breaks down and can become infected. The blood flow limitations and ineffective immune response, as well as the increased healing time, conspire to cause serious trouble. Soon, the infection spreads from the skin to underlying tissues, causing necrosis. To prevent the further spread of the infection the leg must be amputated.

One particular day I arrived to start our session; she broke down and started crying. This was odd because she had always seemed strong-willed and ready for anything. She explained that the loss of her leg was all her fault. I started to explain the sequence of events as described above, to comfort and alleviate her sense of self-blame. She already knew all that information but continued to blame herself. She then explained that although she knew she had diabetes, she did not follow her doctor's instructions. She was prescribed medications that she had filled but never took. She did not follow up with doctor's visits, knowing that she would not follow his orders in the end. When she did get a sore or an infection she did not seek immediate medical treatment. She lied to her family that she was taking care of herself and was on program with the doctor.

This was almost 10 years ago and I remember it like it was yesterday. Today I hear similar stories of patients not following up with their doctors. Patients with cancer who do not go for their radiation and patients with angina who do not take their medication all remind me of that incident 10 years before. I wish that I could show these patients the movie playing in my head of that woman crying over a limb lost, to help them reconsider their decisions and seek the help that they desperately need. Sadly, I can only tell them the story, but they cannot see that poor woman's tears, or hear the pain in her voice.

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