When treating the diabetic foot wound: care is the most important part of treatment.

Ah, the headline is “Honey could save Diabetics from  amputation”.

Why, yes. High sugar content kills germs. So does ordinary sugar. That’s why in the good old days fruits were made into high sugar jams and jellies.

And you know what else? Vinegar kills germs. We often used low (1%acetic acid) vinegar dressings on our diabetic foot wounds. That not only killed Germs (bacteria) but also yeast, which was a major problem when we treated the “ordinary” germs.

And of course, that is why Grandmom preserved her cucumbers and peppers in relishes and pickles.

One of the terrible scourges of Diabetics is that they have poor circulation to their feet, and tend to get numbness from Diabetic nerve damage. So often by the time a wound is discovered, it is infected, and won’t heal.

Treating these wounds is important but frustrating. For the infection can spread and lead to infected bones or even the need to amputate to save a persons’ life. But if you amputate a foot from a 70 year old, chances are he or she will never use an artificial limb, but will end up in a wheelchair for the rest of their life.

I’ve been a doctor for 35 years, and I’ve seen all sorts of plain and fancy treatment for these wounds. Sugar. Papaya. Various ointments. “wet to dry” saline (mild salt solution) dressings. Hyperbaric oxygen. Electrical stimulation. Topical antibiotics. Gold leaf. Even maggots have been proposed to treat these wounds, which tend to be covered with a thick layer of dead smelly tissue that has to be removed to heal.

But the dirty little secret about Diabetic wound care is that what makes a difference is…care.

Most studies that compare two treatments find the healing rate is much improved in both groups, because just having the patient in a program where someone keeps and eye on the wound and makes sure the dressings are changed leads to healing.

So when I worked for an Indian tribe where the amputation rate was high, what made the difference was that a doctor from the University of Minneapolis was willing to drive up 300 miles each month. He got to know the patients, and as they got to know him, they started to trust him. He did “arterial bypass” to increase the oxygen supply, and when needed he would surgically remove dead tissue, but the most important thing he supplied was hope.

And the second thing we did was to train local nurses aides to go every day or two and inspect the wounds and change the dressing, and make sure that the family was changing the dressings twice a day as directed. We used “wet to dry” dressings using either antibiotic solution or weak vinegar solution or simple saline. Nothing fancy.

The result of this simple care was to make amputations rare.

So if you are a diabetic, a good wound doctor and a good visiting nurse might be more important than fancy treatment.
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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes about medicine at HeyDoc Xanga Blog.

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