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Studies have shown that globally, every 30 seconds, a lower limb is lost to diabetes, beginning with a foot ulcer, and that up to 90 per cent of lower extremity amputations are diabetes-related. In addition, statistics show that a person with diabetes has a 15-25 per cent lifetime risk of developing diabetic foot ulcers, and a 50 to 70 per cent recurrence rate.  This means that even if the ulcer heals in the first place, it can be expected to surface again.Staff of the Diabetic Foot Clinic from left: Joanne Blenman, Kamila Atherley Ross, Dr. Kumar Sukhraj, Head of the DFC, Amanda La Rose, Sophie Ranglall and Shanaz KhanNotably, Guyana’s growing population is not excluded from these figures, hence after a year of planning and attempts at accessing, in February 2008, the Georgetown Public Hospital Corporation (GPHC) was awarded a $97,460 grant from the Canadian-Caribbean Cooperation Fund, as the Canadian government’s contribution to $150,000 towards the setting up of the Diabetic Foot Clinic (DFC).The Diabetic Foot Clinic officially opened its doors to the public in July 2008. Located in the main building of the GPHC,NFL Jerseys Cheap, the DFC has been offering comprehensive care for diabetic patients with its primary focus on foot care.Dr. Kumar Sukhraj currently sits at the helm of this small, yet effective facility.One may ask since diabetes is a disease that affects the entire body why so much emphasis is placed on foot care. Hence it must be noted that Diabetic patients suffer mainly from Peripheral vascular disease, (The term peripheral vascular disease is commonly used to refer to peripheral artery disease (PAD), meaning narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain.)In most cases the arteries going to the lower extremities become smaller and smaller, thus decreasing blood flow and causing damage to the nerve so a patient eventually can lose feelings in their feet. This then makes it easy for an injury or wound to the feet to become unnoticeable. Because that injury or wound may not be detected in its early stage, infections may follow, which eventually lead to amputation.Dr. Sukhraj said from its inception the main aim of the clinic was to reduce the percentage of amputation due to ulcers on the feet of diabetic patients. Remarkably, within the first year of its establishment,Cheap Soccer Jerseys Wholesale, the DFC was able to do so by 43 percent.He explained that at the clinic there is a holistic approach which is used to treat diabetic patients so as to avoid amputation. Amputation is a last resort, since it is not always for a person to accept and adjust to a life without a limb, mainly a foot.The DFC has a multi-disciplinary approach to treat their patients and each staffer at the clinic is specialized and has acquired the requisite training in a specified area.Dr. Sukhraj attending to one of his patients.Firstly, when a patient visits the clinic, which in many cases is as a result of a referral from their district hospital, the DFC staff must first seek to get the diabetes under control. Dr. Sukhraj explained that this aids in the fast healing of a wound or ulcer.Secondly, once a wound or ulcer has been found, in spite of its size, immediate care must be given and checks are routinely made for possible infection. Wound care and cleaning and dressing of wounds are done at the clinic.Further the staff at the DFC is trained to deal with what is called Patient Centre Concern. Dr. Sukhraj and two other nurses, Ms. Joanne Blenman and Ms. Thomas have been trained and certified in wound care from the University of Toronto and in turn they have been able to train some of the their other colleagues in the same field.According to Dr. Sukhraj, it is not easy dealing with diabetes, hence the clinic also provides a strong support mechanism for its patients.“We help our patients deal with their issues…be it pain, psychological issues, depression…we have different professionals at our clinic and we are also trained to provide some level of counseling to our patients.”He went on to point out that in instances when they are preparing a patient for amputation, if they find that more professional counseling is needed, that patient is given a referral with the Georgetown Hospital’s Social Workers. Counselling is also offered to the immediate families of these patients, since that patient will need their full support following the procedure.Dr. Sukhraj says that on a daily basis it is heart rending to hear stories from patients who sit and relate their stories in tears of how their families treat them because of their condition. He said some patients would often speak of being put out of their homes because of smelly feet,Wholesale Jerseys China, which is as a result of an ulcer or wound which is taking long to heal.“When preparing a person for an amputation we sit with that patient and we tell them the pros and cons. We try our best to show them that if they keep the limb which needs to be removed, it can pose a threat to the rest of their being…it can turn septic and eventually cost them their life.”After the amputation, counseling and rehabilitation is provided, and in most cases that patient is referred to the Ptolemy Reid Rehabilitation Centre. At that facility, more emphasis is placed on helping a patients acquaint themselves with the use of prosthetics as well as other means of therapy.FOOD CHARTHowever in some cases the patient is given a referral for the health centre in his or her community, but still is required to visit the DFC for routine checkups.Dr. Sukhraj stressed thatwhat is worrying to the staff at the DFC is that despite their efforts to keep this disease under control, persons for various reasons stray away from what they are taught at the clinic despite the severity of their condition.“We give our patients a planned design to help keep their diabetes under control,Wholesale Jerseys From China, yet we find patients coming back to us with varying complications which we often trace back to them not using their medication as they should; to them not sticking to their diet plan, and in some cases, coming completely off the medication.”He went on to say that each patient is given a special diet plan to work with and invariably when that patient comes for his or her checkup and their ‘sugar level’ is above what it should be, it is because that patient is not sticking to that plan.Dr. Sukhraj and his staff also lamented the many cases of late diagnosis for patients with diabetes.“What we find is that persons only come into us when they start experiencing complications as a result of the disease and it’s at that point they know that they have the disease and this is a problem not only among diabetic patients, I find it a lot among Guyanese…very few persons do routine medical screening”.The DFC periodically conducts what is called 60-second screening to members of the public during outreach programmes which are sometimes coordinated by the Ministry of Health.SOME BASIC FACTS ABOUT DIABETESDiabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).There are three types of diabetes:1) Type 1 Diabetes – The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop Type 1 diabetes before their 40th year, often in early adulthood or teenage years.Type 1 diabetes is nowhere near as common as Type 2 diabetes. Approximately 10% of all diabetes cases are Type 1.2) Type 2 Diabetes – The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).Approximately 90% of all cases of diabetes worldwide are of this type. Some people may be able to control their Type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, Type 2 diabetes is typically a progressive disease – it gradually gets worse – and the patient will probably end up have to take insulin, usually in tablet form.3) Gestational Diabetes – This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.Diagnosis of gestational diabetes is made during pregnancy. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% and 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.Foot Care – People with diabetes, and more so neuropathy, need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Because of loss of sensation in the feet, sores or injuries may not be noticed, and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.Diagnosing diabetic neuropathies – Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the examination,Discount Nike Air Force One Shoes, your clinician may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch. The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout your body.Healthy diet and exerciseA healthy diet and an exercise plan are important in managing your condition and controlling your weight. Since food raises blood sugar, be sure to pay attention to your diet, and avoid those foods which build on your blood sugar.Your blood sugar level will be classified as high/normal/low, depending on how your body absorbs and uses glucose for energy. After food is digested, glucose passes into the bloodstream, where it is used by tissues and cells for growth and energy.BASIC NUTRITIONAL GUIDELINES FOR DIABETIC PATIENTS• Control your total carbohydrates• Choose foods low in fat• Eat more high-fibre foods• Control your portion sizes• Eat meals around the same time and about the same amount daily• Monitor blood glucose regularlyMAIN NUTRIENT SOURCES• Carbohydrates• Staples (bread, cereals, rice,Cheap Jerseys USA, pasta)• Fruits (fresh, canned, dried• Milk• Legumes and nuts (peas and beans)• Vegetables, fibre• Food from animals: Meats, cheese, milk, eggs• Food from plants: Peas and beans• Fats & oils: Oils, nuts, salad dressings