Diabetic lower extremity ischemia (DLEI) causes approximately 90,000 leg amputations each year in the United States. A review of the literature revealed that sufficient evidence exists to consider using pulsed electromagnetic field (PEMF) therapy as a non-invasive curative modality that could prevent many of these amputations. However, the staggering number of leg amputations following lengthy episodes of ischemic deterioration suggests a lack of consensus as to the efficacy of PEMF. Therefore, the purpose of this study is to provide an evidentiary basis for using PEMF therapy in a primary care setting to promote microvascular angiogenesis and thereby prevent skin ulceration. In this study, 7 people between the ages 54 and 65 who have diabetes mellitus type 2 and some level DLEI underwent 10 to 22 treatments with a Diapulse® PEMF device. Each participant was tested for microvascular red blood cell (RBC) perfusion (Q), volume concentration of moving RBCs (V), RBC speed (U) and temperature (T) in the plantar skin. These parameters were measured using a laser Doppler flowmeter before and after the course of treatment. The Wilcoxon Signed Rank Test showed significant increases in V and decreases in U (p = 0.018 for both) with Q being slightly above the significance level at p = 0.063. These findings are consistent with those found in the literature. Therefore, the use of PEMF for treating chronic wounds should be considered for inclusion in standard Advanced Practice Registered Nursing (APRN) guidelines for evidenced-based practice. However, the results of the pilot study do need to be confirmed by repeating the experiment with a larger sample size. This paper also provides a review of the evidence in the medical literature that demonstrates the development of angiogenesis in heart muscle as a means of reversing congestive heart failure following myocardial ischemia resulting from atherosclerosis in the minute coronary circulation. The available evidence suggests that achieving new collateral circulation in ischemic heart muscle is highly achievable.

Since we began training in clinical medicine at the Faculty of Medicine at the University of Kufa in Iraq, at the beginning of the nineties of the last century, I have noticed that the gratitude of patients is multiplied and great for the doctor who shows humility, a good reception, hospitality and more attention, while I find grumbling from the patients about the doctor who he deals with them with coldness, lack of interest and arrogance. This observation was repeated to me when I became a doctor residing in the hospital in my city in Hilla in Iraq, and I found the patients comfortable and reassured with the humble doctor who shows good meeting with them and kindness with them and treating them with kindness and love unlike the arrogant doctor who deals with them with arrogance and coldness. From that moment on, I chose to be a friend of the patient, as this is the nature of every human being towards any human being. I trained at that time with two professors of internal medicine, of the same age and science, but one of them was modest with patients and the other was arrogant towards them. I saw that patients resort to the humble doctor and not to the arrogant doctor. And when I was accepted into higher studies for specializations in Baghdad, I also found this note. That patients are more comfortable and reassured with a doctor who shows his interest, humility and intimacy with them, unlike those who deal with arrogance and sharpness. I became more steadfast in the way I am in dealing with the patient with all humility, love and brotherhood. And I made this a method for me in dealing with patients that the patient is my brother and friend, and I am always at his service and work for his benefit, and this is what I recommend to those I teach, students and new doctors. People’s satisfaction with you is a great gain, so how about the satisfaction of your patients and teachers? My teachers gave me training certificates and together they praised the good treatment of patients and colleagues. The patients were leaving the hospital expressing their deep gratitude, and even those whose condition was difficult and we only reduce their suffering, they leave with gratitude and thanks. Indeed, the relatives of some who have died because of delayed their health express their gratitude after the death of their relatives and they meet me so welcome and grateful. I strongly and deeply believe that medicine is a human profession, and humanity is humility. This observation and the experience recorded by many people have mentioned it, and many studies have proven its importance in treating patients, and it is indeed an important factor in the progress and completion of the patient’s treatment.