A California Rotarian tells the story of a Rotarian who is making a difference in the lives of diabetics.
- by Matthew Everson
The screen on my phone read "Mom." Those days, when I saw "Mom" on caller ID, I braced for the worst. Was this the call I'd been expecting for years now?
"Matt, I wanted to let you know your father has an infection in his foot. He's having surgery today," I could hear the worry in her voice.
Dad had suffered from diabetes for fifteen years now. Yet, like many Americans, he didn't really take the disease seriously, eating and drinking whatever he wanted, and often skipping his meds. Meanwhile, the disease progressively worsened. Add forty years of smoking, life-long high blood pressure, congestive heart failure and renal failure, and I was surprised he was still alive.
"What is their plan of treatment?" I asked.
"They are going to cut his foot open and clean out the wound. They feel the antibiotics will get the infection. After that, when the vascular surgeon has the time, they will give him an angioplasty to increase circulation to his feet."
As chance would have it, our Rotary Club of Santa Rosa had just hosted a presentation given by a club member, local plastic surgeon Dr. Barry Silberg. The topic was a new method of care for infected wounds.
During his presentation, Dr. Silberg had talked about the standard treatment for wounds; it was almost word for word what my mother was telling me. He also mentioned it almost never worked.
"Mom, I just recently learned that strategy has zero chance of actually working. Isn't poor circulation the cause of this problem? How would antibiotics get to his wound?"
She had no answer. Terrified, she intended to follow the doctor's advice. Who could blame her?
Dr. Silberg told us that infections had become an enormous problem in our medical system. Despite stepped-up efforts to reduce infections in hospitals, they still rank as one of the top-ten causes of death in America according to the Centers for Disease Control (CDC).
Many infected wounds actually worsen within hospitals. The standard treatment is an example of a system that emphasizes care and treatment over prevention. Unfortunately, Medicare is drowning in care costs associated with chronic wounds. Some estimates show these costs at over $200 billion annually in preventable care costs!
Wouldn't it be amazing if someone could find a treatment for infected wounds that is not only safe and highly efficient but also low-cost and easy to perform? Dr. Silberg was telling our Club he has found that treatment and his discovery is currently in Phase III of FDA clinical trials. It is about to revolutionize the treatment of wounds around the world.
It seems to me that with so many intelligent doctors, someone would have questioned the logic of flooding the body (either orally or via IV) with antibiotics to treat wounds like this. If blood circulation is no good, then antibiotics are not getting to the infected tissue. How could a wound heal? When I'd pose this very question to the hospitalists in charge of my dad's health, I received blank stares.
It was so frustrating to watch my father's health worsen while I knew of the new treatment Dr. Silberg was giving to patients like my dad. During his talk, he gave our Club an analogy: "If you had a fly on the ceiling of this hall, would you fumigate the hall? Or would you rather whack it with a fly swatter?" I was screaming at my dad's doctors to pull out the fly swatter. No one listened.
Dr. Silberg told us, "You might be shocked to hear the medical world uses total fumigation when it comes to trying to cure infected wounds. And their success rate for curing folks is abysmal." But like Dr. Peter Pronovost before him, a doctor who simply suggested surgeons and staff wash their hands and was rebuffed, Dr. Silberg was getting a lot of push back on his idea.
The idea is simple, really. And it came to Dr. Silberg as he was trying to find ways to minimize scarring and infections after open-heart surgery. He found that by injecting a patient's exposed tissue during surgery with a tiny bit of liquid, he could keep that tissue hydrated. It would reduce scarring.
But it wouldn't reduce infections. He experimented a bit and found that after adding a simple antibiotic (Cefazolin) to the solution of saline, not only were patients experiencing much less scarring and pain but the incidence of infection was now close to zero. He sought out the FDA approvals needed to run some more experiments and went to work fine tuning the approach. The findings were truly amazing. No negative side effects, very low cost and nearly 100% success rate!
It takes a lot to impress a room full of Rotarians and even more to stun them to silence. Immediately, everyone could see the impact of this discovery. A low-cost, safe, easy-to-apply technique that could not only save lives but billions of dollars? What a discovery!
"Like the physician who was ignored for years by proposing that doctors and nurses wash their hands before practicing medicine, this very simple idea of mine receives plenty of skepticism, jealous remarks and even attempts to stop me from performing this on folks. But I intend to press on and receive final FDA approvals." I was shocked anyone would want to put a stop to something like this. I was soon to learn how much everything he told our Club that day was true.
As Dr. Silberg had predicted, the course of treatment would ultimately make my dad worse. Not only did his cut get much worse, he also contracted pneumonia while in the hospital. He then became delirious from the side effects of the medications and the infection. After seeing his decline, I began urging my mom to go against medical advice and get Dad to Santa Rosa, where Dr. Silberg could treat him.
Finally, after the handling Dad had received for three weeks had him on the brink of death, my mom was willing to change the course. With much resistance from his doctors, we forced a transfer to Santa Rosa. His delirious state had grown progressively worse as the infection ravaged his body, to the point he could not form words or control his bodily seizures. The hospital in Marin had simply given up, seeing no help from the antibiotics. They were resigned to the fact he would die. Despite this, his doctors still thought my mother was crazy to transfer him for "thisexperimental treatment" they would say with palpable derision.
Within hours of arriving at Santa Rosa Memorial Hospital on a Saturday evening in early June, Dr. Silberg performed his treatment. The following Sunday morning, the delirious man my mother feared would die in the one hour ambulance ride to Santa Rosa was beginning to act himself again. His body was cured of the infection.
Dad ultimately lost his leg due to the weeks of circulatory damage inflicted by the infection. But the treatment saved his life by finally putting an end to the bacteria that was eating him alive. Our family had been given a miracle. My dad was going to survive.
How many people can this help globally? Could one of our own local Rotarians soon be accepting a Nobel Prize for Medicine? When you think of how many people this could assist, along with the cost savings to health systems around the world, why not?
Dr. Silberg saved my dad's life. My hope is the FDA will give him final approvals and this will save many more lives and limbs. There are doubters standing in his way. They will find themselves in the dust bin of oblivion, remembered only for their obstinacy. But it is my belief Dr. Silberg's discovery will be historically significant and he will be remembered for many years to come. He represents what it means to be a true Rotarian, helping those in their time of need. Performing Service Above Self.