Diabetes and Your State of Mind, ‘The Discouraged Diabetic’

The disease process of Type II Diabetes Mellitus is an insidious process that is due to genetic predisposition and life style choices. There is nothing any of us can do about our genetically inherited traits. However, our lifestyle choices are another matter. It is not easy for any of us to get our minds around the fact that these choices have been self destructive. This in particular is discouraging to the diabetic patient.  A diabetic patient will also come to the realization that food manufacturers have pulled off a major con on us all by encouraging our consumption of their processed foods that are specifically researched and designed to make them habit forming but are sold as the best things for us. The confluence of these effects often puts Diabetic patients into a state of denial.
In my opinion there is nothing more dangerous to an individual with Diabetes than the denial process.
A diabetic in denial will not change their eating habits. They will not seek medical care or take prescribed medicine to control their blood sugar. They will not even seek care for serious wound infections when they become limb and life threatening. I know, at Central Florida Foot & Ankle Specialists I have seen and treated these patients for nearly a quarter of a century. I can also tell you that no treatment can be successfully pursued until the patients state of mind has been adjusted, they have received correct information and begin to feel confident and empowered to be able to overcome their currently perceived state of hopelessness.
If you have a family member with Diabetes that comes to mind when reading this article then try and find the best internist (for blood sugar control) and podiatrist (for wound care and limb preservation) that you can. Be certain that the physician has the ability to empathize, communicate and educate. Then go to work encouraging your loved one to seek treatment with your chosen physician. Following this process will increase your chances of success in changing the discouraged diabetics life.

Dr. McNamara

Numb Toes and Feet

Nerve problems in your feet can be caused by several metabolic issues, such as alcohol use, heavy metal exposure, hyperlipidemia and most commonly Diabetes Mellitus.
Numbness in feet and toes that is symetrical is called poly-neuropathy.
In previous years diagnosis of poly-neuropathy was made by subjective, qualitative and indirectly quantitative techniques.
Today an indication of poly-neuropathy can be initially identified by subjective complaints as well as objective qualitative evaluation. These techniques include evaluating vibratory sensation, two point tactile discrimination, warm-cold discrimination, and protective sensorium. The most critical qualitative finding is that of protective sensorium. If protective sensorium is lost in your feet then you will not know if an injury has occurred. Subsequent infection and tissue loss is a result, sometimes as severe as an amputation.
Today at Central Florida Foot & Ankle Specialists, Dr. McNamara has gone beyond the standard of qualitative evaluation to diagnose poly-neuropathy. He provides his patients in Orlando with a directly quantitative measurement of epidermal nerve fiber density and those nerves relative health quality.
Epidermal Nerve Fiber Density (ENFD’s) evaluation is performed by Dr. McNamara acquiring a 3mm punch biopsy of skin from the outside of the ankle of the patient. This biopsy is then processed in a very specific manner and submitted to the scrutiny of a highly trained Dermatopathologist. This process requires two weeks for results to be available. The end result is that a patients loss of small nerve fibers that are the cause of their numbness can be detected often well before a diagnosis of Diabetes has been made. Furthermore, treatment for the regrowth of small nerve fiber loss can be instituted with prognostic indicators for success being given as well. If you have concerns about Diabetes or numbness of feet and toes you can contact Dr. McNamara at Central Florida Foot & Ankle Specialists, 407-228-2838, or through the website at www.orlandofootcare.com
Dr. McNamara

Advanced Wound Care Techniques in Orlando

At Central Florida Foot & Ankle Specialists Dr. McNamara has a very high success rate in treating diabetics with wounds of the feet and legs that have an abnormal ability to heal due to many factors. These factors include uncontrolled blood sugar, low hemoglobin and albumin, poor arterial blood supply, bacterial colonization of the wound, senescent cells and pressure. Dr. McNamara has proven protocols in place to deal with each of these abnormal factors, particularly those dealing with senescent cells.
Once the various factors are normalized or reduced the longstanding diabetic wound is left with senescent cells that lack growth factors and cytokines. Without these chemicals locally at the wound site there can be no wound healing. A lack of growth factors and cytokines is present if the wound has not shown 50% closure within 4 weeks of its occurrence.
This is where the advanced wound closure techniques at Central Florida Foot & Ankle Specialists in Orlando, Florida come into play. The current most utilized options are Dermagraft and Apligraf. These are bioengineered skin grafts of fibroblasts and keratinocytes & fibroblasts respectively. They both are derived from cell lines of neo-natal foreskin and are rich in the growth factors and cytokines necessary to jump start wound healing. There is a new product that we are currently evaluating that is amniotic fluid and amnion derived from consented individuals. This has the potential to be another valuable adjunct therapy to our treatment of these difficult to heal diabetic wounds. For more information go to www.orlandofootcare.com
Dr. McNamara

Diabetes and Your Feet in Orlando

Did you know that it is possible to grow new nerves in your feet? Well, it’s true! But before we can get to how this can be done we have to understand how they are lost in the first place.
In Diabetes, particularly Type II, high levels of harmful chemicals, along with a reduction in beneficial chemicals, cause damage to the interior lining of arteries. In the lower extremity at your feet the arteries are quite small and when their lining is damaged they fail to carry adequately oxygenated blood to the superficial skin nerves. This causes these epidermal skin nerves to be damaged and to slowly die out. This occurs in the hands as well, although less frequently.
Over the past three years medical science has learned how to visualize these nerves and has created standards for their measurement. At Central Florida Foot & Ankle Specialists we have been providing this diagnostic service for our diabetic patients since its availability. This test is called an epidermal nerve skin density analysis and only a few dermatopathologists in the country are capable of performing it. Interestingly, some patients complain of foot numbness and have yet to meet the criteria for diagnosis of Diabetes. This test also gives us advanced warning of the disease process that is on its way and already causing the first stages of nerve damage. This advanced onset of nerve damage can occur as much as six years before the diagnosis of Type II Diabetes is made by your primary physician.
Now the good part! Once the count of nerves and their health character has been determined by the pathologist the Podiatrist at Central Florida Foot & Ankle Specialists will be able to provide our patient with a prognosis for the regrowth of the lost nerves and a return of protective sensorium.

Dr. McNamara

Welcome To My Patients!

After much thought I have decided to attempt use of the ‘blog’ to try and document helpful information for you, my patient.

A previous attempt was made in 2009 under the title ‘Your Foot Care Advisor’.  I expect that some of these pages will be brought into the website www.orlandofootcare.com for your easier access.

If there are any subjects of interest that this medium will help clarify, please make a comment and I will reply as soon as possible.

Dr. McNamara