How I Do It: Callus Debridement and the Diabetic Foot

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Dr. Haywan Chiu

Haywan Chiu, DPM, is a practicing podiatrist in Albuquerque, New Mexico. He has a special interest in the diabetic foot. Haywan runs Diabetic Foot Guardian, an easily digestible resource for patients regarding feet and diabetes.

 

Callus Debridement Can Be Diagnostic

Calluses form when shear forces and pressure induce the epidermis to reinforce itself. In patients with diminished pain sensation such as in diabetic neuropathy, continued friction from shear forces and pressure evolves the callus into a blister, then a blood blister (figure 1). When I see a bloody foot callus, I know that at some point, there was a break in the dermis. I don’t know if it has healed on its own or if it has expanded into a full blown ulcer because I can’t see past the callus. In fact, some calluses can be so thick I can’t even see the blood underneath! The only way to find out what’s hiding is to debride the callus.

Continue reading “How I Do It: Callus Debridement and the Diabetic Foot”

Centor’s Corner: The Story of FENa

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Centor’s Corner

September, 1976: I was a 2nd year internal medicine resident at the Medical College of Virginia.

My attending physician, Dr. Carlos Espinel, had just published a now-classic article: The FENa test.

So that month, I had the wonderful opportunity to understand the rationale behind a test that I now have used for over 40 years.

Continue reading “Centor’s Corner: The Story of FENa”

Interview with MELD Score Creator Dr. Patrick Kamath

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Dr. Patrick S. Kamath

Patrick S. Kamath, MD, is a professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota. His research interests include acute-on-chronic liver failure, nonalcoholic fatty liver disease, polycystic liver disease, Budd-Chiari syndrome and hereditary hemorrhagic telangiectasia. Dr. Kamath is internationally renowned as a leading researcher in hepatology and has also won numerous awards as an educator.

Why did you develop the MELD Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
Following a trans-jugular intrahepatic portosystemic shunt (TIPS) procedure for complications of portal hypertension, some patients do well and others fare poorly. My colleague in statistics, Mike Malinchoc, and I studied laboratory variables prior to the procedure and identified INR, serum creatinine, serum bilirubin and etiology of cirrhosis being predictive of survival. We developed a score based on these variables and demonstrated it predicted survival in a wide variety of patients with cirrhosis not undergoing TIPS. The score was originally called the Mayo End-Stage Liver Disease (MELD) model and was shown to be superior to the Child-Turcotte-Pugh score. Continue reading “Interview with MELD Score Creator Dr. Patrick Kamath”