What makes Dr. Howard Feldman very, very happy? Seeing patients walk out of his office.
Dr. Feldman is the founder and medical director of the Interventional Cardiology Program at Shaw Heart and Vascular Center in Roseburg. He is certified in cardiology, interventional cardiology, vascular medicine and endovascular medicine, and the center provides comprehensives services for a wide range of heart-related conditions.
All of us are aware of the interventions now common with heart disease; most of us know someone with a heart stent, for example. Doctors routinely perform angiograms to determine why and where the blood flow is blocked; angioplasty to clear the blood vessel saves many lives every day.
Dr. Feldman believes that the medicine and technology doctors use so successfully to extend the lives of people with heart disease can and should be applied to avoid amputations and improve the lives of patients who have serious wounds or infections on their feet or legs. Dr. Feldman describes a typical scenario: A diabetic patient goes to his primary care provider with an ulcer on his little toe, and it is amputated. The wound doesn’t heal because there is not enough blood flow, but the doctors don’t know that. Even in major cities where one would expect state-of-the-art care, more than 40% of patients facing major amputations are not offered preoperative vascular evaluation. So there is another amputation to remove half the foot, and it doesn’t heal either.
The doctor may do a vascular study at this point and find peripheral artery disease, which means there is blockage. Most doctors, though, still follow the old adage that says do not do stents and other interventions below the knee. What is next except more amputations?
“They come see me,” Dr. Feldman says. He is committed, passionate even, about saving the limb whenever possible, and his reputation is spreading. “We need a large toolbox because it’s a complex disease. Each individual, each problem is unique. The outcome is much lower complication rates than for surgery.” According to the Shaw website, “Patients often achieve relief from their PAD symptoms without even needing an overnight hospital stay. Many are up and walking the same afternoon and back at work in just a few days.”
Dr. Feldman points out that when angioplasty is an option, the benefits go far beyond just saving the limb:
• 10-15% of those with below-the-knee amputations die within 30 days from the surgery itself.
• In five years, more than 67% of patients with critical limb ischemia (leg pain at rest from arterial insufficiency or tissue loss) die. That is a higher percentage than for breast cancer (11%), prostate cancer (0.8%) and stroke (41%.)
• In addition, fewer than 50% of people with below-the-knee amputations are fitted with prosthetics, so their quality of life is dramatically limited.
It is a huge problem because, according to the American Diabetes Association, 26.8 million Americans have diabetes (2011), with 1.9 million new cases diagnosed in 2010 alone. With the population aging, obesity increasing and smoking remaining an alarming statistic, the incidence of diabetes-related complications like PAD will only escalate. Dr. Feldman’s Aunt Francis developed diabetes eight years ago and had many serious complications, among them acute limb ischemia, which is a sudden lack of blood flow to a limb. Nobody did any studies to see why her blood flow was restricted. Instead, the doctors did several amputations to try to help her: first the toe, then the mid foot, then to the knee. She died within a year. He opened the Shaw Center seven years ago and is on a campaign to make sure people explore all their options before resorting to amputation.
“It’s a great satisfaction to have someone who expects to lose a limb walk out the door. It’s better than chocolate. It’s as good as a good knish.”
Most of Liz Rabiner Lippoff’s clients hire her to get patients to walk INTO their offices. Liz is a medical marketing specialist at Liz, ink (LizInk.biz) and a freelance writer.