In November 2015, Steve, from Rockingham in Western Australia, became one of the 4,400 Australians who underwent a diabetes-related amputation.

While that was tough the worst, or so it seemed, was still to come.

Earlier this year escalating problems on his other foot seemed to be leading towards a second below-the-knee amputation, and life in a wheelchair, but thanks to the excellent healthcare provided by Dr Carsten Ritter, Steve is still able to enjoy many of the things he loves including spending time with his two children and getting out and about in his caravan.

We asked Stephen to talk us through his journey.

“It all started in 1997. I was lying in bed when I heard noise outside,” Stephen said.

“I bolted outside, in my underwear, and there were a couple of kids breaking into my car. I managed to scare them off but, in the process, I stepped on some of the glass from my smashed windshield.

“And that’s where it all started. I thought I’d gotten all of the glass out of my foot but it actually took three years to find it all. When you have type 1 diabetes, something like that can be serious. Eleven operations to remove dead tissue and loss of one-and-a-half toes removed later, I thought that was the end of it.

“Fast forward eight years and I was helping my boss move this massive desk. Then I did the thing you’re not supposed to do and dropped it on my little toe. There goes another one. But, after that, all things considered, everything going great. I’d even got the hang of my prosthetic right leg.

“Then this year, as if my feet hadn’t been through enough, some skin split open on my foot around the old scar tissue. It was healing okay until it wasn’t. I got an infection and with the calcified arteries and reduced circulation in the foot it wasn’t looking promising.

“The doctors started talking about another amputation – not just toes, but the whole foot. But the infection was rampant and the doctors were concerned about how I’d manage an operation and then I was diagnosed with heart failure.

“It seems like 38 years of living with type 1 diabetes were all adding up.”

But things were about to take a turn for the better thanks to a timely intervention from Dr Carsten Ritter, a specialist vascular surgeon at Western Australia’s Fiona Stanley Hospital.

“The initial plan was to send me home, get rid of the infection and use medication to strengthen my heart. That all changed after talking to Carsten who developed a plan that would see me undergo three procedures,” he said.  

“First, he removed all the infected tissue and old scar tissue from the foot including another one-and-a-half toes. All that was left was my big toe.

“The second part was heart surgery to replace the calcified vessels suppling the heart with veins taken from my right forearm.

“Finally, I was ready for revascularisation. This involves taking a vein from the leg, turning it upside down and then re-attaching it and connecting it down into the foot to get the blood supply going down to the foot.

“It’s called a fem-pop bypass. It is not a common option, but the alternative was far worse.”

Steve says it is hard to overstate how important the operation has to been to his life.  

“Look I’ve lost one leg from below the knee which was bad enough but if I’d have lost the second one the consequences would have been huge,” Steve said.

“I would have had to give up work and move back to New Zealand. I still like camping and caravanning so all of that would have been off the table. It’s almost too horrible to contemplate.

“I can’t emphasise enough how important Carsten’s surgery has been to me. It’s given me a shot at a normal future. To continue working, more time with the kids, going to the gym more time doing what I love.”

Steve has a simple message for other people with diabetes.

“Get a second opinion. Different health professionals have different skill sets and different ideas on how to manage problems,” he said.

“If you’re not happy with a diagnosis see who else you can talk to. Diabetes research has come so far that there might be something another specialist can do to help you.

“Ringing the team at Fiona Stanley was the best phone call I ever made.”

4,400 reasons – Kevin’s story

Monopoli is a small city in Perugia in the south of Italy looking out over the azure blue of the Adriatic Sea. It was a peaceful spot for Kevin Towers-Hammond and his wife to while away a couple of weeks at the end of a European holiday of a lifetime.

But it was also almost the beginning of a nightmare.

“Monopoli is a beautiful place. Blue fishing boats in a blue harbour. The kind of place you dream about but then at some point or another I must have kicked or cut my toe because a little abrasion developed,” Kevin says.

“We tried to treat it with some cream we got from a local pharmacy but things weren’t getting better and the little abrasion turned into an infected ulcer.

“Look I’ve lived with type 2 diabetes for 15 years and my father died at 57 of heart issues, which I suspect was a result of diabetes, so I was aware of the seriousness, but I wasn’t sure what came next. 

“It was scary. I’ve got 10 grandkids and I’ve got grand plans to spend my retirement with them, but that all threatened to unravel. When I came back to Australia my GP referred me to a podiatrist.  I was prescribed antibiotics but the situation rapidly deteriorated as the infection had spread to the bone.  

“I was admitted to Fiona Stanley and thankfully under the care of a brilliant vascular surgeon, Dr Carsten Ritter, who inserted seven stents into my infected leg.  He diagnosed severe atherosclerosis, common to people with type 2 diabetes, which had to be repaired to get circulation to my foot in order for it to heal.  I then had my toe amputated to stop the infection.

“So, Dr Ritter was able to put the stents in the arteries in my legs which helped to get the blood flowing down into my foot.

“Without that circulation my foot problems were likely to keep getting worse which would lead to my leg being amputated.”

For Kevin, who enjoyed a successful career in wine tourism, an amputation would have spelt the end of many of his retirement dreams.

“The thought of losing a leg was terrifying. For one I live in a two-storey house. We would have been packing that up and moving. And then there are just the huge implications it would have on my entire lifestyle. The grandchildren are scattered all across the state. We drive to visit them so that would have been off the table.

“I mean I’m not long back from visiting my son up in Kalbarri on the mid-north coast of West Australia. It’s a beautiful spot by the sea. He’s up there with his three kids.

“We went out to Murchison Gorge to the Skywalk. Absolutely spectacular. Like the Grand Canyon but not as grand,” he laughs. “Seriously though I couldn’t have driven up there if I’d had a serious amputation and, secondly, if I could have gotten up there I couldn’t have done the things I enjoyed doing. It would have really meant a quite different retirement to the one my wife and I had planned.”

But Kevin has some important advice for people with diabetes.

“First thing, is to stay on top of your diabetes management and that includes looking after your feet. See a podiatrist regularly and if problems are escalating make sure you get a second opinion.

“There are treatments and therapies out there that might be able to help you, even if the situation is looking grim.  As part of my recuperation Dr Ritter referred me to the Hyperbaric Chamber Unit at Fiona Stanley.  I attended for 40 days of treatment which I believe was the reason my outcome has been so positive.”