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What’s that on the bottom of your shoe?

What’s that on the bottom of your shoe?
On a seemingly normal day during one of their many conversations, Carle patient Terry Harris’ wife Lisa asked an innocent question, “What’s that on the bottom of your shoe?”

His wife followed up by asking to see the bottom of the other shoe too before proceeding to tell him that whatever was on his right shoe wasn’t supposed to be there. In a natural response to her observation, Harris took the shoe off and found a plastic circle affixed to the outer sole by a small nail -- a round cap roofing nail.

“I stepped on this nail and didn’t even know it,” Harris says. Without pain, he proceeded to take the shoe off and on several times unaware that a small section of the nail tip went into his foot and the bone of the second toe. “I didn’t see any visible harm and figured I got lucky,” explains Harris, who lives with type 2 diabetes and thinking back on it, wonders if a touch of diabetic neuropathy may have reduced his ability to feel pain from the nail.

Fast-forward several weeks when in the early morning hours of June 20, 2021, Harris woke to find the bottom of his foot had blown up with an infection. He and his wife quickly made their way to the Emergency Department at Carle BroMenn Medical Center. At this point, no one at the hospital knew about the nail and it wasn’t on Harris’s mind either. Initially the infection seemed to be a consequence of his diabetes management, not a wound.

Once again it was his wife Lisa that noticed something strange. “She saw the bottom of my foot and the little hole on my second toe and noted where that spot would be in my shoe and put two-and-two together. She said this is from that nail,” Harris remembers.

The infection was severe enough that Harris’ care team advised to amputate his second toe. Once out of the hospital the Home Health Care team came to his home in Normal two times per week to administer antibiotics, change the wound dressings and teach Harris and his wife how to care for the wound. He was also receiving wound therapy treatment at the Wound Healing Center at Carle BroMenn. When the first treatment therapies didn’t produce the needed results, he began hyperbaric oxygen therapy (HBOT) two hours per day, five days per week, for 14 weeks.

“Our goals are to heal his ulcer and preserve life and limb,” Caroline Halperin, DO, medical director, Carle BroMenn Center for Wound Healing says. “Diabetes is the most common cause of amputation, with more than 8.2 million people experiencing wounds per year and costing over 90 billion dollars annually.  In this case, our patient had the triple insult- diabetes, peripheral neuropathy, and vascular disease.  Once having amputation, his chances of another amputation or death was about 50% in the next 2 years.

“This patient was referred to the wound clinic and a comprehensive care plan was discussed with him and his family.  They agreed to participate.  We aggressively managed his ulcer with proper offloading and advanced measures including bioengineered skin, negative pressure wound therapy, and HBO.  With improvement in nutrition, diabetes, managing his infection, vascular referral, and the wound care provided, he was able to heal. Based on experience, avoiding further amputation should have a significant impact on his life.”

Chronic wounds, also called non-healing wounds, are serious and require prompt attention and treatment to avoid complications that can lead to a diminished quality of life and possible amputation. The wound therapy experts at Carle BroMenn Medical Center and Carle Foundation Hospital include certified hyperbaric technologists, certified wound-care nurses, infectious diseases specialists, and board-certified hyperbaric medicine physicians. These experts work together to help each patient heal their wounds as quickly as possible by developing specialized treatment plans.

HBOT can speed up the healing process by increasing the amount of oxygen your blood can carry. With repeated visits, the enhanced oxygen levels encourage healing and growth of new tissue and bone.

“My care team gets an A+ from me,” Harris says. “I couldn’t imagine not having a foot and I am grateful for everything they did to help heal my wound. Seeing the same people for almost a year allows you to really get to know them.  It was a big commitment of time and energy by everyone involved and I appreciate it.”

“Patients in the wound care center are expected to visit weekly for assessment of the wound and any change in the plan of care,” Dr. Halperin says. “They may need cleaning of the wound, office surgical adjustments of the wound called debridement, and recommendations about any complicating medical or social issues. Patients with wounds need to make a commit to improve their health. Often time family members and friends are needed to assist with dressing changes and other demands. The earlier a patient seeks help for their wounds and the more invested they are in their healing and health, the better the chances of a good outcome.  This was evident in Mr. Harris’ case.”

Carle specialists work collaboratively to provide patients with comprehensive care. What started with a question about a shoe found paved the way to not just the Wound team, but to the Cardiology team too. “Patients with peripheral artery disease (PAD) have a 50% chance of also having coronary heart disease,” Siddharth Gandhi, DO, cardiology says. “We work proactively to identify associated high-risk conditions so we can address them and contribute to the improved quality of life for our patients.”

In Harris’ case, a cardiac stress test was warranted after the wound issue was resolved, and the outcome revealed a blood flow issue in his heart. At the Cath Lab at Carle BroMenn, Dr. Gandhi inserted three stents to restore blood flow. “I performed the peripheral angiogram to reduce his level of amputation and further reduced his cardiovascular risk to reduce his risk for suffering from stroke and heart attack with medications,” Dr. Gandhi says. Harris is now a regular at the cardiac rehab at the hospital three times per week for 12 weeks.

Patients with a non-healing wound or concerns about their heart health should consult with their primary healthcare provider to discuss next steps and potential referrals. For more information, visit carle.org about wound therapy services and cardiovascular medicine services and treatment options.
 

Categories: Staying Healthy

Tags: Bloomington-Normal, Cardiologya, Carle, Carle BroMenn Medical Center, Champaign-Urbana, Diabetes, Foundation, Hospital, Wound Center

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