Alone and afraid: When family support for diabetes patients falls short

In most of the podiatric, or foot care, patients I see, families are very supportive, and I love that. Painful foot conditions such as bunions often affect the patient’s mobility, quality of life and pain in other parts of the body due to altered gait or uneven pressure on the joints. Family support is enormously helpful. But one group of my patients—frankly, the ones who need it most—often show up to their surgical appointments alone: people who are facing diabetic foot amputation.

I always feel a surge of emotions when this happens. I feel upset for the patient, who must be afraid and in pain. And I feel regret for the patient’s family, whom I may never have met, for abandoning the patient in a time when family support is crucial.

Be there for your friends and family when #diabetes patients come for surgery. They need family support. It’s so important!- Dr. John Steinberg, via @MedStarWHC

When I ask patients if I can reach out to their family, they often decline and express guilt: “I’ve done this to myself, so here I am, alone.” But this couldn’t be further from the truth, and no patient should have to face amputation, or any major surgery, alone.

Diabetes: An “invisible,” taxing illness

Diabetes, like many other “invisible” illnesses, rages inside a patient’s body and manifests in visible problems only after the disease has progressed. This can be due to the nature of diabetes, improper care or lack of education about the disease. As a podiatrist, I care for patients who suffer from painful diabetic foot conditions such as ulcers, which are sores that won’t heal, and diabetic neuropathy, a type of nerve damage. In severe cases, the foot cannot be saved and must be amputated to prevent further complications.

Related reading: Saving limcs and improving lives: The Center for Limb Salvage

Frankly, diabetes does not affect only people who don’t take care of themselves. It’s true that lifestyle choices weigh heavily on type 2 diabetes risk and outcomes, and these choices affect the health of people who have type 1 diabetes. The same is true for many serious diseases, including many types of cancer. The fact is, diabetes has a shameful reputation of being “the patient’s fault,” and it’s time to put a stop to that.

Sometimes, family members become used to their loved one having some sort of surgery or medical complication. Diabetes can ravage the body, and in advanced cases, multiple procedures are common. Some of our patients are almost emotionally detached from surgery. “It’s just another procedure.” But I know if I were on the operating table, even though I perform surgeries regularly, I’d want someone there to hold my hand and wish me good luck–regardless of how many times I’d been in that position.

Too many patients suffer because of their families’ emotional turmoil surrounding their disease. No one wants a loved one to be ill, and the natural human response is to look for reasons to justify why a disease developed. We do this unconsciously to free ourselves from guilt and look for a way to reconcile ourselves with the reality of the situation. And, unfortunately, it’s easier to place anger and blame solely on patients with diabetes than it is with patients who have other chronic illnesses. “If only they would watch what they eat, exercise, lose some weight, they wouldn’t have gotten sick.”

Diabetes is more complex than “If this, then that.” While lifestyle choices can reduce a person’s risk, other physical and environmental factors affect a person’s health in ways that aren’t always obvious to family members. For example, research suggests that a person’s genes may affect their risk for type 2 diabetes. Even with preventive care and education, people in this demographic still may be at increased risk.

How we help families support loved ones with diabetes

I love seeing families who still take every surgery as something important and an opportunity to improve their loved one’s condition. But, as mentioned, chronic disease can drive a wedge between patients and family members. It’s important to my team to try to reconnect patients and families and bridge that gap in support. We always offer to reach out to family members on behalf of the patient, and we offer programs and support services that can help family members cope and learn to be more engaged with their loved one’s health.

Of course, the need for support extends far beyond when the patient leaves the operating room. Losing a foot or a leg is a major life-changing event. Mobility changes and decreases in perceived self-worth can spiral patients into depression, and modifications may be necessary to accommodate a wheelchair or other equipment the patient needs.

Home care nursing or care in a rehabilitation program can take an enormous load off of family members. The nurse can help with questions about the condition, recovery and wound dressing, as well as keep an eye on the patient’s emotional state. This attention and care allows the family to focus more on supporting the patient day to day. Many insurance plans cover home care nursing, and we can help guide families through the process of setting up care for loved ones. This type of care is short-term. Thinking long-term, families must pull together to increase the chance of a positive outcome for the patient.

I can’t stress enough that education is among the most important components for families to create a safety layer around their loved one. I urge family members of diabetes patients to take a step back and process their negative emotions surrounding their loved one’s disease. Yes, it is OK and natural to feel sad and angry when a loved one is diagnosed with a chronic condition. But it is not OK to step out of the picture and leave the patient to deal with the aftermath alone.

Saving limbs and improving lives: The Center for Limb Salvage

Keeping our feet strong and healthy is an important goal for us all. For people with diabetes, good foot health is even more important. That’s because people with diabetes are at an increased risk for developing problems with their feet. Without the right treatment, diabetic foot problems can lead to serious consequences, including amputation.  

We never want to see patients deal with the loss of a body part. That’s why my colleagues, Dr. Christopher E. Attinger and Dr. John S. Steinberg, work to save patients’ feet as part of our Center for Limb Salvage. I oversee this program in my role as regional chief of MedStar Plastic Surgery.  

Diabetes and its risk to the feet

Diabetes affects the body’s ability to process glucose. Glucose is a type of sugar that the body creates from food to fuel the body’s cells.  

If you have diabetes, your body has too much glucose in the bloodstream. These high glucose levels can lead to nerve damage in patients with diabetes. This condition, called diabetic neuropathy, makes it hard or impossible to feel pain in the feet. People who have diabetes are at higher risk for a number of foot conditions or injuries, such as:

  • Bunions, corns and calluses
  • Cuts and sores
  • Ingrown toenails
  • Fungal infections
  • Hammertoes  

Without pain, even small injuries to the foot of someone with diabetes can turn into major issues. Maybe you step on a tack or nail, or your shoe doesn’t fit properly and causes a sore on your toe from rubbing. You don’t feel pain, so you don’t treat it. The injury grows and becomes infected. Diabetes lowers the body’s ability to heal properly, so this infected wound doesn’t get any better. 

Even small injuries to the foot of someone with #diabetes can turn into major issues. via @MedStarWHC

By the time patients notice these sorts of wounds, they’ve often developed into a foot ulcer. Diabetic foot ulcers can involve:

  • Ascending infection, or an infection that spreads up the leg
  • Exposed bone or tendon from the wound
  • Gangrene, or the death of skin and tissue  

Request an appointment with one of our doctors if you have diabetes and you’ve noticed any of these symptoms of diabetic foot ulcers.

Amputation: The worst-case scenario for diabetic foot problems

The average surgeon who sees a patient with a bad diabetic foot ulcer will immediately begin thinking about amputation. Depending on how far the patient’s infection has spread, amputation could involve:

  • A portion of the foot
  • The entire foot
  • The foot plus part of the leg  

Diabetic foot ulcers frequently lead to what’s called a below-knee amputation (also known as a transtibial amputation). A below-knee amputation involves removing the leg at some point along the tibia, one of the two bones that run from the knee to the ankle. This can be a devastating loss for patients. With the loss of that much of the leg, patients have to work much harder to do what they were able to do before their amputation—expending 50 to 125 percent more energy just to maintain their previous activity levels.

In addition, below-knee amputations have been linked with an increased risk of death following the surgery. One study conducted in the Netherlands found that the median survival time after having a below-knee amputation was just 27.8 months—a little more than two years.

Amputation can lead to a sort of vicious cycle for patients. Because it’s harder to walk after an amputation, patients often are less mobile afterward. This can increase the risk of more infections, which can lead to more amputations. More amputations can lead to different prostheses as more of the leg is removed, which can make it harder to walk. It’s a painful series of events we try to avoid for our patients.

How we save diabetic feet

We try to avoid these sorts of problems through limb salvage, or treating diabetic foot ulcers before amputation is necessary. Dr. Attinger and Dr. Steinberg are internationally known experts in the area of limb salvage. More than 1,000 patients per year benefit from their expertise. The Center for Limb Salvage brings together a team of doctors from a variety of medical disciplines, including:

  • Diabetology, or the study of diabetes
  • Plastic surgery 
  • Podiatric (foot) surgery
  • Radiology, or medical imaging
  • Rheumatology, or the study of problems affecting the joints, muscles and bones, as well as the immune system
  • Vascular surgery  

The best case is when we can treat foot problems before surgery is needed. We use a number of advanced treatments to make this possible, including:

  • Braces or orthotics, which can help protect and support the foot and leg
  • Gait evaluation, or a specialized analysis of a patient’s walking pattern to correct problems
  • Hyperbaric oxygen therapy, which can stimulate the body’s natural healing processes

If surgery is needed, we can transplant tissue from other areas of the body to save a patient’s toe, heel, hindfoot or the entire foot. In other words, we can save patients’ feet when other surgeons can’t. This requires advanced microsurgical skill to remove dead or diseased tissue while preserving as much healthy tissue as possible. If tissue transplants aren’t possible, we may be able to use skin substitutes temporarily or permanently to correct wounds. We also may be able to improve blood flow to the foot with vascular surgery, which can promote healing.  

The benefits of limb salvage

Saving the foot increases mobility, which leads to a higher quality of life. When it’s not as hard to walk, you’re much more likely to be active and fit. This means limb salvage can help patients be healthier and live longer.  

On top of all that, limb salvage tends to be less expensive than amputation over the long run. If we can save your foot with one or two surgeries, that’s the end of the surgical process. But if we have to amputate, it tends to start that vicious cycle of developing more infections and needing more amputations. The costs of amputations—in terms of both money and quality of life—can be crushing to patients.  

No one wants a patient to go through the pain and difficulty of an amputation. I’m hopeful that our limb salvage expertise will help more patients stay mobile, active and healthy.  

6 lesser-known and better-known causes of hearing loss

About 48 million Americans, or approximately 20 percent of the population, have some degree of hearing loss. According to the Centers for Disease Control and Prevention, hearing loss is now the third-most common chronic health condition in the United States.

Many cases of hearing loss are preventable. And many more are treatable. We often have an easier time treating hearing loss if you have hearing exams on a regular basis. Talk to your doctor if you think you have hearing loss or if you’re at risk for it.

"Talk to your doctor if you think you have #hearingloss or if you’re at risk for it." via @MedStarWHC

Hearing loss can be a symptom of many other conditions. Some, like diabetes, we know a lot about. And some we’re just recently beginning to understand.

Lesser-known causes of hearing loss

Iron-deficiency anemia

Hearing loss has been in the news recently because of the results of a recent study linking it to iron-deficiency anemia. This study found that iron-deficiency anemia was associated with an 82 percent higher chance of sensorineural hearing loss. In cases of sensorineural hearing loss, there is damage to the inner ear or the nerves leading from the inner ear to the brain. The study didn’t determine that iron-deficiency anemia definitely causes hearing loss, but it suggested that the lack of iron may reduce blood flow to the inner ear.

Several groups of people are at particular risk for iron-deficiency anemia, including:

  • Babies and young children, especially premature babies or those with a low birth weight
  • People who get kidney dialysis treatment
  • People who have internal bleeding because of colorectal cancer, bleeding ulcers or other medical conditions
  • People whose diets don’t contain enough iron
  • Women of childbearing age who have regular menstrual cycles

Otosclerosis

Another cause of hearing loss that most people don’t know about is otosclerosis. Otosclerosis is a condition in which one of the ossicles, or the tiny bones in the middle ear, gets stuck and isn’t able to vibrate normally. This normally happens to the ossicle called the stapes. When these bones can’t vibrate, sound can’t travel through the ear to the auditory nerve, which carries signals to the brain that allow us to hear. This is a type of conductive hearing loss.

Otosclerosis tends to occur in people with a family history of the condition. Researchers think otosclerosis also could be associated with previous cases of measles, stress fractures to the bony area around the inner ear and immune disorders. Some researchers also believe a lack of fluoride in drinking water can contribute to the development of otosclerosis.

Better-known causes of hearing loss

Unfortunately, numerous factors can cause or contribute to hearing loss. Some of the better-known ones include:

  • Ototoxins
  • Ear infections and cholesteatomas
  • Microvascular disease
  • Age

Ototoxins

One fairly common cause of hearing loss is exposure to chemicals or medications that can damage the ear. We call these ototoxic substances or ototoxins. Many medications and chemicals can cause either temporary or permanent ear damage, including:

  • Aspirin
  • Certain antibiotics, including gentamicin and vancomycin
  • Cisplatin and carboplatin, used in chemotherapy for cancer treatment
  • Loop diuretics, used to treat some kidney and heart conditions
  • Quinine, used to treat malaria

"One fairly common cause of hearing loss is exposure to chemicals or medications that can damage the ear." via @MedStarWHC

Ear infections and cholesteatomas

Untreated ear conditions like ear infections can also lead to hearing loss without proper treatment. Ear infections are a common childhood illness, but some adults continue to get them as they age. This can be linked to a condition called Eustachian tube dysfunction, which happens when the tube that links the nose to the middle ear doesn’t open or close properly. Adults with Eustachian tube dysfunction are at higher risk for ear infections.

Chronic ear infections can lead to the development of a cholesteatoma. A cholesteatoma is a cyst of skin in the middle ear space, or mastoid. Someone with a cholesteatoma might have painless ear drainage that they just might get used to over time. But without treatment, the cholesteatoma can break down the bones in the middle and inner ear. Not only can this cause hearing loss, but a cholesteatoma also can cause:

  • Brain infection, or encephalitis
  • Dizziness or a lack of balance
  • Facial paralysis, resembling Bell’s palsy
  • Meningitis

Diabetes, high blood pressure and high cholesterol

Hearing loss is linked to several fairly common conditions, including diabetes; high blood pressure, also known as hypertension; and high cholesterol, also known as hyperlipidemia. All of these conditions can cause microvascular disease, which is a problem with the tiny blood vessels that supply blood to the inner ear. Microvascular disease of the ear’s blood vessels can narrow these inner-ear blood vessels, which can either cause hearing loss or cause it to get worse.

Age

Of course, perhaps the best-known cause of hearing loss has to do with the aging process. Our risk for hearing loss goes up as we get older. This is called age-related hearing loss, also known as presbycusis. Almost 25 percent of Americans between 65 and 74 have some degree of hearing loss. And nearly half of Americans 75 and older have hearing loss.

"Nearly half of Americans 75 and older have #hearingloss." via @MedStarWHC

Lower your risk of hearing loss

Of all the causes of hearing loss, exposure to loud noises is one of the most common. We can minimize this risk by protecting ourselves from loud noises when possible. Keep the volume down on your devices when listening to them with earbuds and headphones. And wear earplugs or other ear protection when you know you’ll be exposed to loud noises, like at a concert or while using noisy equipment.

Microvascular disease from diabetes, high blood pressure or high cholesterol also is something we can work to reduce or eliminate. Talk to your doctor about keeping your blood sugar, blood pressure and cholesterol under control through lifestyle changes, medications and other treatments to reduce your risk of microvascular disease.

Unfortunately, the most common cause of hearing loss is the aging process, and there isn’t much we can do to stop that. But we may be able to stop the aging process’s effects on hearing sometime in the future. During my PhD studies at the University of Minnesota, I created an antioxidant medication that was able to prevent the onset of age-related hearing loss and keep it from getting worse. The goal of my research is for people to one day have a supplement they can take to reduce their risk for age-related hearing loss.

Hearing loss can result from a number of factors. When we identify which of these factors apply to you, we’re one step closer to finding treatment options to either cure or manage your condition.

Type 2 diabetes trial offers chance to further research, treatment understanding

Some people with Type 2 diabetes can manage the disease with diet and exercise alone. Others need medication, in addition to lifestyle management, to reach their target blood sugar levels, and many will eventually need two or more medications.

Studies have demonstrated how these medications perform over a short period of time. But we currently don’t know which of these drug combinations works best long-term.

An ongoing study, following participants for up to seven years, is looking to change that, and District of Columbia and Baltimore-area residents are helping in the effort. The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study aims to enroll 5,000 participants at 45 sites across the country. Along with helping advance our understanding of how best to treat this disease, participants also receive medication and supplies, clinic visits, lab tests and education during the trial.

As of March 1, 2017, nearly 4,400 people were enrolled in the study, and about 200 are from the D.C. and Baltimore area, ensuring that the study’s findings will be representative of our surrounding community. To help reach the 5,000-participant goal, we are recruiting more people in the area with type 2 diabetes to join.

Are you eligible? To learn whether you qualify to join the GRADE study at MedStar Health Research Institute, call 301-560-2915, email [email protected], or take our survey here.

 

Who is a candidate for the study, and what benefits may they see?

GRADE study participants represent patients with type 2 diabetes who have had diabetes for less than 10 years and are currently managed on metformin. The GRADE study is making a focused effort to enroll participants from a wide range of ages, race and ethnicities, and across a broad geography.

Volunteers may be eligible to participate in GRADE if they meet the following criteria:

  • Have had type 2 diabetes for fewer than 10 years
  •  Are older than 30 years of age, or 20 if American Indian
  • Only take metformin (Glucophage) for your diabetes
  • Are willing to take a second diabetes medication
  • Are willing to make four office visits per year for the next four to five years

In the GRADE study, as with other studies conducted here, the care provided in the study does not replace the usual care participants receive from their doctor, but rather complements it. In the study, participants have their glucose control checked (through a blood test called the HbA1c) every three months. During the visits, the study teams works very closely with the participants to help reach good diabetes control.

Current Type 2 diabetes medications

When patients need help beyond diet and exercise to manage their Type 2 diabetes, the medication metformin is usually the first-line choice of treatment. Metformin helps the body respond to insulin more effectively, reduce glucose production in the liver, and decrease the amount of glucose absorbed in the body.

Metformin has been used in the U.S. since the mid-1990s, and among drugs used to treat diabetes, it has the most evidence to date in terms of long-term safety and benefits. Nonetheless, diabetes is a progressive disease. Beta cell function, or pancreatic function, tends to deteriorate over time in diabetes, so many patients eventually will need to add a second medication to help control glucose levels. It is important to maintain good glucose control to minimize long-term complications related to diabetes, such as nerve, eye and kidney damage.

It can be a challenge to determine which of the current available medications is the best choice to give patients along with metformin. There are a limited number of studies that have been able to compare the many choices we have available.

When additional medications need to be added to control blood sugars, a number of factors are considered, including the medication’s:

  • Cost.
  • Safety profile. For example, does this medication increase the risk of having a low blood sugar reaction, or hypoglycemia?
  • Effectiveness. How effective is this medication in controlling blood sugars, and depending on where the patient’s levels of glucose control is, what is the likelihood of the medication getting them to their goal?
  • Complexity of treatment.
  • Likelihood of adherence.

We hope that the GRADE study will help us say with more certainty which treatment works best and for whom.

GRADE first long-term study of medication combinations

Previous studies have looked at the short-term effect of using different drugs along with metformin. The studies typically analyzed how effective drug combinations were in lowering A1C levels. A1C tests are used to understand how well-controlled diabetes is by measuring average blood sugar levels over several months.

Lowering a patient’s A1C is important, but the GRADE study takes it a step further. It is not only looking at A1C lowering but also determining which combination of drugs is most effective at achieving and maintaining diabetes treatment goals over the long term. Specifically, the goal of the GRADE study is to determine which combination of two diabetes medications is best for achieving good glycemic control, has the fewest side effects, and is the most beneficial for overall health in long-term treatment for people with type 2 diabetes. These types of questions cannot be answered in short-term studies, but require longer-term evaluation such as what is being done in GRADE.

Funded by the National Institutes of Health, the GRADE study will follow patients who take metformin along with one of four commonly used glucose-lowering medications: glimepiride, sitagliptin, liraglutide and basal insulin glargine. Each has a different mechanism of action and a different effectiveness and safety profile, and the GRADE study is the first study to directly compare all four treatment choices for this patient population.

This head-to-head comparison of commonly used diabetes medications will examine the effects on glucose levels, durability of maintaining treatment goals, and a number of other areas of interest, including effects on pancreatic beta cell function and quality of life. The study also is unique in that we’ll be able to look at how different groups of people react to the different combinations, which will ultimately help us better personalize treatment for each patient.

Nearly 1.4 million Americans are diagnosed with diabetes every year. With your help, this study will help current and future with type 2 diabetes in our community better manage their disease and stay healthy longer.

Down with Diabetes: How to Lower Your Risks

According to the CDC, 29 million people in the United States today have diabetes.  Worse, one out of every three children born here can expect to be diagnosed with the disease, at younger ages than ever before.

Yet the cause of this alarming trend often lies within our own hands.    

“The rise in diabetes mirrors the rise in obesity,” says Michelle Magee, MD, a practicing endocrinologist at MedStar Washington Hospital Center and an associate professor of medicine at the Georgetown University School of Medicine. “Over the last 25 years or so, we as a nation started walking less and eating out more. As a result, many incidences of diabetes today are related to lifestyle.”

Many, but not all. Type 2 diabetes – the most common type - does run strongly in families.  This means that your family genetics definitely play a role in whether you will get it or not. But Dr. Magee—who is also director of the MedStar Diabetes Institute’s clinical, education and research programs—concentrates on the risk factors that patients at risk for diabetes, known as pre-diabetes, or with diabetes can change and control.

The first step you can take is to know the numbers that tell you if you have pre-diabetes or diabetes.

Tune in to the full podcast interview with Dr. Magee.

There are two major blood tests that physicians use to help determine the presence or absence of diabetes…or the risk of developing it. The first is the fasting blood glucose (sugar) test. This provides a snapshot of how well your body is balancing what you eat and your physical activity at the point in time that your blood is tested.   The second, called the A1C test, measures the average amount of sugar in your blood stream over a two- to three-month period. In both tests, numeric results are broken down into ranges classified as normal, pre-diabetes or diabetes.

The good news is that risks and complications—as well as those tell-tale numbers—can often be driven downward by eating right and exercising regularly. Large national studies have proven that intensive lifestyle changes can reduce risk for going from pre-diabetes to diabetes by up  to 60 percent…and help prevent complications of diabetes itself.  This includes preventing blindness, kidney disease, nerve damage and limb amputation.  Lifestyle changes also help prevent cardiovascular disease, heart attack and stroke which are more common in people with pre-diabetes or diabetes than those without these conditions.   

For those living with pre-diabetes, “As little as a 7 percent weight loss can make a big difference,” Dr. Magee says.  “For a 200- pound person, that’s only 14 pounds. Exercising 30 minutes a day at least five times a week is also key.”    

Once you have diabetes, because it is a progressive disease, most patients will eventually need some form of medication. But this isn’t your grandfather’s treatment. Advances in research and technology have produced 12 different classes of pills and two classes of shots, with delivery systems ranging from needles to pens to patches to pumps. And even more drugs, approaches and management techniques are on the horizon. As a result of advances in diabetes treatments in the past 20 years, people living with diabetes are living well and with less problems from complications than used to be the case.

Even the best of modern medicine can get a boost from a patient’s personal efforts. Toward that end, education is key, so patients understand their readings, how to correct low or high blood sugar levels, what to eat and when, how to recognize side-effects from medication and more. Unfortunately, studies show that nearly 50 percent of patients with diabetes never get the grounding they need to understand their condition and what they can do.

Ever the educator and advocate, Dr. Magee urges people with diabetes to do their own “due diligence” into the disease, and take advantage of management and support programs offered by the MedStar Diabetes Institute and others within the community.

“My biggest message to patients is this: Learn about diabetes.  Then you can take control of it, versus it taking control of you.”

Tune in to the full podcast interview with Dr. Michelle Magee.

A Healthy Diet Delivered to Your Door

Americans spend less time cooking and sitting down to eat than in decades past. Time is a barrier to a healthy diet—we often feel like we don’t have enough time to find recipes, buy groceries, cook or eat in the right ways.

Meanwhile, 29 million people in the U.S. have diabetes, and an additional 86 million adults live with prediabetes.

These trends captured my attention as medical director of the MedStar Diabetes Institute (MDI), because diet plays a critical role in the prevention and management of diabetes and prediabetes.

Introducing WellRooted

To help address these challenges, MedStar Health created WellRooted, a unique food delivery and nutrition education service. WellRooted makes it easier for MedStar patients and associates to put diabetes-, heart-, and family-friendly meals on the table to have a healthy diet.

WellRootedfoods.com offers two menus:

  • Cook-at-Home: Free recipes—selected in partnership with MedStar doctors and diabetes educators—plus ingredient delivery via Instacart.
  • Ready-to-Eat:    Delivery of fully prepared meals by Power Supply, a locally launched company with a hub in the D.C.-Maryland-Virginia area.

With “bite-sized” health and nutrition tips embedded in the website and recipes, WellRooted is an excellent resource for those with newly diagnosed, or uncontrolled diabetes or prediabetes seeking healthy diet options.

WellRooted “meets people where they are” when it comes to cooking—whether time, energy or ability limits your kitchen time.

Making the Menu

All WellRooted meals contain 350-600 calories, 30-60 grams carbohydrates and fewer than 750 mg sodium—while offering delicious taste and cultural variety.

Cook-at-Home meals contain no more than 12 ingredients, can be cooked within 20-35 minutes and use basic cooking equipment and methods. All recipes include step-by-step instructions with pictures. Ingredients can be ordered anytime—even for same-day delivery.

Ready-to-Eat meals are prepared by local chefs, free of gluten and dairy, and contain no added artificial ingredients. The order deadline is every Thursday before midnight, to receive fully  prepared meals the following Monday and/or Thursday.

Trying WellRooted

Cook-at-Home orders for four or more servings start at $30 for home delivery. Ready-to-Eat orders for two servings start at $19 (with pickup at nearby locations) or $23.99 (home delivery).

If you need an extra nudge to try WellRooted, consider the discounts: Enjoy FREE delivery on the first Cook-at-Home purchase, and a FREE meal with the first order of two or more Ready-to-Eat meals.

MedStar doesn’t make money from WellRooted through price “mark ups,” and no subscriptions are required. We’re providing WellRooted because we want the service to be accessible and helpful to a wide range of patients and associates who are interested in having a healthy diet. WellRooted has admirable roots: MDI co-created it with the 2015-16 Health for America at MedStar Health fellows, during a yearlong health innovation program for young professionals.

WellRooted inspires rave reviews. We’ve heard the meals are “wonderful” and made some people “wild for zucchini.” WellRooted has also introduced individuals to grocery delivery in Southeast D.C. neighborhoods, where they previously could only get Chinese food delivered.

So, how will YOU solve a problem like mealtime? Try WellRooted today!

Have any questions?

For more information regarding MedStar Health's WellRooted program, visit WellRootedfoods.com.

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What Are the Warning Signs of Diabetic Limb Damage?

If you or a loved one suffers from diabetes, you may be aware of one of the more troubling aspects of diabetes: limb loss. It's true that diabetes can have dramatic effects on the body's vascular system. Over time, diminished blood flow means that wounds to extremities, such as feet, legs and hands, heal more slowly. And in worst-case scenarios, this can mean the limb itself may be jeopardized.

As a podiatric (foot and ankle) surgeon who specializes in preserving the limbs of diabetic patients – a field called limb salvage – I work with a team of specialists and our patients to implement a strategic plan to preserve the limb and restore healthy blood flow.

But a key part of what I do is educating patients and their family members on the importance of prevention. Because if you can identify the signs of diabetic foot damage, you can work with your doctor to treat your limb as problems arise, and you're less likely to need limb salvage at a later date.

The Hidden Dangers of Diabetes

While many diabetic patients and their families know that limb loss from diabetes is possible, patients often don’t know how to spot symptoms they may be experiencing from diabetic limb damage.

The three top signs of diabetic limb damage are:

Neuropathy, or nerve damage, is one of the most important signs of diabetic foot damage. High or unstable blood sugar levels, over time, cause vascular changes that can choke off or damage nerves. Diabetic neuropathy first affects the body's smallest nerves, such as those in the hands, feet, eyes, and kidneys. Neuropathy initially feels like a pins-and-needles or tingling sensation, and with time it can become a burning feeling that can impede sleep. But in later stages, neuropathy can cause numbness, which is far more dangerous, because the diabetic can no longer feel pain in the limb. Since pain is an important sign of injury or infection, this can lead to serious complications.

Vasculopathy, or peripheral arterial disease, is another significant complication. Diabetes can cause blockages in veins and especially arteries in diabetic patients. This can cause color changes or thinning of the skin, or atrophy. One of the most common signs of vasculopathy is pain when at rest or elevating the legs.

Finally, diabetes can result in a compromised immune system, making fighting off infections – even routine ones – much more difficult. For example, what would otherwise be a small, trivial wound can fail to heal for a diabetic patient, creating a major infection. So it’s important to keep an eye on any changes in your ability to recover from injuries or infections.

You may not consider any of these on their own as something that requires immediate medical attention, but they can point to serious problems down the road, if they’re not examined further by a doctor. But true prevention in this area means maintaining awareness around these signs and proactively seeking the care of a podiatrist, if and/or when they arise.

Your podiatrist will be able to tell you if you’re experiencing something that’s part of a larger diabetic health issue and help you potentially mitigate the effects they have your life – that includes reducing the risk of future amputation.

A Well-Integrated Team

At MedStar Washington Hospital Center, the care we provide to our diabetic patients requires an integrated approach, involving professionals across several medical specialties. This increases our patients’ chances of preserving the affected limb. Infectious disease specialists, for example, prescribe antibiotics to help fight infections, and intensivists monitor the patient's medical status and optimize their nutrition for rapid healing.

So if you are seeking comprehensive care for diabetic limb damage, look for a multidisciplinary team that takes this kind of integrated approach. Because while a podiatrist should be your first call if you’re experiencing symptoms, such as neuropathy or vasculopathy, a more dimensional set of experiences and skill sets will be needed to ensure the best possible outcomes for you or your family, if the symptoms are indeed a sign of diabetic limb damage.

Have any questions?

We are here to help! If you have any questions about MedStar Washington Hospital Center, call us at 855-546-1974.

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