Both Feet on the Ground: Saving Erma's Leg
What began as a blister nearly cost Erma Clinkscales one of her legs—and the freedom to do the things she loves. But thanks to a continuum of care between Northwestern Lake Forest Hospital and Northwestern Memorial Hospital, Erma is getting around just fine.
Flowerpots line the steps of Erma Clinkscales’ quiet North Chicago home, where she has lived since 1954. Now retired after a long career at the First National Bank of Waukegan, she spends her time gardening, playing the piano and visiting with the seven children she and her late husband raised here.
Things began to change last summer, when Erma started feeling pain in her left foot, followed by a blister. The podiatrist she saw for routine foot care chalked it up to gout, but the blister persisted. When the pain became excruciating, her daughter Valerie Spidle brought her to Northwestern Lake Forest Hospital’s (NLFH) emergency room.
“It just didn’t look right, so I brought her to the ER,” she says. “Right away, one of the ER doctors knew that mom had a serious problem.”
That Emergency Room physician was Dr. Rachel Rubin, who thought the sore might be an indication of a vascular problem. She had Erma admitted, and Dr. Mark Eskandari, a vascular surgeon on staff at both Northwestern Memorial Hospital (NMH) in Chicago and NLFH, evaluated the condition.
Dr. Eskandari gave Erma and her family some difficult news: Erma had peripheral vascular disease not previously identified. Peripheral vascular disease is common among people over the age of 50, and often it’s managed with medication. But left untreated, the disease can cut off blood circulation to the limbs and lead to gangrene. Gangrene causes the decay and death of tissue, often resulting in amputation and even death. Gangrene had already set in, and Erma was in danger of losing both her foot and her leg.
A Growing Problem
“A wound that doesn’t heal is often the result of an underlying vascular problem, and your physician should always consider that possibility,” says Dr. William H. Pearce, a vascular surgeon, researcher and professor who is chief of the Division of Vascular Surgery at NMH. “This commonly occurs in diabetic patients, but other vascular problems also lead to dangerous, non-healing wounds.”
According to the Amputee Coalition of America, vascular disease and diabetes are the leading causes of amputation and increases in limb loss in the United States. In fact, nearly 200,000 amputations—over 60 percent of them preventable—occur annually. Those numbers are expected to double by 2050. Among those amputees, African Americans are two to four times more likely to lose a lower limb than white persons of similar age and gender.
“I see a lot of amputees at the facility and in the community who’ve had diabetes—more than you’d expect,” says Valerie, who is a phlebotomist and a unit clerk at NLFH’s Westmoreland Nursing Center. “Mom’s diagnosis came as a surprise because she’s never had diabetes, and she had consistent access to care. It shows that people need to seek out information about these diseases.”
Surgery in the Nick of Time
Dr. Eskandari began treatment for the peripheral vascular disease and immediately scheduled surgery for Erma at NMH. One goal was to try to preserve as much of Erma’s foot as possible. Dr. Eskandari began with a surgery to insert a stent (an artificial “tube” inserted into a natural passage in the body)—which was key to saving Erma’s leg. Dr. Pearce then performed an additional surgery to remove two toes. But with gangrene’s rapid spread, it was necessary to perform a partial foot amputation in a third surgery.
Meanwhile, Valerie’s twin sister Vicki came in from Madison, Wisconsin, and they took turns driving to Chicago from Waukegan to visit and check on Erma. Her brothers Darryl and Rodney would also come by to help out. The news about the partial foot amputation was hard to take, but with it came relief that Erma’s leg—and her life—had been saved.
“We were a little shocked and depressed,” Valerie recalls. “But as extreme as amputation seemed, we were glad it wouldn’t go further. The diagnosis at NLFH and the surgeries by Dr. Eskandari and Dr. Pearce saved her leg.”
Erma remained at NMH for two weeks and was transferred to the Rehabilitation Institute of Chicago (RIC) on Northwestern Memorial Hospital’s Chicago Campus. Since 1991, RIC has been ranked the number one rehabilitation hospital in America in U.S. News & World Report’s annual “Best Hospitals” issue. The experts at RIC got Erma’s pain under control, helped her learn to walk again and provided social counseling.
Healing Wounds, and Moving On
Erma was allowed to continue her recovery at home with care from Northwestern Home Health nurses and therapists. However, the large open wound left by her amputation required proper healing to fully restore her mobility and prevent infection. That’s when Erma became the first patient of NLFH’s new Wound Center. Erma needed treatment at the center several times a week, so her other daughter in New York flew in to help Valerie and Vicki with the driving.
“With family, you do what you have to do,” says Valerie. “But it’s always better to be close to home. Having access to the Wound Center in Lake Forest, without driving downtown again, made things a lot easier.”
Dr. Eskandari and Dr. Pearce come to the NLFH Wound Center for clinic time once a week. At the center, Dr. Pearce performed debridements (removal of dead tissue) and skin grafts on the wound, but the grafts only partially took. Erma then received treatment in the center’s advanced hyperbaric oxygen chamber, cutting-edge technology for wound care that’s not commonly available. The intense oxygen boost in the chamber, and care from the center’s multidisciplinary team of physicians, healed her wound and ensured the success of her surgeries.
“I do wish I had known about the disease earlier,” she says. “But I feel pretty good. I’m still independent.”
Her daughter Valerie agrees: “Mom’s a fighter. She takes on a lot of pain without expressing it—but the worst is over. The continuity of care and the compassion and expertise of the staff at both hospitals helped us get here.”