Location: Gainesville, FL
All her life, Gloria Hutchinson has been an active leader in her community of Gainesville, Florida. For years, she has been a cornerstone of her church and served her community by volunteering at the local food bank, regularly collecting and delivering food to needy residents. It is amazing that Gloria is able to do all of this good work today, despite almost losing both of her legs to Peripheral Arterial Disease (PAD) and Critical Limb Ischemia (CLI) less than 10 years ago.
In 2009, Gloria noticed a hole on her right big toe, which took 11 months to heal. The next year, she reached the end-stage of renal disease, and was prepared to be placed on dialysis. This, combined with her Type One Diabetes, created the perfect storm for PAD to take hold of her lower right extremity. In December of 2012, Gloria was hospitalized for yet another wound on her right foot that had infected her bone after falling into a well. While hospitalized, she was treated for gangrene in her right foot and for kidney failure. She previously had an amputation on the right fifth toe, which was complicated by abscess formation. This ended up requiring an additional amputation of her fourth toe and bones in her feet.
After the toe amputations, Gloria had significantly delayed wound healing, and her physicians told her she needed to have a below-knee amputation of her right leg. It is not clear whether this recommendation was due to the localized infection turning gangrenous, her PAD, or both. Gloria asked for a second opinion at the hospital, which was denied. At this point, she did not know what to do. She strongly wanted to avoid amputation, but her physicians at the hospital had told her that she was at risk of dying if she did not move ahead with their recommended plan of care.
Gloria’s daughter started calling medical practices throughout the area to see if they could treat her mother’s wound and save her leg. After making several calls, she reached the private outpatient interventional radiology practice, Vascular and Interventional Physicians (VIP) in Gainesville, Florida. The practice’s Medical Director, Dr. Bret N. Wiechmann, is an expert on CLI in PAD patients. While Dr. Wiechmann was interested in helping Gloria, he could not treat her while she was an inpatient at the other hospital. He recalled this, saying, “I was happy to look at her case, but I couldn’t see her as an inpatient because I didn’t work at that hospital.” Upon hearing that Dr. Wiechmann might be able to help her, Gloria signed herself out of the hospital that same day and scheduled a consultation with Dr. Wiechmann.
Dr. Wiechmann and his team did a full assessment of Gloria’s vascular status, which had not been completed before. After reviewing her results, Dr. Wiechmann found that she was a good candidate for a lower extremity arteriogram and intervention on her right leg for treatment of CLI. Dr. Wiechmann performed the procedure, which resulted in good angiographic results. Dr. Wiechmann then partnered with the team at North Florida Regional Medical Center’s Wound Care Center to develop a comprehensive and focused wound care program. After nearly a year of aggressive treatment, Gloria was able to ambulate without difficulty and no longer had any ischemic rest pain.
Five years later, Gloria experienced another long-lasting wound on a toe on her left foot, along with a non-healing ulcer. Once again, the hospital offered a left leg amputation as the only option of treatment. Knowing better this time, Gloria made an appointment with Dr. Wiechmann at which time Dr. Wiechmann identified that she had recurrent CLI, this time in her left leg. She underwent another angiogram at Dr. Wiechmann’s outpatient center, with balloon angioplasty of 2 arteries in her lower-left leg. Dr. Wiechmann worked with North Florida’s Wound Care Center a second time to develop a treatment program following the procedure. Only eight months later, Gloria’s wound was completely healed, and she was able to walk again with minimal difficulty.
Gloria’s story is a typical, but unfortunate example, of what can happen to many PAD patients: she was one patient, who had two amputations recommended to her; however, in Gloria’s case, she made one call, to one dedicated physician for treatment of her CLI — who was actually able to save her two legs after all.