A type 1 diabetes diagnosis used to come with a countdown. Dr Dwight Baker was fifteen in 1966, with no finger sticks, no A1C, no insulin pumps, and no continuous glucose monitors, yet he was told he could still outlive the odds if he committed to tight control. Sixty years on, he is 75, active, and free from the major complications many people fear, and he joins us to explain exactly what he did, what he learned, and what he wishes every newly diagnosed person understood from day one.
We get into the real mechanics of long-term diabetes management: why diet remains the foundation, how to think about exercise and hypoglycaemia, and where modern tools like CGMs and automated insulin delivery can genuinely change outcomes when they sit on top of solid habits. We also clear up confusion around type 1 versus type 2 diabetes and why the distinction matters for education, expectations, and day-to-day decisions. If you care about improving A1C, reducing complications, and building routines that last decades, this conversation is packed with grounded guidance.
Dr Baker also shares his career journey through general, vascular, and plastic surgery before moving into wound care medicine, where he treats diabetic foot ulcers and venous stasis ulcers and sees how quickly small problems become limb-threatening when people delay care. We talk about the biggest barriers to healing, the role of compliance, footwear, elevation, compression stockings, and the hard truth of socioeconomic constraints that stop patients doing what they already know they should do. He finishes with a forward-looking take on stem cells and regenerative approaches, informed by his experience with fat grafting in plastic surgery.
If this perspective helps you, subscribe for more clinically grounded conversations, share the episode with someone managing diabetes or chronic wounds, and leave a review so more listeners can find us. What is the one habit you think makes the biggest difference over 10 years?
Guest Biography
Dr Dwight Baker, MD, FACS is a Mayo Clinic-trained, board-certified plastic surgeon with more than four decades of experience spanning general surgery, vascular surgery, plastic and reconstructive surgery, cosmetic surgery and wound care. Throughout his distinguished career, he has dedicated himself to improving patient outcomes through both surgical excellence and compassionate, evidence-based care.
Diagnosed with Type 1 diabetes at just 15 years old, Dr Baker was told his long-term outlook was poor. Nearly 60 years later, he remains free from the major complications of diabetes—a testament to his unwavering commitment to tight glucose control, healthy lifestyle habits and patient discipline. His unique perspective as both physician and lifelong patient brings exceptional insight into chronic disease management and preventative healthcare.
After completing his medical degree at the University of South Alabama College of Medicine, Dr Baker trained in General and Vascular Surgery before returning to the Mayo Clinic to complete a residency in Plastic and Reconstructive Surgery. He spent more than 25 years specialising in breast reconstruction and cosmetic surgery before transitioning into wound care, where he now focuses on helping patients with complex wounds, diabetic foot ulcers and limb preservation.
Beyond clinical practice, Dr Baker is passionate about mentoring, medical consulting and advancing the future of wound healing. His interests include stem cell therapies, patient education and improving long-term outcomes through lifestyle medicine and preventative care.
Connect with Dr Dwight Baker
- LinkedIn: linkedin.com/in/dwight-baker-md-821b5733
- MD Legal Consulting of the Southeast: SEAK Expert Profile
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Voices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.
About Dr Andrew Greenland
UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functiona
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Dr Andrew Greenland (00:00):
So welcome back to Voices in Health and
Wellness.
I'm your host, Dr.
Andrew Greenland, and today I'mjoined by Dr.
Dwight Baker, a physician whosestory is remarkable from both a
professional and personalperspective.
Dr.
Baker has spent four decades insurgery, including careers in
general, vascular and plasticsurgery before transitioning
into wound care medicine.
But what makes his perspectiveespecially unique is that he's
(00:21):
also lived with type 1 diabetesfor nearly 60 years.
When diagnosed as a teenager in1966, he was given a
dramatically different outlookthan the one he's living today.
Now, six decades later, heremains active, healthy, and
free from many of thecomplications commonly
associated with diabetes.
And so today we're going toexplore what he's learned both
as a physician and a patient,the principles that have guided
(00:43):
his health journey, and howthose same principles influence
the way he cares for patientstoday.
So with that right, I'd love towelcome you to the show and
thank you so much for joining metoday.
Dr Dwight Baker (00:51):
Thank you.
Pleasure to be here.
Dr Andrew Greenland (00:54):
So perhaps we could start a little bit with
your journey.
Take us back to 1966, if youwill, and tell us what it was
like being diagnosed with type 1diabetes at the age of 15.
Dr Dwight Baker (01:06):
Well, at age 15, I was a, I guess you'd say,
a fairly typical um adolescentteenager.
And um I started losing weight,drinking a lot of water, and
urinating a lot.
And uh my mother said, uh, weneed to get you to the doctor.
So at the end of the schoolyear, she took me in and he
(01:30):
scheduled me to come back a fewdays later for a fasting blood
sugar and a two-hourpost-prandial.
This was 1966.
There were no finger sticks,there were no A1Cs, there were
no insulin pumps, there were nocontinuous uh glucose monitors,
(01:50):
um, and the outlook with adiagnosis of type 1 diabetes at
age 15 was not very good.
At any rate, I went back in,had the blood sugars done, had
was diagnosed, and uh this was adiagnosis made by my family
physician who birthed me andtook my tonsils out when I was
(02:12):
four and fixed my broken bonesuntil I was 15.
And he said, I'm gonna, he hadtears in his eyes.
He said, I'm gonna refer you toan internist in Montgomery,
Alabama, which was near ourhome.
Well, about two-hour drive.
And um, he's very strict, andthat's what you need at age 15.
(02:32):
He's 65 years old, has had type1 diabetes for 20 years
himself.
And he's I've sent other peopleto him that were like you, and
they've done well.
So the next day I was inMontgomery and met this
physician who um impressed mewhen I was 15 years old that uh
(02:53):
he just seemed so brilliant andso professional, and that was so
impressive to me.
And um, I can't really on thispodcast quote everything he said
the way he said it, uh, becausehe he was very pretty
aggressive and vulgar in hisapproach to me, but he wanted to
(03:15):
establish a relationship of umhe was in charge and he was
going to be very disciplined inmy care.
And um for that today I'mextremely appreciative.
Um, but during that visit, healso looked at my year-end
report card that my mother hadbrought in, and I had all A's
(03:36):
and Latin and everything andalgebra, and he looked at those
and listed them all, and hesaid, Well, what are you gonna
do when you grow up, young man?
And I said, Well, I want to bea mechanical engineer, and I'd
like to go to Georgia Tech orAuburn to be become a mechanical
engineer, and he looked down atme and he said, No, you're not,
you're going into medicine.
I was 15 years old.
(03:57):
Well, he set me a fire and Idedicated my life to medicine
and health care ever since thatday.
Um, but also during that time,I heard from other physicians
that my outlook was not goodwith type 1 diabetes at age uh
15.
At that time, if you werediagnosed with type 1 diabetes,
(04:20):
you had a life expectancy ofanother 20 to 30 years maximum
if you did well.
And at that time, there wasvery much uh there was a lot of
controversy about whether typecontrol of type 1 diabetes made
any difference in preventinglong-term complications such as
(04:40):
blindness from retinopathy,amputations, renal failure, and
heart disease.
Um but one physician, only onephysician, only one physician
gave me any hope.
And this was this mean doctorwho I was sent to when he took
over my care.
Um, he was only one, and hesaid, if you do every blanky
(05:03):
blank thing exactly like I had ablanky blank tell you, you'll
live a longer, healthier lifethan a normal human being
without diabetes.
So 60 years later, here I am atage 75, with no complications
anyone can find, by myophthalmologist, who's a retina
specialist, and by mycardiologist, who's excellent,
(05:25):
um, and my general physician.
I I don't have anycomplications from type 1
diabetes.
I have an A1C of less than7.0%, um, and I've kept it that
way.
And um type control has kept megoing.
And it was in 1992, I think,when the first results of a
(05:49):
long-term study being done todetermine whether type 1
diabetes complicated long-termcomplications of type 1 diabetes
were prevented by type controlof diabetes, and they pulled the
results and showed that ifyou're under tight control for
the first 10 years afterdiagnosis, you will not have the
(06:10):
long-term complications such asamputation and blindness and
heart disease and and uh kidneydisease.
And it so happens that I wentto this first physician who I
look at as my savior, um, forexactly 10 years almost to the
day after I was diagnosed.
(06:32):
So that's my background abouttype 1 diabetes, and um I'm
thankful for every day I liveand thankful for my healthy um
uh health help help that I have,and um and I realized that why
I have such health is thisphysician who took care of me
(06:54):
initially for the first 10 yearspreached that type control was
achieved first and foremost bydiet control.
He taught diet himself, hedidn't leave it to a dietitian
or a nurse, he taught everythinghimself, he didn't trust anyone
else at that time.
(07:14):
And um, I look back today, andhe was so far ahead of his time
in his thinking and in hisknowledge about uh diabetes and
diabetes care.
Dr Andrew Greenland (07:26):
Such an amazing and inspiring story.
Thank you for sharing.
So, this obviously going backto 1966, um, and you've
mentioned a lot about himtalking about tight control.
What did that look like at theage of 15 in terms of you know
your day-to-day?
How did you maintain this tightcontrol from the advice you
were given way back then?
Dr Dwight Baker (07:46):
The desire to beat the odds, the desire to
prove people wrong that tightcontrol could prevent
complications, plus, it was onlyhope I had tight control.
So, you know, it's a very goodquestion to ask me because uh
(08:06):
why was I why did I behave thatway at age 15?
Uh I wasn't for I wasn'tafraid, I wasn't afraid of this
physician.
Um, I had tremendous respectfor the physician, and uh he was
the only one who gave me hope.
So I listened to his every wordand live by it, and it's paid
(08:29):
off.
Dr Andrew Greenland (08:31):
Thank you.
So if somebody knew was newlydiagnosed with type 1 diabetes
today in 2026, what advice wouldyou give them?
I mean, is it the the sameadvice you were given way back
then, or is it kind of morphedinto something else for 2026?
Where do you stand on this?
Dr Dwight Baker (08:47):
Well, I would first emphasize to them that
diet is the best way, the firstand foremost way to control
diabetes.
Um and then I would direct themto the latest um tech
technologies we have forcontrolling diabetes, which
includes the um automatedinsulin delivery pops, the um
(09:11):
continuous glucose monitors,CGMs, and the um and I would
also emphasize that exercise isimportant.
You know, it's very interestingthat the uh internist who took
care of me in the first 10years, who's my hero and who
guided me into medicine,directed me into medicine, and
(09:34):
took care of me and the reasonI'm here today, did not believe
in exercise.
He thought it was wayoverblown.
And I cannot tell you how oftenI experienced hypoglycemia and
still do, but not nearly so muchnow that we have the new
technologies, because I refuseto believe him about the
(09:55):
exercise portion.
I enjoyed exercise, enjoyedplaying tennis at that time, and
I did a lot of running andjogging um for a long time, but
don't now, and um I learned howto live with hypoglycemia.
But the the newly diagnosedtype ones today, of course, it
(10:17):
depends on the age as to what Iwould tell them, but I would
certainly emphasize to them thatdiet is the reason I'm here.
Diet is critically the is thecritical basis for control of
type 1 and type 2 diabetes, andum and then I would explain to
them how they're blessed todayto have all these newer
(10:37):
technologies, particularly theautomated insulin delivery uh
systems that are available.
Dr Andrew Greenland (10:46):
So, what misconceptions do patients
commonly have about managing achronic disease such as diabetes
in your experience?
Would you repeat that question?
So, yeah, what whatmisconceptions do patients
commonly have about managing achronic disease such as
diabetes?
Dr Dwight Baker (11:02):
Well, you know, the honest truth is I'm a
surgeon.
I don't directly take care ofpatients with type 1 or type 2
diabetes, although I've been uhpracticing wound care for the
past six years.
Also I run into a lot ofdiabetic patients who are mostly
type 2s who are mostly adults.
(11:24):
I think back to the time when Iwas 15 years old, even though
15 is um being younger couldhelp in a lot of ways.
Um I think today that if I wasdiagnosed with type 1 diabetes
at age 40 or 50 or 60, which isfairly unusual, or even type 2,
(11:47):
it would be more much moredifficult for me to become
compliant with diet and managingmy diabetes.
So I have a degree of empathyand sympathy for patients who I
see today in the wound careclinic who have the diabetic
foot ulcers and the poor controland are not compliant.
(12:11):
And I get on to them a bitabout compliance, but not too
heavily because I think aboutthe fact that if I were
diagnosed at their age insteadof when I was diagnosed, I would
not have the same habitsingrained in me that have helped
me be healthy andcomplication-free.
Um, so when you ask thatquestion, it's an open-ending
(12:35):
question, that opens up a lot ofdifferent areas because it
depends on when the patient wasdiagnosed and whether we're
diagnosed with type one and typetwo.
A lot of people don't realizethe big difference between type
one and type two.
And type type one is anautoimmune disease, as we found
out.
They didn't know that at thetime when I was diagnosed.
(12:57):
And type two is a is uh relatedto um some people call it
metabolic syndrome and uh poorhealth habits.
Dr Andrew Greenland (13:11):
Thank you.
So you've been talking a lotabout your personal journey, but
could you maybe talk a littlebit more about your professional
journey and what drew you intoall of this?
I know your inspiration was theintern who obviously had an
early contact with, but whatabout um you know general
surgery and then later plasticsurgery?
Talk us about your inspirationand choice to go into those
(13:33):
particular specialities.
Dr Dwight Baker (13:36):
Well, um I'm not sure what led me.
I am sure what led me intogeneral surgery.
I love to work with my handsand I'll and I um felt like I
could best help people as asurgeon.
Um also at the time when Ichose to go into general
(13:59):
surgery, I was thinking aboutgoing back to my small hometown
of 5000 in East Central Alabama,um, and being a I wanted to be
a physician to everyone andhandle all the problems.
Um probably I wanted to doeverything except deliver
babies.
And um, and to do that, I feltlike I had to be a general
(14:21):
surgeon first.
And and and frankly, along theway, being a physician and a
type one diabetic has led me toread a lot of different uh
medical articles outside of thesurgical realm, which has helped
balance me and I think helpedme become a better physician
overall.
But um uh I started out ingeneral surgery somewhat with
(14:46):
that idea, and along the way, Iwas during my training um
introduced more to vascularsurgery, so I did general lamb
vascular surgery when Ipracticed.
During the nine years Ipracticed general surgery and
vascular surgery, I also tookcare of a lot of ladies with
(15:07):
breast lumps and breast cancer.
And um this was in the late1980s.
The plastic surgeons at thattime were coming up with ways to
reconstruct the breast and alady after she'd been treated
with breast cancer with a masssurgical mastectomy, and that
(15:27):
fascinated me.
Um, and I'd always been told inmy general surgery training
that I needed to go on and dosomething more than be a general
surgeon, I need tosubspecialize.
So I went back to the MayoClinic in 1991, the Mayo Clinic
in Rochester, Minnesota, and dida two-year plastic and
(15:48):
reconstructive residency uh tobecome a plat, a board certified
plastic surgeon.
And when I came out my firstfive years, we did I was in with
two others, and we did umeverything in plastic surgery.
We did reconstructions, we didhand surgery, did we did finger
(16:08):
replants, we did um free flapsat that time, and um as well as
uh cosmetic procedures.
And slowly over about fiveyears, I evolved into a cosmetic
breast surgeon for the so thelast 20, 20, 23, 24 years of my
(16:30):
28 years as a plastic surgeon.
I was doing a lot of cosmeticsurgery, particularly cosmetic
surgery, the breast and thebody.
And then along came thebariatric surgery for weight
loss, and now the um medicationsfor weight loss.
(16:52):
So an awful lot of people cometo the plastic surgeon for
renovation of their body aftermassive weight loss.
So that was coming along as Iretired from the operating room
and just devoted my time towound care a few years ago.
But I'd say that breast cancerand reconstruction after breast
(17:17):
cancer is what enticed me tomake that major change from
general surgery to plasticsurgery, and I'd never regret
it.
I've loved every minute of it.
The reconstructive and the andthe cosmetic part.
Thank you.
Dr Andrew Greenland (17:31):
This was I'm curious about the sort of
transitions in the differentphases of your career, and I
didn't quite get what was itthat drew you to wound care
rather than just retiringcompletely.
What was the kind of switch foryou at that point after having
done various different umspecialisms within surgery to
make that final choice intowound care?
Dr Dwight Baker (17:49):
Well, I also um as a youngster growing up, the
physicians were all general,generals, general medicine
doctors, general generalpractitioners, what we call
them, and that evolved intofamily practice.
And um, that's another reason Iwent into surgery, is when they
(18:11):
started talking about familypractice and changing the course
of from general practice tofamily practice, the courses
were um, I was just didn't uminterest me.
Um but I always looked atmyself as a physician first,
(18:34):
surgeon second, a plasticsurgeon third, and uh still do.
And uh I looked at um the timewhen I was retiring from surgery
and thinking I don't know, I'mnot ready to quit taking care of
patients.
This is my life, I'm dedicatedto this.
I want to do this as long as uhGod will allow me to do so.
(18:57):
And what can I do?
And uh my wife turned to me oneevening and said, You know,
you'd be really good at woundcare.
I've always thought you'd begood at wound care.
And I had two uh mentors a fewyears older than me that I
looked up to in my residency andin my practice.
(19:17):
One was an infectious diseasespecialist, and one was a
general surgeon, who was mypartner in general surgery
before I went back to plasticsurgery.
And they both said, and theywere leaders in the field of
wound care in my home state ofAlabama, and they both said
you'd be great at wound care,and that's what you ought to do.
So that's what I've done.
I look at wound care as primarycare for a surgeon, and um, as
(19:43):
a surgeon, I always took care ofwounds, and I feel like um
that's where I belonged at thisstage of my life, so that's
where I'm at.
And the other reason is becauseof having diabetes, I can't
open my shingle and say, Hey,I'm an endocrinologist, I know
how to take care of yourdiabetes, although I may be able
to practically tell people moreabout the day-to-day ways of
(20:05):
taking care of themselves andhelp them.
How can I do that?
And I can do that wound carebecause a lot of what I see in
wound care is diabetic feet,diabetic foot ulcers, a
complication of diabetes.
So that's how I got into woundcare.
And frankly, I quite well enjoythat too.
Dr Andrew Greenland (20:28):
Amazing.
So, what does your practicelook like at the moment?
Tell us a bit about your kindof your typical week.
Who are you seeing?
What are you dealing with?
What where are you operatingfrom or working from?
Just tell us a bit about yourpractice.
Dr Dwight Baker (20:41):
Well, currently I am not seeing patients.
I'm medical directorcollaborator from nurse
practitioners in the wound carecenter where I work, but I took
some time off for some um hips,I had to have a hip replacement
and recover from that.
So um, I haven't been seeingpatients in the last three or
(21:04):
four months, but in wound careI've been seeing um mostly
diabetic foot ulcers and venostasis ulcers.
Uh everything else was kind oflike uh surgical wound
complications, which with myexperience as a surgeon, I knew
(21:26):
what to do.
And uh but a lot of diabeticfoot ulcers and a lot of venous
stasis ulcers.
Dr Andrew Greenland (21:33):
Thank you.
So, on the subject of wound carethat you've just been talking
about, how much of successfulwound healing comes down to
lifestyle factors, in youropinion?
Dr Dwight Baker (21:45):
I would say 90 to 95%.
Um yeah, um, I look atlifestyle as um Tight control of
diabetes.
Following a diet that controlsyour diabetes and taking the
(22:07):
medications.
To me, that's lifestyle.
Being active is lifestyle sothat you're not overweight.
Venostasis ulcers are a bitdifferent in many ways, but in a
(22:33):
lot of ways the same.
And the the as you remember theum the the um vein veins have
(22:59):
valves in the lower extremitiesto help avoid blood backflowing,
and uh venous stasis ulcersoccur from the backflow of blood
basically.
So um that's a lifestylesituation, but people don't
realize that when they'reworking every day for 40-50
years on their feet.
(23:20):
Um, and those who worecompression stockings or elastic
stockings to try to avoid theirswelling of their feet and legs
are the ones who have lessVenus ulcers.
Dr Andrew Greenland (23:35):
Um on that point, I was just gonna talk
about surgeons because we allknow surgeons are standing up
for much of the time.
Um, did any of that um you sortof do anything preventatively
during your many years ofstanding up operating?
Dr Dwight Baker (23:49):
When I went back to do plastic surgery, I
learned to start wearing uhcompression holes or jotes, uh I
wore jotes, elastic stockingsthat were uh of good quality,
excellent quality.
And um I've worn those as awound care doctor over the last
six years, even though I'm notstanding in an operating room.
(24:11):
I do a lot of standing.
Um I do more walking now than Idid as a uh surgeon.
Um it's funny, my orthopaedicsurgeon, who I actually I've
known since he was in highschool, I went to him in
Birmingham, looked at me, helooked at the x-rays, and he
(24:33):
said, You won your joint outstanding in the operating room
all those years.
Um, but I don't have muchvenous problem.
It's because I wore thosestockings for for many years,
for many years.
Dr Andrew Greenland (24:50):
So um on the on the whole thing of wound
care, then what are some of thebiggest barriers that prevent
patients from healing?
You've talked about some of thepreventative things, some of
the lifestyle things, but arethere any if anything anything
else which um prevents or slowspatients healing?
Dr Dwight Baker (25:04):
Well, again, I go I I I consider it lifestyle,
but it's non-compliance withrecommendations because a lot of
our recommendations arelifestyle recommendations.
Elevation of the lowerextremities, um, wearing the
proper shoes as a diabetic.
Uh, most of all, as a diabetic,watching what you eat and
controlling your A1C to keep itbelow 7%.
(25:25):
Um exercise, um, all thosethings we talked to the patients
about, but so many of them arenot compliant, and so many of
them um well most, if not all ofthem, are in our wound care
(25:48):
clinics with problems because ofnon-compliance of what people
have told them already to do toavoid these complications.
Um that's not true 100%, butit's that's a it's it's our
greatest, I think it's ourgreatest challenge in wound care
is non-compliance by patientsand trying to get them to be
(26:09):
more compliant and um help themany help them with that in any
way we can.
Uh there's just no magic bulletfor that, unfortunately.
Dr Andrew Greenland (26:19):
I mean, do patients arrive later than they
should do, or are they a littlebetter now than they were about
you know presenting themselvesearly?
And with that, what impact doesdelayed treatment have on their
outcomes?
Dr Dwight Baker (26:31):
Oh, delayed delayed treatment and wound care
is uh has all the difference inthe world.
If they if we get to themearly, if we get to them
earlier, we can usually preventfurther problems, and uh of
course all of wound care anddiabetic all of wound care and
diabetic foot ulcers,particularly is is um related to
(26:53):
trying to avoid uh majoramputation.
Um but yes, getting to the theearlier you get to a wound of
any type, anywhere, the thebetter chance you have of
getting it healed and getting ithealed without complications.
Um on the other side of thefence, the um patients who come
(27:13):
in late are the ones who areusually the most uh likely to be
compliant with their care inthe first place.
That's how they got there, andthey delay and delay and delay.
And as you um may be aware, I'mnot sure in Great Britain, like
here in the United States, butthe socioeconomic part of it is
(27:38):
tremendous, and I see it a lotat wound care.
The patients can't afford theright foods to eat.
Not only do they not knowwhat's right and wrong to eat,
they can't afford to eat theproper things.
Um, but there are ways aroundthat.
It's just you know, we uh I'veoften said since I went into
wound care, I'd look up at thestaff and I'd say, you know what
(28:00):
we need on this staff is asocial worker, someone who can
help the patients get to thethings they need on a regular
basis.
Um but the socioeconomic partis a tremendous part that I see
in wound care.
Dr Andrew Greenland (28:17):
Thank you.
Now you must have treated manythousands of patients over the
course of your career.
Are there any success storiesthat have particularly stuck
with you that you alwaysremember and recount?
Dr Dwight Baker (28:31):
There's one in particular.
And it goes back to my umperhaps my I think it was my
first year in practice ingeneral surgery in 1982.
Um I was on call one evening inan emergency room seeing one
(28:57):
little emergency after theother, and I just prepared um a
laceration of the radial arteryin the wrist in the emergency
room.
And the ER physician grabbed meand said, Hey, could you look
at this chest x-ray?
I'm puzzled.
Um, this patient came instabbed in the chest, and I
thought I needed to put a chesttube in, but I look at the chest
(29:19):
x-ray, I don't see a line of umwhere the lung is collapsed.
And uh I look at it, and thefirst thing I noticed is a
pretty narrow um cardiacsilhouette, and I looked at him
and I said, Where is he stabbed?
And he said, in the second,anterior second in a costal
(29:41):
space, and I said, What doesyour jugular vein look like?
And he said, Jugular vein, whyam I looking at that?
And I said, Where is thispatient?
So he took me in to see thepatient, and there was this
large, very healthy appearing,32-year-old African-American
(30:02):
gentleman who looked verymuscular and athletic, and he
had a stab, single stab wound inthe second intercaustal space
to the left of the midline.
His blood pressure was at thatpoint about 85, and he was
talking, and I said to thenurses, I said, get me a central
(30:28):
line kit and um an empty 1000ccbottle that I can hook up an IV
tubing to.
In the meantime, I was out inthe uh hallway grabbing the
(31:24):
phone and calling the whole andsaid, I gotta bring this patient
up and open his chest and fixhis heart.
And they said, We don't have apump, we don't do hearts here.
And I said, I'm not gonna needthat, hopefully.
So then I took him up with thecatheter in draining the blood,
and uh opened his chest thatnight and repaired a laceration
to the um to the mycardium leftleft ventricle, and it was about
(31:51):
a centimeter away from uh uhleft anterior descending artery.
So he was close to notbelieving.
And um he went home five dayslater.
He had no insurance, and he hehe was a painter, but he had no
insurance, and he never cameback to see me, and I never sent
(32:16):
him a bill, never paid me.
And about a year later, threepatients in a week came in to
see me, all with good insurancefrom the same company, and they
said, I always want to know whosent you.
And they said, Well, it's thispatient you treated one time,
and he said you saved his life,and it go to no one else but you
(32:38):
for my surgery for my herniaone for gallbladder breast lump.
True story, not embellished,didn't make it up.
First year in practice, generalsurgeon, and I would tell
plastic surgery patients that,and tell my nurses that when I
was a plastic surgeon 20 and 30years later, and I'd say, you
(33:00):
know, that's what I did when Iwas a general surgeon.
But as a plastic surgeon, Ialso touch a lot of lives
because if I have a lady thatcomes in here depressed about
herself and I do a surgicalprocedure on them, and they come
back three months later, smile,makeup, new horror, new
wardrobe, and happy.
(33:20):
I've made her happy, I've madeher significant other happy.
If their children, I've madethem happy to see their parents
happy, and if they work, theirco-workers, hey, she is a
pleasure to work with again.
I'm telling you.
It's a great, great feeling tohave to help people, and that's
(33:41):
why I did what I did at age 15.
Dr Andrew Greenland (33:45):
That's a fantastic story, a really real
heroic story.
So I can understand why youremember that and you recount
it.
So thank you for sharing thatone.
So, where do you see wound careand chronic disease management
going over the next five to tenyears from in your perspective?
Dr Dwight Baker (34:01):
The same place I see cure for type 1 diabetes,
and the same place I see curefor a lot of other illnesses,
stem cells.
I think stem cells are beingway underutilized in wound care.
I don't know why.
I don't know if it's because ofcost.
I don't know, I don't know umif it's um medical economics
(34:27):
overall.
I don't I don't know, but um Ihad a lot of experience with fat
grafting in my plastic surgerycareer.
Some very, very successfulstories.
You're familiar with um with uhfat atrophy from steroid
injections into the subcutaneoustissue space, I'm sure.
(34:50):
And you come in and you see apatient and they've got a big
divot in their contour.
And uh I've taken some fatgraph, done some fat graphs on
some people, take a little fatwith a needle from the abdomen
and put it into their buttockair where they'd had an
injection.
Um had a lady who had afacelift and had a theroid
(35:13):
injection afterwards, and shehad terrible atrophy.
And I put this put the fatgraphs in, and a few years
later, um she was talking tosomeone about having a scar from
facelift, but she couldn't findit, and um it was gone.
And I attribute that to thestem cells that are in fat.
(35:36):
People really downplay fat inthe body, and they don't like to
be fat, but they don't realizethat fat contains a large supply
of stem cells, they can do alot of different things in the
body.
Um, and I think that can bedone used in uh wound care.
(36:00):
Um I've not had any experiencewith it directly, but I you
know, you ask me where thingsare going, um, I think that's
where things will go someday.
And probably I hope I hopesooner rather than later,
because you see dramaticimprovements.
(36:21):
Well, I see dramaticimprovements in um the fat
grafting I've done in plasticsurgery for contour deformities
mainly.
Dr Andrew Greenland (36:30):
Thank you.
And speaking of the future,what does the future hold for
you?
I guess you're in no danger ofwanting to retire anytime soon.
So, what are your plans for thefuture?
Um, you know, professionallycareer-wise.
Dr Dwight Baker (36:41):
Well, I've enjoyed being off and being at
home with my wife, um, andsomething I've not been used to
for the last 50 years.
Um, and I'm doing someconsulting work for companies,
and I'm finding that there are alot of areas I could do, and
I'm hoping maybe that I can umcut way back on clinical care,
(37:04):
although I still want to dosome.
Um I'd like to do moreconsulting and work at home, and
uh, I have a little bit moretime where I control my own time
because I've never had thatluxury until now.
Although uh getting over thiship surgery was uh not a piece
of cake the first two or threeweeks.
(37:25):
Um it's getting better everyday, but um you know and I'm
ready to go back and seepatients now.
Uh but I'm looking at doingmore uh part-time work, perhaps
welcome ten's work and woundcare to see patients and then do
more consulting.
Dr Andrew Greenland (37:42):
Amazing.
Well, with that, I'd love tothank you so much for joining me
today.
It's been a really fascinatingconversation.
I think your perspective asboth a patient and a physician
is incredibly valuable, and I'msure our audience can take away
some great takeaways from theconversation we've had.
So thank you so much.
Dr Dwight Baker (37:57):
Thank you.
So welcome back to Voices in Health and
Wellness.
I'm your host, Dr.
Andrew Greenland, and today I'mjoined by Dr.
Dwight Baker, a physician whosestory is remarkable from both a
professional and personalperspective.
Dr.
Baker has spent four decades insurgery, including careers in
general, vascular and plasticsurgery before transitioning
into wound care medicine.
But what makes his perspectiveespecially unique is that he's
(00:21):
also lived with type 1 diabetesfor nearly 60 years.
When diagnosed as a teenager in1966, he was given a
dramatically different outlookthan the one he's living today.
Now, six decades later, heremains active, healthy, and
free from many of thecomplications commonly
associated with diabetes.
And so today we're going toexplore what he's learned both
as a physician and a patient,the principles that have guided
(00:43):
his health journey, and howthose same principles influence
the way he cares for patientstoday.
So with that right, I'd love towelcome you to the show and
thank you so much for joining metoday.
Dr Dwight Baker (00:51):
Thank you.
Pleasure to be here.
Dr Andrew Greenland (00:54):
So perhaps we could start a little bit with
your journey.
Take us back to 1966, if youwill, and tell us what it was
like being diagnosed with type 1diabetes at the age of 15.
Dr Dwight Baker (01:06):
Well, at age 15, I was a, I guess you'd say,
a fairly typical um adolescentteenager.
And um I started losing weight,drinking a lot of water, and
urinating a lot.
And uh my mother said, uh, weneed to get you to the doctor.
So at the end of the schoolyear, she took me in and he
(01:30):
scheduled me to come back a fewdays later for a fasting blood
sugar and a two-hourpost-prandial.
This was 1966.
There were no finger sticks,there were no A1Cs, there were
no insulin pumps, there were nocontinuous uh glucose monitors,
(01:50):
um, and the outlook with adiagnosis of type 1 diabetes at
age 15 was not very good.
At any rate, I went back in,had the blood sugars done, had
was diagnosed, and uh this was adiagnosis made by my family
physician who birthed me andtook my tonsils out when I was
(02:12):
four and fixed my broken bonesuntil I was 15.
And he said, I'm gonna, he hadtears in his eyes.
He said, I'm gonna refer you toan internist in Montgomery,
Alabama, which was near ourhome.
Well, about two-hour drive.
And um, he's very strict, andthat's what you need at age 15.
(02:32):
He's 65 years old, has had type1 diabetes for 20 years
himself.
And he's I've sent other peopleto him that were like you, and
they've done well.
So the next day I was inMontgomery and met this
physician who um impressed mewhen I was 15 years old that uh
(02:53):
he just seemed so brilliant andso professional, and that was so
impressive to me.
And um, I can't really on thispodcast quote everything he said
the way he said it, uh, becausehe he was very pretty
aggressive and vulgar in hisapproach to me, but he wanted to
(03:15):
establish a relationship of umhe was in charge and he was
going to be very disciplined inmy care.
And um for that today I'mextremely appreciative.
Um, but during that visit, healso looked at my year-end
report card that my mother hadbrought in, and I had all A's
(03:36):
and Latin and everything andalgebra, and he looked at those
and listed them all, and hesaid, Well, what are you gonna
do when you grow up, young man?
And I said, Well, I want to bea mechanical engineer, and I'd
like to go to Georgia Tech orAuburn to be become a mechanical
engineer, and he looked down atme and he said, No, you're not,
you're going into medicine.
I was 15 years old.
(03:57):
Well, he set me a fire and Idedicated my life to medicine
and health care ever since thatday.
Um, but also during that time,I heard from other physicians
that my outlook was not goodwith type 1 diabetes at age uh
15.
At that time, if you werediagnosed with type 1 diabetes,
(04:20):
you had a life expectancy ofanother 20 to 30 years maximum
if you did well.
And at that time, there wasvery much uh there was a lot of
controversy about whether typecontrol of type 1 diabetes made
any difference in preventinglong-term complications such as
(04:40):
blindness from retinopathy,amputations, renal failure, and
heart disease.
Um but one physician, only onephysician, only one physician
gave me any hope.
And this was this mean doctorwho I was sent to when he took
over my care.
Um, he was only one, and hesaid, if you do every blanky
(05:03):
blank thing exactly like I had ablanky blank tell you, you'll
live a longer, healthier lifethan a normal human being
without diabetes.
So 60 years later, here I am atage 75, with no complications
anyone can find, by myophthalmologist, who's a retina
specialist, and by mycardiologist, who's excellent,
(05:25):
um, and my general physician.
I I don't have anycomplications from type 1
diabetes.
I have an A1C of less than7.0%, um, and I've kept it that
way.
And um type control has kept megoing.
And it was in 1992, I think,when the first results of a
(05:49):
long-term study being done todetermine whether type 1
diabetes complicated long-termcomplications of type 1 diabetes
were prevented by type controlof diabetes, and they pulled the
results and showed that ifyou're under tight control for
the first 10 years afterdiagnosis, you will not have the
(06:10):
long-term complications such asamputation and blindness and
heart disease and and uh kidneydisease.
And it so happens that I wentto this first physician who I
look at as my savior, um, forexactly 10 years almost to the
day after I was diagnosed.
(06:32):
So that's my background abouttype 1 diabetes, and um I'm
thankful for every day I liveand thankful for my healthy um
uh health help help that I have,and um and I realized that why
I have such health is thisphysician who took care of me
(06:54):
initially for the first 10 yearspreached that type control was
achieved first and foremost bydiet control.
He taught diet himself, hedidn't leave it to a dietitian
or a nurse, he taught everythinghimself, he didn't trust anyone
else at that time.
(07:14):
And um, I look back today, andhe was so far ahead of his time
in his thinking and in hisknowledge about uh diabetes and
diabetes care.
Dr Andrew Greenland (07:26):
Such an amazing and inspiring story.
Thank you for sharing.
So, this obviously going backto 1966, um, and you've
mentioned a lot about himtalking about tight control.
What did that look like at theage of 15 in terms of you know
your day-to-day?
How did you maintain this tightcontrol from the advice you
were given way back then?
Dr Dwight Baker (07:46):
The desire to beat the odds, the desire to
prove people wrong that tightcontrol could prevent
complications, plus, it was onlyhope I had tight control.
So, you know, it's a very goodquestion to ask me because uh
(08:06):
why was I why did I behave thatway at age 15?
Uh I wasn't for I wasn'tafraid, I wasn't afraid of this
physician.
Um, I had tremendous respectfor the physician, and uh he was
the only one who gave me hope.
So I listened to his every wordand live by it, and it's paid
(08:29):
off.
Dr Andrew Greenland (08:31):
Thank you.
So if somebody knew was newlydiagnosed with type 1 diabetes
today in 2026, what advice wouldyou give them?
I mean, is it the the sameadvice you were given way back
then, or is it kind of morphedinto something else for 2026?
Where do you stand on this?
Dr Dwight Baker (08:47):
Well, I would first emphasize to them that
diet is the best way, the firstand foremost way to control
diabetes.
Um and then I would direct themto the latest um tech
technologies we have forcontrolling diabetes, which
includes the um automatedinsulin delivery pops, the um
(09:11):
continuous glucose monitors,CGMs, and the um and I would
also emphasize that exercise isimportant.
You know, it's very interestingthat the uh internist who took
care of me in the first 10years, who's my hero and who
guided me into medicine,directed me into medicine, and
(09:34):
took care of me and the reasonI'm here today, did not believe
in exercise.
He thought it was wayoverblown.
And I cannot tell you how oftenI experienced hypoglycemia and
still do, but not nearly so muchnow that we have the new
technologies, because I refuseto believe him about the
(09:55):
exercise portion.
I enjoyed exercise, enjoyedplaying tennis at that time, and
I did a lot of running andjogging um for a long time, but
don't now, and um I learned howto live with hypoglycemia.
But the the newly diagnosedtype ones today, of course, it
(10:17):
depends on the age as to what Iwould tell them, but I would
certainly emphasize to them thatdiet is the reason I'm here.
Diet is critically the is thecritical basis for control of
type 1 and type 2 diabetes, andum and then I would explain to
them how they're blessed todayto have all these newer
(10:37):
technologies, particularly theautomated insulin delivery uh
systems that are available.
Dr Andrew Greenland (10:46):
So, what misconceptions do patients
commonly have about managing achronic disease such as diabetes
in your experience?
Would you repeat that question?
So, yeah, what whatmisconceptions do patients
commonly have about managing achronic disease such as
diabetes?
Dr Dwight Baker (11:02):
Well, you know, the honest truth is I'm a
surgeon.
I don't directly take care ofpatients with type 1 or type 2
diabetes, although I've been uhpracticing wound care for the
past six years.
Also I run into a lot ofdiabetic patients who are mostly
type 2s who are mostly adults.
(11:24):
I think back to the time when Iwas 15 years old, even though
15 is um being younger couldhelp in a lot of ways.
Um I think today that if I wasdiagnosed with type 1 diabetes
at age 40 or 50 or 60, which isfairly unusual, or even type 2,
(11:47):
it would be more much moredifficult for me to become
compliant with diet and managingmy diabetes.
So I have a degree of empathyand sympathy for patients who I
see today in the wound careclinic who have the diabetic
foot ulcers and the poor controland are not compliant.
(12:11):
And I get on to them a bitabout compliance, but not too
heavily because I think aboutthe fact that if I were
diagnosed at their age insteadof when I was diagnosed, I would
not have the same habitsingrained in me that have helped
me be healthy andcomplication-free.
Um, so when you ask thatquestion, it's an open-ending
(12:35):
question, that opens up a lot ofdifferent areas because it
depends on when the patient wasdiagnosed and whether we're
diagnosed with type one and typetwo.
A lot of people don't realizethe big difference between type
one and type two.
And type type one is anautoimmune disease, as we found
out.
They didn't know that at thetime when I was diagnosed.
(12:57):
And type two is a is uh relatedto um some people call it
metabolic syndrome and uh poorhealth habits.
Dr Andrew Greenland (13:11):
Thank you.
So you've been talking a lotabout your personal journey, but
could you maybe talk a littlebit more about your professional
journey and what drew you intoall of this?
I know your inspiration was theintern who obviously had an
early contact with, but whatabout um you know general
surgery and then later plasticsurgery?
Talk us about your inspirationand choice to go into those
(13:33):
particular specialities.
Dr Dwight Baker (13:36):
Well, um I'm not sure what led me.
I am sure what led me intogeneral surgery.
I love to work with my handsand I'll and I um felt like I
could best help people as asurgeon.
Um also at the time when Ichose to go into general
(13:59):
surgery, I was thinking aboutgoing back to my small hometown
of 5000 in East Central Alabama,um, and being a I wanted to be
a physician to everyone andhandle all the problems.
Um probably I wanted to doeverything except deliver
babies.
And um, and to do that, I feltlike I had to be a general
(14:21):
surgeon first.
And and and frankly, along theway, being a physician and a
type one diabetic has led me toread a lot of different uh
medical articles outside of thesurgical realm, which has helped
balance me and I think helpedme become a better physician
overall.
But um uh I started out ingeneral surgery somewhat with
(14:46):
that idea, and along the way, Iwas during my training um
introduced more to vascularsurgery, so I did general lamb
vascular surgery when Ipracticed.
During the nine years Ipracticed general surgery and
vascular surgery, I also tookcare of a lot of ladies with
(15:07):
breast lumps and breast cancer.
And um this was in the late1980s.
The plastic surgeons at thattime were coming up with ways to
reconstruct the breast and alady after she'd been treated
with breast cancer with a masssurgical mastectomy, and that
(15:27):
fascinated me.
Um, and I'd always been told inmy general surgery training
that I needed to go on and dosomething more than be a general
surgeon, I need tosubspecialize.
So I went back to the MayoClinic in 1991, the Mayo Clinic
in Rochester, Minnesota, and dida two-year plastic and
(15:48):
reconstructive residency uh tobecome a plat, a board certified
plastic surgeon.
And when I came out my firstfive years, we did I was in with
two others, and we did umeverything in plastic surgery.
We did reconstructions, we didhand surgery, did we did finger
(16:08):
replants, we did um free flapsat that time, and um as well as
uh cosmetic procedures.
And slowly over about fiveyears, I evolved into a cosmetic
breast surgeon for the so thelast 20, 20, 23, 24 years of my
(16:30):
28 years as a plastic surgeon.
I was doing a lot of cosmeticsurgery, particularly cosmetic
surgery, the breast and thebody.
And then along came thebariatric surgery for weight
loss, and now the um medicationsfor weight loss.
(16:52):
So an awful lot of people cometo the plastic surgeon for
renovation of their body aftermassive weight loss.
So that was coming along as Iretired from the operating room
and just devoted my time towound care a few years ago.
But I'd say that breast cancerand reconstruction after breast
(17:17):
cancer is what enticed me tomake that major change from
general surgery to plasticsurgery, and I'd never regret
it.
I've loved every minute of it.
The reconstructive and the andthe cosmetic part.
Thank you.
Dr Andrew Greenland (17:31):
This was I'm curious about the sort of
transitions in the differentphases of your career, and I
didn't quite get what was itthat drew you to wound care
rather than just retiringcompletely.
What was the kind of switch foryou at that point after having
done various different umspecialisms within surgery to
make that final choice intowound care?
Dr Dwight Baker (17:49):
Well, I also um as a youngster growing up, the
physicians were all general,generals, general medicine
doctors, general generalpractitioners, what we call
them, and that evolved intofamily practice.
And um, that's another reason Iwent into surgery, is when they
(18:11):
started talking about familypractice and changing the course
of from general practice tofamily practice, the courses
were um, I was just didn't uminterest me.
Um but I always looked atmyself as a physician first,
(18:34):
surgeon second, a plasticsurgeon third, and uh still do.
And uh I looked at um the timewhen I was retiring from surgery
and thinking I don't know, I'mnot ready to quit taking care of
patients.
This is my life, I'm dedicatedto this.
I want to do this as long as uhGod will allow me to do so.
(18:57):
And what can I do?
And uh my wife turned to me oneevening and said, You know,
you'd be really good at woundcare.
I've always thought you'd begood at wound care.
And I had two uh mentors a fewyears older than me that I
looked up to in my residency andin my practice.
(19:17):
One was an infectious diseasespecialist, and one was a
general surgeon, who was mypartner in general surgery
before I went back to plasticsurgery.
And they both said, and theywere leaders in the field of
wound care in my home state ofAlabama, and they both said
you'd be great at wound care,and that's what you ought to do.
So that's what I've done.
I look at wound care as primarycare for a surgeon, and um, as
(19:43):
a surgeon, I always took care ofwounds, and I feel like um
that's where I belonged at thisstage of my life, so that's
where I'm at.
And the other reason is becauseof having diabetes, I can't
open my shingle and say, Hey,I'm an endocrinologist, I know
how to take care of yourdiabetes, although I may be able
to practically tell people moreabout the day-to-day ways of
(20:05):
taking care of themselves andhelp them.
How can I do that?
And I can do that wound carebecause a lot of what I see in
wound care is diabetic feet,diabetic foot ulcers, a
complication of diabetes.
So that's how I got into woundcare.
And frankly, I quite well enjoythat too.
Dr Andrew Greenland (20:28):
Amazing.
So, what does your practicelook like at the moment?
Tell us a bit about your kindof your typical week.
Who are you seeing?
What are you dealing with?
What where are you operatingfrom or working from?
Just tell us a bit about yourpractice.
Dr Dwight Baker (20:41):
Well, currently I am not seeing patients.
I'm medical directorcollaborator from nurse
practitioners in the wound carecenter where I work, but I took
some time off for some um hips,I had to have a hip replacement
and recover from that.
So um, I haven't been seeingpatients in the last three or
(21:04):
four months, but in wound careI've been seeing um mostly
diabetic foot ulcers and venostasis ulcers.
Uh everything else was kind oflike uh surgical wound
complications, which with myexperience as a surgeon, I knew
(21:26):
what to do.
And uh but a lot of diabeticfoot ulcers and a lot of venous
stasis ulcers.
Dr Andrew Greenland (21:33):
Thank you.
So, on the subject of wound carethat you've just been talking
about, how much of successfulwound healing comes down to
lifestyle factors, in youropinion?
Dr Dwight Baker (21:45):
I would say 90 to 95%.
Um yeah, um, I look atlifestyle as um Tight control of
diabetes.
Following a diet that controlsyour diabetes and taking the
(22:07):
medications.
To me, that's lifestyle.
Being active is lifestyle sothat you're not overweight.
Venostasis ulcers are a bitdifferent in many ways, but in a
(22:33):
lot of ways the same.
And the the as you remember theum the the um vein veins have
(22:59):
valves in the lower extremitiesto help avoid blood backflowing,
and uh venous stasis ulcersoccur from the backflow of blood
basically.
So um that's a lifestylesituation, but people don't
realize that when they'reworking every day for 40-50
years on their feet.
(23:20):
Um, and those who worecompression stockings or elastic
stockings to try to avoid theirswelling of their feet and legs
are the ones who have lessVenus ulcers.
Dr Andrew Greenland (23:35):
Um on that point, I was just gonna talk
about surgeons because we allknow surgeons are standing up
for much of the time.
Um, did any of that um you sortof do anything preventatively
during your many years ofstanding up operating?
Dr Dwight Baker (23:49):
When I went back to do plastic surgery, I
learned to start wearing uhcompression holes or jotes, uh I
wore jotes, elastic stockingsthat were uh of good quality,
excellent quality.
And um I've worn those as awound care doctor over the last
six years, even though I'm notstanding in an operating room.
(24:11):
I do a lot of standing.
Um I do more walking now than Idid as a uh surgeon.
Um it's funny, my orthopaedicsurgeon, who I actually I've
known since he was in highschool, I went to him in
Birmingham, looked at me, helooked at the x-rays, and he
(24:33):
said, You won your joint outstanding in the operating room
all those years.
Um, but I don't have muchvenous problem.
It's because I wore thosestockings for for many years,
for many years.
Dr Andrew Greenland (24:50):
So um on the on the whole thing of wound
care, then what are some of thebiggest barriers that prevent
patients from healing?
You've talked about some of thepreventative things, some of
the lifestyle things, but arethere any if anything anything
else which um prevents or slowspatients healing?
Dr Dwight Baker (25:04):
Well, again, I go I I I consider it lifestyle,
but it's non-compliance withrecommendations because a lot of
our recommendations arelifestyle recommendations.
Elevation of the lowerextremities, um, wearing the
proper shoes as a diabetic.
Uh, most of all, as a diabetic,watching what you eat and
controlling your A1C to keep itbelow 7%.
(25:25):
Um exercise, um, all thosethings we talked to the patients
about, but so many of them arenot compliant, and so many of
them um well most, if not all ofthem, are in our wound care
(25:48):
clinics with problems because ofnon-compliance of what people
have told them already to do toavoid these complications.
Um that's not true 100%, butit's that's a it's it's our
greatest, I think it's ourgreatest challenge in wound care
is non-compliance by patientsand trying to get them to be
(26:09):
more compliant and um help themany help them with that in any
way we can.
Uh there's just no magic bulletfor that, unfortunately.
Dr Andrew Greenland (26:19):
I mean, do patients arrive later than they
should do, or are they a littlebetter now than they were about
you know presenting themselvesearly?
And with that, what impact doesdelayed treatment have on their
outcomes?
Dr Dwight Baker (26:31):
Oh, delayed delayed treatment and wound care
is uh has all the difference inthe world.
If they if we get to themearly, if we get to them
earlier, we can usually preventfurther problems, and uh of
course all of wound care anddiabetic all of wound care and
diabetic foot ulcers,particularly is is um related to
(26:53):
trying to avoid uh majoramputation.
Um but yes, getting to the theearlier you get to a wound of
any type, anywhere, the thebetter chance you have of
getting it healed and getting ithealed without complications.
Um on the other side of thefence, the um patients who come
(27:13):
in late are the ones who areusually the most uh likely to be
compliant with their care inthe first place.
That's how they got there, andthey delay and delay and delay.
And as you um may be aware, I'mnot sure in Great Britain, like
here in the United States, butthe socioeconomic part of it is
(27:38):
tremendous, and I see it a lotat wound care.
The patients can't afford theright foods to eat.
Not only do they not knowwhat's right and wrong to eat,
they can't afford to eat theproper things.
Um, but there are ways aroundthat.
It's just you know, we uh I'veoften said since I went into
wound care, I'd look up at thestaff and I'd say, you know what
(28:00):
we need on this staff is asocial worker, someone who can
help the patients get to thethings they need on a regular
basis.
Um but the socioeconomic partis a tremendous part that I see
in wound care.
Dr Andrew Greenland (28:17):
Thank you.
Now you must have treated manythousands of patients over the
course of your career.
Are there any success storiesthat have particularly stuck
with you that you alwaysremember and recount?
Dr Dwight Baker (28:31):
There's one in particular.
And it goes back to my umperhaps my I think it was my
first year in practice ingeneral surgery in 1982.
Um I was on call one evening inan emergency room seeing one
(28:57):
little emergency after theother, and I just prepared um a
laceration of the radial arteryin the wrist in the emergency
room.
And the ER physician grabbed meand said, Hey, could you look
at this chest x-ray?
I'm puzzled.
Um, this patient came instabbed in the chest, and I
thought I needed to put a chesttube in, but I look at the chest
(29:19):
x-ray, I don't see a line of umwhere the lung is collapsed.
And uh I look at it, and thefirst thing I noticed is a
pretty narrow um cardiacsilhouette, and I looked at him
and I said, Where is he stabbed?
And he said, in the second,anterior second in a costal
(29:41):
space, and I said, What doesyour jugular vein look like?
And he said, Jugular vein, whyam I looking at that?
And I said, Where is thispatient?
So he took me in to see thepatient, and there was this
large, very healthy appearing,32-year-old African-American
(30:02):
gentleman who looked verymuscular and athletic, and he
had a stab, single stab wound inthe second intercaustal space
to the left of the midline.
His blood pressure was at thatpoint about 85, and he was
talking, and I said to thenurses, I said, get me a central
(30:28):
line kit and um an empty 1000ccbottle that I can hook up an IV
tubing to.
In the meantime, I was out inthe uh hallway grabbing the
(31:24):
phone and calling the whole andsaid, I gotta bring this patient
up and open his chest and fixhis heart.
And they said, We don't have apump, we don't do hearts here.
And I said, I'm not gonna needthat, hopefully.
So then I took him up with thecatheter in draining the blood,
and uh opened his chest thatnight and repaired a laceration
to the um to the mycardium leftleft ventricle, and it was about
(31:51):
a centimeter away from uh uhleft anterior descending artery.
So he was close to notbelieving.
And um he went home five dayslater.
He had no insurance, and he hehe was a painter, but he had no
insurance, and he never cameback to see me, and I never sent
(32:16):
him a bill, never paid me.
And about a year later, threepatients in a week came in to
see me, all with good insurancefrom the same company, and they
said, I always want to know whosent you.
And they said, Well, it's thispatient you treated one time,
and he said you saved his life,and it go to no one else but you
(32:38):
for my surgery for my herniaone for gallbladder breast lump.
True story, not embellished,didn't make it up.
First year in practice, generalsurgeon, and I would tell
plastic surgery patients that,and tell my nurses that when I
was a plastic surgeon 20 and 30years later, and I'd say, you
(33:00):
know, that's what I did when Iwas a general surgeon.
But as a plastic surgeon, Ialso touch a lot of lives
because if I have a lady thatcomes in here depressed about
herself and I do a surgicalprocedure on them, and they come
back three months later, smile,makeup, new horror, new
wardrobe, and happy.
(33:20):
I've made her happy, I've madeher significant other happy.
If their children, I've madethem happy to see their parents
happy, and if they work, theirco-workers, hey, she is a
pleasure to work with again.
I'm telling you.
It's a great, great feeling tohave to help people, and that's
(33:41):
why I did what I did at age 15.
Dr Andrew Greenland (33:45):
That's a fantastic story, a really real
heroic story.
So I can understand why youremember that and you recount
it.
So thank you for sharing thatone.
So, where do you see wound careand chronic disease management
going over the next five to tenyears from in your perspective?
Dr Dwight Baker (34:01):
The same place I see cure for type 1 diabetes,
and the same place I see curefor a lot of other illnesses,
stem cells.
I think stem cells are beingway underutilized in wound care.
I don't know why.
I don't know if it's because ofcost.
I don't know, I don't know umif it's um medical economics
(34:27):
overall.
I don't I don't know, but um Ihad a lot of experience with fat
grafting in my plastic surgerycareer.
Some very, very successfulstories.
You're familiar with um with uhfat atrophy from steroid
injections into the subcutaneoustissue space, I'm sure.
(34:50):
And you come in and you see apatient and they've got a big
divot in their contour.
And uh I've taken some fatgraph, done some fat graphs on
some people, take a little fatwith a needle from the abdomen
and put it into their buttockair where they'd had an
injection.
Um had a lady who had afacelift and had a theroid
(35:13):
injection afterwards, and shehad terrible atrophy.
And I put this put the fatgraphs in, and a few years
later, um she was talking tosomeone about having a scar from
facelift, but she couldn't findit, and um it was gone.
And I attribute that to thestem cells that are in fat.
(35:36):
People really downplay fat inthe body, and they don't like to
be fat, but they don't realizethat fat contains a large supply
of stem cells, they can do alot of different things in the
body.
Um, and I think that can bedone used in uh wound care.
(36:00):
Um I've not had any experiencewith it directly, but I you
know, you ask me where thingsare going, um, I think that's
where things will go someday.
And probably I hope I hopesooner rather than later,
because you see dramaticimprovements.
(36:21):
Well, I see dramaticimprovements in um the fat
grafting I've done in plasticsurgery for contour deformities
mainly.
Dr Andrew Greenland (36:30):
Thank you.
And speaking of the future,what does the future hold for
you?
I guess you're in no danger ofwanting to retire anytime soon.
So, what are your plans for thefuture?
Um, you know, professionallycareer-wise.
Dr Dwight Baker (36:41):
Well, I've enjoyed being off and being at
home with my wife, um, andsomething I've not been used to
for the last 50 years.
Um, and I'm doing someconsulting work for companies,
and I'm finding that there are alot of areas I could do, and
I'm hoping maybe that I can umcut way back on clinical care,
(37:04):
although I still want to dosome.
Um I'd like to do moreconsulting and work at home, and
uh, I have a little bit moretime where I control my own time
because I've never had thatluxury until now.
Although uh getting over thiship surgery was uh not a piece
of cake the first two or threeweeks.
(37:25):
Um it's getting better everyday, but um you know and I'm
ready to go back and seepatients now.
Uh but I'm looking at doingmore uh part-time work, perhaps
welcome ten's work and woundcare to see patients and then do
more consulting.
Dr Andrew Greenland (37:42):
Amazing.
Well, with that, I'd love tothank you so much for joining me
today.
It's been a really fascinatingconversation.
I think your perspective asboth a patient and a physician
is incredibly valuable, and I'msure our audience can take away
some great takeaways from theconversation we've had.
So thank you so much.
Dr Dwight Baker (37:57):
Thank you.
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