New L+M program aims to help patients facing amputation

Dr. Robert Attaran and patient William Beebe of Groton shake hands after discussing his discharge instructions and follow-up information after having a procedure done at the office of the Limb Preservation Program at the Lawerence + Memorial Pequot Health Center in Groton on Thursday, Feb. 15, 2018.  (Dana Jensen/The Day)
Dr. Robert Attaran and patient William Beebe of Groton shake hands after discussing his discharge instructions and follow-up information after having a procedure done at the office of the Limb Preservation Program at the Lawerence + Memorial Pequot Health Center in Groton on Thursday, Feb. 15, 2018. (Dana Jensen/The Day)

A new program at Lawrence + Memorial Hospital, aimed at helping people at risk of losing a limb to amputation, is taking shape.

About 40 patients in the New London area are now seeing a team of doctors from multiple specialties who assemble at L+M’s Pequot Health Center in Groton once a week to treat patients with foot or leg wounds that come with complications from diabetes or vascular diseases.

The L+M program assembled a team of podiatrists, radiologists, cardiologists, surgeons and internal medicine specialists from across the Yale New Haven Health System who began seeing patients in Groton in November.

It reflects a more collaborative approach to caring for hard-to-treat wounds common in people with blood circulation disorders or diabetes that, if left untreated, can often require doctors to amputate a limb, said Dr. Carlos Mena, a Yale-New Haven cardiologist co-directing the program.

A patient with diabetes or hypertension who got a cut on their foot wouldn’t heal as quickly, and may have to see multiple doctors in more than one location to get it treated early enough to avoid amputation, Mena said.

“Each one of them would treat the illness in a different fashion,” he said.

The L+M program is modeled after the limb preservation system at Yale, which Mena said improved communication between doctors and allowed them to treat each patient with one common approach.

“Yale is a place where there is expertise in every single field,” he said. "The problem sometimes in an environment like that is that many of those (doctors) work in silos. Even though the expertise was there, the lack of communication between the specialties was a problem. The care that the patient was getting was disjointed.

“In a program like this,” he said, “all those barriers are taken down."

Helping people with diabetes or vascular disease treat their pain or tissue damage before amputation is necessary can mean the difference between a patient having to leave their job and the ability to continue working, Mena said.

"There's the economic impact of it, there's the social impact — (not only) for society but also for the individual," said Mena, who co-directs the program with Yale New Haven Hospital podiatrist Peter Blume. "Think of a guy who's 50 years old who supports a family, who suddenly loses his limb and no longer can work. On an individual basis, you just affected that family in a dramatic fashion. (On a) societal basis, that guy who is no longer working is now lost to the workforce."

Groton, surrounded by relatively high populations of black, Hispanic and low-income residents, was a logical place to locate an offshoot of the Yale New Haven Hospital limb preservation program, Mena said.

"Connecticut is a small state, and it's not homogeneous in the way they take care of themselves," he said. "There are certain pockets where the prevalence of the risk factors ... is higher. When you look a the incidence of amputation, it's higher in this part of the state than in other areas."

A 2016 state Department of Public Health report based on 2013 data showed that black and Hispanic Connecticut residents were admitted to the hospital for diabetes and diabetes-related amputations at higher rates than white residents.

Citing a Medicare study that showed amputations can cost the national economy $10 billion to $20 billion a year, Mena said helping people avoid amputations can save money for both the patient and the hospital system, as well as the economy at large.

The Department of Public Health report calculated that amputations for diabetes patients generated $71.7 million in hospital bills in Connecticut in 2013.

“From the financial point of view, the impact is huge,” Mena said.

The program is meant both for patients who might be seeing a doctor for the first time for their disease and those that want the convenience of seeing Yale doctors — now available to L+M patients since the hospital affiliated with the Yale New Haven Health system last year — closer to home.

“There are patients that have never seen a provider before and have had a long-lasting wound, and suddenly they realize it’s a problem,” Mena said. “The other end of the spectrum is someone that has already been seen by providers, has already been in the system, has had angiograms ... and all these other procedures, and knows that the level of expertise is such that coming to a place like this makes sense."

m.shanahan@theday.com

Dr. Carlos Mena, co-director of the Yale New Haven Limb Preservation Program, talks about the program while standing in the exam treatment area in the office of the Limb Preservation Program at the Lawerence + Memorial Pequot Health Center in Groton on Thursday, Feb. 15, 2018.  (Dana Jensen/The Day)
Dr. Carlos Mena, co-director of the Yale New Haven Limb Preservation Program, talks about the program while standing in the exam treatment area in the office of the Limb Preservation Program at the Lawerence + Memorial Pequot Health Center in Groton on Thursday, Feb. 15, 2018. (Dana Jensen/The Day)

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