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Thursday, Mar 28, 2024

Dr. George Andros

At a time of enormous change and uncertainty for the health care industry, the San Fernando Valley region is home to many who are embracing the challenges boldly with new ideas and fresh vision. The 10 innovators profiled in the following pages are emblematic of the important work performed by health care workers every day. They are working to improve care and lower costs — and answer the urgent need for a better health care system. Every 20 seconds, someone with diabetes loses a limb. Reducing those shocking figures is the goal of the Amputation Prevention Center, the two-year-old project of longtime Valley vascular surgeon Dr. George Andros, who fought for the center for many years before Valley Presbyterian Hospital helped him realize his dream and built him a 4,000-square-foot center with 22 beds in 2008. Since opening, the center has helped nearly 500 patients keep their foot. Dr. Andros does this by treating an ulcer of the foot, or a leg that’s lost much of the circulation, as if it was a heart attack. Other doctors often see a diabetic with a foot ulcer and send the patient home with antibiotics. When the patient comes back a month later, they get more of the same. A month later, when the foot is infected and is developing gangrene, they may try cutting away the dead tissue. After another month, they may call in an infectious disease specialist or a plastic surgeon. “It’s delay, delay, delay and it’s a huge problem,” Dr. Andros said. “Diabetic foot ulcers are under-diagnosed and under-treated.” And the outcome is usually amputation, he said. In the U.S., nearly 100,000 diabetics lose a foot every year; worldwide, the figure is 1.5 million, he said. Dr. Andros does things differently. The secret is a coordinated, team-approach that includes a vascular surgeon, a vascular specialist and a diabetic podiatrist. Between the three specialists, patients are quickly diagnosed. If the problem is poor circulation, Dr. Andros performs a bypass or an angioplasty, much the way a heart attack would be treated. If the problem is ulcers, the podiatrist takes over with a plan to heal the wound or perform foot surgery. The integrated approach leads to faster healing and the prevention of amputation. Some 95 percent of patients treated at the center keep their foot, compared to 80 percent of those who are treated at academic medical centers, Dr. Andros said. When his patients go home, it is by foot, not wheelchair. That’s because a rehabilitation center adjacent to the hospital makes sure that patients are healed and walking before they are finally discharged, Dr. Andros said. If they walk, they are more likely to remain active, and if they remain active, they are more likely to live. By contrast, half of patients who lose their leg die within two years, Dr. Andros said. For all the work the center has done, Dr. Andros says most area hospitals turned him down when he floated the idea of opening an amputation prevention center. Vascular surgery, when not done right, can be a drain on hospital resources and profits, and the idea of a center focused on this specialty did not appeal to many facilities. “They didn’t have the will or vision,” Dr. Andros said. Valley Presbyterian recognized the potential. The center is now one of only a handful of such centers in the country. The others are housed at academic medical centers, not community hospitals like Valley Presbyterian. Dr. Andros, who had one of the largest vascular surgery practices in the country, came to the idea of opening an amputation prevention center after discovering that so many of his patients were diabetics. “I kept doing more complicated procedures and each one took me further down the body,” he said. “When I finally got to the foot, I realized almost all my patients were diabetics.” When he started to investigate the statistics, he grew alarmed. One-third of Americans are either diabetic or pre-diabetic, according to the American Diabetes Association. Treating them eats up more than 20 percent of all federal health care dollars. Among Valley residents, the problem is even bigger. Latino Americans, who make up a significant part of the Valley’s population, are 1.7 times more likely to develop diabetes. Most vascular surgeons shy away from the field of caring for diabetics. “It’s not sexy,” Dr. Andros said. “But it’s important work, and I wanted to work on something important.”

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