DIABETIC ULCERS: One Patient’s Story

To this day, Peter Visvardis is still not sure how he got it.

It may have been when walking barefoot around the pool while vacationing in Arizona. Or, he may have gotten that small puncture wound on his foot at home in the Bronx.

What the 57-year-old contractor remembers is that in September 2019,
seemingly overnight, his foot became swollen and changed color, and his temperature spiked to 105 degrees. He’s had type 2 diabetes for 20 or so years, but this would be his greatest crisis.

“I didn’t know the fever had anything to do with the foot. I didn’t think the two were related,” says Visvardis. “I have high blood sugar and my feet are not as sensitive as they should be. The fever was getting to me and I was bedridden for a couple of nights, but I continued working. I took some Tylenol to bring the fever down. I thought it would go away on its own.”

He called his podiatrist with the intent of taking the next available appointment. “When I described the symptoms to him he told me I couldn’t wait. He said, ‘From what you’re telling me, it sounds like a bad foot infection and you better go to the hospital immediately.’ So I drove to St. Barnabas and even then I thought I’d be in the E.R. for a few hours, or maybe at the hospital overnight.”

Podiatrist Dr. Andrew Campbell rushed him to the operating room, where he made deep cuts in the foot to drain it. The foot would soon become gangrenous, which cost him his middle toe. Visvardis’s optimistic expectations failed to materialize. He was admitted, and stayed in the hospital for more than a month.

“After his discharge, Peter came into the wound center as an outpatient. He was very concerned about his foot,” says Suzan Bramante, a registered nurse and regional director at Restorix Health, SBH Health System’s partner at its Center for Hyperbaric Medicine and Wound Healing. “He had a grave infection that had travelled to the bone. These infections are hard to treat. He was at risk of losing his foot and lower extremity.”

Dr. Campbell told him that his white blood count was very high, and that wounds like this more often than not end up in amputation. He treated him with several rounds of IV antibiotics and recommended hyperbaric oxygen therapy (HBOT).

HBOT uses 100 percent oxygen at a pressure greater than that at sea level to promote healing. Safe and painless, it involves treating patients inside a transparent tube for 90-minute sessions. Studies have found that an aggressive multidisciplinary therapeutic protocol of diabetic foot ulcers in conjunction with HBOT is effective in decreasing major amputations.For those with diabetes, this is critical as it is estimated that their lifetime risk of foot ulcerations is about 15 percent. This was most obvious during the recent pandemic. According to an article in the Journal of the American Podiatric Medical Association (JAPMA), diabetes patients were 10.8 times more likely to undergo any level of amputation and 12.5 times more likely to receive a major amputation during the pandemic. Major amputations tripled during the pandemic and the high-low amputation ratio, a quality marker in limb salvage, more than doubled.

Visvardis started seeing improvement, but over the next few weeks suffered several setbacks. This meant going back on antibiotics. He believes, however, that the daily dives he took every morning for three months in the chamber saved his foot. The HBOT, he says, was the tipping point.

“Without it, I believe I would have had an amputation,” he says. “It speeded up my recovery. When you suffer from seeing your foot like it was, with deep six-inch cuts and re-infections, you can quickly lose hope and get very nervous. Having hope is very important and so is your attitude towards it. The hyperbaric oxygen changed it for me.”

Emotional support, says Bramante, is an important component of the treatment. As with many patients in the wound center, staff also provides transportation for those who can’t drive if the wound is on their driving foot (and, like Visvardis spend months on crutches). Financial assistance may be necessary. “It is really more than giving the patient antibiotics,” she says. “Aggressive infections and aggressive wounds require aggressive treatment. With that said, it really took a village to treat Peter.”

Today, a year after the onset of his infection, Visvardis says he’s leading a normal life. His foot is nearly back to normal. He’s walking normally without any sign of a limp and can perform low impact aerobic exercise. This includes walking on a treadmill and using the elliptical at a local gym. He’s returned to work. And, as importantly, he’s become far more observant in managing his diabetes.

“I won’t let my blood sugars get out of hand again and I’m making a greater effort to control my diet,” he says. “I used to drink a lot of beer, especially in the summer, and would eat hot dogs, pizza, high carbs in my car during the day between jobs. I now make a conscious effort to have something to eat in the morning and wait until I get home to eat again. Suzan and Dr. C (Campbell) got me in a right way.

“Sometimes it takes something bad in order to turn it around into something good. It was a big warning sign, a red flag, but it’s something that changed my life.”