Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Last week we mentioned diabetes as a major cause of
amputations. This is due in part to impaired disease fighting
capability, but also from poor circulation, as diabetes
affects the small vessels and impedes the flow of blood.
It then is easy to understand another major cause of
amputations is vascular disease, that is disease of the
vessels. Here, however there is more hope, as vascular
surgeons can often bypass diseased areas, or open them up
with special catheters and they have a variety of other
machines to improve circulation.
A major circulation problem of note in the leg is DVT, a
blood clot in the deep veins of the leg that is painful and
causes swelling just like cellulites. The danger here is that
the clot can break off and lodge in the lungs, which can
cause death lo aleinu. People who get these are those
with cancer. Indeed it is often the first sign of the
disease. Also, people with vessel disease, people who have
had long periods of immobilization such as people on long
trips (one should walk as much as possible on the plane) and
people after surgery, particularly hip or pelvic surgery also
get such clots. Long term blood thinning is usually
required.
Clots in superficial veins are often seen after birth, and
require just pain control, antibiotics if it is infected, and
careful follow-up. A leg that is cold, weak, pale, lacking in
feeling, and painful is sometimes due to a blockage in the
artery. This requires urgent opening of the vessel.
Now back to skin problems. Fungi under the nails are
particularly tough to deal with as they grow in areas that
have poor blood supply. They take months to clear up, and in
the case of toenails, many times success is not obtained.
Antifungals by mouth are tried, and occasionally removing the
nail and starting all over again is tried. Recently, an
antifungal nail polish has been approved; it is very
expensive.
Warts are an inglorious name for a pesky disease caused by a
virus. They like young skin, and grow out as a lump on
fingers with some specks of brown in them. Removing them by
yourself often results in their returning and can lead to
infection.
On the foot, they can come from ill-fitting shoes or, again,
public baths. On the foot they grow inward, causing more
pain. These look like holes with a netting in them.
Removal is by freezing them off with liquid nitrogen, burning
them off with electrocautery, using liquid salicylic acid
(recommended daily use of the 17 percent solution), or
antiviral solutions.
Another nail disease is the ingrown toenail, often due to ill-
fitting shoes and improper nail cutting. A small piece of
nail grows under the nail skin fold, causing pain and
infection. Removal of the piece often suffices, but
occasionally a whole piece of nail must be removed from the
side and the nail be cauterized to assure that it doesn't
grow back. Write me in care of the Yated.
A message from Glaxo, sponsor of this column.
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