4 | SBH Caring
FOR YOUR
Health
For more than 30 years, Jaime Mercado
drove a truck taking products from a
warehouse to local stores, and a bus
bringing students to and from school.
He thought his driving days were over,
however, when stubborn open wounds
on his right foot caused by diabetes
resulted in the amputation of his toes.
Several months ago, after unsuccessful
treatment at foot clinics in Manhattan, the
64-year-old came to the Center for Wound
Healing and Hyperbaric Medicine at
SBH Health System where his treatment
has included hyperbaric oxygen therapy
(HBOT), the use of skin substitutes and
the removal of damaged tissue.
Foot sores, also known as ulcers, are a
primary risk of diabetes – with studies
showing that about one in four diabetics
are likely to have one during their lifetime.
Of these, as many as one in five will
undergo an amputation within five years
of the ulcer’s formation. Diabetic foot
ulcers lead to 85 percent of major leg
amputations. High levels of blood sugar
caused by diabetes can, over time,
affect the nerves and lead to poor blood
circulation. This makes it difficult for blood
– needed for skin repair – to reach areas
of the body affected by these wounds.
The Effects of HBOT
Each day for 90 minutes, for a total of 60
sessions, Mercado lies in the hyperbaric
oxygen chamber, a transparent tube that
provides 100 percent oxygen inhaled at a
pressure greater than sea level.
He spends this time watching television.
Being claustrophobic – he won’t use a
closed MRI – he takes a mild sedative an
hour or so before entering the chamber to
relax him.
The therapy works by “force feeding”
oxygen through the lungs to the rest
of the body. Increased oxygen – more
than 10 times the normal amount in the
bloodstream – promotes white blood cell
activity, encourages tissue development
and enhances capillary growth.
According to one study, diabetics suffering
with foot ulcers avoid amputation 61
percent of the time while undergoing
traditional wound treatment. That number
jumps dramatically – to 89 percent – when
HBOT is added.
Although “every ulcer has its own story,”
says Dr. Andrew Campbell, a podiatrist
at the Center, he has seen a high rate
of success with HBOT for those with
diabetic ulcers. The risks of HBOT are
minimal, he adds, and most patients can
tolerate it.
In addition to HBOT, the doctor cleans
Mercado’s foot ulcers and applies a contact
cast to his foot every week. The cast takes
off the pressure from the open wounds on
the bottom of the foot (an option to bed
rest). At this time, a nurse checks his blood
sugar and takes a photo of his foot, which
is showing good improvement.
While progress has been slow, both the
patient and medical team are pleased with
the improvement. Mercado finally feels
confident about the future. He says he is
looking forward to getting back to his life.
This includes driving again soon.
Wound Center
has
a
Cure
for
Foot Sores
SBH Caring
FOR YOUR
Health | 5
F
our-and-a-half years ago, Loretta Fleming weighed 378
pounds and had a blood glucose level off the charts.
When handed a flyer for a workshop series on diabetes self-
management by a man who pegged her as someone who might
have the disease, she figured, “What do I have to lose?” Over
the next few weeks, the one-time nurse’s aide attended weekly
classes. The information changed her life – over the subsequent
months she would lose 130 pounds and cut her blood glucose
level in half. She’s now working on helping her sons – her
31-year-old who has diabetes and her 18-year-old who has just
learned he has prediabetes.
“I learned to read labels, to eat in moderation and in portions,”
she says. “I learned how to be an advocate for myself by making
sure the doctor explains things on my terms and that it was okay
to ask questions.”
Loretta embraced the program with such a passion that soon she
enrolled in the organization’s intensive seven-week peer education
course, learning a curriculum developed by the Stanford Patient
Education Research Center. This certified her – and the others in
the room – to become an instructor for Health People’s Diabetes
Self-Management Program.
Since then, she estimates that she’s brought this information to
about 125 people in her community, many of whom she says
lacked even the most basic knowledge of a disease that if not
controlled can wreak havoc in their lives. Multiply that number by
the other people sitting around the table that morning, women like
Heidi Rodney, a one-time teacher with diabetes, who now makes
healthy smoothies instead of drinking soda, and is overjoyed to
be teaching again; Pamela Washington, who lost 28 pounds
after taking the workshop, and has since been a diabetes peer
educator to drug addicts with the disease; and Nadeem Moore,
who has prediabetes and family members who have suffered the
cruelties of uncontrolled diabetes, including amputations and
blindness, and teaches her students “not to cross the line.”
The workshops, with each class taught by two peer educators, in
both English and Spanish, provide 12 to 20 students with plenty
of critical information – how to eat healthy, monitor their blood
sugar, exercise, think positively, take their medication, care for
their feet, communicate with their health providers, and handle
stress. Students develop a weekly action plan, which spells out
how many hours a day and for how many days that week they
will follow their plan (to walk two miles, cut down on soda, stay
away from sweets) and rate, on a scale of one to 10, how much
confidence they have in achieving it. Should they fall short, they
can then ask the class and teachers for steps they can follow. For
example, if someone is still buying soda, they learn to avoid that
aisle when shopping.
Loretta Fleming, meanwhile, routinely sees her students in the
neighborhood, many of whom give her a hug for how she helped
change their lives. “They come up to me to let me know how
they’re doing and to tell me that ‘A lot of the stuff you taught me,
I’m still doing in my life,’” she says.
She has little doubt about the effectiveness of her efforts. “This is
a program that I know works,” she adds. “It can work for anyone.
Just look at me.”
Health People
A Community Resource in Fighting Diabetes
The strategy used by Health People
to fight diabetes, the Bronx’s most
resistant foe, is a simple one:
find compassionate people in the
community who have witnessed the
disease first-hand, give them the
tools they need to fight back, and then
release them into the community to
help others. Health People is one of
the 200-plus organizations in SBH
Health System’s Bronx Partners for
Healthy Communities, whose shared
mission is to change the health of
people living in the state’s least
healthy county. On a cool March day,
a dozen or so of Health People’s
“diabetes peer educators” sit around
a conference table in a walk-up in the
south Bronx, passionately discussing
what brought them here and how they
are changing the lives of those caught
up in the county’s diabetes epidemic.
Loretta Fleming, diabetes patient and Health People educator.
