University of Arizona Surgeon Chairs Session at Largest Medical Technology Meeting

Mon, 22 Sep 2008 20:59:00 -0700

WASHINGTON David G. Armstrong, DPM, PhD, Professor of Surgery and Director of the University of Arizona College of Medicine's Southern Arizona Limb Salvage Alliance (SALSA), joined numerous major policy makers, politicians and CEOs at this years AdvaMed2008 Symposium. The session under his chairmanship, which discussed how technologies could change the course of diabetes, amputation prevention, and health in general, included members of pharma, academia, and the insurance industry. "I really believe we are moving to a point where prevention can start to pay", noted Professor Armstrong. "This is such an exciting time to be in this field and to be working to make a difference." Amongst the technologies discussed were home monitoring devices that could detect wounds and prevent amputations using a simple to use yet sophisticated thermometer used at home or even as an insole. Armstrong went on to note that "Elegantly executed technologies can make this dream of prevention a reality. This is particularly important now, as we are losing a leg every 30 seconds due to diabetes. This is unconscionable and it is preventable." Other speakers at the symposium included Senator Hillary Clinton and the Health Policy Advisors to both the McCain and Obama campaigns.

advamed.com

UMC doctor works to help diabetics save limbs

Sat, 13 Sep 2008 20:36:25 -0700

HEIDI ROWLEY
Tucson Citizen

Published: 09.13.2008

Albert Begay's decadeslong battle with diabetes has come to this:
He's lost his little toe, and maggots were used to remove the dead skin on his left foot as he fights to prevent its crippling amputation.

As it has in tens of thousands of Pima County diabetics, the sugar in Begay's blood slowed his circulation and he began to lose the feeling in his toes and fingers.

Without sensation there, an injury can escape notice and lead to dire consequences.

Still, Begay has hope and help from one of the world's leading experts in amputation prevention, who joined University Medical Center last month.

Dr. David Armstrong has joined with UMC vascular surgeon Dr. Joseph Mills to
create the Southern Arizona Limb Salvage Alliance, which will focus specifically on
healing wounds to prevent amputation.

"Pain is a gift," Armstrong said. "What happens in diabetes is they lose that gift."

Armstrong came to Tucson from Chicago, where he founded a similar program. He is a past member of the National board of the American Diabetes Association and is the founder and co-chair of the International Diabetic Foot Conference.

Armstrong said one of the things that drew him to Tucson was the high rate of
diabetes in Arizona. The Arizona Department of Health Services said that in 2005
there were 72,000 people in Pima County living with diabetes and 17,000 diabetes- related emergency visits during that year, the most recent data available.

The state health agency said there were 1,300 diabetes-related amputations in Arizona that year. The Centers for Disease Control and Prevention report an average of 70,000 diabetes-related amputations nationwide a year.

A study by Armstrong, a university in Spain and a hospital in the Canary Islands,
released earlier this month, found that fewer than half the people with severe and life- threatening infections require an amputation when treated first with hospital
therapies, such as vascular surgery, in which doctors open blocked blood vessels and increase blood flow from the heart.

"The data from this study are very encouraging," Armstrong said. "It suggests that
people who once were thought to be condemned to amputation may be treated with local conservative therapy."

Begay said, "I know that Armstrong is into getting patients through this time of their
life where hopefully they don't lose any of their limbs."

Armstrong said Begay's wound is typical of diabetics.

The American Diabetes Association said that high blood glucose causes poor
circulation, which can result in poor vision, nerve damage and inability to heal
wounds and fight infections.

Begay, 71, of Tuba City, came to UMC on Aug. 25 with an infection in the bones of his left foot. A diabetic for 43 years, Begay spent most of his life on the Navajo Nation. Earlier this year, he ended up with a blister on his little toe that became infected.

The infection spread to the bone, and a doctor in Tuba City amputated the toe.

The amputation didn't heal, leading to a much larger infection in the bones of his foot. His doctor in Tuba City contacted UMC and Armstrong agreed to look at the foot.

Under Armstrong's care, Begay underwent several vascular surgeries to increase the blood flow to his foot, which in turn will help it heal faster.

Begay has also undergone three rounds of Food and Drug Administration-approved maggot therapy. Medically grown maggots eat dead skin, allowing live skin to heal, and have been found to be more effective than surgical removal.

Third-year resident Dr. Tracy Leavitt used a cotton swab to place several hundred
rice-size maggots on Begay's wound last week. The maggots were then covered with a bandage and left to eat only the dead skin.

Begay's condition has improved to such a degree, Armstrong said Thursday, that he was released from the hospital this week and is being seen regularly as an out-patient.

Armstrong had instituted a similar program at the Dr. William M. Scholl College of
Podiatric Medicine at Rosalind Franklin University of Medicine and Science, in
Illinois. His research group is still being run out of Chicago and he is well-known for his research into diabetes and foot wounds.

Armstrong has worked with European organizations to understand the link between diabetes and foot wounds. He was recently inducted into the Podiatric Hall of Fame.

Dr. Rainer Gruessner, the University of Arizona surgery department chairman, said he didn't have exact numbers on how many amputations UMC performs a year but that he hoped the hospital would reduce that number by 20 percent to 25 percent by hiring Armstrong.

"Above all, it will allow patients to stay here and have their surgeries instead of going to Phoenix," Gruessner said.

Armstrong said the most important tip he could give diabetics is to make their feet a top priority.

"Look at your feet every day, and if you can't look at your foot, get your family to do it," he said. "Everyone with diabetes should be seen annually by a foot specialist."

For Begay, the high rate of diabetes is a reality he lives with every day. As an
American Indian, he daily sees friends and family members who have had their limbs amputated as a result of diabetes. He said he plans to speak out in his community about the importance of taking care of oneself.

"If anybody is a diabetic and has a foot problem like this," Begay said, "don't let it
go."

ADDITIONAL INFORMATION
Southern Arizona Limb Salvage Alliance
www.diabeticfootonline.com
American Diabetes Association
www.diabetes.org
Arizona Department of Health Services, diabetes page
www.azdiabetes.gov
Diabetic Fodfcon.com

Hope for Diabetes Patients: Bone Infection Doesn't Mean Amputation

Fri, 5 Sep 2008 20:49:20 -0700

http://www.healthnewsdigest.com/news/Diabetes_Issues_640/Hope_for_Diabetes_Patients_Bone_Infection_Doesn_t_Mean_Amputation.shtml

Dr. David Armstrong, Renowned Podiatrist, Joins UA Department of Surgery To Build Southwest's Most Advanced Clinic for Wound Care

Mon, 25 Aug 2008 20:18:05 -0700

Contact: Jo Marie Gellerman, (520) 626-7219
Aug. 25, 2008

The Southern Arizona Limb Salvage Alliance (SALSA) uses a multidisciplinary team approach to wound healing and prevention of amputations in people with diabetes.

David G. Armstrong, DPM, PhD, a renowned podiatrist and researcher, has joined The University of Arizona Department of Surgery as professor of surgery and director of the new Southern Arizona Limb Salvage Alliance (SALSA) at University Medical Center and the Southern Arizona VA Health Care System.

"The most common reason a person with diabetes is admitted to the hospital is for a foot problem. It takes a team to prevent an amputation, and a group of clinicians working together can make a real difference," said Dr. Armstrong, who co-directs the SALSA program with Joseph Mills, MD, UA chief of vascular surgery.

"Diabetes is a significant health issue that greatly impacts Arizona and the Southwest," said Dr. Mills. "Dr. Armstrong and our new limb salvage clinic, SALSA, offer a service that's much-needed throughout the region."

"The UA Department of Surgery, University Medical Center and the VA are expanding the fight on diabetes with more treatment options and research programs," said Rainer Gruessner, MD, UA surgery department chairman. "SALSA blends into our pancreatic and islet cell transplantation programs because many of these patients have diabetes-related foot problems and neuropathy. Dr. Armstrong is a great addition to the UA and to our armatarium against this disease."

Dr. Armstrong instituted a similar program at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago that achieved international recognition in the field of diagnosis and treatment of the diabetic foot and its related diseases/complications. He has collaborated with clinicians to help create programs in amputation prevention on six continents. He and his colleagues developed classifications of risk and wounds that are used as standards worldwide.

After receiving a degree in podiatry from California College of Podiatric Medicine, Dr. Armstrong completed a diabetic foot fellowship at the University of Texas Health Science Center, San Antonio, Department of Orthopaedics. He also received a master's degree in tissue repair and wound healing from the University of Wales College of Medicine, and a PhD from the University of Manchester College of Medicine.

The author and co-author of more than 240 peer-reviewed research papers in more than two dozen scholarly medical journals, as well as more than two dozen book chapters, Dr. Armstrong is co-editor of the American Diabetes Association's (ADA) Clinical Care of the Diabetic Foot.
He has delivered lectures and completed visiting professorships in more than 40 nations, and was selected as one of the first six International Wound Care Ambassadors. He also is the recipient of numerous awards from national and international medical organizations, including the inaugural Georgetown Distinguished Award for Diabetic Limb Salvage. In 2008, he was the 25th, and youngest-ever, member elected into the Podiatric Medicine Hall of Fame.

Dr. Armstrong is current Chair of Scientific Sessions for the ADA's Foot Care Council, a past member of the National Board of Directors of the American Diabetes Association, and past commissioner with the Illinois State Diabetes Commission. He sits on the Infectious Disease Society of America's Diabetic Foot Infection Advisory Committee. Dr. Armstrong is founder and co-chair of the International Diabetic Foot Conference (DF-Con), the largest annual international symposium on the diabetic foot in the world.

Study Indicates Clinical Practice Standards in Lower-Extremity Care of Diabetes Not Being Met Nationwide

Fri, 22 Aug 2008 13:13:34 -0700

Contact: Jo Marie Gellerman, (520) 626-7219
Aug. 22, 2008

UA Researchers Involved:

TUCSON, Ariz. -- Researchers at The University of Arizona College of Medicine participated in a groundbreaking study of clinical practice patterns in lower-extremity care of diabetes that suggests standards of quality care are not being met nationwide.

The Southern Arizona Limb Salvage Alliance (SALSA), the Department of Veterans Affairs, and Rosalind Franklin University of Medicine in Chicago also participated in the study, published Aug. 11 (ahead of print) in the online edition of the journal Diabetes Care.

"I think the bottom line is that clinicians, for a variety of reasons, are not practicing what is preached," said the study's senior author David G. Armstrong, DPH, PhD, professor and director of SALSA in the UA Department of Surgery and the Southern Arizona VA Healthcare System.

"The simple task of using the right technique to take pressure off of the bottom of the feet is being practiced in the majority of cases by fewer than 2 percent of the reporting centers. In a time when every 30 seconds someone loses a limb due to diabetes, this is unacceptable." Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers, the authors stress.

The three-year study evaluated nearly 900 diabetic foot clinics across the nation. Stephanie Wu, DPM, MSc, assistant professor of surgery at Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University and the first author of the study, voiced similar sentiments.

"We must marry effective reimbursement with effective care. Right now, most insurance plans will pay for an amputation, but not for the boot or cast that would heal the wound and prevent the amputation."

The study is available online at:
http://www.ncbi.nlm.nih.gov/pubmed/18694976?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum