An engaging program on diabetic foot ulcers (DFUs) offering many perspectives from distinguished presenters in partner with Wounds Canada. In addition to learning more about DFUs, this webinar provided an opportunity to ask the experts about viewers concerns, understand the importance of proper foot care, and access resources to aid in foot care. #LetsEndDiabetes
Featured Speakers:
Dr. Zaina Albalawi, Endocrinologist at Eastern Health and Clinical Assistant Professor at Memorial University of Newfoundland
Dr Robyn Evans, Medical Director of the Wound Healing Clinic at Women’s College Hospital
Crystal McCallum, Director of Education at Wounds Canada
Matt Anderson, patient advocate.
welcome everyone
00:04
uh my name is brooks roach i am a
00:06
diabetes education specialist with
00:08
diabetes canada
00:10
my pronouns are he and him and i'd like
00:12
to begin by acknowledging that i'm
00:13
joining this webinar
00:15
from the traditional and unseated
00:16
territory of the migma people
00:18
wherever you're joining or watching from
00:20
i'd like us to please express gratitude
00:22
for the land on which we live and
00:23
acknowledge
00:24
all past inhabitants of what we now call
00:26
canada
00:27
i am here today with some wonderful
00:29
guests to talk about how those of us
00:31
living with diabetes or pre-diabetes
00:34
can find support for diabetic foot
00:35
ulcers to decrease the incidence of
00:37
amputations
00:39
and practice general foot care to
00:40
prevent or best manage complications
00:44
this webinar is a very special
00:45
collaboration between wounds canada
00:48
an organization dedicated to the
00:49
advancement of wound prevention
00:51
and management for all canadians and
00:53
diabetes canada
00:54
which is committed to helping people
00:56
with diabetes live healthy lives
00:57
while working to find a cure
01:00
so today i'm very pleased to introduce a
01:03
few wonderful guests as mentioned dr
01:05
zaina al-balawi
01:06
who is an endocrinologist at eastern
01:08
health and a clinical assistant
01:10
professor
01:11
at memorial university of newfoundland
01:13
in st john's
01:16
we also have dr robin evans who is
01:18
medical director
01:19
of the wound healing clinic at women's
01:22
college hospital
01:24
welcome robin we have matt anderson who
01:27
has lived
01:27
experience with diabetic foot ulcers
01:30
welcome matt
01:31
and we have crystal mccallum director of
01:33
education at wounds canada
01:36
so welcome and thank you to you all
01:44
uh our experts will be answering some
01:46
key questions that we've been hearing
01:48
from our community
01:49
and that our experts have been hearing
01:51
from their patients we're very pleased
01:53
to present
01:54
the patient's perspective as well from
01:55
matt at this webinar
01:57
we will also be taking questions from
01:59
you our viewers so
02:01
some questions have already been
02:02
submitted and you can ask by typing in
02:04
the q
02:05
a or the comments um
02:08
so let's let's dive right into it um
02:10
first question is going to be uh
02:12
presented to dr al balawi
02:14
we'll start with you can you walk us
02:16
through the burden
02:17
of peripheral neuropathy diabetic foot
02:20
ulcers
02:21
and the resulting amputations on
02:23
patients and on our health care system
02:26
absolutely and i just want to thank this
02:28
great collaboration first of all
02:30
between diabetes canada and wounds
02:32
canada which have been leaders
02:34
in trying to educate and reduce those um
02:38
complications with diabetes so uh yeah
02:41
so i know
02:41
this is great we'll set the stage first
02:43
and draw that big framework of why we're
02:45
here today and why it's important to
02:47
speak about foot care
02:48
um and i am going to be sharing numbers
02:51
uh but i'm reminded today from one of my
02:53
patients where i had a visit this
02:54
morning
02:54
telling me that you know i'm more
02:58
than a number and it really resonated
03:00
with me as i was kind of prepping for
03:02
today and so as i say those numbers i'd
03:04
like us to
03:05
really think beyond the numbers and
03:07
think about the lived experience of
03:08
people with this and it looks very
03:10
different
03:11
for everybody um so i am going to start
03:13
with peripheral neuropathy
03:15
which is one of the causes of under
03:18
one of the underlying causes of diabetic
03:20
foot complications
03:21
um and where you know it's one of the
03:23
microvascular complications where
03:24
nerves are impacted due to multiple
03:26
factors relating to diabetes
03:28
and you know putting that into context
03:31
about
03:32
50 of people with diabetes will
03:34
experience
03:35
peripheral neuropathy and in addition to
03:37
other risk factors
03:39
um like circulation deformities
03:42
um and other factors ulcers may result
03:46
um secondary to that and so if we think
03:48
about
03:49
you know how common are ulcers and
03:50
people with diabetes that number ranges
03:52
between
03:53
15 to 25 percent and it's still thought
03:56
to be an underestimate because we don't
03:57
really have good tools to capture all
03:59
that
04:00
so you know putting that again in
04:02
perspective of people with diabetes in
04:04
canada and the prevalence of that
04:06
once somebody has experienced an ulcer
04:08
and skin breakdown
04:11
even once it heals they're not really in
04:13
the safe
04:14
and we know now that the recurrence of
04:16
those ulcers
04:17
are quite high so a year after a wound
04:20
heals
04:21
the chance or the risk of recurrence is
04:22
about 40 so we think about it in the
04:25
framework of
04:26
cancer that once it's healed there still
04:28
needs to be that act of surveillance and
04:30
interventions to reduce that
04:32
and we have some new data to show that
04:34
once ulcers do occur
04:36
it's not simply a wound that's healed
04:37
end of the story but
04:39
there have been associations with
04:40
mortality as well
04:42
so five-year mortality once somebody has
04:45
experienced a diabetic foot ulcer
04:47
is about 30.5 percent um
04:50
so we've talked about peripheral
04:51
neuropathy diabetic foot ulcers
04:53
and one of the most feared complications
04:56
you know from patients is
04:58
amputations and literature has shown
05:01
that you know it's no surprise people
05:02
fear that more than death
05:04
with the disability the impaired quality
05:06
of life that comes with it
05:08
as well as uh the big changes and so we
05:10
know once somebody has had an amputation
05:13
um the risk of death following that
05:16
three years after an amputation is about
05:19
71
05:20
now that's a that's quite a staggering
05:22
number
05:23
and you know we add a layer to that
05:26
looking at the burden of diabetic foot
05:28
complications
05:29
is the disparity those complications are
05:31
not equal among people with diabetes we
05:33
find people
05:34
of different race indigenous status
05:37
socioeconomic status
05:38
uh rural populations um those added
05:42
layers
05:42
uh we see those numbers magnified even
05:45
further
05:46
um so i think putting that into
05:47
perspective it's it's a serious issue
05:50
uh diabetes contributes to a number of
05:51
different complications this is not to
05:53
take away from any of the others
05:55
but about 70 of amputations um are
05:58
contributed by diabetes
06:00
um not to mention the impaired quality
06:02
of life that comes with that
06:03
and then from a patient perspective
06:06
significant impairment of quality of
06:07
life
06:08
i'm leaving the health care system until
06:10
the end because you know that is more of
06:12
a system issue and as healthcare
06:13
providers we're looking at
06:14
sustainability but
06:15
i think it's important issue to talk
06:17
about as well
06:18
so the gemini group in ontario has done
06:20
some elegant studies looking
06:21
at what does it cost tax uh dollars
06:25
and payers for this and so somebody
06:27
comes in with a diabetic foot ulcers
06:30
the cost of a stay is about 22 and seven
06:33
hundred and fifty four dollars
06:35
and if an amputation is uh happens
06:38
because of those complications that
06:40
number jumps
06:40
to forty eight thousand and eight
06:42
hundred and eight per stay
06:44
so we can see what a significant cost
06:47
and burden it is
06:48
starting and most importantly at the
06:49
individual level but then also
06:51
magnified at the system level and so
06:55
really you know until we have a cure for
06:57
diabetes uh the focus is to reduce the
06:59
risk of those complications
07:01
and support people with diabetes living
07:03
healthy lives
07:07
thank you so much and i i really
07:10
appreciate the
07:11
navigating that difference between
07:13
individual and system level
07:15
challenges thank you for for setting
07:17
that stage for us
07:18
um now we're going to kind of zoom in
07:22
and the next question that i'd like to
07:23
ask is to matt
07:26
i'm wondering if you could share with us
07:28
a bit what it's like to to live with
07:30
these complications and your experience
07:31
with that
07:32
um uh once again i'm happy to be here
07:36
i'm i'm glad that uh
07:37
we get to shed some light on this issue
07:39
um i've been dealing with
07:41
diabetic foot ulcers for a good 17 years
07:43
my first foot ulcer
07:45
uh started on my big toe my right foot
07:48
from a pair of golf shoes
07:49
i used to play 100 rounds a year i don't
07:51
play golf anymore
07:54
i basically it's it started out as i was
07:58
a
07:58
i was younger i was 30 at the time and i
08:00
was 30 years younger than anybody that
08:02
was in the clinic
08:03
whatsoever and that's what i kept seeing
08:05
i i'm very young to have this i'm very
08:07
young to have this
08:09
um and i there was a lot of denial i
08:12
didn't want to listen
08:13
i didn't it was my own fault in the
08:15
sense like my
08:16
my job i walked on concrete all the time
08:18
my worst field toe boots
08:20
i didn't have correct offloading i
08:22
didn't really know anything about it i
08:23
got diabetes when i was 22
08:25
and my doctor told me you're fat lose
08:27
weight your diabetes will go away
08:30
send me to a nutritionist and that was
08:31
that and see you later
08:33
so i mean through i've started
08:36
i my experience with diabetic foot
08:39
ulcers i basically
08:41
became a compliant patient through
08:42
maturity and through experience because
08:45
i mean over the last 17 years i've
08:47
probably lost about six years out of
08:48
work
08:49
um i've been on disability i've had
08:51
problem with disability
08:53
um insurance i've had to fight battles
08:55
because you can't see a diabetic ulcer i
08:57
don't limp
08:58
um i don't limp if you're just looking
09:01
at me
09:02
but you like my i have a deformed left
09:04
foot i've had six surgeries on my left
09:06
foot
09:07
i've got eight toes i but i refuse
09:10
to i refuse to give up like my last my
09:13
last surgery
09:14
dr lau who's unbelievable in toronto
09:17
western
09:18
at toronto western hospital said to me
09:20
he goes matt you're
09:21
like i've always been a big guy so matt
09:24
you're you're 500 pounds they don't give
09:26
they don't give steel legs to a guy's
09:28
500 pounds they give
09:30
steel chairs and that was kind of
09:33
started me on a pathway where i'm kind
09:35
of saving my life i'm down about 150
09:37
pounds in the last 10 months
09:39
um but it is it's it totally
09:41
encapsulates
09:42
everything you do in your life having a
09:44
diabetic foot also from
09:46
what you do with your family from what
09:48
your family has to deal with with you
09:50
from like just the simple thing of
09:52
having a shower in the morning i can't
09:53
get my foot wet
09:55
so i have a stool in the shower i have
09:57
to put my leg out of the shower
09:59
so that leg doesn't get wet and then
10:02
i've got to spend an hour changing my
10:03
own dressing
10:05
um every single day like so you get me
10:08
getting ready for
10:09
me getting ready to go do anything in
10:10
the morning takes me an hour and a half
10:12
whereas it'll take you 10 minutes you
10:14
know what i mean so
10:15
just little examples and it just i
10:17
wasn't compliant at the start of all
10:19
this stuff i i fought tooth and nail
10:21
against the doctors
10:23
and everything like that and then
10:24
finally i i
10:26
i started to advocate for myself and i
10:28
wanted consistency in my health care so
10:30
i started seeing dr
10:31
evans and dr evans only um with regards
10:34
to my foot care and then she put me
10:36
in the right frame of mind
10:39
and with the right surgeons and what
10:40
they they're about prevention
10:42
they're not about um they're not about
10:45
amputation
10:46
and so that's the right spot but it took
10:48
me a long time to get to that spot the
10:49
first chiropodist i ever went to when i
10:51
had an ulcer
10:52
told me to soak my foot in epsom salts
10:55
for an hour every day and all that did
10:58
was wear away the joint and that toe was
10:59
gone in a year and a half
11:01
and so it's like it's education because
11:03
there's different
11:04
there's different things and i'm from
11:06
durham region but i go
11:08
all my foot care and all my is in
11:10
toronto
11:11
because their approach to it is much
11:14
different
11:15
different regions have different
11:16
approaches to this right so
11:19
there's a lot like i mean i could talk
11:21
for two hours
11:22
based on everything you have to deal
11:24
with but just to start off and it's
11:26
my relationship with my doctors um
11:29
and my orthotist and my pharmacist and
11:33
my advocating for myself and not taking
11:36
i'm gonna amputate your foot as the be
11:39
all and end-all
11:40
answer from some doctors that say that
11:43
that just leads me down to this point
11:45
where i just want to have people to know
11:47
exactly how difficult it is
11:51
i told you i was a talker i'm sorry
11:54
nothing uh nothing to be sorry about
11:56
matt i'd like to say thanks uh on behalf
11:58
of you know everyone on this call but
12:00
also everyone watching
12:01
um it means a lot to hear you share your
12:03
story um
12:04
and to you know i i've lived with type 1
12:07
diabetes for 20 years and i
12:09
i can relate to some challenges but um
12:11
it's incredibly helpful to hear
12:13
you know your take living day after day
12:15
with these challenges
12:17
um and and the learning and growth that
12:19
you've done to
12:20
you know take a more active role in how
12:23
you're sort of pushing back
12:24
it uh it's very honestly very inspiring
12:28
to hear that
12:29
and that thank you i appreciate it and
12:30
that's what it is too like like i said
12:32
i'm the youngest guy in the waiting room
12:34
at the women college hospital
12:35
dermatology day clinic and everything
12:36
like that i'm the youngest guy at all
12:38
times
12:39
and if i see a younger person come in to
12:41
that waiting room i know exactly where
12:43
they're going i know exactly what
12:44
they're going to come out with they're
12:45
going to come up with an air cast
12:47
but there's no one there to tell them
12:48
there's no one there to tell them if you
12:50
don't
12:50
if you don't wear that air cast until
12:53
your ulcer is healed or if you don't
12:55
offload that wound
12:57
until your ulcer is healed you're just
12:58
going to do damage to yourself so
13:00
i mean i don't want to be nosy to some
13:02
people but i can tell people i can
13:03
approach and i've approached people to
13:05
say hey
13:06
this is what you're going to go this is
13:07
the road you're going to go down with
13:08
this don't take this lightly
13:10
because i did the first couple that i
13:12
had and so it's like
13:14
my my ulcer story is a tale of like it's
13:16
been 17 years and for seven it's been
13:19
me taking care of myself and for eight
13:21
it was just what am i going to do
13:23
so the problem is people especially at
13:27
my age like i'm 47
13:29
i've been dealing this since i was 30.
13:31
the average age of people in the waiting
13:32
room at the clinics are over
13:34
60. so maybe i just
13:37
you know what i mean i want to work
13:38
harder towards it but it's it's
13:40
difficult when when you're young
13:43
yeah 100 and i think it's really clear
13:45
to
13:46
those listening that you you must have
13:48
an impact on those you speak with math
13:50
and
13:50
i think you point to an interesting side
13:52
of this
13:53
you know this lived reality which is
13:55
developing trust and developing a strong
13:57
relationship with a care provider
13:59
and that's my version of a segway to say
14:01
that our next question is
14:03
to dr evans who is matt your care
14:06
provider
14:07
and i wonder if the two of you can can
14:09
speak a little bit about
14:10
your experiences both treating and
14:13
advising
14:14
those living with complications for for
14:16
dr evans but also
14:18
um you know what's what that's been like
14:20
on a one-to-one
14:21
scale um
14:24
okay well i thank you very much
14:26
everybody who's spoken already and matt
14:28
for all those uh
14:29
that that uh chat you've given us all
14:31
it's very eye-opening
14:33
i'm very lucky to work at a
14:34
multi-disciplinary clinic and we have
14:36
expert chiropodists and nurses and
14:38
and we really work work as a team and
14:40
i'm sure matt would agree and he's been
14:41
on the receiving end of
14:43
a lot of care from our chiropodists who
14:46
have made a major impact for matt as
14:48
well
14:49
i mean i really like the work i do there
14:51
i really feel like it's impactful for
14:53
patients
14:54
they come in quite worried about
14:55
amputations and
14:57
i think we do manage to change the care
14:59
path and it's it's
15:00
uh it's great work to do um over the
15:04
last 10 years though i
15:05
you know thinking back about all the
15:07
things that i think happened at the
15:09
clinic i
15:09
i think the biggest thing is that i
15:11
think patients present a little bit late
15:14
um unfortunately um by the time we get
15:17
them
15:17
they've had this diabetic ulcer for
15:19
quite a while and the complications that
15:22
uh zaina described uh occur quite
15:25
quite readily um so i think we
15:28
hope we could do a better job with that
15:30
and then um
15:32
i think i want to echo what matt said
15:34
about managing
15:35
these diabetic foot ulcers is the whole
15:37
concept of offloading
15:39
um this is something we're asking
15:40
patients to do wear a device that's not
15:43
necessarily necessarily attractive
15:47
we're asking them to limit their walking
15:49
changing their activities to daily
15:50
living completely
15:52
and they're not particularly feeling
15:54
this ulcer so
15:55
uh it's a real process to gain the trust
15:57
uh with the patients and to impart this
15:59
knowledge about offloading
16:01
uh at the beginning of the program and i
16:03
usually put it to patients uh
16:05
now is that you know we need to go big
16:07
at the beginning
16:08
and you know do everything we can to get
16:10
rid of this ulcer to start
16:12
offloading is key um so we get rid of
16:14
this ulcer
16:15
in in sort of weeks rather than seasons
16:18
and uh
16:18
over time i think uh we get we mostly do
16:22
get by them but
16:22
i think it's the hardest part about
16:25
dealing with it i think that's what matt
16:26
has struggled with all these years
16:29
um and then in those that we do heal
16:31
ulcers
16:32
and i think it's quite a lot the biggest
16:35
issue then
16:36
is ongoing surveillance and where these
16:37
patients go to after that
16:39
how we manage the patients in the in the
16:42
system
16:43
and we have great chiropodists and
16:45
podiatrists in the community
16:47
but there's a financial burden to this
16:49
and patients uh
16:50
you know it's not always feasible to be
16:52
able to manage that
16:54
so um discharge is sometimes a difficult
16:56
process from our clinic uh
16:58
people feel quite stranded when we say
17:00
you know you don't need to come back
17:01
again
17:02
that's not that's not music to their
17:04
ears sometimes um
17:05
for many and then we have the whole
17:08
issue regarding
17:09
um offloading itself like the funding
17:12
for that
17:13
in ontario we've been very fortunate
17:14
from the government to get funding for
17:17
some removal cast walkers etc but
17:20
uh going forward beyond that there's a
17:22
bit of a glitch in the system
17:24
and that that's um a difficult time so
17:29
i mean working with matt has been great
17:30
and we've had a really good positive
17:31
relationship over the years but
17:34
i think you know there's always things
17:35
you can look back on and maybe think you
17:37
know matt
17:37
what what do you think would have been
17:39
more impactful to hear at the beginning
17:41
of your
17:42
journey back you know years ago uh is
17:45
there something that could have been
17:46
done
17:47
better or quicker no no like i would
17:50
have to say
17:51
my maturity it's not it you can't look
17:54
back like i would have to say my
17:55
maturity level is as
17:56
is increased like when i when i got
17:59
diabetes i was young i was 21.
18:01
i was doing everything that a 21 year
18:03
old kid would do um
18:04
i didn't take it seriously i didn't take
18:07
it seriously until i had a problem so
18:09
that that's on me
18:10
um i didn't think though i didn't
18:13
understand
18:14
it i was like okay fine i have diabetes
18:16
lose weight you'll be fine i listened to
18:17
what the doctor said to me and i and i
18:19
fluctuated all my life
18:20
so but the point be
18:24
so it's not as if you can't go back and
18:26
change time but it
18:27
but you can go back and change your
18:29
attitude and my attitude was horrible
18:31
when i first had it i was
18:32
i was single at the time i was i owned
18:34
my own house i needed to work
18:36
i needed to i couldn't go off work
18:39
despite i had this hole in my foot
18:41
it didn't hurt and then when it the only
18:43
way the only way an ulcer hurts
18:45
is if you get an infection and so and i
18:48
know exactly
18:49
through the years however many
18:51
infections i've had in my foot i know
18:53
the exact signs where it's going to hurt
18:55
when my infection's coming and what
18:57
antibiotic i need to take
18:59
so in order to avoid iv antibiotics
19:02
and i'm pretty good with it i think dr
19:04
evans can attest that
19:06
then i'm pretty good at knowing when my
19:07
body is telling me i'm getting an
19:09
infection
19:10
but it's it's it's it's it's honestly
19:12
about it's
19:13
it's i couldn't live without my
19:15
orthotist melanie
19:17
from back to feet i could not live
19:19
without her she is the one person that
19:21
keeps me walking
19:22
all the time and whether it's adjusting
19:25
my
19:25
orthotics monthly whether i wear an afo
19:29
on my left foot which is an orthotic and
19:31
a and uh in a brace to keep my ankle
19:33
stable
19:35
whether it's that like i'm i'm as soon
19:36
as i have a problem with at
19:38
the the clinic and dr evans has to see
19:40
me my next call is my
19:42
my is my is my um orphatist
19:45
and so then we go and try and offload
19:47
but it's like you rob peter to pay paul
19:48
when you offload
19:50
and like i'm six foot five
19:53
right so i'm very tall and and i'm top
19:56
heavy i'm
19:57
so it's very hard to offload you're you
20:00
can't change your gate no matter what
20:01
you try and do
20:02
sometimes orthopedic shoes don't work
20:05
whatsoever and it's tough to get them
20:06
because
20:07
some benefits companies don't cover them
20:09
and i have two pairs of orthopedic shoes
20:11
worth five thousand dollars
20:12
collecting dust upstairs because they
20:14
didn't work um
20:16
when i had to wear an air cast for my
20:17
last ulcer i had to get my air cast
20:19
modified by my orthotist because
20:22
it wasn't offloading correctly and i was
20:23
too big for the air cast and i was
20:25
bottoming out in the air cast
20:27
so there's it's it's a lot of diligence
20:30
between me
20:31
and saying okay let's try this let's try
20:34
this
20:34
to the point where and then i'll pass
20:37
that information off with dr evans and
20:39
we'll work together
20:40
to try and to try and fix the issues but
20:43
it's
20:44
it's it's an ongoing thing i have to
20:47
call if
20:48
if i if my wife says let's go for a long
20:50
walk on the beach i'm going to say sorry
20:52
honey i can't go
20:53
because i can't take my shoes off and i
20:55
can't if i
20:57
i can't walk in sand because it's not
20:58
flat ground
21:00
and all that sort of stuff so it's it's
21:02
it's it's a
21:03
it's a it's a snowball effect if you
21:05
don't and now that i've been kind of
21:07
managing it my
21:08
my quality of life's a little better
21:10
because my sugars have been better i'm
21:11
about i'm a more compliant patient
21:13
however there's still all these things
21:15
that add up to your day
21:17
and because it's not seen and because
21:21
like i can fake through an ulcer if i'm
21:23
sick i've had so many before
21:25
but only people that really truly know
21:28
you know you're in pain and when you're
21:30
in pain so again i think one of
21:33
i think matt one of the things you've
21:34
highlighted in this is the fact that
21:37
you really need to know how to navigate
21:38
the system who you need to know and i
21:40
think
21:41
i think early on in um you know a
21:44
person's journey with an ulcer
21:45
i think that's one of the things that uh
21:48
i think we probably could do better at
21:49
is knowing where to send people having
21:50
the resources of where to
21:52
send people and of course obviously
21:54
prevention is really the key in
21:56
in all of this and and uh making you
21:59
know
21:59
more aspects of care readily available
22:01
to people with diabetes
22:02
and ulcerations but just to add to that
22:06
though it's it's it's the
22:07
it's the it's the it's the
22:10
how to i don't it's the mindset of the
22:12
doctor that you're dealing with as well
22:14
from a patient perspective like i've
22:16
seen so many surgeons in in my life with
22:18
regards to this
22:20
and i know the first surgeon is always
22:22
the intern and they look at me and say
22:24
you're fat you're overweight we're gonna
22:25
have to cut off your leg
22:26
and i'm like just come and see me when
22:28
the real guy that's gonna cut open my
22:30
foot
22:30
and then we'll talk about it and it's
22:32
like so then then you get a different
22:33
approach so
22:34
i worry about younger doctors coming
22:36
into the system with an archaic doctor a
22:39
70 year old doctors
22:40
look at things well we have to do this
22:42
we have to amputate his leg
22:43
no we don't like you could have
22:46
amputated my leg
22:47
10 times if i had the wrong doctor
22:51
but i have the right doctors and the
22:53
right people that care
22:54
and so they're all about saving my foot
22:56
and so if they're all about saving my
22:58
foot i have to be about saving my foot
23:00
too
23:00
so that's where you get on that page but
23:03
it's it
23:04
like there's a the lack of empathy
23:07
towards a patient
23:08
when you when you just take a look and
23:10
take a snapshot of what you're looking
23:11
at
23:12
because me oh my god you're overweight
23:14
you're diabetic
23:15
you used to smoke blah blah blah blah
23:17
all this stuff you're
23:18
you know it's it's easy to take a
23:20
picture but i found the more
23:22
that i talk to talk to medical
23:25
professionals and educate myself on what
23:27
i'm dealing with and everything like
23:28
that
23:29
they'll sit and give me the time of day
23:31
a lot more so
23:33
in that but not every patient can do
23:35
that not every patient
23:36
wants to not every patient understands
23:39
that push for it and you'll get the help
23:40
you need
23:42
yeah i think there's a real uh i think
23:44
we really need to educate both
23:45
patients and uh early on
23:48
patient education is really important
23:50
and it all just comes back to the
23:51
preventative piece and we wouldn't be
23:53
going down this road
23:54
if we had really good preventative care
23:56
i think
23:57
um but thanks thanks very much matt i
24:00
think that
24:00
really outlines the whole system
24:05
yeah thanks so much for both of you
24:06
that's it's really it's fascinating to
24:08
see a bit of a
24:09
patient doctor dialogue so to speak
24:13
i think the next question we're very
24:15
pleased again as mentioned to be
24:17
partnering with
24:18
wounds canada and we have crystal
24:19
mccallum as a guest and
24:21
my next question is for you crystal and
24:24
i'm wondering if i'm a viewer who lives
24:25
with diabetes
24:27
uh if i live with foot complications or
24:29
if i care for someone
24:30
who lives with this uh what resources or
24:34
programs
24:34
are available through wounds canada
24:38
that's a great question brooks and i
24:40
think i've got a little slide prepared
24:42
is it okay if i share that with your
24:44
audience go ahead
24:46
sure so let me give this a whirl
24:52
can you see my slide
24:57
yep we're good
25:02
all right so wounds canada has a number
25:05
of resources for people with
25:06
and at risk for diabetes related foot
25:08
complications and for their caregivers
25:11
in response to the covet-19 pandemic
25:13
once canada created a series of 10
25:15
resource documents
25:17
to empower people living with or at risk
25:19
for wounds and their caregivers to
25:21
prevent and care for the wounds
25:23
known as the care at home series these
25:25
easy to read educational resources have
25:27
been downloaded 27
25:29
000 times since their launch last year
25:33
two of the caret home series documents
25:35
may have been particular interest to
25:37
your audience
25:38
safe foot care if you have diabetes and
25:40
diabetic foot complications
25:42
one is in an emergency these resources
25:45
which are freely downloadable from the
25:47
wounds canada website
25:49
so www dot wounds canada dot ca
25:52
provide practical guidance on preventing
25:54
and identifying
25:57
diabetes related foot complications
26:01
including amongst other things adopting
26:03
a healthy lifestyle
26:05
performing daily foot inspections and
26:07
foot care performing safe nail care
26:09
and selecting shoes that fit french
26:12
language
26:12
translations of these documents will be
26:14
available on the wounds canada website
26:16
shortly
26:17
in addition access to diabetes healthy
26:20
feed and new resources can be obtained
26:21
through the wounds canada website
26:24
offered by select lins or local health
26:26
integration networks in ontario
26:28
the diabetes healthy feed and u program
26:31
consists
26:31
of a two and a half hour interactive
26:34
workshop
26:35
or two one and a half hour interactive
26:38
virtual sessions
26:39
that empower people living with diabetes
26:41
and their caregivers
26:43
with the knowledge and skills needed to
26:45
prevent diabetes related foot
26:46
complications
26:48
many of the resources associated with
26:51
this program
26:52
have been translated into 16 languages
26:55
and include amongst others finding the
26:58
proper shoe fit
27:00
foot examinations for people with
27:01
diabetes questions to ask your health
27:04
care professional your audience can also
27:07
sign up to receive monthly foot care
27:09
tips sent directly to their inbox
27:12
and finally wounds canada recently
27:14
partnered with queen's university
27:16
to create a diabetic foot care facebook
27:19
study group
27:20
this group aims to determine the study
27:23
aims to determine the feasibility of a
27:25
facebook group based program
27:29
to support adults with diabetes in their
27:31
foot self-care practices and the
27:34
prevention of foot officers
27:36
if anyone listening today is interested
27:38
in joining this private community
27:40
to learn foot care strategies and gain
27:42
motivation to better care for their feet
27:44
prevent ulcers and live a healthy life
27:47
visit the wounds canada website for more
27:48
details
27:50
now participants in this study group
27:51
must be 18 years of age or older
27:54
have a diagnosis of diabetes be
27:56
proficient in the english language
27:58
have access to the internet and have an
28:00
active facebook account
28:02
or be willing to create one wounds
28:05
canada
28:06
also has some resources for healthcare
28:08
professionals as well which you see on
28:10
this screen
28:12
and what's most exciting about these
28:14
resources
28:15
is the upcoming wounds canada limb
28:18
preservation symposium
28:19
which is taking place next friday may
28:22
the 28th
28:24
this full day event virtual event has
28:26
been accredited by the canadian
28:28
society for vascular surgery
28:32
and features some of canada's top
28:34
experts in
28:35
diabetes diabetes foot related
28:38
complications
28:40
and limb preservation so i encourage any
28:43
health care providers
28:44
to consider joining this event next week
28:47
and certainly members of the public are
28:48
welcome to join as well
28:56
thank you very much crystal um i i
28:59
really
29:00
appreciate the the diversity of programs
29:04
and resources that you've been
29:04
developing and and you know
29:06
uh there was a line that said when is it
29:08
an emergency which i found really
29:10
encapsulates some of what we've been
29:12
talking about which it is
29:14
by definition a slow process so it can
29:16
be very important to recognize those
29:18
those warning signs um that may creep up
29:20
on a person
29:21
so thank you um going to
29:25
to pass the next question to dr albalawi
29:28
and uh the question is if you could just
29:31
share some best practices and strategies
29:34
for folks living with diabetes to
29:35
prevent complications
29:37
to advocate for themselves with their
29:39
healthcare providers
29:41
and just to to live well with foot
29:43
complications
29:45
alina and thanks for that question i
29:46
think this is the flip side of the story
29:48
this is the bright
29:50
light at the end of the tunnel and i
29:52
this brings me the most joy to speak
29:54
about so i'm happy to share this with
29:55
everybody and i just want to really echo
29:57
what crystal said and wounds canada
29:59
um you know when i moved to newfoundland
30:00
we we did have a multi-disciplinary team
30:03
in
30:03
in alberta working there and moving over
30:05
here i've seen firsthand
30:07
the impact of the educational programs
30:09
that are honestly you know
30:11
top-notch not only for providing
30:13
education but training people to train
30:16
others and i
30:16
i can say probably single-handedly
30:18
wounds canada you know
30:20
you have the credit for reducing the
30:22
risk of amputations across so i just
30:24
want to applaud you for all that great
30:25
work and
30:26
uh i think canada is very fortunate to
30:28
have you
30:29
um so for prevention i think i'm going
30:31
to start with
30:33
key principles um and this is pretty
30:35
much standard across
30:36
all uh diabetes and foot care prevention
30:40
guidelines in canada
30:41
uh the us and the international working
30:43
group for the diabetic foot so five
30:45
principles
30:45
to reduce the risk and uh we know from
30:48
the literature that up to 80
30:50
of ulcers and amputations are
30:52
preventable and i usually start off
30:54
right there
30:54
uh for patients with my you know first
30:57
line on education
30:58
uh and and just to have that empowerment
31:00
to know that
31:01
there are things within our reach that
31:03
we can do and again i think i'll just
31:05
touch on what you mentioned brooks
31:06
about the system and individual level we
31:08
should not be gaslighting
31:10
and having patients carry the burden of
31:12
all the care i think we need to be very
31:14
clear and acknowledge the gaps in
31:16
our healthcare system and so it saddened
31:18
me a bit matt to hear about
31:20
kind of your sense of failure or so on
31:21
but i think it's it's a lot to bear on
31:23
one person there are system
31:25
aspects in us as healthcare providers we
31:27
have responsibility in terms of focusing
31:29
research on
31:30
primary prevention which is lacking uh
31:32
healthcare
31:33
policy advocates have a role non-profit
31:36
organizations
31:37
um and politicians as well to put this
31:39
at the frontier
31:40
uh so it's just broader than the
31:42
individual and i'd like to make sure i
31:43
highlight that
31:44
so five key principles for prevention
31:46
the first one is going to be
31:48
finding those people with neuropathy who
31:50
are at risk so screening
31:52
number one uh so be sure to have a foot
31:55
exam
31:56
once a year at minimum for everybody
31:58
with diabetes and five years after
32:00
people have type 1
32:01
because we can't really manage or
32:03
address what we don't uh
32:05
know about and the risk category which
32:07
wounds canada again provides great
32:09
resources
32:09
low moderate high or very high that's
32:12
kind of like the traffic light system uh
32:14
and that's what i usually communicate to
32:15
people you're at low risk next exam is
32:17
in one year
32:17
versus moderate versus high and we have
32:19
action plans um so i would encourage
32:21
people to
32:22
be aware from an individual level that
32:24
you know this is standard of care
32:25
uh if you haven't had it bring it up at
32:27
your visit the second thing is going to
32:29
be
32:31
regular inspection and that's both
32:33
healthcare provider
32:34
system as well as individual level where
32:37
people can inspect
32:38
their feet daily and if they find any of
32:40
the red flags or what we call
32:42
pre-alternative lesions so calluses
32:43
blisters areas of friction increase
32:45
temperature
32:46
um that or nail changes those need to be
32:49
addressed
32:49
early on um and they're of course you
32:52
know very
32:53
so many challenges with inspection with
32:55
people with diabetes and other
32:56
comorbidities so
32:58
you know there are always certain tricks
32:59
that we can talk about on how to do it
33:01
or maybe involve health
33:02
family or a podiatrist or a wound nurse
33:06
or a diabetes educator for that piece
33:09
and then third is education and i think
33:12
you know i don't need to speak more
33:13
about that
33:14
uh matt highlighted quite a bit as well
33:16
as dr
33:17
evans um and uh crystal about
33:20
you know the importance of education and
33:22
making it very clear of
33:24
what we're recommending why we're
33:26
recommending it and what are
33:27
the outcomes that we're aspiring for and
33:29
education spans
33:30
the spectrum of individuals so people
33:32
living with diabetes
33:34
healthcare providers family members as
33:36
well
33:37
and i think that's a key factor so that
33:39
takes us to our fourth
33:40
key principle in prevention and that's
33:42
going to be footwear
33:43
um so two key things over here routine
33:46
wearing a footwear
33:48
and appropriate footwear and i think
33:49
you've heard as well firsthand
33:51
about the orthotist and the role of
33:53
whether it's casting for offloading or
33:55
even for reducing the risk of
33:56
of complications uh the role of that and
33:59
i i
34:00
echo and i will say it here again i
34:01
don't think they're appreciated or
34:03
understood in
34:04
the paradigm of foot care podiatrists
34:06
are corner
34:07
stone to foot care prevention they are
34:10
the heart and soul
34:11
and you know i was guilty in
34:14
understanding that early on and i think
34:16
we now have models
34:17
of podiatry or podiatry-like skills that
34:19
are key
34:20
for this and i think we need to advocate
34:23
as well for broad national coverage of
34:25
podiatrists chiropody across the country
34:27
that's a big barrier
34:28
and i think their skills are very
34:29
undervalued and they have a very very
34:31
important role to play
34:33
and that takes us to the fifth one which
34:36
really ties everything together
34:37
and it's timely management
34:40
of either early signs or actual ulcers
34:44
so just like heart attacks where time is
34:46
tissue
34:47
and similar with a stroke uh time is
34:50
also tissue when it comes to feet
34:52
so sitting on an infection uh sitting on
34:55
um you know a hot foot or a swollen foot
34:58
is is costly and i think matt you uh you
35:02
know i think if somebody's looking for
35:03
recruitment
35:04
for food care i always used to joke in
35:06
my multidisciplinary clinic
35:08
people are very knowledgeable once you
35:10
actually are able to provide them
35:12
and have the resources to provide a
35:13
multi-disciplinary clinic they know
35:15
when they need to come in earlier they
35:17
know the early signs and and we need to
35:20
listen
35:21
so timely access to care and that spans
35:24
heavily on a system
35:25
perspective where you need we need to
35:27
have clear pathways i think alberta has
35:28
done
35:29
a wonderful job in leading that work
35:32
to unify care so that whether somebody
35:34
is in the northwest territories or
35:36
in a rural area versus urban area if
35:39
they present
35:40
with those red flags
35:43
they move through the system regardless
35:46
of where they are and where they present
35:49
so that's really kind of a system level
35:50
and i know a number of wonderful
35:52
researchers
35:53
who are working on trying to put a case
35:55
forward to try to get fundings and
35:57
having that sustainably
35:58
integrated into our healthcare systems
36:00
at a national
36:01
level so those are the five principles
36:04
i'll just really kind of go over them so
36:05
we said screening
36:06
regular inspection education appropriate
36:09
and routine wearing a footwear and then
36:11
timely treatment
36:12
and you can see how all that fits in
36:14
with what dr evans mentioned within a
36:16
multi-disciplinary
36:17
uh system and that is really the ideal
36:19
what we aim for we realize there are
36:21
resources and
36:22
and you know this can look different
36:24
especially in the coveted era
36:26
but we think about the multidisciplinary
36:27
in its broad and expansive
36:30
view where yes you may not have
36:32
everybody in that one center
36:33
but our community is broader and you may
36:35
have a podiatrist in your community that
36:37
you can access
36:37
a wound nurse um i know we have a number
36:40
of champions of care who try to leverage
36:42
and bring that forward so
36:43
uh wounds canada again leverages and
36:45
tries is creating a resource
36:47
and i encourage everybody you know if
36:49
you know of a foot care center
36:51
or expertise in your community there's a
36:53
website where you can email wounds
36:54
canada and add it to the list it's by
36:56
province and by region
36:57
and i think we can all populate that and
37:00
and
37:00
and have that as a one-point access for
37:02
everybody across the country
37:04
um and i think you know your point uh
37:08
brooks kind of about um you know
37:11
strategies for people
37:12
and really to advocate for themselves
37:14
and to live well i think at the end the
37:16
key message is
37:17
um you know broad picture and just
37:20
zooming out improving quality of life
37:23
and reducing the risk of complications
37:25
through an individualized care pattern
37:28
that
37:28
takes into account people's values
37:32
is really key and i'll just share a
37:34
story of one of my patients uh with
37:35
chronic diabetic foot ulcers
37:37
where you know i asked i was asking you
37:39
know how are you doing and he was like
37:40
well you know i'm starting ball dancing
37:42
my wife always wanted to and my
37:44
immediate thought was like oh no your
37:45
feet what shoes are you wearing
37:47
and i didn't say that out loud but i
37:48
said oh that's great you know
37:51
and it took me a moment just to think
37:52
okay wait i have to process this is
37:54
incredibly important for him for his
37:56
relationship for his life
37:57
and how are we going to support him i'm
37:59
not going to kind of just blurt out
38:01
you know the one two three four steps
38:02
that need to be done so i said okay so
38:04
it looks like we'll need to bring you in
38:05
a little bit earlier to manage those
38:07
calluses he's like yeah do you think i
38:08
can come in because the clinic was
38:09
packed i'm like you know let's do this
38:11
so sometimes we need to know what's
38:12
important well not sometimes we always
38:14
need to know what's important to people
38:16
and what their values are
38:17
and then with our knowledge about system
38:19
and the prevention strategies to try to
38:21
work around
38:22
um with the broader picture of still
38:24
reducing the risk of complications
38:26
but also improving quality of life and
38:28
at the same time individual is
38:30
individualizing it to align with
38:32
people's values and their
38:34
what's important to them which will
38:36
continuously change
38:39
thank you dr that's that's a really
38:42
beautiful example
38:43
of starting with a person's value and
38:45
building
38:47
back up to a plan of care from there i
38:50
think that's
38:50
there's a lot of lessons that we can we
38:52
can take from that so thanks for sharing
38:54
um before we open up to two questions
38:57
i'm seeing
38:58
a few questions that have come in in the
38:59
chat
39:01
i'd just like to briefly touch on how
39:03
diabetes canada is helping support
39:04
people with diabetes as it relates to
39:06
food care
39:07
so one of our 2021 advocacy priorities
39:10
is to push for provinces and territories
39:12
to fund amputation prevention and lymph
39:15
reservation devices
39:17
and to introduce comprehensive
39:18
strategies that include
39:20
screening education and resource budgets
39:23
this is also supported by the continued
39:25
push to implement diabetes 360 which is
39:28
uh gaining a lot of momentum recently a
39:30
national framework that would raise the
39:32
quality of care for all canadians
39:34
living with diabetes and that includes
39:36
specific investments into foot care
39:38
so for those of you who are looking for
39:40
investment for uh
39:42
resources that are specific to folks
39:44
living with diabetes
39:45
we have a number of resources on our
39:47
website diabetes.ca
39:49
and our social media which is diabetes
39:51
canada
39:52
crystal do you have any information on
39:54
the ongoing work from wounds canada
39:57
sure at wounds canada our mission is to
40:00
advance
40:01
wound prevention and care for canadians
40:03
and we are working towards this school
40:05
by supporting research
40:06
professional and patient wound education
40:09
evidence-based best practice
40:11
and national standards as well as
40:13
advocacy
40:14
currently we're working with governments
40:16
to provide better access to wound
40:18
education resources and supports
40:20
using a population health approach that
40:23
promotes both downstream and
40:25
upstream interventions for those
40:27
interested in more information i
40:29
encourage them to check out the wounds
40:31
canada website
40:32
at www dot wounds canada dot ca
40:38
thank you crystal so we're going to uh
40:41
to move to a few questions that have
40:42
been submitted so first of all thank you
40:44
to everyone
40:44
uh for submitting your questions um you
40:46
have a great uh panel of of experts that
40:48
can
40:49
probably give you a hand here um first
40:52
one
40:52
is from a viewer that has a crack in
40:56
their heel
40:57
and just wants to take a preventative
40:58
approach what's the best first step
41:04
moisturize
41:08
uh yeah i think that's that's a good
41:11
point to moisturize
41:12
uh i'll always look at the footwear the
41:15
moisturization
41:16
and sort of a conversation with the
41:18
patient about what causes the dryness of
41:21
the foot and how it's related to
41:22
diabetes so
41:24
ensuring blood sugars are good foot care
41:26
is good
41:27
and appropriate instruction on how to
41:29
moisturize that foot and protect it
41:31
and also to be very diligent about um
41:34
watching for signs of it it's uh
41:35
deteriorating or getting any worse
41:37
so that if there is anything happening
41:40
or signs of infection that can be caught
41:41
very quickly
41:45
next next question is uh is wearing
41:47
socks or
41:48
protective footwear recommended if you
41:51
already have a diabetic foot ulcer
41:57
is wearing socks or socks are protective
42:01
but we're recommended if you have
42:02
diabetic foot ulcer so i think
42:05
go ahead so generally in general um
42:08
for anybody with a diabetic foot also we
42:10
recommend offload all the time and
42:12
and and uh that includes inside the
42:14
house and i sort of
42:15
tell patients whenever your foot's on
42:16
the ground uh whether it be inside or
42:18
outside
42:19
it needs something to protective uh
42:21
footwear that has been approved by
42:24
the person who's managing your ulcer
42:26
care so
42:27
um i would talk with a chiropodist or
42:29
the physician whoever's managing that
42:31
is the best advice and i'd like to add
42:34
to that robin around socks so
42:37
cotton socks are great without seems
42:40
even better and
42:41
light colored is most preferred and the
42:44
reason we suggest
42:45
light-colored cotton uh socks
42:48
is so that if your foot does bleed or
42:51
your dressing leaks through
42:53
you can see that it's a visual indicator
42:55
on that sock
42:56
that something is not right
43:00
great tip thank you crystal um we have a
43:03
question that's ontario specific so it's
43:05
does
43:05
odsp cover for orthotics with a diabetic
43:09
patient on insulin
43:14
um so um there there is some funding for
43:18
orthotics for people with diabetes
43:20
in ontario um but the footwear itself
43:24
is not covered by odsp
43:28
removal cast walkers are and
43:31
total contact costs and some of the
43:33
other types of shoes
43:34
that are in turn measures are but going
43:37
forward in terms of shoes no
43:39
but some of the orthotics yes okay
43:42
thank you next one has to do with
43:45
identifying
43:46
an ulcer so how does someone know if a
43:48
sore is an ulcer
43:49
what's is there a line that makes that
43:52
definition
43:53
clear
43:57
can i can i throw something in there
43:59
sure
44:00
basically if you if you see something on
44:02
your foot
44:04
if it's like redness or heat or anything
44:07
like that don't touch it go to your
44:08
doctor
44:09
right away whatsoever don't pick at it
44:12
don't pick full skin away
44:14
don't do anything because you're just
44:15
gonna wreck it you're gonna make it
44:17
worse by
44:18
not by addressing it yourself um so
44:21
you see any sort of redness any sort of
44:23
fatigue notice that your blood sugars
44:25
are rising
44:26
whatsoever and you take one look at your
44:28
foot that's
44:29
exactly what the problem is so you need
44:30
to go get it addressed but don't ever
44:32
touch it yourself
44:33
ever like ever take it from someone
44:35
who's done it it's not smart
44:38
thanks matt um but i would i would say
44:41
to add to that is
44:42
is a lot of people will have
44:44
pre-ulcerative lesions like even just a
44:46
small
44:46
callus and any callus is meaning that
44:49
there is pressure in that area and
44:51
that's just
44:51
your body's mechanism of of defense is
44:54
to build a callus
44:55
and any kind of callous can be a
44:57
pre-illustrative lesion so surprisingly
44:59
enough
45:00
uh i've had patients come to the clinic
45:02
and we just scrape off a little bit of
45:03
that
45:04
callus and lo and behold uh there's
45:06
fluid under there
45:07
and actually a direct passage to the
45:10
bone
45:11
so i think all these pre-alterative
45:12
lesions need to be taken seriously in
45:14
patients with neuropathy and diabetic
45:16
foot
45:16
issues thank you very much
45:20
um the next question is is also a bit
45:23
geographically based
45:24
um but women's canada might have an
45:25
answer for this one and it's uh
45:27
from an asker who lives in brampton and
45:30
would find it helpful if they could see
45:32
a specialist in their area i'm wondering
45:34
about a link
45:35
so that they could find someone by
45:37
whether it's
45:38
postal code or region
45:41
sure i would encourage that person to
45:43
log into the wounds canada website so
45:47
www.boonscanada.ca
45:48
and navigate to the clinic directory and
45:51
you'll see in the clinic directory
45:53
it's broken down by province there's not
45:57
a lot of wound clinics or specialty
45:59
clinics in
46:00
canada so it's not a giant list that you
46:02
need to toggle through
46:04
but anyone who has identified that they
46:06
do see wound patients or patients with
46:08
diabetic foot related complications
46:11
will be listed there alternatively in
46:14
ontario and this is ontario specific
46:17
you can also log into the health line
46:21
so it's the health line dot ca
46:25
and it essentially is a rolodex of
46:27
healthcare services
46:28
and support services in ontario by
46:30
geographic region
46:31
and you can use your postal code and
46:34
enter it to find services close to you
46:38
okay beautiful thank you very much the
46:41
next question is
46:42
uh from someone who has very dry feet
46:44
and they're cold 24 7.
46:46
i know they're okay but what can i get
46:49
to apply to keep them hydrated this
46:51
person is type 1 diabetic
46:56
yeah i mean with peripheral neuropathy
46:58
uh altered temperature regulation in the
47:00
feet
47:01
um is one of the symptoms and the sign
47:03
would be the dryness so
47:05
uh just knowing that that may be the
47:06
underlying cause and until we can cure
47:07
that and change that it would be
47:09
symptomatic relief with
47:10
what was mentioned previously about
47:11
moisture so in general anything that
47:14
provides moisture moisture
47:15
works and that gives you results just
47:18
make sure to dry between the toes to
47:19
avoid any
47:21
maceration of the skin there and then
47:23
the other thing is
47:24
you know regular moisturizing to get the
47:26
maximum out of it doing it after a
47:28
shower
47:28
uh just to optimize that uptake and um
47:32
yeah an optimized uptake there if people
47:34
are having challenging challenges
47:35
despite regular routines with
47:37
moisturizing those areas
47:39
another option is choosing a product
47:41
that has something called
47:42
attractane um so sorry
47:46
not i just mentioned the trade name
47:48
sorry i wanted to just mention the
47:49
product um
47:51
is it's uh can you help me out robin was
47:54
it your urea or
47:55
it's well there's there's uramul or
47:58
black hydrogen it has what has it as
48:00
well but
48:01
yeah any one of those perfect so the
48:04
product itself just because it can help
48:05
moisturize additionally so no particular
48:07
i didn't want to recommend i'm not
48:08
recommending any particular product but
48:09
just uh
48:10
um that medical component in the cream
48:13
would help
48:13
it is off the shelf i should say uh to
48:15
maximize uh hydration
48:18
and i'd like to add generally speaking
48:20
when you're choosing a moisturizer it's
48:22
important to choose something ideally
48:24
that does not have a scent so something
48:27
unscented
48:28
uh and something that is um doesn't
48:31
contain a lot of known allergens to the
48:33
skin like lanolin
48:35
for example and when in doubt ask your
48:38
pharmacist
48:38
community pharmacists are can make some
48:40
excellent recommendations
48:42
on appropriate cream or moisturizing
48:45
options for you
48:49
the the next question is from a person
48:51
who has sharko
48:53
c-h-a-r-c-o-t wondering if they are more
48:56
susceptible to ulcers as a result
49:02
um absolutely um for everybody who
49:05
doesn't know what charcoal is
49:07
it's it's caused by neuropathy and that
49:09
neuropathy and some people can lead to
49:12
sort of micro fractures of the bone
49:14
leaving a deformity of the foot most
49:16
commonly in the mid foot so at the arch
49:18
and sometimes you'll see it as a dropped
49:20
arch
49:21
and of course this then provides a
49:22
prominence in the foot and it's
49:24
susceptible to pressure
49:26
and for that reason alone and the loss
49:28
of sensation
49:30
ulcers can develop and go down a very uh
49:33
difficult road
49:34
and many complications so with charcoal
49:37
foot
49:38
customized or footwear is is highly
49:41
recommended as well as
49:42
they become a high-risk patient and
49:44
should be followed very carefully
49:46
and surprisingly you do need to have the
49:48
footwear adjusted very regularly because
49:50
gait changes
49:51
and the foot does change over time so it
49:54
is a lifelong process of managing this
49:59
we have a question from someone who has
50:01
been a type 1 diabetic since september
50:03
2020
50:04
so a relatively new diagnosis they've
50:06
not yet seen a podiatrist
50:08
they have no issues now but don't want
50:10
any either pretty reasonable
50:12
request should they make an appointment
50:17
so if they have type one diabetes
50:19
generally the recommendation from a
50:20
guideline perspective is starting to
50:22
screen for complications five years
50:24
outside of the diagnosis because you
50:26
don't have that is quite different than
50:29
type two
50:30
um and uh and so with that we'll
50:32
generally start screening
50:34
uh at five years with a 10 gram
50:37
monofilament to check for protective
50:38
sensation circulation and so
50:40
on um so i think you know just these are
50:42
the recommendations however if someone
50:44
we don't want to have things i think
50:47
stem from
50:48
fear and build anxiety and so on so i
50:50
think i just want to make sure that the
50:51
facts are clear in the data
50:53
however if you know they have other
50:55
issues relating to their feet for
50:56
example if they have deformities or
50:57
bunions or
50:58
or they're noticing areas of pressure
51:00
absolutely podiatrists will be helpful
51:02
uh from a prevention perspective to do
51:05
it but that might not be directly
51:07
related to your diabetes
51:08
yet um if peripheral neuropathy develops
51:12
down the road that might be another
51:14
layer another reason to have frequent
51:15
follow-up and i'll just turn it over to
51:17
crystal robin or matt if you have any
51:19
other thoughts
51:23
go ahead dr evans
51:27
um no i i i totally agree with with
51:30
what's already been said i don't really
51:31
have anything else to add i think that's
51:32
that's
51:33
that's quite complete
51:37
um a question regarding uh do does this
51:40
person need to be referred
51:42
to a diabetic foot clinic for corns and
51:44
plantar sports
51:48
are we talking about the same person as
51:50
just newly diagnosed with type 1
51:51
diabetes
51:52
uh no different question okay so
51:55
um again i think anybody with any issues
51:57
on the feet
51:59
really depends on the extent of the
52:01
neuropathy
52:02
and the number of years with diabetes
52:04
and the diabetes control
52:06
so i think to be on the safe side and
52:08
the standard answer should be with
52:10
calluses corns and warts
52:12
they should be assessed by a medical
52:14
professional and chiropodists in the
52:15
community
52:16
that's trained in dealing with with
52:18
these and advice regarding
52:20
footwear etc um
52:23
there is there is always a concern with
52:25
with planters warts with people that are
52:27
um die have had diabetes for a while and
52:30
have some aspect of peripheral vascular
52:32
disease that
52:34
you know being very aggressive with wart
52:35
treatment can be um
52:37
you know can be problematic so i think
52:39
that needs to be taken into
52:40
consideration
52:43
um we have an asker who says that
52:46
chemotherapy
52:47
has led to neuropathy in the soles of
52:49
the feet
52:50
and now diabetes is complicating this
52:52
problem what should they do
52:58
i think the five key principles would
53:00
still apply
53:01
um once peripheral neuropathy is there
53:03
regardless of the cause
53:04
the screening is still essential and if
53:06
they already have established neuropathy
53:08
rather than the once a year screening
53:10
and checking by a healthcare
53:11
professional then
53:12
it would need to be depending if they've
53:14
had ulcers or not every three to six
53:16
months or even
53:17
shorter intervals uh so basically trying
53:20
to focus on that fifth principle which
53:22
is early detection and so that if
53:24
anything
53:24
does show up that it is addressed
53:26
through either education proper and
53:28
routine wear footwear and so on so the
53:30
five principles would still apply
53:32
okay thank you um next question is
53:36
is can a lack of certain vitamins and
53:38
minerals essentially fatty acids
53:40
lead to dry skin
53:47
um i guess i'll take that
53:51
um i i'm not aware i mean nutrition i
53:54
think
53:54
and proper hydration is the biggest
53:57
factor for
53:58
for skin i'm not aware of any specific
54:01
fatty acid deficiency
54:03
but i'd probably defer to a specialist
54:05
in dermatology to address that
54:06
question directly um i
54:10
i think that really fluid intake and
54:12
just managing blood sugar and being the
54:14
best you can with your
54:15
your lubrication is key to preventing
54:18
these dry areas in your on your feet uh
54:24
thank you dr evans i think that's a fine
54:25
answer and
54:26
a next question is uh regarding what was
54:29
mentioned which is
54:30
is urea or uramal okay for kidney
54:33
patients for their feet
54:38
yes that's that's not a concern for for
54:40
kidneys
54:41
i can see how the uh you the urea part
54:44
of it
54:44
is is confusing but yes it's it's fine
54:47
as far as i'm aware yes
54:49
um and uh final question recognizing we
54:52
are at
54:52
uh 3 p.m eastern um is i have neuropathy
54:56
and only see
54:57
a chiropodist is this okay
55:02
i just want to say your story sorry
55:05
you're seeing astrophotos which is great
55:08
um
55:09
so yeah i mean astrophysicist is a
55:11
professional who
55:13
is equipped with all the skills needed
55:15
to screen and identify
55:17
whether you are at risk and i think you
55:19
are in great hands
55:21
okay yeah i would echo that we train a
55:23
lot of chiropodists in our clinic they
55:24
come through and
55:25
and they go out with a lot of knowledge
55:28
and i have full confidence
55:29
in in their training and treatment of
55:31
patients in the community
55:33
and their first eyes on which is the
55:35
best
55:37
okay we've um we've got quite an
55:39
outpouring of questions so i am going to
55:41
uh
55:42
toss a couple more if you folks are okay
55:44
with that
55:45
um so we have uh a question that is is
55:49
it safe to use
55:50
jublia j-u-b-l-i-a for nail fungus
55:59
i don't manage nails so i'll
56:02
okay so julia um is an anti-fungal agent
56:05
for
56:06
um male fungus infections and
56:09
it is got very good evidence for the
56:11
best topical agent that's available
56:13
um it is quite expensive if you don't
56:15
have drug coverage so
56:17
that does preclude a lot of people from
56:19
using it it is best used um
56:21
for when it's part of one nail if it's
56:24
all the nails
56:25
you'll probably find it's not that
56:26
effective and it does take
56:28
48 weeks to apply to get a result so
56:32
it's uh it's not overnight if you're
56:34
really thinking about
56:35
treating a fungus and it needs to be
56:37
treated you might need to use oral
56:39
agents
56:42
okay thank you um a question regarding
56:45
the the recommended treatment for
56:46
plantar warts
56:47
uh are lasers effective
56:53
uh for planters warts uh we should have
56:56
had a corotis here for planters warts
56:58
um there's a number of different ways of
57:01
treating those
57:02
and you really have to be nasty to a
57:03
planter's wart to get rid of it
57:06
there are anything from surgical to
57:09
topical
57:10
um harsh sort of chemo therapeutic
57:13
agents that you can put on these
57:14
and burning agents in terms of laser
57:18
i've not had patients go for laser
57:20
because i don't think it would be
57:21
covered
57:23
okay the final question is
57:26
if a person has a lot of deep fissure
57:28
cuts on their feet
57:30
what is your suggestion
57:34
i think this is similar to the first
57:36
question of the afternoon about the
57:38
cracks
57:39
and again these deep fissures can be
57:41
concerning of course
57:42
and an entry for bacteria into the
57:44
system and of course you can get a
57:46
deeper infection so they are openings of
57:49
the skin we do need to take seriously
57:50
but the results
57:52
primarily of if there's not a primary
57:55
skin disorder
57:56
then it's probably more related to the
57:58
dryness so
57:59
you know i i think it requires a
58:01
healthcare professional to look at this
58:02
if it's dryness i think we've discussed
58:05
treatments with lubricants
58:06
and moisturizers for the feet and
58:09
careful attention to doing that on a
58:11
daily basis
58:12
avoiding the web spaces
58:16
okay so thank you so much and first of
58:18
all i'd like to say thank you to our
58:20
guests
58:21
and to our viewers um for you for your
58:23
excellent questions and
58:25
uh really hope that those were helpful
58:27
for you
58:28
to our guests we're nearing the end of
58:30
our time here i just want to close off
58:31
before we do do you have any final
58:33
remarks or words of
58:35
advice or encouragement for our viewers
58:41
well for me i would just like to say um
58:43
i think
58:44
prevention is a key for this and a lot
58:46
of patient engagement and education
58:48
is what we need to do i i really look
58:50
towards associations like diabetes
58:52
canada and wounds canada
58:54
to promote the care of diabetic patients
58:56
across the country
58:57
try to coordinate this and i know
58:58
women's canada is working on a diabetic
59:00
pathway which i'm hoping will help
59:04
direct and educate care providers at all
59:07
levels
59:08
and provide education for the community
59:10
and patients at a large
59:12
so happy on a happy note i i feel
59:15
optimistic that
59:16
things will improve i'll write that wave
59:20
and i agree i think the future is bright
59:22
there are some great researchers
59:24
uh scientists clinicians who are putting
59:26
foot care at the frontier
59:28
and i think just a reminder to people
59:29
that you are not alone
59:31
this takes a village so don't take on
59:33
more
59:34
than you can or should and know that
59:37
there is a role for all of us to play
59:39
here together and it's a privilege to be
59:41
working with you all you know living
59:43
with diabetes and working on
59:45
improved quality of life and better
59:47
outcomes
59:48
and thanks for having me here this has
59:49
been a great great space to
59:52
talk about feet and prevention
59:55
and i agree with both robin and xenia
59:59
prevention is key it's the number one
60:03
thing we need to be focusing on
60:05
and as mentioned it does take a village
60:09
it does take an incredibly large
60:11
team with uh people living with diabetes
60:14
being the leader of that team people
60:16
like matt
60:17
so it's important math that you and
60:20
others living with diabetes
60:21
be your own advocates uh caregivers
60:25
or people who are living with people
60:27
with diabetes also act as advocates and
60:29
organizations like diabetes canada and
60:31
wounds canada
60:33
will continue to advocate for the best
60:35
preventative care
60:37
and the best treatment for people who do
60:40
incur
60:41
foot ulcers
60:44
my uh my just my best advice to any
60:47
patients out there or anyone dealing
60:48
with type 2 diabetes or type 1 diabetes
60:50
and they get a foot problem is just
60:53
address it right away the more you are
60:56
part of the team
60:57
working towards um healing that ulcer
61:01
the faster it will heal
61:04
if there's other aspects of your health
61:06
in your life that you need to fix
61:08
in order to manage your diabetes better
61:10
than fix it now
61:12
so you don't like i learned the hard way
61:14
and i'm realizing okay
61:16
there's somewhat of a light at the end
61:17
of the tunnel but dr evans is still
61:19
going to be my best friend for a long
61:20
time
61:21
but address it don't sit and wait
61:25
don't think you're superman don't have a
61:27
complex because i did that and it put me
61:29
in a bad position
61:30
so don't wait address your issues and
61:33
and
61:34
and just work together with your care
61:35
providers and you'll you'll you'll end
61:37
up with better results than if you don't
61:40
thanks matt and i think you're you
61:42
represent one of those very
61:43
knowledgeable patients who's been
61:45
been through a lot and i hope uh hope
61:48
that our association is less and less
61:51
wisdom
61:52
i yeah i want to get to the point where
61:54
i see every six months myself but
61:56
yeah for now that's a goal together
61:58
that's a goal
62:00
yeah alrighty well thank you so much
62:02
everyone
62:03
and to be honest i just i really
62:05
appreciate the conversation
62:06
that we were able to have today and uh
62:09
i i am confident and i'm hopeful that uh
62:12
the future is bright and i'm also
62:13
hopeful that all the answers and
62:15
information he provided
62:17
was truly helpful and impactful for
62:18
folks watching and folks that will watch
62:20
this in the future so
62:22
um truly thank you so much i'm very
62:25
grateful that you all made the time to
62:26
join
62:26
today um and to our viewers please never
62:29
hesitate to reach out to
62:30
either diabetes canada or women's canada
62:33
you can contact us at
62:38
www.diabetes.ca.orgcanada.ca
62:40
via email both of them start with info
62:43
at that same website so
62:47
you know we we have information and we
62:48
can connect you with with further
62:50
experts and
62:51
um i hope that you're left feeling uh a
62:53
little more
62:55
knowledgeable and empowered and uh
62:57
optimistic
62:58
after this uh this webinar so thank you
63:01
to everyone and
63:02
be well
Category Tags: Foot & Dental Care, General Tips, Management, Healthy Living;