Medical Experts Dr Carsten Ritter is committed to changing lives As part of our 4400 Reasons campaign we spoke to specialist vascular surgeon Dr J Carsten Ritter from Western Australia about his role in treating people with diabetes facing diabetes-related amputations and what’s contributing to higher rates in regional and remote communities. Dr Ritter is a specialist vascular surgeon at Fiona Stanley Hospital in Western Australia where he is the surgical lead for the Multi-disciplinary Diabetic Foot Unit. Many of the people he sees in that role are facing the possibility of a diabetes-related limb amputation. “As a vascular surgeon I am usually at the end of the road. Unfortunately, by the time a person with diabetes comes to see me they have already developed limb-threatening complications like ulcerations or infections,” Dr Ritter says. “I can work to save their feet through procedures like revascularisation but this still means that the person with diabetes is facing a long and complex road to recovery. Quite often multiple complex surgical procedures are necessary.” Dr Ritter said it was important people with diabetes and their healthcare team understand and use the best available diabetes management strategies to reduce the risk of a diabetes-related amputation. “Education is an essential part of diabetes management and people with diabetes should be encouraged and supported to understand the best diabetes management options on offer. This includes everything from food and lifestyle choices to appropriate footwear,” he said. “Of course, it isn’t always easy. Ongoing diabetes management requires a lot of self-discipline especially in the face of a barrage of marketing and advertising which can make it easier for people to make less healthy choices. “It also involves a time commitment which can be tough for some people. Regular check-ups with healthcare professionals take time and effort, and don’t always fit in easily with people’s busy schedules.” Dr Ritter said the health system also has a role to play, particularly in regional and remote areas. “In rural Australia, services are limited and the distances are great. Things like the first visit to a GP and then the referral to a specialist are often delayed,” he said. “The difficulty in accessing services means that by the time many people with diabetes in rural areas see a specialist they are in the advanced stages of diabetes-related complications.” Find out what you can do to care for your feet here. Vascular surgeon Dr Ramon Varcoe has made it his life’s mission to reduce diabetes-related amputations “If you’re told that you need to have a limb amputated, get a second opinion,” is the unambiguous advice from Dr Ramon Varcoe, leading vascular surgeon at Sydney’s Prince of Wales hospital. Dr Varcoe and his team perform limb saving procedures every week using advanced refinements of a technique known as endovascular revascularisation. This involves passing a wire into the arteries of patients and inflating them with a balloon before inserting a stent that acts like scaffolding to keep the arteries open. This helps improve blood flow and gives the limb a much better chance of survival. A surgeon for more than 20 years, Dr Varcoe has seen significant developments in the field of vascular surgery in that time. “When I first started training, there were a huge number of amputations on the vascular ward. “The face of vascular surgery has completely changed. We now focus on a minimally invasive approach to surgery so that we can minimise the risk to patients. “Often we can perform surgery as a day procedure and there has been a massive reduction in major amputations as a result. People who have to have minor amputation will usually go home within a few days. “In fact, we looked at the experience here at the Prince of Wales Hospital over an eight-year period and we were amazed to see that we had reduced the number of major amputations by more than 60 per cent. It reinforces that taking a minimally invasive approach to saving limbs can be as effective, or even more effective, than old open surgery techniques. “In my early years at the hospital, one in five people who came in with Critical Limb Ischemia would end up with limb loss, and we have now reduced that to around one in fifteen.”
