Amputation prevented in time
11.11.2010 17:42
Thanks to the new supply structure, Hans Michels was able to keep his footing
It all started with a small splinter of wood: “I don’t know where it came from, but you’ve had something like that before,” says Hans Michels today. When he caught the splinter in his little toe at the end of 2009, he had no idea how much trouble this seemingly insignificant injury would cause him. Hans Michels is diabetic and therefore has problems with blood circulation. Although the 50-year-old, who has known about his illness since he was 21, never smoked or drank excessive amounts of alcohol and was always active in sports, the permanently elevated blood sugar still left its mark on Hans Michels' arteries. “I probably waited too long to put my foot down. “Today I would go to the doctor straight away if I had something like that, but you’re always smarter afterwards,” says the machine operator.
When Hans Michels could no longer bear the pain in his foot in the run-up to Christmas in 2009, he went to the emergency room at St. Franziskus Hospital in Cologne-Ehrenfeld. “I could only wear a cut-up sneaker on my right foot, the pain was so bad,” remembers Hans Michels. The surgeon at the hospital had to remove both the pinky toe and the joint bone in one operation due to the advanced infection. “I thought, at least I can still walk and if everything heals now, everything will be fine again,” says Michels, describing his emotional state at the time.
There was a threat of amputation of half the foot
Unfortunately, the healing did not go as Hans Michels wanted. “I had to go to the hospital again and I have to say that the doctors there did a really good job,” he says happily today. In order to rule out further amputation that would have affected half of the foot, the doctors at St. Franziskus Hospital also consulted an external expert. “If half my foot had been amputated, I would hardly have been able to walk. The doctors told me that amputation could really only be a last resort. That’s why they brought in a colleague who specializes in my foot syndrome,” reports a relieved Hans Michels. Diabetic foot syndrome (DFS), as in Hans Michels, occurs when circulatory or nerve disorders occur due to permanently elevated blood sugar. The smallest wounds or injuries can develop into serious infections, while at the same time making wound healing more difficult. In the Cologne area alone, around 30,000 people are affected by DFS.
Rescue through “preventing amputation”
The external diabetologist, Dr. Dirk Hochlenert, looked at Hans Michels' foot and checked the blood circulation, but could not find any problems in the first step. The doctor therefore called in a vascular surgeon. Together with the doctors from St. Franziskus Hospital, they finally found out that Hans Michels suffers from a rare vascular disease that only simulates good blood circulation. Two arteries in Hans Michel's leg were already so narrowed and hardened that the foot could no longer receive sufficient blood flow. As a result, the wound could not heal properly. “There's probably not much that can be done about one artery, but fortunately the doctors were able to repair the other artery. Now my foot has 70 to 80 percent blood flow and the wound can heal,” says Hans Michels happily. His foot has been causing him problems for around nine months, but now he can look positively into the future again: “My foot is saved! Now I will continue to be looked after by St. Franziskus Hospital until everything has healed again and hopefully I can go back to work in a few weeks. I am really very happy and grateful that the hospital sought a second opinion.”
Hans Michels was lucky because the Diabetic Foot Network in Cologne and the surrounding area launched the “Prevent Amputation” campaign at the beginning of this year. In the so-called foot network, doctors from different disciplines have been working with other specialists since 2002 to provide the best possible care for patients with DFS. Doctors now want to specifically draw attention to this secondary disease and hope to be able to reduce the number of unnecessary amputations. Currently, 75 percent of all amputations related to DFS could be avoided. This insight and the concept of “preventing amputation” now benefited Hans Michels. The campaign also includes the second opinion campaign. As part of this, all participating hospitals in Cologne generally voluntarily obtain a second external opinion if amputation is being considered and in this way achieve even better treatment results. This was also the case with Hans Michels. “We are glad that we were able to help Mr. Michels and are also pleased overall about the good networking with external specialists. This type of collaboration is unique in Germany,” says Dr. Elmar Kleimann, chief physician at St. Franziskus Hospital, emphasized.
Hotline for emergencies
A collaboration as smooth as in Hans Michels' case cannot be taken for granted. “A voluntary association for second opinions, like the one we created in Cologne, requires a great deal of trust from everyone involved and is an organizational challenge. For this reason too, this new structure is something very special,” explains Dr. Hochlenert. It's usually up to the patient to get a second opinion, which is difficult simply because patients don't know who to turn to. As part of “Prevent Amputation”, a hotline was set up that diabetics can contact if they are threatened with amputation. Although Hans Michels did not need the hotline, he still recommends that every patient insist on a second opinion: “Fortunately, the hospital took care of the second opinion for me on its own. If that hadn't been the case, I would probably have called the hotline. On the other hand, as a patient, you of course have other worries than making sure you get the right treatment yourself. In this respect, I think it would be better if the hospital took this step. Either way – the second opinion was definitely the best thing that could have happened to me.”
The emergency number for the “Prevent Amputation” campaign is 01803 123406. Those affected and their relatives can call here if they have any questions about diabetic foot syndrome and can get help in their area if they are threatened with amputation. A call to the campaign hotline costs 9 cents per minute from a German landline and a maximum of 42 cents per minute from a mobile phone network.
November 11, 2010