Wednesday, June 25, 2014

Flesh Eating / Deadl Bacteria in Gulf of Mexico and Backwaters of Naples Bay what you need to know now

Another recent article on Flesh eating Bacteria

Today 7/30/2014 another victim of this flesh eating bacteria.
HEALTH ALERT: Sarasota County confirmed Tuesday that one person has died after coming in contact with a “flesh-eating bacteria” that's found in our beach's warm waters. It's called vibrio vulnificus. Here's what you need to know about it:

Here is an earlier blog post. 

In 2013 ,  31 people across Florida have been infected by the severe strain of vibrio vulnificus and 10 have died due to such infection.   This strain of bacteria is found mainly in salt water.  The  Family Foot and Leg Center, PA  in 20013 had 2 cases treated that were reported to the CDC.     Although the warning is for immunocompromised patients such as diabetic, cancer patients, etc., the two patients at FFLC, were young, healthy patients and contracted the bacteria while fishing in the  mangroves.      

The most recent patient was a healthy, athletic 19 year old male who was snook fishing and happened to brush his foot along some oyster shells.    He immediately reported to the office due to his mother being an RN and promptly received cultures, incision and drainage of the infected tissue.    Cultures revealed Vibrio Vulnificus and the patient was immediately sent to an infectious disease specialist for intravenous antibiotics.   Luckily, the initial care in the office saved this young man's foot and possibly his life (25% mortality rate).  If the bacteria would have progressed to his blood the outcome would have been different (50% mortality rate). 

In a review of our charts, the other patient is a 30 something year old female that scraped her foot on barnacles while getting on a boat.  Her fiancee didn't think much of it but she still presented to the office as she is an established patient of FFLC, and our slogan to our patients, "When in doubt give us a shout."

Symptoms: redness may look like a spider bite,  dizziness, nausea, warmth, blistering wound usually when these are present it could be late.   See a podiatrist for any puncture wounds found of the foot / ankle / lower leg immediately to avoid a life threatening infections.   

Aggressive local care with surgical flushing, cleaning of damaged /  infected tissue with combination of antibiotics must be initiated to avoid limb threatening or life threatening infections.   No exact recommendations have been made for antibiosis regimen as of this writing, but our patients were initially started on Cipro and a Tetracycline as recommended by researchers in Taiwan.    Our patients had the added advantage of a through incision and drainage in the office under local anesthesia which significantly helped their chances.    

WHAT YOU  NEED TO KNOW:   If you have sustained a cut on your foot/ leg /arm/ anywhere while on the beach or brackish water, please see a doctor immediately for a thorough checkup and possible antibiotics.   Cultures, cotton swabbing the wound and sending it to a lab, will show this bacteria. 

25% death rate with this infection
50% death rate when it is in the blood, sepsis

This is a serious problem and do not walk on the beach or shallows in the backwater without  water shoes, beach shoes, etc.  See below for suggestions

Most recent story 1/7/2015
Man Dies after fishing trip  

Any foot / leg injuries while on the beach or backwaters should be assessed by a podiatrist ASAP.

Dr. Kevin Lam is an avid fisherman of the backwaters and deep sea.    Rather share fishing stories than life saving stories.

661 Goodlette Road, suite 103
Naples, FL 34102

Call: 239 430 3668
Like our Facebook page for up to date information about foot and ankle and interaction with our doctors.

Subscribe to my youtube channel for up to date information.
Follow on twitter!  drkevinlam

beach shoes

Wednesday, June 18, 2014

Dr. Kevin Lam Naples Top Podiatrist on the Rise to the Top

  • How you got started?
Started when I visited my current mentor Dr. Stephen A Monaco in Havertown, PA as a college student. As a biochemistry / microbiology major the possibilties  were endless.   As a high school student I was exposed to Osteopathic Medicine and the holistic approach to wellness during my 2 years at the Pennsylvania School of Osteopathic Medicine in Philadelphia as a medical explorer.  Always in the back of my mind, D.O. was my path for my future.   The premedical club at my university had a tour of Temple University School of Podiatric Medicine, I figured I would attend and explore for up until this part of my education I had no idea what Podiatry was and now the rest is history after being accepted for admission as the youngest student to matriculate that year after 3 year of undergraduate work. 

  • How you work?

Always like being on the cutting edge in the field.    As a resident in training I always gravitated towards the more difficult cases.    The ability to transform someone's life by realigning their foundation either via orthotic therapy, padding or surgery is very gratifying.     Protocols are set in the office to give patients the optimal care, for those that don't respond to our typical protocols advanced testing /imaging can be done for more aggressive care.     Conservative care will always be an option that is explored and exhausted prior to surgery.    

  • Teach with a lesson—using rich, authentic stories?
Always giving the patient the correct advice , thorough picture of their condition. Sometimes the correct solution may not be the easiest solution.  I had a patient that required a severe bunionectomy at the base of the bone rather then the regular type at the head of the bone, this required 6 wks off the foot to recovery.  She went to another surgeon who gave her what she wanted a simple fix with no time off her feet.    6 months later the bunion returned as did she to the office for a revision.    The moral of the story is that the simple answer may not always be the correct answer. Some surgeons / doctors will do things to appease the patient's request, hence doctoring themselves and using the doctor as a vehicle to achieve such.  My goal is to always give the Best answer whether it is difficult or not. 
  •  Vision
Vision is that one day the profession of podiatry fulfills the quest to have all DPM's trained equally and have the profession as a whole recognize the true value of our services.  
  • Obstacles to overcome. 
Often I hear, what would a foot / ankle orthopedic surgeon do that is different from what you propose?  Why would I have you do the surgery vs an orthopedist?   My answer is seek out the one that does most of these procedures, not the title.  Foot and ankle Orthopedist spends 1 year on the foot / ankle after orthopedic residency while reconstructive podiatrist spends 4 years in podiatric medical school building a strong foundation in biomechanics and foot medicine, then 3 years of surgical residency with concentration on the foot / ankle and now many are going for a 1 year fellowship after such for a total of 4 years of concentrated foot /ankle surgery concentration.     Both professions have great doctors and some not so great ones.     Choose based on reputation , # cases and not the initials would be my best advice.    Check with hospital OR nurses, etc to ask who does more foot / ankle surgeries and who is most successful at them.    Anesthesiologists see the good, bad and ugly in the OR, they can give you an excellent recommendation if you happen to know one.     

Thursday, June 12, 2014

Avoid amputation as a diabetic

Diabetes remains the most common reason for nontraumatic amputation in the USA.    Diabetic amputations and complications from diabetes kills more people then some cancers.   5 year mortality rate after a leg amputation is depressing at close to 50% in some studies.    People don't realise this until it is way too late.
If you have been diagnosed with diabetes  you must see a podiatrist on a regular basis as well as do daily foot checks by yourself or a family member.  

Few reasons why diabetics are at high risk for foot problems.

  1. "Lazy immune cells"  can't fight off infection as efficiently
  2. Lack of feeling on the bottom of the feet, you can't feel if you have a blister or ulcer that would stop most people to check.
  3. Peripheral arterial disease (PAD): diabetics tend to have higher rate of arterial insufficiency or decrease in blood flow.  That lack of blood flow inhibits healing of the wound. 
  4. Glycosylation of muscle, sugar coating muscle cells causing stiffness of the calf muscle and cause contractures. Same way a hemoglobin can be sugar coated hence the HBA1C test that is done to assess diabetic control. 

Ways to increase your odds of keeping your toes, feet, legs.

  1. Keeping your HBA1C  around 5.7
  2. Maintain healthy weight
  3. Visit a DPM every 6 months for low risk or every 3 months for moderate to high risk. 
  4. Always get fitted for shoes, measured by your podiatrist or pedorthist do not wear open toed shoes. 
Some diabetic amputations are preventable with proper preventative care and observation by a podiatrist. 
Save your limb or a loved one's. 

One major reason for diabetic amputation is diabetic polyneuropathy.  There is research from Dr. Dellon of John Hopkins Medical Center that explains one of the causes of diabetic polyneuropathy is caused by the compression of the nerve.    Theory explains that when a metabolite of sugar, sorbitol is abundant around a nerve, this causes the nerve to swell, initial symptoms are numbness, then can progress to pain as the nerve disease progresses.  Tests that can be done to evaluate this or to rule out other nerve compressions as a root cause are the following: nerve conduction studies and EMG, nerve biopsies. cutaneous nerve biopsies, nerve blocks, etc.    Typically neuropathy will start with tingling, numbness, can later progress to severe pain such as pins and needles.   Treatments include vitamin supplementation, nerve medications such as lyrica or neurontin, cymbalta, etc. , physical therapy, nerve stimulation via TENS unit.   Latest treatment combines the nerve stimulation along with nerve blocks to help re ignite the nerves to decrease pain and discomfort associated with neuropathy. Results have been staggering:
As you can see from above at visit / treatment #14 the pain scale goes from a 10 to less then a 1.   This is an awesome result given that up until now there have been very little choice besides medications.

Dr. Kevin Lam

diabetic testing diabetic testing strips

Tuesday, June 10, 2014

Severe Bunion travels 150 miles to Naples, FL for Surgery

Before the bunionectomy, note large Bump on the Bunion
1 wk after surgery with the toe in position and wire
At about 8 weeks patient is in sneakers & regular activities. 

There is no reason to wait for your minimally invasive bunionectomy.  This can be done in the office safely under local anesthesia or in outpatient hospital setting under sedation and local anesthesia.

  1. Can be used for serious bunions such as above
  2. Minimal Pain to no pain. 
  3. Walk immediately after surgery in a boot.
  4. Less risk of infection or complication due to 5mm incision
  5. Office or Outpatient hospital Surgery
  6. Can be used for revisional surgery
  7. Very minimal complication rates
  8. Virtually scarless. 

Tuesday, June 3, 2014

Revisional Bunion Surgery via Minimally Invasive Technique

Patient had bunionectomy 20 + years ago. You can see the preop right foot.   During recovery and fully recovered.   You will note that the screw was removed and the angular deformity has been corrected. 
Guess who's coming back for the left foot revision? 

This modification of the Peabody bunionectomy not only is good for initial bunion surgery but also for revisions.     

Get more information at: