Dr. Michael Anderson (Host): Hello, everyone, and welcome to this episode of the FortCast, the official podcast of Fort HealthCare. I'm your host, Dr. Michael Anderson. And what you may or may not know is that November is Diabetes Awareness Month, and I'm very excited to have our very special guest today, Dr. Smith-Chase, who's our Medical Director of our Wound Clinic and Center. Dr. Smith-Chase, welcome to this episode of the FortCast.

Dr. Latisha Smith-Chase: Thank you, Dr. Anderson. I'm glad to be here and talk about my passion, which is diabetic foot ulcer. So, thank you for having me.

Host: I look forward to that and, you know, before we get started, Dr. Smith-Chase, I mean, most people know I've been with the organization a couple of decades now. How long have you been with Fort HealthCare and how long have you been doing wound?

Dr. Latisha Smith-Chase: Well, I started here in 2020, so I've been here right around four years. And I started doing Wound Care shortly after I finished my Internal Medicine training, and that was in 1983. So, I've been doing it about 30 years.

Host: Oh, you're just getting started, right? But I think that's important for people to know. I mean, you do a whole residency, Internal Medicine residency, before you even do the Wound. So, your knowledge is vast. And I think it's wonderful to have you treat our patients in our community. You do an incredible job. And the month of November, we want to kind of highlight diabetes a little bit, and diabetes is literally like the medical ocean. It is such a large topic, and it's really hard to boil it down, and we're going to get to those diabetic foot ulcers. But if you could just summarize real quick, Dr. Smith-Chase, what is diabetes and why is it important?

Dr. Latisha Smith-Chase: Well, in short, diabetes is what happens when your body doesn't process the carbohydrates that you take in in your food. And that causes your blood sugar to become elevated. And when the blood sugar is elevated chronically, it can cause changes in all of the organ systems. For diabetics, that means early heart attacks, early strokes, hypertension. It can cause peripheral neuropathy. It can cause chronic kidney disease. Essentially, it can affect every organ in the body just from having your blood sugar chronically elevated.

Host: Yeah. And like I said, it is the medical ocean. So, let's focus down little bit, Dr. Smith-Chase, and talk specifically about a problem you see quite often in your practice at the Wound Center, and that is diabetic foot ulcers. And I would just love if you could just give us a definition on what a diabetic foot ulcer is, and kind of what are the causes of it.

Dr. Latisha Smith-Chase: Diabetic foot ulcers are breaks in the skin that occur either with some minor trauma or sometimes with no trauma at all. But they're occurring typically on the foot or on the ankle and they happen for a variety of reasons. They happen because of poor circulation as I talked about before. The arteries are very much affected by the high blood sugar so you can have hardening of the arteries in the leg and the foot, and the skin starts to break down, even if you don't have any kind of bump or injury to the skin. And it can also happen because there can be changes in the foot shape. It can become deformed because of peripheral neuropathy, and it can happen because of changes in the skin. That is the skin can become more dry, and you get more breakdown because of excess dryness of the skin on the lower extremities. So, mechanical reasons, arterial reasons, changes in the skin, there's a variety of reasons that it happens. But once it happens, there's a long process to getting a foot ulcer to be healed.

Host: If I could just pause there for a second, so if I understand correctly, diabetes, it sets the stage for this problem to happen because of the effects of the vascular system down in the foot. So, as you get further away from the heart, those blood vessels become more vulnerable with diabetes, is that correct?

Dr. Latisha Smith-Chase: it's correct. They get smaller. So, the same amount of hardening of your heart arteries gets much more significant when you have very small arteries in your feet. So, it's the same hardening of the arteries from your brain to your toes, but when the artery is very, very small, it's considerably more significant in the smaller arteries.

Host: So once that skin starts to break down, it's a little bit challenging for it to heal. Is that right? And that's what contributes to an ulcer developing.

Dr. Latisha Smith-Chase: That's correct. The skin breaks down and then you have no defense against the environment. So, infection is very common and infection gets into not just the skin but in the muscles and the bones below the skin. And that's when you have deep tissue infection and it becomes extremely difficult to treat.

Host: So, Dr. Smith-Chase, in your practice, if there's a patient that's concerned that they have a diabetic foot ulcer, do they typically get referred to you from their primary care provider or physician, and then they come to see you?

Dr. Latisha Smith-Chase: Very much so. One of the requests that the healthcare system makes a primary care is that the diabetic patients have their feet checked two or three times a year. So, our primary care providers are looking at people's feet to look for deformity and early skin breakdown, that it might be discolored, but not actually an ulcer yet. So, early detection is key. We don't want to wait until something is ulcerated to say there may be a problem with this foot and get them referred to Podiatry or to have their blood vessels checked for hardening of the arteries. It's a much easier wound to treat before it gets to be a deep, infected ulcer.

Host: I'd like to explore that a little bit. So when somebody does get referred to you, what are the typical treatments? What do you typically start with in the Wound Clinic for diabetic foot ulcers?

Dr. Latisha Smith-Chase: Well, the most important thing is assessment. We, on the first visit, always want to check for blood flow to the feet. And if the pulses in your feet are not able to be felt, that is, I take my fingers, I lay it on someone's foot and ankle, and if I can't feel pulses, I need an ultrasound to make sure that they have good blood flow. Because without blood flow, nothing I do in the clinic for the skin is going to make much difference. But for the skin, we will check a culture to see if there's infection. We'll do what I call debridement, which is cleaning off the dead tissue or things that are not viable, and then put a wound dressing on. Wounds heal when they're warm and moist and not dry and crusty.

Host: Well, that makes sense. So, there's a lot that goes into the treatment to this. Now if those measures don't work, if those measures aren't getting the healing process done, what other options do you have for patients?

Dr. Latisha Smith-Chase: Well, we always try to do what I term conservative wound care first. After that, we have to try to be more aggressive. So, I may call in our Podiatry consultant who actually works in our clinic and have the patient go to the operating room for a deep debridement where you go under anesthesia and they clean it out thoroughly, more than I can do in the wound clinic, and then have you go into hyperbaric oxygen, which can stimulate healing by super oxygenating the tissues. If you think of a bottle of Coke, when you take the cap off, it fizzes up, and my hyperbaric chamber does the opposite. I put the cap on, and I supersaturate you with 100% oxygen. And that'll get healing down into those tissues that are not well-oxygenated due to poor circulation. And then of course, ultimately, if oxygen doesn't work and deep debridement don't work, it may be time for vascular surgery, that is to go in and repair the arteries. And if that doesn't work, amputation is unfortunately one of the things that happens to patients with advanced diabetes.

Host: So, let's touch base a little bit more on the hyperbaric oxygen. So basically, these are tanks. And the first time I saw them in the wound center, I really thought I was in like Star Trek. You know, I had never really seen the tanks before. I was really impressed at the technical side of the tanks. You have to have a hyperbaric oxygen technician on site whenever the tanks are being used, but these are actually enclosed tanks that people 100% enter into the tank to get that a 100% oxygen. Correct?

Dr. Latisha Smith-Chase: That's correct. If you put the whole person into a chamber, and ours are made of plexiglass, so it's like a clear cylinder with a metal cap on the end. There's a metal cap on both ends, and we pressurize the inside of this cylinder with oxygen. So, we're basically putting you in, closing the door and oxygenating your whole body. We do that for 90 minutes. And typically for someone with diabetic foot ulcers, we'll do that for 30 or 40 treatments. That's once a day.

Host: Thirty to 40 treatments once a day, and they're there for how long?

Dr. Latisha Smith-Chase: It's usually 90 minutes. It will vary depending on the patient's tolerance or any other things. We can shorten it, we can lengthen it, but typically it's 90 minutes from start to finish.

Host: Well, we ENTs, sometimes we feel like we're part of the process because sometimes we have to put tubes in the ears for those hyperbaric oxygen treatments.

Dr. Latisha Smith-Chase: Yes. Just like when you're in an airplane, you can feel the pressure changes. Like when the airplane's coming in to land, the pressure inside that airplane cabin is going up. That is exactly what you feel in the hyperbaric chamber. So, you have to get your ears to pop. And there are a few individuals who have trouble with that, and so we'll send them to the Ear, Nose, and Throat specialists to have tubes put in the eardrum so that the air just flows back and forth. That's the most common difficulty we have in hyperbarics, but very few people need tubes. I'd say it's one in ten or less will need pressure equalization tubes.

Host: Yeah. It doesn't happen often. And I feel like we're very fortunate to have your level of expertise and to have really the hyperbaric oxygen tanks, chambers available for our patients and communities. There's not a lot of healthcare centers that have that treatment option for their patients.

Dr. Latisha Smith-Chase: Yes, we are very fortunate. This has been shown to heal diabetic foot ulcers that have not been able to heal by other means, and it will avoid amputation in some patients and that's really important because once we get to amputation. That's kind of a downhill spiral because that usually means that the blood vessel circulation is very, very compromised from the diabetes. So, having hyperbaric oxygen to help us avoid amputation is critical to the patient's overall well being and length of life. One of the problems we have in patients with diabetes is that because of the blood vessel conditions, they have higher death rates just from having diabetes.

Host: Well, I tell you nobody wants to get to amputation, that is for sure. And I can't stress enough how important diabetes awareness is and also prevention. For the patients listening, Dr. Smith-Chase, what would you tell them in regards to trying to prevent diabetes in the first place?

Dr. Latisha Smith-Chase: Well, we know that diabetes happens because of inability for the body to control blood sugars. So, watching what you eat, exercising regularly, and trying to see your doctor regularly for checkups to make sure you're not in a prediabetes state is important. We may not be able to wholly avoid the diabetes, but there are things you can do, particularly with eating properly and having regular physical activity. It doesn't mean going to the gym. It means going for a walk sometimes so that you're getting some physical activity. Those are very good for keeping your blood sugar better controlled. And then if you have diabetes, for preventing foot ulcers, just look at your feet. Most ulcers are occurring in patients who have no feeling in their feet. So if you don't have feeling in your feet, you can't know, you can't feel that there's a problem, you have to visually check your feet every day. It takes about 10 seconds to do that, but it takes about 10 to 12 weeks to heal an ulcer once it forms.

Host: Wow, that's pretty powerful. That's very well said. I can't thank you enough for educating myself and our listeners on this topic, Dr. Smith-Chase. If you have diabetes, check your feet work with your primary care provider, your professional, and I appreciate it. If you do need the services of Dr. Smith-Chase or anybody in our Wound Center, they are more than ready to help you with all wounds, but in particular diabetic foot ulcers. So, Dr. Smith-Chase, thank you very much for being on this episode of the Fortcast.

Dr. Latisha Smith-Chase: Can I add one thing? This is my pearl for all patients with diabetes. Whether you have numbness in your feet or not, do not go barefooted. Many people like to go barefooted in their homes. Things in your home is just as dangerous to your feet as things outside your home. Wear shoes all the time if you're a patient with diabetes. That's my pearl.

Host: That makes total sense. So, please listen to Dr. Smith-Chase. She knows what she's talking about. But thanks again for being on this episode of the FortCast.

Dr. Latisha Smith-Chase: Thank you, Dr. Anderson.

Host: All right. Well, I hope you all enjoyed this episode of the Fortcast. This is Dr. Michael Anderson signing off. Please also check out our complete podcast library on our website, and please share it on your social channels. All right, everyone, have a great rest of your day. Take care. Bye-bye.