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Blood
Flow to the Feet
Letter
to the New England Journal of Medicine, in response to an article
published in the New England Journal of Medicine that recommended hot
tub soaks as a treatment for type 2 diabetes
January 20, 2000
To
the Editor:
Blood flow to the skin of
a normal foot can readily increase by 100 times if necessary, to
conduct heat away from challenged areas. Impaired circulation and
impaired endothelial dilatation (which are common in patients with
diabetes) may make this increase in blood flow impossible, and the
resultant burn may not cause pain if peripheral neuropathy is present.
My
late mentor, Heinz I. Lippman, found that many patients with diabetes
had burns of the feet after exposure to whirlpool baths set at 33.3°C
(well below body temperature). In 1960, he gathered statistics on the
reasons for amputation in the Bronx, New York, during 1959. Fully half
of the amputations were performed because of infected burns in
patients with diabetes.
Even
if burns do not occur after hot-tub therapy, prolonged soaking in
water causes maceration of skin. Macerated skin is more susceptible to
injury and is less likely to heal than normal skin. Therefore, my
colleagues and I advise all patients in our diabetes clinic to shower
or bathe in cool water and to "get in, get washed, and get
out." We never prescribe foot soaks except sometimes for 5 or 10
minutes in potassium permanganate solution for fungal infections. We
never use wet-to-dry dressings but occasionally use moist-to-dry
saline dressings for wetting dermatitis.
Richard
K. Bernstein, MD
New York Diabetes Center
To view other
advice from Dr. Bernstein go to www.diabetesincontrol.com/bernsteinarchive.htm
For Information on
Dr. Bernstein’s book “Diabetes Solution” go to
www.rx4betterhealth.com
Visit Dr.
Bernstein’s site at: www.diabetes-normalsugars.com for
excerpts
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