Foluso A. Fakorede, MD

Foluso A. Fakorede, MD, received his medical degree from UMDNJ-Robert Wood Johnson Medical School in Camden, NJ. He completed his internship and residency at New York Presbyterian Weill Cornell Hospital and returned to New Jersey for a fellowship in cardiology, interventional cardiology, and endovascular intervention at Cooper University Hospital in Camden. Today, he is an expert at preventive cardiovascular management, women’s heart health, and catheter-based procedural focus in coronary atherosclerosis disease (CAD) and peripheral atherosclerosis disease. He has advanced technical skills in preventing amputations, and in 2015 he opened Cardiovascular Solutions of Central Mississippi in Cleveland, located in the Mississippi Delta. Dr Fakorede is a national advocate for ending health disparities in underserved communities.

As our health care system works to address the many disparities and inequities that Americans of color—particularly Black, Hispanic, and Native Americans—continue to face, there remains too little understanding of our nation’s amputation epidemic. Over the past 2 years, the pandemic has brought attention to the health disparities that continue to affect people from racial and ethnic minority groups. Although some policymakers encourage action through health education, early detection, and control of disease complication, the systematic inequities that result in unnecessary and senseless amputations must be addressed.

, due primarily to peripheral artery disease (PAD), an all-too-common complication of diabetes, kidney disease, and chronic hypertension. For the 20 million Americans living with PAD, it will become increasingly difficult for oxygen to reach the legs and feet due to plaque building up in a person’s arteries—unless the chronic condition is diagnosed and treated early. Without medical intervention, amputation will become the only option for a high number of individuals, many of whom don’t even find out they have PAD until it’s too late to save their limbs.

PAD-related amputation is a major crisis in communities of color. According to a landmark report by the Dartmouth Institute, Americans who identify as Black are 

 to have their limbs surgically removed than the national average. Take a ride with me through the South to my community in the Mississippi Delta and you’ll likely see 

 who have lost their legs to this chronic disease.

As you can imagine, amputations have a tremendous impact on patients’ lives. Not only does the loss of a leg or foot mean permanent disability, but it also makes it more difficult for individuals to work, get around, and do what they love. It is no surprise then that amputations can lead to 

high rates of chronic pain and depression

between 52% and 80% of patients with diabetes-related amputations die

 with access to timely care, amputation is a racial justice issue. Unfortunately, many patients don’t even know they have PAD until amputation became their only option. Even in metropolitan areas where access is theoretically better due to a higher number of providers, 

 shows that being Black is associated with higher rates of major lower limb amputations.

Not only is amputation a racial justice issue, but 

. Black females are the the group most likely to undergo amputation, and they have a higher risk for amputation compared with other women and with Black males. More Black females undergo amputation for PAD than males. Gender disparities reflect the combination of higher PAD prevalence and lower socioeconomic status, as well as the higher prevalence and differing impact of diabetes, chronic kidney disease, hypertension, and metabolic syndrome.

With too few patients being screened for PAD until it’s too late, Washington must act to correct the amputation epidemic.

Fortunately, Representative Donald Payne, Jr. (D-New Jersey) is spearheading a bipartisan effort to do just that. If passed, the 

 (H.R. 2631) would ensure Medicare and Medicaid both cover PAD screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care. It would also establish a PAD education program to better empower patients and providers with accurate information about the disease, as well as how they can get timely care before amputation becomes the only option.

Facing such a dire situation, communities of color need national healthcare solutions to ensure better healthcare access and outcomes—especially when it comes to the amputation epidemic. The time to highlight this issue is now. To help advance racial justice in medicine and reduce preventable amputations, it is time for Congress to pass the ARC Act.

Foluso Fakorede, MD, is CEO of Cardiovascular Solutions of Central Mississippi. He is a co-chair of the Association of Black Cardiologists’ PAD Task Force and an advocate for persons of color at risk of limb loss.

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The Amputation Reduction and Compassion Act (H.R. 2631) would ensure that Medicare and Medicaid both cover peripheral artery disease screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care. 

Contributor: Congress Must Act to Stop America’s Amputation Epidemic

With the holiday season fast approaching, most Americans are looking forward to feasting with family and friends and taking a much-needed break from work.

However, for over 30 million Americans living with diabetes and 84.1 million living with prediabetes, the consumption of unhealthy food and long periods of inactivity during the holiday season can make symptoms worse.  Diabetes is a public health crisis, costing $327 billion dollars per year, according to the most recent analysis from the American Diabetes Association. As many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue, according to a new analysis from the CDC.  Racial and ethnic minorities have a higher prevalence and greater burden compared with whites. Disparities in health and health care lead to higher rates of complications in minority populations. 

November is National Diabetes Month and is the perfect time to promote awareness of diabetes and diabetes-related complications so that, through awareness, we can prevent the suffering diabetes causes to ourselves, our families and our friends.   It is important for everyone to be aware of this disease and its complications.  

One important complication of diabetes is the development of atherosclerosis and peripheral arterial disease (PAD). Atherosclerosis is the hardening of our arteries and accumulation of fatty deposits in our arteries. Our arteries are delicate tubes that carry blood with oxygen and nutrients to all the parts of our bodies. There is no room for plaque! Plaque narrows these vessels and restricts blood flowing through them. If the narrowing is severe, the blood flow can become completely blocked causing a lack of blood to an affected body area, for example, the brain, the heart, the leg. If there is a lack of blood flow to any of these areas, the results can be devastating, especially if we do not recognize the symptoms in time to get help. A lack of blood flow to the heart can cause the death of heart muscle. If the brain is affected, a stroke can occur. If the legs are affected, this can lead to pain in the legs, poor healing of diabetic ulcers, gangrene, and eventual amputation.   

When atherosclerosis affects the limbs, this is called peripheral arterial disease, or PAD.  We know that PAD the one complication of diabetes that causes the most significant long-term disability and economic burden. It is estimated that 1 out of 3 people with diabetes 50 years of age or older has PAD, yet millions of people with diabetes don’t realize they are at risk for losing a limb until it is too late. Each year, approximately 200,000 non-traumatic amputations occur. African Americans are 4 times more likely to experience diabetes-related amputation than whites. In the United States, every 17 seconds someone is diagnosed with diabetes, and everyday 230 Americans with diabetes will suffer an amputation.  Throughout the world, it is estimated that every 30 seconds a leg is amputated.  And 85% of these amputations were the result of a diabetic foot ulcer.

Unfortunately, as the epidemics of diabetes and PAD worsen, people still don't recognize the symptoms.  Early detection and treatment of the PAD is crucial to saving limbs. With timely screening, in-depth assessment of symptoms and thorough physical examinations, millions of amputations could be prevented. Like cancer, PAD must be caught early and treated to prevent progression and suffering. It is often asymptomatic in the early stages, making ultrasound screenings a life-saving necessity.

As a limb salvage specialist, I am committed to educating and providing quality healthcare to prevent the loss of limbs. Early screening, diagnosis and intervention saves legs and thus preserves quality of life. More importantly, it saves lives, as 50% of diabetics who experience amputation will die within 2 years of the amputation. 

To help prevent complications from diabetes and PAD, it is important for everyone to manage this disease every day. A little physical activity goes a long way in soothing leg pain and keeping blood flowing to the legs and feet. Controlling blood sugars, knowing your glycated hemoglobin (A1C) number, and eating a well-balanced diabetic diet can significantly reduce the risks for PAD and amputations. By quitting smoking, individuals can reduce 6-fold their risks for PAD!

On a national scale, I recently joined a group of advocates in Washington, DC, to call on lawmakers to adopt a national strategy to increase public awareness of PAD. This distinguished group of advocates included both physicians and patients who have endured amputations, who had a shared mission to change policy to help prevent unnecessary limb loss. PAD advocates are asking the Trump administration to convene an intragovernmental workgroup to develop a standardized model for amputation reduction and to raise awareness on this critical issue.

Whether you feel pain in your legs or not, every diabetic should talk to their doctor about screening for PAD. Take your shoes off at every appointment with your doctor and learn how to exam your feet.  Take control of your health this November during National Diabetes Month. Doing so can literally save your limbs and your life.  

Foluso Fakorede, MD, is a practicing cardiologist and CEO of Cardiovascular Solutions of Central Mississippi as well as co-chair of the PAD Initiative for the Association of Black Cardiologists.

Atherosclerosis and peripheral artery disease are significant long-term complications of diabetes that demand more education and quality care to prevent limb loss. The conclusion of National Diabetes Month offers an opportunity to draw attention to ways to prevent these outcomes and screen for them early.

Foluso A. Fakorede, MD

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Contributor: Congress Must Act to Stop America’s Amputation Epidemic

Increasing Awareness This National Diabetes Month Can Save Limbs and Lives