Only 6 amputations so far

From January to November this year, there have been only six cases of major amputations at the Commonwealth Health Center, translating to an 80-percent reduction in the number of major limb amputation cases in the CNMI.

CHC physical therapist Dana McFadden said the decline came about after the Department of Public Health started its foot care prevention program for diabetics.

“The International Diabetes Federation reports that, through effective foot care programs, amputation rates can be reduced by 49-85 percent. …Most countries belonging to the IDF have set goals to reduce their amputation rate by 50 percent,” she said.

In the CNMI, McFadden said that Public Health has seen a 50 percent reduction in amputation rate within the first year of implementing the foot care program, “meaning we are getting to people sooner and preventing foot complications early on through education, instruction in self inspection and simple foot care.”

The program was started early this year.

In 2004, there were 31 major lower extremity amputations below the knee or above the knee; over the same period, the number of patients being treated in the PT Department at CHC quadrupled.

Amputations are associated with high morbidity and mortality due to decreased mobility, increased risk of infection, reduced independence and overall poor health status that leads to amputation, said McFadden.

To date, the U.S. mortality rate is estimated at 60 percent within five years following a major limb amputation.

In the CNMI, the average lifespan following a major limb amputation is as short as 258 days or about 9 months, she added.

McFadden said the keys to limb preservation includes: realizing that wounds and amputations associated with diabetes are preventable; adequate blood sugar control is at <120mg/dL or A1C <7; early effective intervention for small foot problems; appropriate daily foot care and self-inspection; ability to recognize early signs and symptoms of a problem; regular foot examinations at least every three to six months by a healthcare professional such as physical therapist, doctor, nurse; regular exercise like walking, swimming, and biking; and speaking to a physical therapist or doctor about right exercises before beginning a new exercise program. The CHC Foot Clinic, which started operating on Jan. 4, 2006, will have its Open House today from 1pm to 4pm. The clinic is open every Wednesday from 9am to 11am only. McFadden said both referred and walk-in patients are welcome, especially those diabetics with or without callous, wounds, or sensation changes. The clinic, though, does not cater to non-diabetic patients. McFadden said the clinic accommodates at least five to 10 patients per week. As of today, the clinic has assisted approximately 330 diabetic patients for 45 weeks now.