Male Speaker 1: We are in middle of an epidemic of diabetes. We used to see juvenile diabetes, now we are seeing late onset, Type II diabetes in kids because of the obesity problem, lack of exercise, yet people always warn you. You always see an eye doctor, and you have to worry about circulation in the lower, especially the feet. As a podiatrist, I know you have seen the very young ones, specifically someone older, what would you be looking for so that you can guarantee the best you can that would have the least amount of complication of diabetes in the feet.
Male Speaker 2: Well, people generally have to be aware of their feet and one of the ways that's recommended for them to either look and feel their foot every single day. If they can't do it for whatever reason it is, such as been too overweight and they can't look at their foot, there are special mirrors that we can have right now. So they are even going to have lights attached to them, they could have a spouse or some of the family member to look at their foot. If there is something that they think is not the usual case, such as color changes in the foot, if they feel the foot, and the temperature is different between one foot and the other or if it's excessively cold or excessively hot, if there are some wounds or injuries that are not healing in a normal fashion, there is some numbness and tingling, this is an indication that something is actually happening in a bad way, and therefore, a professional should look at it. If it's a child, a pediatrician; if it is adult, they may be able to handle it. If not then the guy is just going to evaluate the circulation with some of the equipments that we have available right now. This could be done in the office, it's quick, it's easy, it's painless. So therefore a person with diabetes should really be looked at if they have any sort of symptoms.
Male Speaker 1: If they have numbness or discoloration of the toes, they went to a podiatrist, what could he do to increase circulation?
Male Speaker 2: Well, if the problem is caught earlier on as any particular illness, we evaluate the area first, that's the most important thing, we could take an x-ray to make sure there is no bone deformity. We could check the circulation with what we call a Pulse Volume Recording or a Doppler or a Laser Doppler. If there is a problem with what we call sensation, where they have numbness or tingling or a discomfort like burning or pain, I think they evaluate it with what we call a Nerve Conduction Velocity test.
Once we have all these tests, once we have all the results, then we could formulate a proper treatment plan. So there are people that could respond, there is just some simple exercise, like use an exerciser bike if their circulation problem is at the beginning and you catch it in time. Sometimes they need to have a vascular doctor look at them. They may need to have something done such as an angioplasty or ballooning, and there is actually a very conservative way, which is called the circulated boot which helps people which do have circulation problems or wounds of gangrene, and again if it's caught early enough, it could be addressed with this particular non-evasive way for people who cannot have surgery. This has been done in the near clinic and a number of podiatrists do have this particular equipment in their office.
Male Speaker 1: Of course the first thing you do here with diabetic is to make sure your diabetes is well-controlled.
Male Speaker 2: Obviously.
Male Speaker 1: If you get well controlled in spite of all that outfit, you are doing the exercise as you have mentioned, the boot and everything can be done to help situation down the road. But in occasion that even the best of attentions, their toe gets more, it becomes gangrenous. What we can do -- are there early signs or anything we can do to prevent it going to probably going to lose the toes?
Male Speaker 2: Well again, it needs to be addressed by -- actually rather than the rest of the circulation, if it's just a localized problem to a toe, unfortunately, sometimes it needs to be addressed surgically but many times, if we just treat the area very nicely, with the proper wound care, we can help the wounds heal, and could help the toe and actually save the toe. But there are times unfortunately where the toe needs to be removed, so that the rest of the foot does not develop the problem.
Male Speaker 1: A diabetic who smokes has a greater risk of having circulatory problems in the toes?
Male Speaker 2: Everybody who smokes has a problem with circulation. It's been found that roughly, it takes about seven seconds for the smoking to affect the circulation. One of my biggest problems is people who smoke can have diabetes. I can't give you the exact numbers but it's probably doubled or tripled the normal population.
Male Speaker 1: Just pure smoking without diabetes can cause a problem with the circulation?
Male Speaker 2: Absolutely, it causes problem in every part of your body from the head on down to the feet.
Male Speaker 1: And today they just announced a new tax on cigarettes and I think New York State that cigarettes cost -- it's now $9 to buy a little pack of cigarettes.
Male Speaker 2: That may help to stop people smoking, although I think that people are so addicted, it's kind of tough to stop them from smoking, no matter how much it costs.
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