Charcot Foot

[Tj12761]

For everyone following the Charcot Foot threads, I wanted to post an article about Brent Bernstein, DPM, FACFAS the surgeon who took care of my husband. Bernstein is a phenomenal man and went out of his way to show us that he cared about hubby and I both. When his name is mentioned in medical circles, it is with awe by other doctors and patients alike yet this man is the most humble person I've met.

His philosophy:
“Wound care and podiatry mirror each other,” Dr. Bernstein says. “Where once it was said ‘People with diabetes don’t heal’, we are now seeing amazing results in wound healing with advanced dressings. The same holds true for advances in reconstructive foot surgery. Charcot patients used to be treated using simple offloading and we would watch them slowly fail because of a chronically swollen foot that eventually becomes ulcerated and infected. Worse yet, many patients with diabetes presenting to the emergency room with a big, red angry-looking foot characteristic of Charcot would be misdiagnosed as having cellulitis, abscess, or infection and an inappropriate amputation would occur. Hopefully, those days have ended. My fellowship showed me we can reconstruct the damage and subsequently the patient’s outlook.”

Read the full article here:
http://www.o-wm.com/article/6241

Bernstein's Bio:
http://www.mystlukesonline.org/find-doctor/doctor-detail.aspx?doctorID=890&sid=64831&sort=3&pg=1

Latest article by Bernstein and his head nurse John Motko.
Developing a Comprehensive Diagnostic and Treatment Plan for Charcot Neuroarthropathy Part 1 & 2
http://www.podiatrym.com/cme.cfm

[joyceful]

I read the post "Hope for the Charcot Foot Patient" with great interest. I was diagnosed with Charcot Foot in December, 2008. Since then I have read everything I could about this as I had never heard of it before my diagnosis. I was given an appointment for Mar 3, 2009 to see an orthopedic surgeon. I was so anxious to hear what could be done for me I went to the appointment with great hope. The first thing he told me was that I didn't need the wheelchair I had obtained. He said that the newest research showed that walking did no harm to the Charcot Foot. He asked me if my feet hurt when I walk and I told him "yes" a fair amount and I showed him where it hurt. He asked, "Could you walk a block?". I said I was sure I could but not without pain. I also told him that I walked like a drunken sailor, had poor balance and had fallen several times in the last month. He answered that by telling me I should see a podiatrist to take care of my toe nails. Then he said, that there was nothing he cold do for me until I had developed an ulcer on my foot. Once I had an ulcer he would then operate and repair my foot. I am not a doctor but I do have a university degree, and it seemed that what he told me contradicted everything I had read these last few months.
At this time I am feeling very frustrated and confused. I am happy that there are doctors who are treating Charcot Foot with great success and I am glad for their patients. But I am sitting here wondering, "What about Me?" Where is my hope? I feel that I have lost all hope and I have no idea where to turn next. You see, I live in Saskatchewan, Canada, and I am dependent on the Canadian medicare system. I am seeing a new doctor tomorrow to ask him to send me to a different orthopedic surgeon but I have no idea if another doctor will have more knowledge of what I need for treatment. I cannot even go to another province in Canada unless the government determines that there is no place in Saskatchewan where I can receive treatment.
I am also an American citizen, a senior citizen and on Medicare Part A. I did not enroll for Part B as I had no idea if I would live in the U.S. again. I don't suppose there is much hope for me in my situation but I do wish that all podiatrists and orthopedists etc. would have the same education and expertise for the treatment of foot ailments.

[Tj12761]

Joyce,

All doctors here in the US say no walking until the acute phase is over....it just plain takes longer to heal and you have a better chance of healing without much deformity. I'd use the wheelchair or a kneewalker. The ulcer the doctor mentioned to you is caused by the bone rubbing from the inside...and that happens when you walk in the charcot acute phase.

Keep me posted about the new doctor visit tomorrow...and check with the doctors about gabapentin to help with the pain you are feeling. The doctor here also uses Fortical (a Nasal Spray) to help promote bone healing.

Take the articles along that I posted and ask him about this form of treatment/surgery. Also take Dr. Bernstein's bio sheet....he'd gladly talk to your doctor. As a matter of fact, he was just in Canada last summer (Toronto, I believe) for a symposium on charcot foot.

[joyceful]

I went to a general practitioner today. He did not know much about charcot foot, but when I told him how much pain I was having he gave me a prescription for gabapentin without my asking for it. This is the first time I have been given anything for the neuropathy pain since it developed in 1997. He did not know if it would be harmful for me to walk even. So he is sending me to a rehab doctor because he said that doctor would be more familiar with the credentials of the podiatrists and orthopedists in that city. I feel better today and more hopeful but I can't help wishing I was back in the U.S.A. I hear of so many doctors that are on the cutting edge of a new wave of thinking about charcot treatments, notably Dr. Bernstein. I will let you know of my progress as I see these next doctors. I am anxious to get my gabapentin tomorrow to see if it will help.
Joyce

[Tj12761]

Joyce,

That is hopeful news! I'm glad to hear you found someone who understood what you are going through. When do you see the rehab doctors?

Let me know if the gabapentin helps. (Don't take antacids within 2 hours of taking it - antacids can reduce it's effect.)

When you go to the rehab doctors, take the articles about Bernstein and his surgery technique with you. Since he was in Canada, you may find the doctors know of him and attended his symposium.

[joyceful]

Thank you TJ
Could you send me the link to the information about Dr. Bernstein. His bio and his surgical techniques. I have not been able to access them.
Joyce

[Tj12761]

Where should I email them?

[joyceful]

my email address is [moderator note: e-mail address has been removed]

Thanks so much...

Joyce

[Tj12761]

On their way!

[joyceful]

Received, printed out (in colour) and in manila envelope. Cannot thank you enough. If I cannot find a foot doctor here that will co-operate with this information, do you think there is any possibility that I could be treated by Dr. Brent Bernstein or a doctor that he has trained. I am quite concerned about the ignorance of the doctors here. I am wondering if it would be possible to find out if there are doctors in Canada familiar with Dr Bernstein's techniques that would be willing to review my case and take me as a patient. How would I find such a doctor? And of course, because I live in Saskatchewan, I would have to be referred to another province only on the grounds that I could not be properly treated in Saskatchewan. It is getting complicated but thank God for computers. I am going to keep searching for help.

Again, thank you from the bottom of my heart for your kindness for giving me hope and making this information available to me.

Joyce