Diabetic amputee issues a warning to other sufferers
AFTER 12 surgeries in 30 days, Philip Rule will spend at least another month in Ipswich Hospital adjusting to life without his right foot.
As he recovers from one of the most extreme risks associated with diabetes, Philip is taking his story public to raise awareness for diabetes prevention.
He has lived with Type II diabetes for more than a decade and has been fighting foot ulcers for more than two years.
When he was admitted to hospital earlier this year, Philip's left foot was already missing three toes that had been amputated over the past four years to stop infection.
"About 12 months ago I got a little ulcer on the bottom of my right foot. It wasn't very severe, it was probably the less severe out of the two feet," he said.
"And then the right foot starting getting worse and worse and worse."
On changing the bandages one day in February, Philip felt increasingly unwell and noted the dramatically worsening damage to the small toe on his right foot. He phoned an ambulance that took him to Ipswich Hospital. He has yet to leave.
"They had one look at it and said I needed surgery straight away," Philip said.
"They prepped me, put me in the ward and next day I had surgery where they removed that little toe."
Over days and weeks, surgeons attempted to stop the gangrene and infection that had set in despite Philip's attempt to control it at home.
It meant scraping away infected bone and dead tissue to ensure infection did not reach further into the body.
"If you don't amputate, then it can get into the bloodstream and kill you," Ipswich Hospital's Dr Angus Moxon said.
"Often it starts with one toe or a couple of toes."
Dr Moxon, the deputy director of Ipswich Hospital's orthopaedic department, performed Philip's amputation surgery.
He said foot ulcers were a major risk for people with diabetes because of the effect sugar levels have on blood supply and nerve function in the feet.
Poor sugar control can limit blood flow at the same time that it damages the nerves.
The effect on the vascular system means it becomes harder for the body to fight off infection and the person might not be able to feel the pain that would signal an injury.
"They can't feel it (an ulcer) and if it is on the bottom of their feet, they can't see it," Dr Moxon said.
"The bacteria have a real advantage. It's a terrible cycle."
Dr Moxon said about 10 people go through an amputation at Ipswich Hospital each year as a direct result of diabetes. About one person a week will lose a toe.
He said foot ulcers were often in a bad state by the time diabetic patients got to an emergency department. It makes treatment difficult and amputation more likely.
"By the time they come to us, there is not a lot we can do except debride and take away tissue," Dr Moxon said.
In a surgery lasting little more than an hour on March 7, Philip's right foot was removed.
One of the two remaining toes on his left foot had also been amputated. Doctors are still working to control the infection to help Philip keep his left foot.
The risk of a 'BKA' - below the knee amputation - is something Phil knew he would face.
"Being a diabetic, it's obviously very challenging," he said.
"My sugar control at periods during that time (when he lost the toes on his left foot) wasn't the best it could be. After losing my big toe on my left foot, it was a wake-up call.
"I used to joke with the nurses all the time… 'We're not having a BKA this week, no BKAs here'.
"And then all of a sudden, the doctor comes in after about the eighth surgery and says to me 'we're looking at a BKA'."
Philip hopes sharing his story will shake up other diabetes sufferers.
Queensland Government statistics released in 2015 show about 4.3% of people in Ipswich have type II diabetes. That equates to more than 7500 people. Type II is also often described as a hidden disease thanks to the large number of people who go undiagnosed for years.
"I want to tell them how important it is to monitor your sugar levels three times a day," Philip said.
"It can be life or death."
Dr Moxon said a major factor in diabetes care was prevention. Unlike type I diabetes, type II diabetes can in many cases be managed or prevented completely by controlling weight and diet.
"It tends to progress because people don't manage it very well," he said.
"Glycaemic (sugar) control is the key."
Philip is also running a GoFundMe account that has already raised more than $15,000 to pay for a set of prosthetic legs.
He aims to raise $30,000 to pay for three different prosthetics, including one for everyday use, a waterproof one and one for sports and outdoor use.
Prosthetics are notoriously expensive. Paying for a foot joint capable of a desired range of movement can cost $7000 - and that doesn't include the rest of the leg.