Participants: Agatha Thrash
Series Code: HYTH
Program Code: HYTH000224
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00:01 Hello, it was about 2000 years ago that the
00:06 ancients recognized that there were some 00:08 people, not everybody, but some people had 00:11 sweet urine. They recognized this because 00:14 if the urine spilled on the ground the ants 00:18 were attracted to it. They called the disease 00:21 as diabetes mellitus. Diabetes because that's 00:24 the Greek word for fountain and mellitus 00:27 because that's the Latin word for sweet or 00:30 honey. So, its honey fountain or we call it 00:34 diabetes mellitus or sugar disease. So, if 00:41 you would like to learn something about this 00:43 sugar disease we will be talking about this 00:46 during this program and we hope you'll join us. 01:09 Welcome to Help Yourself to Health with 01:12 Dr. Agatha Thrash of Uchee Pines Institute. 01:15 And, now here is your host, Dr. Thrash. 01:20 Now, diabetes is actually two separate 01:24 diseases. One, we call it type I diabetes and the 01:29 other we call type II diabetes. Those we 01:32 used to say, we used to call them juvenile 01:35 diabetes and the adult onset diabetes. Now, 01:39 we don't actually refer to them anymore by 01:42 those terms because we recognize now that 01:45 some adults can get that what we used to call 01:48 juvenile diabetes and now with overweight 01:52 being so prevalent among children we're 01:55 now seeing the type II diabetes very 01:57 frequently in small children. And, so we 02:01 now refer to them as type I and type II, 02:04 but there are two separate diseases and 02:06 have totally different ways, so they express 02:10 themselves in the blood test. Now, in order for 02:14 us to fully understand about this, we of course 02:18 would like to know something about how 02:21 the blood sugar is handled in the body. 02:25 And, just what we can do to make the body 02:29 better able to handle sugar. When sugar 02:33 builds up in the bloodstream that causes 02:36 an irritative problem to blood vessels. Sugar 02:40 itself is what we might call an irritant in the 02:44 blood. And insulin while it's essential to 02:49 life as sugar is also. While insulin is 02:52 essential to life, we cannot function without 02:55 it. If we get too much then we can look at it in 02:59 lay terms as an irritant. And, it causes a number 03:03 of problems for the body. One of which is 03:06 overweight that's one reason for that is, that 03:08 it's a very good appetite stimulant. So, as it goes 03:12 higher in the bloodstream, the person 03:15 has more-and-more appetite. So, if they see 03:18 something they like and they don't have habits 03:20 that are very strict and make it so that they will 03:23 not eat at certain times and will not eat certain 03:26 things that they know to be unhealthful. They 03:29 don't have those habits well ingrained then 03:32 because of the surge of appetite that comes 03:35 with the high insulin levels they tend to 03:39 overeat and to eat too frequently. And to be 03:43 willing to eat foods that are very sweet, they 03:45 tend to have a very good appetite for foods 03:49 that are very sugary or very salty or very fatty 03:53 and all of those tend to promote more appetite 03:56 and also tend to promote overweight. 03:59 So, there are some ways that we can help 04:05 ourselves by dietary restrictions, but if we 04:10 know some of the complications that can 04:12 occur from diabetes that too is a deterrent or 04:17 an inspiration or a motivating factor to 04:20 help us to learn about these diseases and to 04:23 get so that we are not ravaged by the diseases 04:28 and the complications. So, I have some pictures 04:31 to show you of some of those problems that can 04:34 occur on the skin. And the first one that I 04:38 would like to show you is a diabetic ulcer. 04:41 Now, the usual diabetic ulcer is just as you see 04:46 here with a little pus and dead material down 04:51 in the active part of the ulcer. The edges are 04:54 little raised and a little reddened and if the 04:58 usual leg will be a little different from this 05:01 because it is usually quite a lot larger and it 05:04 is quite a lot more swollen. Because of the 05:08 swelling of it, it makes the skin tense. And that 05:11 tends to draw the edges apart more and to retard 05:18 healing. So, one of the things that we can do to 05:21 improve the healing is to put on a type of 05:25 bandage that will make the, the leg, the skin on 05:32 the leg to pull together more, so that the, the 05:36 tissue can grow, can spread over, the skin 05:42 surfaces can spread over the wound and 05:45 heal it in that way. Now, another thing that 05:48 we need to do with this ulcer is to clear up the 05:51 pus and the dead material down in the 05:54 active part of the ulcer. And, there is a rigid 05:58 bandage, which we call the Unna boot, which I 06:01 would like to show to you now. 06:03 The, and for that I would like to have a 06:08 product, which you can buy on the market may 06:11 not go by this brand name, but it will have 06:14 or may have the name of Unna boot or Unna's 06:17 boot as this one does. Now, the Unna boot is 06:21 the original and of course we have used 06:24 the Unna boot for I suppose 100 years or 06:28 more and it goes on very nicely, even when 06:32 you use the old fashion Unna's boot itself. And, 06:36 I've here the ingredients for the old Unna boot 06:40 that we used to make up 50 years ago and it 06:44 is zinc oxide, which you simply measure out 06:46 into a cup and you get the formula properly 06:50 for it. And at which you can get online and then 06:54 you use glycerin. And glycerin can also be 06:57 obtained from a pharmacy as this one 07:01 was. And the glycerin is mixed with it along 07:05 with some gelatin, which you can get from 07:07 a grocery store just the plain Knox gelatin or 07:12 any kind of clear gelatin, which you can 07:15 use. I suppose Agar could also be used in 07:17 the same way, but the Knox gelatin is by all 07:21 means the best. And so you can make, you can 07:24 make this yourself, it needs to be heated 07:27 because of the gelatin, so the gelatin is 07:30 softened in some water and heated to dissolve 07:35 it and then the zinc oxide and the glycerin 07:37 put in. And then the part of foot and leg and 07:44 the ulcer is wrapped with gauze such as this 07:49 and then with a little paint brush the old 07:53 Unna paste is painted on the first layer of the 07:57 gauze and then a second layer of gauze is 08:00 wrapped on that and it's allowed to harden and 08:03 to gel and that makes the rigid bandage. Now, 08:08 while I have put on I suppose a hundred 08:12 Unna boots with the old fashion paste and the 08:16 paint brush. I would like to show you how to 08:19 use this, this new variety. This is more 08:23 expensive, but it's also it's so much more 08:26 convenient. So, I've asked an assistant and 08:30 that so Arianna Hartsfield. So, Arianna 08:33 if you will come here and join me, and I 08:35 would like you to sit right here and Arianna is 08:40 one of our students in our church school at 08:44 Uchee Pines and we are pretending that she has 08:47 a large diabetic ulcer on her left leg. So, if you 08:51 remove your left sock, we will proceed to put 08:57 on an Unna boot. Unna boots are extremely 09:00 successful and they will both clear up the ulcer. 09:06 It will clear that to dead an infective material 09:09 up. And also will make the, the swelling go 09:14 down and heal the ulcer, you can see it 09:17 from one bandage change to the next. 09:19 Okay, Arianna if you let me have your left foot 09:22 and I'll just put this right up here on my 09:24 knee that's the very best way that you can put 09:27 this Unna boot on. And then you just take the 09:32 gel cast that you have and it would be 09:35 packaged very tightly because it is, it, it 09:40 should not dry out and then you can see that 09:44 sort of sticks together little bit like this and on 09:48 the ulcer we will put a 4x4, so, let's pretend 09:53 that she has a big ulcer right here. So, we will 09:55 put this right there and then we will put this on 10:00 top of that just like so that will help it to stay 10:04 on. And, then we just wrap this on, it isn't 10:08 difficult to put it on, it goes on sort of like a 10:11 little cast. And because it is made of rather thin 10:16 gauze, it is of course going to mold a bit to 10:21 her foot and this has to go down all the way to 10:24 the base of the toes as you see me doing here. 10:28 The reason for that is so that the little rigid 10:33 bandage, once it gets rigid then it will be 10:37 right at the base of the toes and if you have to 10:40 make it fit then you can just twist it little bit as 10:43 you see me do there. And then it goes back 10:46 up and if you will notice you can see that 10:51 there is some chalky material that gets on 10:53 my fingers like that. This chalky material is 10:57 the zinc oxide, which we had in the original 11:01 Unna paste. The original Unna paste was 11:04 a very good paste with zinc oxide. One more 11:07 wrap around the foot and then it goes up over 11:11 the leg. Now, the reason that it must go 11:13 up over the leg is because the, the 11:18 swelling needs to come down, but we don't, we 11:21 don't make it tight. We simply make it fit 11:24 because the way that it's going to be 11:26 functional is that her walking and 11:31 moving and flexing her muscles will make it so 11:35 that she will have the muscles to make the 11:42 fluid go out of her leg. So, we wanted to go up 11:46 a good way on her leg just for that very 11:49 purpose. Now, each roll around leaves about 11:55 one-third of the last roll exposed. So, that its, 12:02 it's not, don't make one edge go to the next 12:06 edge just make it about like this. Now, once it 12:11 gets on before they do too much walking on it. 12:15 It has to harden and that takes with this 12:20 commercial form, they will often tell you how 12:23 long it's going to take, but it will often take 12:27 maybe a couple of hours before it gets 12:29 fully hardened, but it's not a big problem just 12:34 make it, make it fit and let them have the time 12:39 to have it to gel. Now, that looks as if it's 12:43 about enough. So, cut this off right here. 12:46 Now, you can put the rest of it back in the 12:49 water tight package and use this for the next 12:53 time you put the bandage on. Now, at 12:56 this point we need to assume a couple of 12:59 things. One is that couple of days have 13:03 gone by and it's time for a dressing change. 13:07 So, with the dressing change the way to do 13:10 that, you will notice now that this looks like 13:12 a cast, looks like the cast, so that the 13:16 orthopedists put on for a broken bone. And 13:19 that's good too, you can give it a little bit of a 13:21 rub, so that makes it smooth, but when you 13:25 take it off you simply cut it off away from the 13:29 place, where the ulcer is. Ulcer is over here 13:32 and you simply cut it off somewhere away 13:36 from the, the ulcer. So, as I'm doing now, takes 13:42 a little to do although it will be once they have 13:45 walked on it for a couple of days and 13:48 usually the dressing change is every 2-5 13:51 days depending the stage, where the ulcer 13:55 is. But let say this one, this one is ready to 13:59 come off and this is simply the way that you 14:02 do it. And sometimes the patient can, can 14:06 help you to get, get it cut off, but as you can 14:10 see it's takes a little bit of, of working to get it 14:14 off. Very affective treatment, I like it very 14:19 much for the diabetic ulcers and I'm sure that 14:23 anyone who has experienced with this 14:26 will tell you the same thing that I've had. 14:29 Now, usually after a couple of days of 14:34 having the, the bandage on, the person, the 14:38 bandage will be a little bit loose on the leg, but 14:42 the leg will be much smaller then it had been 14:45 when you put the bandage on. Thank you, 14:47 Arianna. We appreciate your working with us, 14:52 with this. That's fine. 14:53 So, little bit messy. Now, as you can see 14:58 it's, while it's a little trouble to put the 15:01 bandage on. I can assure you that it's quite 15:04 affective for this problem. Now, I have 15:08 some other pictures that I would like to show 15:10 you of other problems that can occur in the 15:14 diabetic. So, at this point we will take, we 15:18 will look at a toe. Now, here you can see that 15:20 this toe has a chronic ulcer on it. This toe 15:26 may progress in the diabetic with an ulcer 15:29 like that to amputation either the toe itself has 15:34 to be amputated or sometimes a portion of 15:38 the foot perhaps half of the foot or even a 15:41 below the knee amputation may have to 15:44 occur for such an ulcer is this. This ulcer 15:48 happened because the, a heating pad was used 15:53 for the patient and that got too hot and this 15:57 little ulcer develop. little blister first, and 16:01 then the ulcer, which would not heal and that 16:04 points out the fact that diabetics should not 16:07 have hot things put on the feet. They can't 16:11 experience the pain like a normal person can 16:14 and therefore they've serious problems with 16:18 excessive heat. Hot foot baths are best avoided. 16:22 A warm foot bath body temperature is about the 16:26 hottest that a diabetic should take a hot foot 16:29 bath or a foot bath not hot foot bath. Now, we 16:33 have another picture to show you. This picture 16:35 also shows a typical problem with a diabetic 16:39 on the just behind the great toe will develop 16:45 an ulcer on the, on the sole of the foot. It's not 16:49 an uncommon place. One of the reasons why 16:52 it develops there is that the, the diabetic cannot 16:55 see on the bottom and often because of weight 16:59 they may not be able to reach down and, and 17:02 recognize that something is 17:04 developing different on the bottom of the foot. 17:07 And because the nerves are not sensitive 17:11 anymore then the person develops an 17:15 ulcer before they know it and it's a serious 17:18 ulcer before they even know it. Now, the next 17:21 picture that I will show you is also in a 17:23 diabetic, also illustrates a typical problem. This 17:27 problem is Gangrene you will see that 17:30 developing in the right foot the second toe. See 17:35 the end of that toe is black that is called dry 17:39 Gangrene, but you will notice that on the left 17:43 toes there are, there are three of the left toes 17:46 that have the purplish red discoloration. If 17:50 you were to press your thumb into that area of 17:54 the purplish red discoloration, it might 17:57 take as long as a minute for the blood to run 18:02 back into the skin at that point. Where as a 18:05 normal person will have the, if you press 18:07 on the foot on a toe the, the normal person will 18:13 have the blood to run back into the skin in 18:17 maybe one or two seconds doesn't take 18:19 long at all. So, you can see by that, that the 18:22 diabetic is having a serious problem with 18:26 the skin. Now, let's talk a bit 18:29 about how the diabetic develops an infection 18:34 more frequently and more easily than the 18:37 average person does. Because of the fact that 18:41 when the blood sugar rises after a meal, the 18:45 bodies first objective is to get the, get all of the 18:53 sugar that's excess above the fasting level 18:56 to get all of that, out of the bloodstream and put 19:00 into various places, where sugar can be 19:04 stored. Now, sugar can be stored in muscles, it 19:08 can be stored in the kidney, in the liver, and 19:11 in the skin and various other places. But the 19:14 skin is an important immediate reservoir for 19:19 sugar. So, sugar is taken out of the 19:23 bloodstream and temporarily stored in 19:26 the skin. That makes the sugar in the skin go 19:29 high. Sugar is a good culture medium for 19:33 bacteria. So, a small scratch, a little 19:36 abrasion, can result in quite a serious 19:40 infection. And I would like to show you some 19:44 charts that I have that will illustrate this the 19:47 way that infection occurs. Let, let's 19:51 take a look here at a germ itself. This is a 19:56 bacterium one with flagella, which are little 20:04 threads with which the bacterium swims, so it 20:09 moves these and propel themselves along. Also 20:14 you will notice this on the outside is the 20:16 capsule, then comes the cell wall and then 20:20 comes the cell membrane before you 20:22 ever get to the cytoplasm then the 20:25 nucleus is down here. You can see by that, 20:28 that the germ is well armored to invade and 20:34 has good resistance against us. But, we also 20:37 have very good advancing substances 20:44 and advancing structure such as our white blood 20:47 cells and the vast array of chemical substances 20:51 that the immune system can produce. An 20:55 amazing array of substances that are 20:58 powerful to kill bacteria or to wall them off and 21:02 make them, so that they cannot move. So 21:05 bacterium maybe one without flagella, they 21:09 don't all have flagella most of them in fact do 21:12 not, but as something happens let us say, 21:16 there you get an infection somewhere on 21:20 the skin or in the internal organs and the 21:24 germ gets into the bloodstream and goes 21:28 to other parts of the body. You can get a 21:31 meningitis from, from one, from the germ 21:36 called Neisseria meningitidis and that is 21:39 the, the germ most likely to affect the 21:44 meninges then you can get a streptococcus that 21:47 can infect the number of places that can get in 21:50 the bloodstream, can even go to the heart 21:52 valves. You can get streptococcus 21:55 pneumonia, which can go to the lungs and a 21:58 streptococcus aureus, which can involve the 22:02 skin and the pseudomonas, which 22:04 can involve the prostate and the salmonella, 22:07 which can involve that the colon of course and 22:10 we are familiar with that from reports that 22:14 we have out of people, who have eaten 22:16 infected meat or eggs or chicken and this has 22:20 caused them to get a salmonella infection 22:23 in the colon. So, of course with these germs 22:28 that can go all over the body, one can certainly 22:31 see how these germs could either originate in 22:34 the skin or could go from the blood into the 22:37 skin. Now, let's take a moment for an anatomy 22:42 lesson, if you will indulge me. This is a 22:44 most wonderful illustration of the grand 22:49 design of the human body. We have in bone 22:53 marrow and before we are born these cells, 22:58 which is called here hemocytoblast or a 23:01 stem cell, you may have heard of stem cell 23:04 transplants. Well, here is a stem cell, we will say 23:08 that this is a bone marrow and this is the 23:11 red bone marrow and this is the cortical bone. 23:14 The red bone marrow such as in ribs and in 23:17 the breast bone that kind or and other flat 23:21 bones, the skull, the hip bones. These are, this 23:26 red bone marrow is the place where these 23:29 grow. Then over here we have the line that 23:33 will form red blood cells. And here is a 23:35 mature red blood cell right here in this area. 23:40 Then we have what is called the granulocytes 23:43 and they develop from a stem cell, which can 23:46 develop in anyone of our blood cells. The 23:48 stem cell, this is a myeloblast and then 23:51 we have over here the neutrophils, the 23:53 eosinophils and the basophils. Eosinophils 23:58 are increased in number when we have allergies, 24:02 intestinal parasites very common thing to cause 24:07 a very high eosinophil count. Certain collagen 24:12 diseases can also cause a high eosinophil count. 24:16 The neutrophils are our first line of attacking 24:21 soldiers. They attack any germ that comes 24:26 into the body, any bacterium that comes into 24:28 the body and will also move into any kind of 24:32 inflammatory position. Then the basophils, we 24:36 don't know as much as we would certainly like 24:38 to know about basophils, but one of 24:41 the things that we have recognized in the 24:43 basophil line is that, when there is a cancer 24:46 in the body somewhere basophils can increase 24:51 in number. Then here are the monocytes. 24:54 These are also called macrophages they can, 24:58 they can also be called dendritic cells or a 25:01 macrophages, very excellent fighting cells 25:05 for us. All of these are good fighting cells. 25:08 Then the lymphocytes and one of there line 25:11 can make antibodies and plasma cells, which 25:16 we used to think didn't have any good reason 25:20 for being. Now, we know that they are the 25:22 part of the immune system and very 25:23 important for us. Then way over here we have 25:27 what is called a megakaryoblast. And 25:30 the megakaryocyte, which develops from 25:33 the megakaryoblast has also platelets. These 25:37 platelets have a very important part in our 25:42 clotting mechanism and in abnormal... in times 25:47 when there are abnormalities in the 25:49 body, an inflammation. These platelets can 25:52 become sticky and then they make a clot. If we 25:56 get a cut they can become sticky and 25:59 make a clot. Now, in the urinary tract, we 26:04 have some other problems that can be 26:07 very common in diabetics. So, now I 26:09 would like to just show you here is the adrenal, 26:12 here is the kidney, here is the cut surface of a 26:16 normal kidney and here is a dilation of the 26:20 kidney pelvis because of a, of an impaction of 26:26 a stone that has developed here in the 26:29 kidney pelvis and the top part of the ureters, 26:31 so this the ureter gets blocked by a stone and 26:35 we've a dilation of the ureter there. Here the 26:40 ureter comes down and empties into the bladder 26:43 and the bladder can have in the diabetic 26:47 may have cystitis or may even get a little 26:51 ulceration. Here we have a jack stone type 26:57 of stone in the bladder, which is not too 27:01 uncommon. And here we've stones in the 27:06 kidney. These stones, these kinds of stones, 27:10 but then this stone is called a staghorn 27:15 calculus. Now, staghorn calculus is 27:18 quite to find for the pathologist and I have 27:22 several in my collection of stones from various 27:26 parts of the body. Stones that require 27:29 a special license for prospecting for them 27:32 and so I try to hang on to them, they 27:35 are now called semi- precious stones. 27:38 Diabetics are more likely to produce stones 27:41 then others and I hope that by our going into 27:45 these things you can understand how 27:48 diabetics must protect themselves in many 27:50 ways, but by following a good lifestyle they 27:54 too can live normally. |
Revised 2014-12-17