Prevention is always better than cure.
SINGAPORE - In about eight years, he went through not one, not two, but four
amputations on his right leg.
Mr
Heng Liang Hai, 63, a former carpenter, was diagnosed with Type 2
diabetes about 30years ago and he did not manage his
condition well at
first.
Between 1995 and 2003, Mr Heng had two toe
amputations and two lower-limb
amputations.
First, it was his ankle, then the knee.
Said Mr Heng in Mandarin: "It was only after that last amputation that I realised I had to take care of my
health."
Diabetes
remains a
major health issue with one in three Singaporeans developing
it by the time they are 69, Professor Chia Kee Seng, the dean of the NUS
Saw Swee Hock School of Public Health, told The Straits Times in an
earlier interview.
Although the number of amputations caused by
diabetes has been decreasing, doctors said more can be done.
Figures
from the
Ministry of Health (MOH) showed that from a high of 717 in
2004 (an average of two amputations a day), it dropped by 36 per cent to
457 cases in 2010.
The New Paper met three
diabetic amputees who shared how their lives changed after they lost their lower limbs.
Concerns for the future
One of them, Mr S.
Damotharan, 45, who lost his right ankle three months ago, urged
diabetics to manage their
condition and prevent
amputations.
"Try not to lose
anything. No point regretting afterwards," said the former canteen
operator, who has four children aged between 4 1/2 and 10.
His wife, who works as an assistant engineer, is now the sole breadwinner.
While he maintains a cheerful demeanour, he is concerned about how he is going to provide for his family.
Dr
Sathappan, senior consultant in the department of orthopaedic surgery
at
Tan Tock Seng Hospital, said it is common for diabetics to have
microvascular diseases because their blood vessels clog up easily.
This results in deprivation of oxygen and nutrients to tissues in the leg. If left untreated, tissue death or
gangrene sets in.
Amputation
is necessary because
gangrene is potentially life-threatening, said
Associate Professor Aziz Nather, senior consultant for foot and ankle
surgery at the
National University Hospital (NUH).
Dr Bee Yong
Mong, director of the
Diabetes Centre at the
Singapore General Hospital,
said toe
amputations are the most common, followed by ankle and knee
amputations.
Miss Tiffany Chew, a TTSH podiatrist who specialises
in the diagnosis, treatment and management of foot, ankle and lower leg
conditions, said toe
amputations affect how a person walks.
"This results in abnormal pressures on the feet which may lead to ulcerations.
"With
the risks of ulcerations being higher, the risk of getting amputation
further up on the same limb is definitely higher," said Miss Chew.
Learning not to give up
There is also the psychological effect of limb loss.
To help patients cope with this,
SGH set up an amputee support group in 1999.
Miss
Grace Lim, the senior nurse clinician in-charge of the group, said: "It
was important for them not to give up on themselves, otherwise their
health will worsen.
"We got those who had recovered well to come back and visit the patients, inspiring them to live
healthily."
Mr
Heng, for example, has changed his lifestyle habits. Instead of eating
two bowls of rice at mealtimes, he stops after half a bowl.
"I know of another
diabetic who is younger than me. He didn't watch what he ate and he's now gone," said Mr Heng.
With his prosthetic leg, he is able to go to the exercise corner near his home every day for 30 minutes and take long walks.
As
for Mr Lim Chin Huat, 41, who was diagnosed with
Type 2 diabetes in
1988 and lost his left ankle in 2002, he exercises in a different way.
Mr
Lim lives in a Sungei Kadut factory owned by a distant relative and his
room is so far from the toilet that it takes him at least five minutes
to wheel himself there.
"Imagine how bad it is when I get
diarrhoea," said Mr Lim, who does not live with his family because he is not close to them.
Type 2 diabetes is caused by the body's ineffective use of insulin to
regulate blood sugar levels and the risk of contracting the condition is
linked to
unhealthy lifestyles.
Mr Lim worked as a driver and security guard for a while but then he suffered kidney failure due to
diabetes.
He
had to start
dialysis and would often fall sick, so he lost his job.
His marriage to a woman in the Philippines also suffered as he had
limited mobility and finances to travel there.
They eventually got a divorce in 2010.
He
will always remember the moment he woke up from his
operation: "I felt
my life was destroyed. It took me at least two months to come to terms
with my loss."
Amputations in numbers:
Number of
diabetic patients undergoing lower-limb or toe
amputations in Singapore
2004: 717
2006: 597
2008: 466
2010: 457
Breakdown of the 457
diabetic amputations bygender: Two out of three were men (66.3%)
Breakdown of the 457
diabetic amputations by age in 2010:
20-39: 1.8%
40-59: 47.7%
60-79: 42.7%
80 and above: 7.9%
Note: The percentages do not add up to 100% due to rounding error.
Diabetic amputations are preventable
Up to
half of the
amputations linked to
diabetes are preventable, said Dr Bee
Yong Mong, director of the
Diabetes Centre at
Singapore General Hospital (SGH).
Here are tips from Dr Bee, who is also a consultant at the
SGH
endocrinology department, and Tan Tock Seng Hospital podiatrist Tiffany
Chew:
1. Self-care
Inspect the bottom of your feet and between the toes daily to ensure there is no wound
Wear proper footwear at all times
Thoroughly dry between the toes after bathing or washing your feet
Apply moisturiser daily except between the toes
Cut
nails straight across and not too short, then use a nail file (Those
who have impaired vision should get help to manage their nails.)
2. Annual foot screening
This
is a structured screening process by health-care professionals to
identify patients who are at high risk of developing foot complications.
3. Podiatrist care
Specialist care is needed for high-risk patients or those who already show early signs of diabetic foot complications.
Miss
Chew said any calluses and corns must betreated by a podiatrist as they
are predisposing riskfactors for ulcerations when mismanaged or
leftuntreated.
Associate Professor Aziz Nather, senior consultant
in the division of foot and ankle surgery at National University
Hospital, said Singapore currently does not have many trained
podiatrists.
He said there is a need to train assistant nurses and
technicians to increase the pool of health-care workers who are
equipped to do foot screening and educate on foot care.
NUH runs a foot screening training course for all hospitals in Singapore and also hospitals in the regional countries.
To date, they have run five training classes and trained 116 nurses, said Assoc Prof Aziz.
