That costly amputation due to diabetes and smoking-driven

[admin]

THE price quoted above is the sum of money patients pay in India when their limbs are amputated and an artificial limb is fitted. Amputating a limb in India, according to a colleague doctor from India lecturing us on Non-communicable diseases, the direct costs patients pay for amputation is USD 400, and an artificial limb is USD 700. The procedures are also done in Tanzania; the prices could be the same as direct costs. Artificial limbs in Tanzania are made at KCMC and MOI.

There are many causes of gangrene. Long-term results for poorly-managed diabetes mellitus (kisukari), especially in adults and in particular in people who smoke, are gangrene and other complications. Once a person has diabetes, it means treatment for life.

There is need to know that, one needs clear message from his/her doctor how best to manage chronic diseases. The fact that these diseases are amongst us in our communities, it is good for your husband and or wife to know. Your family including your relatives should know. I bring this concept to the public, because many people do not know that gangrene can occur in smokers and in patients who are diabetic. The part of the body especially the limb changes colour, from normal skin to more blackish, smells awful. The immediate conclusion is he/she is bewitched (karogwa).

Gangrene is death of tissue, usually as a result of loss of blood supply. Gangrene can affect a small area of skin, but can also affect for example, a finger or even a substantial portion of a limb.

Pain is felt in the dying tissues, but once they are dead they become numb. The affected skin and underlying tissue turn black. Bacterial infection may develop, causing the gangrene to spread and give off an unpleasant smell. There may be redness, swelling, and oozing pus around the blackened area.

There are two types of gangrene (dry and wet). In dry gangrene there is usually no bacterial infection; the deprived area dies because its blood supply is blocked. This type of gangrene does not spread to other tissues. It may be caused by arteriosclerosis (hardening of small blood vessels) diabetes mellitus, thrombosis (clot inside a blood vessel) an embolism (a bleb of air inside blood vessel). Wet gangrene develops when dry gangrene becomes infected by bacteria. A particularly virulent type-known as gas gangrene is caused by a dangerous strain of bacteria that destroys muscles and produces a foul smelling gas. Gas gangrene has caused millions of deaths in war.

Treatment of dry gangrene consists of improving circulation to the affected body part before it is too late. If the tissue becomes infected, the patient is given antibiotic drugs to prevent wet gangrene from setting in.

If wet gangrene is diagnosed, amputation of the affected part is unavoidable. Usually some of the adjacent living tissue must be removed as well. This article reminds me of my elder brother, who was a laboratory technologist in his retirement, worked in our dispensary back home and was diabetic. He was competent and able to measure blood sugar and all the tests. The day he told me he had ulcers in his feet, I requested him to show me his ulcers. I could not believe my eyes, these were typical gangrene feet ulcers.

He was treated in Bombo Hospital in Tanga; he had his two limbs amputated above knees. Later of course he died. The bill brought to me was one million shillings; the amount was direct costs for hospitalization and treatment. I argued the case to the Permanent Secretary of the Ministry of Health that was in 2003. The regulations say that elderly who cannot pay for the medical bill should be treated free of charge, why do you charge me for the treatment of my brother as diabetic patient? Thank god the amount was waived.

There is need to know that sometimes in clinical practice a snake bite from poisonous snakes like black mamba and others may also cause gangrene due to the nature of the poison. Those manual labourers, who handle vibrating equipment and drilling machines in road construction, are advised to put on gloves which are thick and heavily insulated to minimize the vibrations. If that is not done, as occupational hazard gangrene of the fingers can occur.

To a smoker, it is the nicotine that reduces the blood flow to the tips of your fingers and other peripheral organs like the limbs, as long term effect of smoking as complication gangrene sets in. At times smokers have been complaining of impotence, in fact it is the same phenomenon of reducing blood flow to that organ as well.

While thinking about impotence or your potency, check your heart, not for gangrene but for reduced blood flow that causes heart attack. The story does not end there; your blood pressure also needs a check up. One finds blood pressure elevated in diabetics and smokers. Your pancreas could also be damaged due to smoking and end up with diabetes mellitus. Diabetes mellitus and smoking combined are very awkward strange fellows.

The message is enjoy your life do exercises and stop smoking and change your life style for investing in your health before your retirement.