A Multigenerational Look at Limb Preservation
In this month’s Wound Care Q&A, Podiatry Today had the chance to speak with a father-son DPM duo; Drs. Joseph and Luis Caporusso. They touched on multiple topics in wound care, including the guiding forces in their training, the importance of recognizing social determinants of health, multidisciplinary approaches to care, and what keeps them grounded and passionate about their chosen field.
Q: Can you share with us a little bit about yourselves and your experience with University of Texas Health Science Center at San Antonio (UTHSCSA), specifically?
A: Joseph Caporusso, DPM, shares he trained with the UTHSCSA program from 1989 to 1991.
“For me, the program was what really started my whole career in limb preservation and limb salvage,” he says. “I was taught how to handle all these difficult patients with diabetes, and I think one of the main things that I got from the program was the work ethic.”
He goes on to explain that the program instilled a “the more you give, the more you get” attitude that he still carries with him today.
Luis Caporusso, DPM, Dr. Joseph Caporusso’s son, is a first-year resident at UTHSCSA. He relates that he is excited to start his career, and that he particularly enjoys being able to work to help others.
Q: From your experience, what should podiatrists strive to know when it comes to social determinants of health?
A: Even at this early stage in his career, Dr. Luis Caporusso acknowledges the importance of this topic and the role that podiatrists play. His father agrees, and adds that when one examines the geographic area in which one practices, there are many factors, including educational level, financial challenges, and access to care, that can impact outcomes.
“We try to talk about helping the patient in their environment,” he explains. “We need to differentiate what we can do for these patients to try to get them to heal.”
Dr. Joseph Caporusso cites attainable payment plans and existing shoe modifications as examples of pathways in his practice that he has found helpful in working in concert with patients to achieve the best possible outcome, even in challenging circumstances.
He goes on to say that he finds significant personal gratification when he works with a patient in such a way that they then make an effort to educate themselves on their condition and their treatment, becoming a full partner in the process.
Clinical research trials are another option that he points out as a possible way for patients to access treatment that otherwise they may not have.
“I have to look at their social determinants of health and how that’s affecting them so that I can treat them better and try to make it so that they can feel that they’re getting treatment that’s necessary for them,” says the senior Dr. Caporusso. “And in doing clinical research, I’m able to put them in a trial where they’re getting treatments that they couldn’t afford … and so it’s a great marriage of clinical research, having a big practice, being able to use some things that I have left over to help these patients. And so (in our area), not only do we have to worry about the diabetic foot ulcer and all the complications that go on with that, we have to worry about the social determinants of health, the access to care, the finances, the education—how do we get around all of that? So, it’s challenging but very rewarding.”
Dr. Luis Caporusso states he still has much to learn, but that each patient encounter contributes to his understanding of overcoming challenges for and with patients.
“(I find) you have to be more patient, you have to reason with them, and you have to change the treatment plan to consider their lifestyle as well,” he says. “It’s not just going by the book.”
Q: How do you feel the doctor-patient relationship contributes to one’s understanding of social determinants of health?
A: The junior Dr. Caporusso cites the volume of patient interaction he is experiencing in his training as particularly enlightening.
“It’s very important to connect with our patients, to let them know that we are there to help them, that they can trust us, and that we are doing our best to provide the best care,” he says.
Q: Specific to diabetic foot ulcers (DFUs), what do you feel podiatrists can do to have a positive impact on these issues impacting access to care?
A: Dr. Joseph Caporusso feels that being involved with the community, understanding the resources and how you can do your part to enhance those, is key.
“… Being out there in the community, talking, and doing health fairs or diabetic foot screenings, then treating those patients in the hospital—it pays off in the end,” he says. “I’m making a relationship here, this is my home, these are the people that I work with, live with, interact with every day of my life. So, how can I give back? When you give, you get plenty back in return.”
Dr. Luis Caporusso notes the importance of resources within one’s hospital or institution, such as social work, that can have a significant impact for patients and providers. In the clinic, he shares that he is interested to learn more about the programs for coordinating services like home health that he knows helps advance the goals of patient care plans.
Q: Speaking of additional services, how does an interdisciplinary team come into play when it comes to addressing social determinants of health?
A: One cannot do this work alone, says Dr. Joseph Caporusso. Forming a team and multidisciplinary approach, especially among fellow community-minded individuals, is key.
Q: Are there any scenarios or cases you’d like to share that have had a significant impact on your wound care career?
A: The gratitude that patients express is something that you really take with you, says Dr. Joseph Caporusso.
Dr. Luis Caporusso says that seeing the pure emotion of a patient when you heal an ulcer or save a limb is especially rewarding, knowing that as a DPM, you contributed to their continuing to walk, or being able to play with their grandkids.
His father then shares that he particularly finds poignant the practice of ringing a bell when a wound heals. This practice, he explains, is common in cancer centers, and some have framed wound healing as “ulcer remission,” so the spirit of the practice is the similar. Noting that milestone in treatment and celebrating the effort is something he finds impactful.
Q: What advice might you have for practitioners who are struggling in the current health care environment?
A: Remembering the trust that patients put in you as a provider is one keystone that Dr. Joseph Caporusso holds onto in tougher times. He feels can be reinvigorating, as can reflecting on conversations with patients and their families that drive home why one does this work.
Q: What do you want students or prospective students to know about a career in limb preservation?
A: “Focus on what you’re doing, study all you can, and it will all be worth it,” says Dr. Luis Caporusso. “It’s bigger than you, you’re helping people – the more prepared you are, the better it will be.”
