Maggie McKay (Host): Welcome to Wellness in Reach: A Mount Carmel Podcast. I'm your host, Maggie McKay. Today, we'll discuss the Limb Preservation Program with podiatric physician, Dr. Richard Schilling, and infectious disease specialist, Dr. Steven Bobula. Thank you both for being here today.

Steven Bobula, MD: Thank you for having us, Maggie. We're happy to be here.

Richard Schilling, DPM: Thank you, Maggie.

Host: Dr. Schilling, let's start with you. What is the mission of Mount Carmel's Limb Preservation Program?

Richard Schilling, DPM: Our goal is to have less amputations, more functional outcomes of wounds, and have people heal quicker with less comorbidities.

Host: And Dr. Bobula, which medical conditions most commonly lead patients to seek care for a limb preservation team?

Steven Bobula, MD: What we frequently see when people hear about a limb preservation team, the first thing they ask is: What is that? Why would you be seeking [00:01:00] that care? And, you know, we have to think about all the things that can lead to problems with limb loss. And that would be circulatory issues, mainly vascular problems; that would be wounds and ulcerations of the feet and lower extremities that can herald problems with circulation, infection, uncontrolled diabetes, things of that nature. So, people come to see us for many different reasons, but those are the big ones.

Host: How do early screenings and risk assessment help identify patients at high-risk for limb loss?

Steven Bobula, MD: We can do a lot more early on. So frequently, patients or our excellent primary care physicians and podiatrists in the community will go ahead and be screening for issues with diabetes, circulation, things of that nature. And if we start to see wounds starting to develop or having problems of that nature, this usually leads to [00:02:00] them being referred to a podiatrist or to one of our wound care team. At that point, that's when we start to see do we need to be more aggressive from a vascular standpoint? Do we need to go ahead and look into aggressive co-management in the hospital, things of that nature.

Host: Dr. Schilling, how do you help patients navigate the decisions between limb salvage and amputation? Because that's got to be rough.

Richard Schilling, DPM: when we speak about these cases, this is multifactorial and includes many team members. With Dr. Bobula and the infectious disease team, with the vascular team here at the hospital, with managers of their other conditions, we all really sit together and discuss what is viable and what is reasonable.

We're looking for an outcome that is the best for the patient. And it's so specific to each patient that it takes the time and the effort for the group decision. And the patient really has [00:03:00] to, decide for themselves how much they want to put into the treatment plan. These plans can be very complicated and include many different modalities of treatment. And so to go through all this, we have to have the buy-in of the patient, and then we really want to make sure that each team member agrees with the plan.

Host: Dr. Schilling, what are the signs that a patient or family member should consider asking for a referral to a limb preservation program?

Richard Schilling, DPM: I would say that if this wound that they have is not healing in the proper amount of time, which can be in the range of about four weeks. Anything up until four weeks is pretty standard for healing progress. But after four weeks, if we're not seeing regular improvements in their healing, intervention with advanced modalities is very important. And the fact that we have the technology and the know-how here at Mount Carmel with our limb preservation team, we are able to do things that some of the outside [00:04:00] clinicians just can't do.

Host: And what strategies are used to prevent avoidable amputations?

Richard Schilling, DPM: We really start with the simple things. We act like detectives in some sense. You know, we're looking for what's missing. Is it a nutritional issue? Is it a blood flow issue? Is there an infection that's underlying that we don't know about? Is there a pressure point that needs to be relieved?

And so again, the multifactorial nature of the limb preservation program allows for different perspectives and cooperation. I think the biggest thing that we are bringing to the table is collaboration. In our care, one plus one is three. We really have a symbiotic relationship between these different services that allows for a better outcome with our patients.

Steven Bobula, MD: And that's just a really important point that Dr. Schilling brings up. Because, when someone comes to us, whether it be in the emergency department and a new wound is noted, or there's uncontrolled vascular issues or things of that nature. The important thing of a limb [00:05:00] preservation program that you see at our facility is that we can bring many different disciplines to bear very, very quickly and really try to maximize the speed and efficiency at which someone can have a problem identified, managed, and then have a comprehensive care plan when you leave. Not just taking care of the small problem, but how do we manage this in the future, how do we complete the healing , and most importantly, how do we prevent it from happening again? So, it's identification, management, and then prevention. And this program can do all three of those things because we have access to those specialists and advanced providers that can do these things for the patient and make it happen very quickly.

Host: It sounds like Mount Carmel has really covered all the bases in this program. So in closing, is there anything else you'd like to add, Dr. Bobula?

Steven Bobula, MD: Well, I think the most important thing is [00:06:00] awareness. A lot of times, we don't think about, is there a wound on the foot? You know, is it odd that there's not as much hair on my foot or my leg as there used to be before? Is it different that I'm starting to note some redness and maybe that wound's not healing as quick as it used to, or maybe something's a bit more painful? It's okay to ask questions. It's okay to come in and get those things taken care of. And if there is a significant problem, we can take care of that quickly, because what we want to avoid is amputations, whether that be the toe, the foot, a leg, because these things frequently, if identified early, can be prevented. And it all comes down to recognition by our patients, and also by our excellent network of primary care physicians. If we look for these things and we ask those questions, we can get the problems taken care of, and then people come and see myself, Dr. Schilling, and the rest of our team, whether it be from a vascular, other infectious disease physicians, and really can get this whole problem taken [00:07:00] care of. Dr. Schilling, anything you'd like to add?

Richard Schilling, DPM: I concur with all of that, but for me, advocacy. I think the self-advocacy of the patient and understanding what is available and realizing that not one doctor necessarily knows all the answers. As well educated as we are, we learn things from each other all the time. And I like the collaborative nature of this program. And so for me, it's more of the integrated approach and having that early intervention, preventing poor outcomes.

Host: Thank you so much, both of you, for being here today. This has been so informative and very useful.

Richard Schilling, DPM: Thank you.

Host: Again, that's Dr. Steven Bobula and Dr. Richard Schilling. For more information or to schedule an appointment, please visit mountcarmelhealth.com. Thank you for listening to Wellness in Reach: A Mount Carmel Podcast. [00:08:00]