Diabetes patients head to Toronto or lose a limb

Diabetes patients in danger of losing limbs are being sent to Toronto for treatment because Hamilton’s waits are too long.

The Mayer Institute, which specializes in diabetes wound care, sends patients needing urgent treatment, within 30 days, to vascular surgeons at Sunnybrook Health Sciences Centre instead of waiting for diagnostics and surgery at Hamilton Health Sciences or St. Joseph’s Healthcare.

“In my world, I wait an inordinate amount of time,” said the institute’s medical director, Dr. Perry Mayer. “It’s a ridiculous situation in Hamilton. We have brilliant, gifted surgeons here, they’re second to none. But their hands are tied.”

Hamilton’s lead vascular surgeon says the problem is that 90 per cent of patients referred to them are urgent, so it can be difficult to determine who gets the care first.

“A lot of us feel overwhelmed with the sheer volume of disease,” said Dr. David Szalay, division head of vascular surgery at HHS, St. Joseph’s and McMaster University. “The challenge can be to try to work through your list and make sure nobody dies of a ruptured aneurysm waiting for you, nobody has a stroke waiting and you can intervene on the leg quick enough to prevent limb loss.”

Szalay says the delays occur when patients are referred and waiting for their first appointment and again when surgeons order diagnostic tests. In contrast, Toronto has more vascular surgeons to share the load, so patients get their first appointment faster. The doctors at Sunnybrook also have access to their own angioplasty suite so they do the diagnostics themselves and immediately do the treatment.

“Their model is ideal but pretty unique,” Szalay said of Sunnybrook.

Angelo Maletta says he would have lost his foot if he’d waited any longer for treatment. The 61-year-old Welland maintenance worker was told in August his right foot would have to be amputated because of a diabetic wound.

His cousin knew someone whose leg was saved by Mayer and recommended the clinic on Railway Street. Many of Mayer’s patients tell the same story of finding the institute by chance from friends or family after being told they’d need an amputation.

“My cousin, who I hadn’t seen in months, happened to be at my house the day they told me they wanted to amputate,” said Maletta, who shudders to think what would have happened otherwise. “It would have been terrible for me.”

Maletta saw Mayer at the end of August. Tests showed there was not enough blood flow in his foot, so he was referred to Sunnybrook in October and had surgery on Nov. 9.

“Everything was just boom, boom, boom,” said Maletta, commenting on the speed of treatment.

His foot is now healing well.

Getting treatment fast is significant considering Wound Care Canada reports there is a “small window of opportunity” for therapies. More than 50 per cent of lower extremity amputations are due to non-healing foot ulcers and the long-term prognosis isn’t good for amputees. The death rate is 39 per cent to 68 per cent over a five-year period.

There is hope that waits will ease a bit in Hamilton as another vascular surgeon is being recruited — the equivalent of three fewer surgeons are practising in this area compared to seven years ago. A second vascular ultrasound opened last week to double diagnostic capacity, and other health professionals such as physician assistants are being added to the vascular team.

But until then, Mayer says he will continue to send patients to Toronto: “These people can’t wait. The patients who don’t get to me lose their limbs. They lose their limbs at an astonishing rate.”

jfrketich@thespec.com

905-526-3349 | @Jfrketich