Commentary: Losing a limb to diabetes is painful but not the end of the road

SINGAPORE: For many diabetic amputees, the fateful day might start very very similar to some other – a bump towards the door, a small blister from strolling a bit too lengthy or an ill-fitting pair of recent sneakers. 

This surprising incidence quickly results in a fever, swelling and ache that gained’t go away or a wound that refuses to heal. And earlier than the affected person is aware of it, his physician has unhealthy information: The limb have to be amputated. 

In Singapore, diabetes mellitus is on the rise. From 2019 to 2020, the crude prevalence of diabetes was 9.5 per cent, a rise from 8.8 per cent in 2017 (regardless of a five-year “War on Diabetes”). 

According to the International Diabetes Federation’s 2021 report, Singapore continues to have a excessive prevalence of diabetes mellitus at 11.6 per cent, in comparison with the worldwide common of 9.8 per cent, the American common of 10.7 per cent and Australian common of 6.4 per cent.

Commonly known as a “lifestyle disease”, diabetes can worsen if the affected person doesn’t change their weight loss program, doesn’t do common train, has poor compliance with remedy or continues to smoke and drink. When the illness just isn’t managed effectively, foot ulcers might develop and this will progress to decrease limb amputations (outlined as under knee or extra proximal amputation).

Singapore has a reasonably excessive fee of amputation – in response to information, as much as 4 decrease limb amputations have been executed in a day between 2015 and 2016. 

At Tan Tock Seng Hospital (TTSH), 80 per cent of our sufferers who want amputation have important comorbidities – like hypertension or coronary heart illness. Add to that, a big proportion lack consciousness about how damaging untreated foot ulcers will be.

In 2017, TTSH had about 90 main decrease limb amputations. Thankfully although, the incidence of decrease limb amputation is coming down with early intervention by vascular surgical procedure and a multi-disciplinary method. 

Amputation is a final resort accepted solely when life is at stake or when a chronic course of conservative remedies fails. It isn’t straightforward to agree on amputation even whether it is to avoid wasting lives, as a result of life after an amputation will be daunting.

DAUNTING PROSPECT OF LIFE AFTER LOSING A LIMB

The surgical removing of a limb and its affect will be devastating information. The announcement strikes concern in each affected person – concern of ache and struggling and of uncertainty over what the longer term might maintain.

Questions on the social entrance hit particularly arduous: Will I be capable of maintain a job? How will I assist my household? What will occur to my housing mortgage and different loans on high of paying all these medical payments?  

But not like the previous days, sufferers immediately have higher outcomes to sit up for. As in most public hospitals in Singapore, TTSH has a multi-disciplinary group which cares for amputees. This group includes therapists, prosthetists, podiatrists, social employees and specialty nurses working with the docs. 

Importantly, volunteers from the Amputee Support Group (ASG), of whom many are amputee sufferers themselves, will join with the sufferers and their caregivers.

Once a affected person has accomplished surgical procedure, the group takes over and the primary cease is to teach them about their rehabilitation journey. 

They are given info on how they will stroll with the assistance of a prosthesis, the selection and price of prosthesis fabrication, the period required to be skilled to stroll and learn how to be unbiased once more – all these assist sufferers discover hope and braveness to face life after amputation. 

It is essential that the sufferers and their households hear from each the healthcare suppliers and ex-patients to get a way on how the rehabilitation journey will appear like. 

In the final 10 years, extra monetary help has been launched and accessible for sufferers who require prosthetics, mobility gadgets and assist in their properties. The precedence is for sufferers to be fitted with prosthesis and allow them to stroll once more.

Any delay in acquiring prosthesis can delay their rehabilitation remedy and result in improve in nervousness and despair. An expanded record of subsidised prosthetics with extra monetary help choices additionally assist our sufferers get to work faster. 

BACK TO FULL LIVES – EVEN WORK AND SPORTS

One little recognized a part of the work we do is that sufferers can ultimately go on to reside full lives – they will resume work and even participate in sports activities.

Our group of docs, physiotherapists, occupational therapists, prosthetists and medical social employees work to set out customised remedy objectives. A affected person who needs to return to adaptive sports activities similar to bowling might be prescribed appropriate prosthesis.

Another affected person who needs to return to driving after an amputation may even be advisable remedy programmes to assist him obtain this. For some, that is additionally their livelihoods and it’s important they get again to with the ability to work when attainable.

A multi-disciplinary method is required to assist amputees who want to return to work entry their choices, carry out job particular coaching on high of gait coaching and job counseling. Collaboration between hospital practitioners and neighborhood companions (e.g. ABLE in Toa Payoh) in addition to befriending assist from ASG may help on this side.

We discover that sufferers profit drastically from the ASG. Launched in 2010, its lively members are skilled to be befrienders giving recommendation to amputee sufferers. ASG programmes have reached out to greater than 200 sufferers, members of the family and caregivers of amputees.

While we may even see lesser amputations from higher care of diabetes mellitus and advances in revascularisation surgical procedures (an operation to open up blocked blood vessels), diabetic amputation stays a problem in Singapore as our amputees are sometimes older, and they’re prone to additional amputations after the primary amputation.

But higher public consciousness on the plight of this group of sufferers, early intervention and assist for his or her care and inclusion within the society can additional enhance the standard of life for them.

Tess Hng is a Principal Medical Social Worker at Tan Tock Seng Hospital and Dr Tjan Soon Yin is a Senior Consultant of the Department of Rehabilitation Medicine at TTSH.