6.11.08 Case History
Case1 :Diabetic Foot
Mr Y, 65 year old, male, chinese
-known DM for the past 10 years with HT
- 28.9.08: complained of difficulty in breathing and swollen left lower limb. Admitted to hospital in Klang.
- 6.10.08: Amputated left little toe
-18.10.08: Below knee amputation was suggested. Patient panic and ran off to this hospital and seek help from Dr Wong.
- the patient's case was kind of grave as he has poor capillary refill,
-on angiogramme: complete absence of digital arterial blood supply. Poor posterior tibial supply and finally some good news: visible anterior tibial artery supply.
- in the end patient's foot after careful management survived but he need to make some decision: Chop how much of his foot off?
-Dr. Wong suggested that he can promise the patient as much as letting him have a leg that reach the floor. Part of his foot will be chop off leaving some for weight bearing and he can even drive with shoes on ( this is the best part of it.)
-Mr Y and family is still thinking about it at the moment.....anyway good for him to have a chance of having a longer leg and able to drive if everything went well. Seriously just imagine the impact of DM on the patient himself and for the family too. Luckily he is not the sore supportor for the family or else what will happened? When ever we do hospital visits I wil always hear about a lot of sad sad storied...family poor,no money, can't work, lots of kids....etc...and it is so helpless and I feel I am so ' xin fu' , really lucky to be where I am today.
Warning: Medically related pictures ahead!!
May induce--> disturbingly nauseating effect and uncomfortable feeling in people who are not used to it.
Diabetes Mellitus:
a chronic syndrome of impaired carbohydrate, protein, and fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance. It occur in type 1 or type 2 DM which differ in etiology, pathology, genetics, age of oncet and treatment.
Diabetic foot ulcers
source: health.allrefer.com
Ulcer ulcer. All the DM patients please please be very very careful.
The patient lost his little toe but as I can't take a pic of his foot so use this instead. Just imagine: Little toe OFF and rest intact.
Warning: this is not a fake Halloween scary plastic foot it is a real amputated foot. This is how much to chop off Dr Wong had suggested to Mr Y.Everyone : " No Sugar Sugar anymore!
People Say NO to sugar. This poor Mr Y is suffering from Diabetis Mellitus which statistics ( done by HUKM Prof) has shown: 40% among Malays, 30% Indians, 10-12% Chinese. DM is a really serious case in Malaysia. 95% of dialysis is done by DM patients who has Diabetic nephropathy. This is way too scary....(><)!! Most of the patients above 50 yrs of age I have met in hospital are all for DM follow up. DM is essentially a vascular disease that accelerate arterial degeneration in the body. Thus result in so many horrible things!!! Pls refer to official site for infor on DM, I am not giving a lecture on it here. In Malaysia there is a Malaysian Diabetic Association which in some ways the government do seen eager to make everyone join. Like Malaysia's sugar is cheapest in the world.
Quick comparison:
Malaysia: RM 1.45/kg
Singapore: $2-3/kg
Indonesia: RM 4/kg
Sugar is poisoning Malaysian's health! Milo, chocolates, cakes, coca cola, candy, sugar rich kuih etc... anything you can think of. Sugar sugar everywhere. We should have a PDA: Prevent Diabetics Association. According to Dr Wong who is a Christian, he told us that God promises a land of milk and honey---> not sugar. But this does not mean take lots of honey also. Anything in excess is BAD.
Note: Fat cells are made from SUGAR!!!
ok.ok...Think I must cut down on all my sugar intakes. Base on the genetic theory, for 4000 years Chinese history our ancestors diet is not full of sugar. Actually it is only the recent decade when the EAST meets the WEST then we all start take in a lot of sugar. Coca cola, cheese cake, chocolate cake, milk tea, lollipop, ICE Cream!! etc etc....
Come to think of it all the Chinese food even snacks and little tit bits are not made of sugars or just very little bit. Mostly are salty: Dim sum, kuih, hot paos, rice cake, dumplings etc... Those western people are very used to thousands of years of sugar not like us... Thus UK statistic they only have 7-8% Diabetics in their population. Malaysian can not live the 'ANg Moh' way or maybe till the early diabetics all die off maybe left with those resistant ones.
Glycemic index:
The glycemic index ranks foods on how they affect our blood glucose levels. This index measures how much your blood glucose increases in the two or three hours after eating.
| Classification | GI range | Examples |
|---|---|---|
| Low GI | 55 or less | most fruit and vegetables (except potatoes, watermelon), grainy breads, pasta, legumes/pulses, milk, products extremely low in carbohydrates (fish, eggs, meat, nuts,oils) |
| Medium GI | 56 - 69 | whole wheat products, brown rice, basmati rice, orange sweet potato, table sugar |
| High GI | 70 - 99 | corn flakes, baked potato, watermelon, some white rices (eg. jasmine), croissant, white bread, candy, cereal |
| 100 | straight glucose |
So Byebye Sugar....Been reading a lot of 30-40 yrs old ppl getting DM nowadays...scary scary... Should go back follow our ancestors drink hot Chinese tea...No more coke... maybe once a month. :P
DM is preventable. So stop eating so much junk food.
Tiffany in a weird vibe today keep talking about Diabetes. The Sweet Urine disease. And I am sure quite a number of people have heard of this lame joke:
Long time ago on one fine day,a doctor brought a bunch of year 1 medical student for rounds around hospital. Upon reaching the patients bedside, He told them that patient is having DM. Dr:" The best way to test for DM in a patient is to test the sweetness of his urine." Here Dr. hold up his index finger for everyone to see. " As a professional doctor you must be observant and alert to everything around you. Be curious and test it for yourself to confirm and not rely on others."
Nurse hold out a glass cup of yellow coloured urine of patient. Doctor dip his finger and lick his finger. " Ok. Everyone try and do it."
Dr.:" So is the urine sweet??/"
Students:" Yes." :( yucks.......................
Dr:" As I said Doctors Must be observant! Nobody notice what I have done?"
-----Doctor only dig his MIDDLE finger into the urine and lick his INDEX finger. -----
Poor med students got con by the Doctor/ lecturer once again.
**** This sort of similar things have always been done to poor med students all the time ever since the very beginning of medicine. Is it to take out the boredom or stress or monotonous life by the lecturers/doctors/professors??? We may never know. But seriously we got con a lot of times too!!!! And ended up getting nicknames like : Jelly fish, you sure failed...etc I forgot there are so many funny nicknames our lecturers like to call us. Dr. Tin Tun love to tell everyone that everyone will screw up, die and get kick out of med school.. LOL...Think it amused him.
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