Ignore Warning Signs, Lose a Limb

Americans Ignore Warning Signs -- 200-plus Amputations a Day, Many Avoidable

February 09, 2009, 10:01 AM

Dec. 19, 2007 — -- For eight years, Jeanne Houtz, who has a family history of diabetes, ignored all the symptoms — visual problems, weird sensations in her feet and blisters that would not heal.

The San Diego woman was diagnosed with type 2 diabetes at age 40, but she refused to take her medications or to lose weight. Houtz never realized she was in danger until the bones in her right foot collapsed, causing wounds that eventually led to infection.

But attention to this insidious disease came too late, and it finally cost her a leg, which was amputated in 2005.

"I know I am the worst person on the planet, acting like this," said Houtz, now 56.

"My mom had it, everyone had it," she said. "When I was a young girl, I had an aunt who had it and she was told not to eat brownies. She would crave them and I thought, 'Why does she eat them?' I later realized it's an uncontrollable urge."

Houtz is one of 20.8 million Americans who have been diagnosed with diabetes, a disease that is now epidemic and is linked with the increased prevalence of obesity in the United States, according to the National Diabetes Education Program Progress Report 2007.

About 6.2 million Americans have the disease, but go undiagnosed.

The total number of people with diabetes in the United States is projected to rise from 17.7 million in 2000 to 30.3 million in 2030, placing the United States third in global prevalence, second only to India and China, according to the report.

About 66 percent of all adult Americans are overweight, a major risk factor for type 2 — or adult onset — diabetes. Left untreated or not managed well, the disease can lead to peripheral neuropathy, which can lead to foot deformities and eventually amputation.

Today, Houtz listens to her doctor, though at 5 feet, 9 inches tall, she still weighs 260 pounds. The bones in her second foot are now starting to deteriorate, putting her at risk again.

More than 60 percent of all amputations are caused by diabetes, according to the National Institutes for Health.

Ron Santo, an all-star baseball player for the Chicago Cubs and later the White Sox, concealed his type 1 diabetes in the 1960s. Later in his career he went public with the disease, but eventually lost both legs to amputation, one in 2001 and the other in 2002.

Each day, doctors perform 230 amputations in the United States, but some experts estimate that half of all such operations would have been preventable if minor infections were caught and treated in time.

That was not the case with Houtz.

After her diagnosis in 1992, Houtz said she felt "fine." But by 2000, she began to lose her sight, eventually undergoing four eye operations. Diabetes also ravages vision and can attack the kidneys.

Soon, her feet were affected.

"One day I looked down and my feet weren't straight — they were curving to the side," said Houtz. "This went on for a couple of years, then I felt knots at the bottom of my feet, and they started to become flat. One day, all of a sudden, the bones started cracking."

According to her doctor, Houtz was experiencing Charcot foot, a deterioration of the weight-bearing joints, most often caused by diabetic peripheral neuropathy. The condition develops over time and is seen most often in patients who have had the disease for years and poorly controlled it.

"It starts out at the tips of the toes, developing a burning sensation," said Dean Vayser, a podiatrist doing diabetes research at the Whittier Institute for Diabetes at Scripps Health in La Jolla, Calif. "Like a glove pattern, it goes up to the arches, heels, ankles and leg."

The condition is likely due to a combination of factors — high blood glucose, long duration of diabetes and abnormal blood fat levels. Lifestyle choices, such as smoking and alcohol use, also can lead to diabetic neuropathy.

Doctors now suspect that the body's sugar invades and eventually damages the nerve in the foot, setting off a "cascade of events," said Vayser.

In men, the first sign is often erectile dysfunction, but then it characteristically moves to the feet. In the early stages, diabetics most often feel a "burning or tingling, like ants crawling," according to Vayser.

Eventually, the foot goes numb, and diabetics are in danger of stepping on glass or a tack and not feeling the wound. That "pivotal event" sets off a infection.

Because there is no sensation in the foot, many patients are not aware of the wound until they smell the infection or see puss or blood on the sock, he said.

As was the case with Houtz, diabetes can weaken the architecture of the foot.

"Like the World Trade Center, it gets hot, inflamed and will eventually cause the bone to collapse," he said. Because the patient feels no pain, they continue to walk and create more pressure.

"My foot was bulging to the side and looked like it was pregnant," said Houtz, who continued to walk, but soon developed blisters that would not heal.

By 2005, her leg was amputated from the knee down, and she now wears a prosthesis.

"It starts to brew and at that point it's too late," said Vayser. "The foot can be salvaged, but sometimes it starts locally and spreads through the body."

If doctors are unable to treat the wound with antibiotics or surgery, amputation is the only option. Doctors most often amputate below the knee where "there is more girth and substance to hold the prosthesis," he said.

Doctors say diabetics often let their conditions slide because they cannot afford medical care. Like diabetes, amputations are also skewed by race and ethnicity. Numbers are higher for blacks, Hispanic/Latino and Native Americans.

"Some just don't want to accept that they have it," said Vayser. "They say they don't feel anything, so they don't see a problem."

But amputations are largely preventable, especially with new wound treatments like bioengineered skin and growth factors. Houtz is currently in a study using skin grafts from cadavers for her left foot.

Those diagnosed with diabetes at a young age have to be especially cautious because the longer they have diabetes, the more likely they are to lose a limb.

But experts say education is the real key to a managing diabetes and amputation prevention.

At 61, Charles Steele of New York City has devoted his retirement to educating people about diabetics and its devastating effects. He, too, ignored the painless symptoms — weight loss, frequent urination and thirst.

The hard-driving manager for IBM was 60 pounds overweight and never met a sweet he didn't like. By 1987, the disease wreaked havoc on his system, and he was diagnosed with diabetes.

"This is one nasty disease," Steele told ABCNEWS.com. "It's painless and silent."

As a volunteer and board member for the Amputee Coalition of America, he tells diabetics, "If, every time your blood sugar went up it hurt like a toothache, you bet your ass you'd go to the doctor."

At the age of 43, after bouts with blood clots and heart bypass surgery, Steele had a leg amputated. After that, Steele said, "I quickly got religion and did the right things."

He changed his diet and lifestyle, losing 60 pounds and working out five times a week.

Steele said doctors and nutritionists should do a better job of persuading diabetics to maintain proper treatment. "They need to get in the face of diabetics and scare them straight," he said.

Meanwhile, Houtz is finally paying attention to her doctors. She has resumed a somewhat normal life after the amputation, though she misses the long walks with her two dogs through the San Diego hills.

"I don't trust my balance anymore," she said.

Her advice to other diabetics is not to do as she did: keep blood sugar in check, take medications and lose weight, a battle she still fights with 110 extra pounds.

"We are seeing more diabetics because people are overweight and eat bad stuff," she said. "I have always been a chocolate freak. My sister and I used to go to the Hometown Buffet [restaurant] and when I am stressed and in an emotional crisis I go for food."

"This is all my fault, and I know it," said Houtz. "I'm not raging and depressed. I accept it."

For more information on amputation, visit Amputee Coalition of America.

Lauren Cox of the ABC News Medical Unit contributed to this story.

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