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Type 2 Diabetes: How Diet Can Reduce Amputation Risk

· Heart of Innovation

Type 2 diabetes and obesity are epidemics that can lead to amputation due to a common complication known as peripheral artery disease (P.A.D.), which is plaque build-up in mainly the leg arteries that restricts blood flow. But the right diet can help mitigate risk for limb loss. Hosts Kym McNicholas and Interventional Cardiologist Dr. John Phillips are joined by Nurse Practitioner Kay Smith to chat with special guest Dr. Michael Dansinger, Wellness Director for Boston Heart Diagnostics, about diabetes reversal, eating strategies to for P.A.D. prevention, and the secret to weight loss based on USA Network's The Biggest Loser reality show.

Dr. Michael Dansinger is Founding Director of the Diabetes Reversal Program at Tufts Medical Center in Boston . He also serves on the CDC’s Expert Panel for Worksite Wellness Programs and on the Council of Directors for the True Health Initiative, a leading international voice for health and wellness. Dr. Dansinger previously served as the Nutrition and Obesity Editor for Medscape Journal of Medicine and was the principal investigator of the Tufts Popular Diet Trial comparing the Atkins, Zone, Weight Watchers and Ornish eating plans for weight loss and heart disease risk-factor reduction (published in JAMA). Dansinger was the nutrition doctor for NBC's The Biggest Loser for 10 years and designer of the Biggest Loser Diet, which won top awards from U.S. News & World Report (including No. 1 Best Diet for Diabetes). 

Before Dr. Dansinger got into the heart of this episode's feature topic on how diet can reduce a diabetic's risk for vascular complications, the show kicked off with a discussion about obstacles patients face in healthcare. Nurse Practitioner Kay Smith shared her experience in Scotland, spending four hours in pre-operative protocols for a surgery planned for next week, only to have her physician cancel her surgery appointment due to a condition called, atrial fibrillation, that she was never informed of but was written in her medical chart. Kym and Dr. Dansinger weighed in on lessons others can learn from this experience which includes two critical questions all patients should ask following any medical appointment:

1. What are you writing in my chart that I should be aware of so I don't miss any assessment or diagnosis?

2. Can I get a copy of my cases notes for this appointment? This may be available through your facility's medical app or platform. You can also request it through a facility's medical records department.

Kym also shared her nightmare experience with her dad falling a second time in two weeks. The first fall was out of their area and resulted in emergency surgery to replace a previous hip replacement and stabalize an elbow fracture with pins and wires. This second fall resulted in an additional hairline fracture in his femur, re-opening of the hip replacement incision, and a displacement of the pins in his elbow. An ambulance trip to the emergency room left Kym and her dad with more questions than answers. The emergency physician and clinicians refused to call the on-call orthopedic surgeon to review his xrays. If they did, they would've learned of his additional hairline fracture in the femur and would've sent him home in a wheelchair. Instead, he was told to get up and walk despite debilitating pain and a continued run of the fracture. Even more, they didn't remove that half pulled off wound dressing, didn't apply temporary steri strips to reseal the wound that opened, and sent him home with only half the wound covered. So, when he arrived home, within 10 minutes the paramedics had to be called as the wound dehiesced further and he had to be taken to a larger hospital facility in Marin County, California with a more experienced trauma team. There, he was scheduled for time in the operating room to properly clean, re-sutre, and dress the incision site. He was also admitted until an orthopedic surgeon could get a physical therapist and occupational therapist to work with him on his new orders for limited weight-bearing.

Dr. Dansinger and Dr. Phillips both were horrified by Kym's experience with her dad. They agree that under no circumstances should Kym's dad have been released from the first emergency room without an orthopedic surgeon reviewing the images and without proper wound care. They each expressed the importance of physicians and clinicians taking the time necessary to listen to the patients and fully assess the entire situation and for patients and their advocates to have patience with medical staff. But they were also not surprised due to an overwhelmed healthcare system, especially since the COVID epidemic. Dr. Dansinger says as our population continues to age this will become an even bigger problem of overcrowded hospital facilities and not enough staff to manage them. It's why he shifted from an urgent care doctor to focusing on prevention of chronic illness. That includes diabetes. That's where the hosts transitioned the conversation into focusing more intently on what patients can do to reverse it and mitigate their risk for serious vascular complications such as amputation.