He tried to avoid sugar, as his doctor recommended, but bad habits die hard. “It takes a lot to eat right,” he said, “and it costs more.”
TMPHBITEU
It's the Doctor's fault? Not this time.
Diabetic Amputations A ‘Shameful Metric’ Of Inadequate Care | Kaiser Health News
Even though they really don't know how to manage it, the medical community cannot make people get their heads out of their asses. Is this "blaming the victim"?For decades now, the American medical establishment has known how to manage diabetes. Even as the number of people living with the illness continues to climb — today, estimated at more than 30 million nationwide — the prognosis for those with access to good health care has become far less dire. With the right medication, diet and lifestyle changes, patients can learn to manage their diabetes and lead robust lives.
Yet across the country, surgeons still perform tens of thousands of diabetic amputations each year. It’s a drastic procedure that stands as a powerful example of the consequences of being poor, uninsured and cut off from a routine system of quality health care.
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He tried to avoid sugar, as his doctor recommended, but bad habits die hard. “It takes a lot to eat right,” he said, “and it costs more.”
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But Rip, you simply can’t do that in these enlightened times. Blame the rich, instead.Originally Posted by Mark Rippetoe
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It is always relevant to question how narrow the focus is of medical management of chronic, lifestyle related diseases. From that perspective what we do is the ideal, no doubt. However, diabetes is one of the best examples to use to illustrate the damage of lack of access to health care. If you make the following two comparisons:
1) a patient who does what we advocate vs one who simply goes down the medical management path and is compliant with their meds
2) a medically managed patient as above vs one without access to healthcare
between those, the difference in the outcome is negligible in the first case compared to the difference in the second.
TMPHBITEU
Pushing aside the issue of personal responsibility, you're right.
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There is a physical rehab section at the nursing home where my mother is now. In the rehab area I notice numerous late middle aged amputees. It is unsettling. I can’t help think about it. Yes access to quality medical care matters. But so do the many small decisions we make every day.
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Your two comparisons leave the most important one out: A medically managed patient who is compliant with their meds and the insured, medically managed patient who is not.
There are scores of patients in my practice who have lost significant amounts of vision from complications of diabetes. In the vast majority of these cases, there is not a big gap in their chart where they went for years without coverage or access to medications. Instead, their charts are littered with notes from their primary care physicians, endocrinologists, nephrologists, ophthalmologists, etc, exhorting them to take steps to better control their disease with some combination of medications, diet, and exercise. And by the time they come in to see me with a big retinal bleed, their HgbA1c is still over 10, and they are demanding I repair the irreparable. Its not a coverage issue (at least here in California with an uninsured rate in the single digits), its the personal responsibility thing that Rip mentions below.... And that is lacking to an appalling degree (at least it is here in NorCal).
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Two months ago, a co-worker (60-ish years old) recently announced he had an A1C of 9... much to his doctor's horror. "Well, my doctor told me I can never eat bread again", says my co-worker. (To which I say, why have you been eating bread since your first type II diagnosis)
...a little background: this guy has been injecting type II meds for years. He's already had eye surgery in both eyes for diabetes related issues. He's carrying an extra 80lbs or so.
I felt horrible. I was seemingly so close a couple years ago to getting him into my circle of lifters. I know through real world examples what lifting can do for health and blood profiles.
A week ago, I attended a meeting with the "usual affair" of donuts and coffee. My "no more bread guy" was first in line for a donut. $*#^!. I wanted to vomit. The time is nigh for serious life threatening problems. I tried. He's made his choices.
The good news I can report is that others in my pod are making the wheels go up and down. Many many thanks to the crew here for a marvelous program that I have had the opportunity to share.
I so much want to resist the notion that we are narrow casting. I'm sometimes frustrated but not giving up. My co-worker is apparently out of my casting range.
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When I was in medical school one of my preceptors told me about a patient: Middle aged, overweight, diabetic, hypertensive on one medication and close to adding another medication. Not following general recommendation to eat less processed food and get some exercise. The patient did not show to his next appointment but called a year or two later and came in for a checkup. He had run out of medication because he was not seeing a doctor. His blood pressure and hgb A1c were normal. His car had died (which is why he missed his appointment) and he had been walking three miles each way to and from work 5 days a week.
I met a patient in vascular surgery clinic He had come in 3 months earlier complaining of an achy heavy feeling in his calves when he walked (claudication). He was having symptoms walking from handicapped parking into stores. Like every claudicating patient he got the standard initial non-operative management instruction, which includes "walk until it hurts, stop until it feels better, walk some more, do it every day, increase the distance between rests every week, work up to a couple miles". When I saw him he had done as instructed, he was walking 2 miles with 5 rests, and he had no symptoms with normal activity. In six months of going to that clinic once a week he was the only patient I met who followed these instructions.
We all know that walking has minimal effect compared to strength training, but even walking would have saved most of the feet I have amputated.
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Here in Italy we all have access to health care. And for chronic diseases it's completely free
Neithertheless Vascular surgeons in my hospital perform a lot of amputations because patients don't take care of themselves.
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