Foot Soldier

April Johnston 

Times Staff

To Dr. Tina, Podiatrist,’Every Toe is Important’

Back in 1999, Robert Schenk’s right foot was a red, hot, swollen bag of bones.

He couldn’t drive his limousine for the Marriott Hotel or lift his passenger’s luggage from the trunk. He was having trouble just walking. And he was starting to run a fever and shiver with the chills.

When Schenk, a diabetic, visited his doctor, they traced his symptoms to the circular wound on the bottom of his right foot. They called it osteomyelitis a bone infection, and suggested amputation.

Schenk scheduled the surgery.

Days later when he took his now deceased father, Andrew to the podiatrist for a checkup, he decided a second opinion was worth a shot.

“Hey, doc, take a look at my foot,” Schenk said.

Dr. Christina Teimouri, a podiatrist with office in Hopewell Township, Beaver Falls and Ambridge, pulled off his shoe and sock, peered at the wound and immediately told him to cancel his surgery.

“They are not taking his foot,” she told him.

Turns out Schenk, 66, of Center Township, did not have osteomyelitis at all. Instead, he was suffering form a diabetic foot deformity called Charcot’s foot. The condition is characterized by fractured foot bones, dislocated joints and circular ulcers.

Teimouri got Schenk a special cast so that the foot wouldn’t bear any weight and the bones could harden and heal, and she treated the ulcer with topical medications and dressings.

“Within three to four weeks, his foot was baby-butt smooth,” Teimouri said.

And more important Schenk didn’t have to loose a limb.

That, says Teimouri, was imperative. Doctors had wanted to amputate at Schenk’s ankle.

“Most amputees die within five years because they’re depressed and they’re not as active. They’re not moving, and because they’re not moving or exercising, their (blood) sugar goes up,” she said.

But not Schenk.

“I’m walking better now than I did before,” Schenk said.

Diabetics such as Schenk make up to about 6.2 percent of the country ‘s populations and large portions of Teimouri’s practice, largely because diabetics are more prone to foot problems than the average person.

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone needed to convert starches and other food into energy. The cause remains unknown, although genetics and environmental factors, including obesity, appear to play roles.

“(The unconverted) sugar is toxic to the nerves and blood vessels, especially in the hands and feet,” Teimouri explained. Which is why many diabetic patients end up with poor blood flow and little or no feeling in the extremities.

“Diabetic’s could step in something and not even feel it,” Teimouri said. “I had a patient who had a tack in his shoe and it caused a big hole in the bottom of his foot, and he didn’t even know it until he came in here.”

Making the problem even is that many diabetics also have problems with the eyes, so even if they gather that something is amiss with their feet, they’re frequently unable to see the problem.

So Teimouri often ends up seeing patients whose conditions are advanced and nearly impossible to heal or look at. Wounds are deep, and skin is eaten away. Sometimes they’re filled with a mess of bacteria. Once, she found a wound filled with maggots.

Fortunately for her patient, Teimouri doesn’t have a weak stomach.

“I love podiatry so much,” she said, a grin spreading across her face.”Every toe is important to me. People come in here with problems, and I get to make them feel better.”

Teimouri is known to introduce herself to patients as Dr. Tina, bring her children into the exam rooms and visit early 200 home bound patients. Robert Schenk became one of those patients in 2002 when he was at the Friendship Ridge geriatric center in Brighton Township suffering from another wound.

Schenk’s second diabetic foot condition – this time on his left foot – fell into the Teimouri’s impossible-to-heal category. By the time he called Teimouri, the wound was filled with bacteria, including E.coli, and had to be partially amputated at the toes. He now walks normally with the aid of a special brace and shoe.

The third time Schenk came to Teimouri, she dug into her arsenal of treatments. She wouldn’t amputate again.

“You can’t have just one approach,” Teimouri said. “You have to have 20 tricks in your bag. These people’s wounds don’t wait.”

Fortunately, two tricks recently showed up at her doorstep:Vacuum Assisted Closure and Dermagraft.

The VAC works by draining the would of bacteria and pulling blood toward it. the blood helps the wound heal. Teimouri used the VAC on a patient with a 4-centamiter would on his foot. Within two months, it was more than half gone. Then she began to apply Dermagraft to make it disappear.

“(Dermagraft) was serendipity,” Teimouri said. “A representative from Cleveland was coming through the area and thought this (the Hopewell office) was the place he was suppose to stop.”

Teimouri has been reading about Dermagraft in medial journals and invited the representative to her office. She has now treated 27 patients, including Schenk, with the new treatment.

Dermagraft is a think slice of polyester mesh that is lined with human tissue. The graft is applied to the wound, the human cells grow and the body doesn’t have to anything. There are no side effects or adverse reactions, Teimouri said.

When Schenk suffered a third diabetic ulcer on his right foot, caused by a bad seam in his shoe, Dermagraft is what Teimouri used to heal it. It was gone in three visits.

“It feels good,” Schenk said, peering down at his foot as he sat in one of Teimouri’s exam rooms. “Before, I couldn’t take a shower for two months. Now, I’m going back to work as soon as I can.”

Then he look up at his doctor and grinned. “Dr. Teimouri, she’s my buddy.”

Article from the Beaver County Times

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