Med prof starts diabetes clinic

Now diabetics can worry less about losing their limbs. Preventing foot amputations in diabetics is the goal of Robert Goldman, assistant professor of rehabilitation medicine at the Medical Center. Diabetics commonly develop foot ulcers. As a result of nerve damage, they lose sensations in their feet and will continue to irritate foot wounds by walking on them, Goldman said. Surgery involving amputation has been the solution in the past. But Goldman has developed the Comprehensive Chronic Wound Program, which aims at eliminating the necessity of amputation. A care team including a physician, nurse, therapist and orthotic shoemaker are responsible for designing an individualized treatment plan for high risk and current ulcer patients. The clinic is designed so that patients can receive diagnoses from varied specialists, said Cutaneous Ulcer Center Director David Margolis, who is also a dermatology professor. This makes it unnecessary for patients to have to visit numerous medical professionals. "The reason for the clinic is so doctors can anticipate patients' problems and give them proper care and so patients don't have to go to all different clinics," Margolis said. Experts say that in clinics like the University's, there has been a 45 percent reduction in amputations and a 51 percent reduction in hospital stays for diabetics. One preventive procedure involves encasing the entire foot in a cast. The cast works by spreading pressure over the entire foot, thereby avoiding continual friction on any one area of the foot. The cast also serves as a moist environment -- aiding in the healing process. "What's been most successful is total contact casting," Margolis said. "It's a nice modality to have access to." And to prevent exacerbation of the wound, the patient is able to wear custom-molded shoes. Besides the health benefits of the preventive program, there are financial benefits as well, according to Goldman. "If people can prevent ulceration, hospital bills could go down," he said. He added that he believes health insurance should cover costs of the preventive methods. "Dollars need to be put into prevention," he said. Goldman emphasized that it is becoming increasingly important in health care to focus on eliminating potential illness. "I'm very optimistic," Goldman said. "I think the future is in prevention." The program is the only rehabilitation-based preventive care program for diabetic foot ulcers in the Delaware Valley.

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