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Published on August 27, 2019

Back in stride after losing part of his foot to gangrene

Foot Injury

Three years ago, Antone “Kip” Gaspar went into Falmouth Hospital with a gangrenous wound on his right foot. It was the beginning of a health journey that eventually led him to Cape Cod Healthcare’s wound care services and podiatrist Shawn Braunagel DPM, whom Gaspar calls “a miracle worker.”

Gaspar, 62, is an auto mechanic and self-described “jack of all trades” from Martha’s Vineyard who owns an auto repair business there. But he also owns a house in Falmouth, where he stays to avoid the complexities of island living. That turned out to be a lucky break when he developed an infection and gangrene in his right foot and went to Falmouth Hospital. There, he was diagnosed with type 2 diabetes, which can damage blood vessels and cause peripheral neuropathy or loss of sensation in the feet, legs, hands and arms. For patients with neuropathy, there’s a danger that a small injury or blister can go unnoticed and then get infected. If left untreated, infection can lead to gangrene – the death of body tissue. Gaspar’s foot was so damaged that part of it had to be amputated.

After surgery, Gaspar required trips to the Cape Cod Healthcare (CCHC) Wound Care Center in Bourne. Gaspar also developed a diabetic ulcer on his left foot, which also became infected.

That’s when he met Dr. Braunagel.

“He was all over me like a new suit,” Gaspar said. “He took me into surgery and did what he had to do to the [left] foot to get the infection out. Then – the [right] foot that hasn't healed in three years, he started working on that. That guy's a miracle worker, if you ask me, and he cares. Cape Cod Healthcare is lucky to have him, you know?”

Dr. Braunagel, who trained as a podiatrist at Beth Israel Deaconess Medical Center, works at Falmouth and Cape Cod hospitals as well as the CCHC Wound Care Centers in Hyannis and Bourne, and his own practice in Hyannis. While he appreciates Gaspar’s admiration, wound care really requires a team approach, he said. Among the goals is avoiding amputations such as Gaspar’s.

Podiatrists work with vascular surgery and infectious disease experts to stabilize wounds and treat them with surgery and sometimes intravenous antibiotics, he said. In Gaspar’s case, Dr. Braunagel worked with Cape Cod Healthcare vascular surgeons Lindsey M. Korepta, MD, RPVI, and James B. Knox, MD, FACS, RVT who helped improve blood flood to the foot and did a skin graft.

“You get vascular onboard, you get infectious disease on board, you get the Wound Care Center, and it comes down essentially to breaking it down to why he has the wound or why it’s there and why it’s not healing,” Dr. Braunagel said.

Four main factors affect how wounds heal, he said. Those include diabetes, pressure or irritation, infection, and restricted blood flow.

“If you can’t solve all those four variables, you’re not going to heal the wound,” he said.

And, as the diabetic population increases, the issues with wound care also increase, he said.

At least 100 million American adults are now living with diabetes or prediabetes, according to a 2017 report by the Centers for Disease Control and Prevention (CDC). Based on data from 2015, the report found there were 30.3 million Americans – 9.4 percent of the U.S. population – living with diabetes. Another 84.1 million had prediabetes, a condition that if not treated often leads to type 2 diabetes within five years.

Patients with diabetes often have neuropathy, which blocks sensations on the bottom of their feet. “It starts with small nerve fibers, and can spread, and ultimately they could step on a nail and not know they stepped on a nail,” Dr. Braunagel said.

Infection from even a callous or blister can happen quickly, he said.

“Routine foot care and monitoring is very important to help catch things before they get worse,” he said. “Because what happens is you go to bed one day, wake up the next morning, and your foot’s red, hot, warm, swollen and you’ve got a pus pocket.”

He suggests patients at risk use a handheld mirror to check their legs and feet, looking for changes, such as new callouses.

These days, Gaspar gets treatment for his diabetes, continues to visit the Wound Care Center and is working on getting a filler for his right shoe. After three years and some discouraging moments, he’s optimistic about getting back on his feet. While he credits much of his progress to Dr. Braunagel, he says he’s made some changes.

“Yeah. I want to stay good with this diabetes,” he said. “It slapped me. You can live with it, no problem. Just you behave, you know what I mean?”