Welcome And Guest Introduction

Dr Andrew Greenland 0:00

So welcome back to Voices in Health and Wellness. I'm your host, Dr. Andrew Greenland, and today I'm joined by Dr. Dwight Baker, a physician whose story is remarkable from both a professional and personal perspective. Dr. Baker has spent four decades in surgery, including careers in general, vascular and plastic surgery before transitioning into wound care medicine. But what makes his perspective especially unique is that he's also lived with type 1 diabetes for nearly 60 years. When diagnosed as a teenager in 1966, he was given a dramatically different outlook than the one he's living today. Now, six decades later, he remains active, healthy, and free from many of the complications commonly associated with diabetes. And so today we're going to explore what he's learned both as a physician and a patient, the principles that have guided his health journey, and how those same principles influence the way he cares for patients today. So with that right, I'd love to welcome you to the show and thank you so much for joining me today.

Dr Dwight Baker 0:51

Thank you. Pleasure to be here.

Dr Andrew Greenland 0:54

So

Diagnosis At 15 In 1966

Dr Andrew Greenland 0:55

perhaps we could start a little bit with your journey. Take us back to 1966, if you will, and tell us what it was like being diagnosed with type 1 diabetes at the age of 15.

Dr Dwight Baker 1:06

Well, at age 15, I was a, I guess you'd say, a fairly typical um adolescent teenager. And um I started losing weight, drinking a lot of water, and urinating a lot. And uh my mother said, uh, we need to get you to the doctor. So at the end of the school year, she took me in and he scheduled me to come back a few days later for a fasting blood sugar and a two-hour post-prandial. This was 1966. There were no finger sticks, there were no A1Cs, there were no insulin pumps, there were no continuous uh glucose monitors, um, and the outlook with a diagnosis 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 a diagnosis made by my family physician who birthed me and took my tonsils out when I was four and fixed my broken bones until I was 15. And he said, I'm gonna, he had tears in his eyes. He said, I'm gonna refer you to an internist in Montgomery, Alabama, which was near our home. Well, about two-hour drive. And um, he's very strict, and that's what you need at age 15. He's 65 years old, has had type 1 diabetes for 20 years himself. And he's I've sent other people to him that were like you, and they've done well. So the next day I was in Montgomery and met this physician who um impressed me when I was 15 years old that uh he just seemed so brilliant and so professional, and that was so impressive to me. And um, I can't really on this podcast quote everything he said the way he said it, uh, because he he was very pretty aggressive and vulgar in his approach to me, but he wanted to establish a relationship of um he was in charge and he was going to be very disciplined in my care. And um for that today I'm extremely appreciative. Um, but during that visit, he also looked at my year-end report card that my mother had brought in, and I had all A's and Latin and everything and algebra, and he looked at those and listed them all, and he said, Well, what are you gonna do when you grow up, young man? And I said, Well, I want to be a mechanical engineer, and I'd like to go to Georgia Tech or Auburn to be become a mechanical engineer, and he looked down at me and he said, No, you're not, you're going into medicine. I was 15 years old. Well, he set me a fire and I dedicated my life to medicine and health care ever since that day. Um, but also during that time, I heard from other physicians that my outlook was not good with type 1 diabetes at age uh 15. At that time, if you were diagnosed with type 1 diabetes, you had a life expectancy of another 20 to 30 years maximum if you did well. And at that time, there was very much uh there was a lot of controversy about whether type control of type 1 diabetes made any difference in preventing long-term complications such as blindness from retinopathy, amputations, renal failure, and heart disease. Um but one physician, only one physician, only one physician gave me any hope. And this was this mean doctor who I was sent to when he took over my care. Um, he was only one, and he said, if you do every blanky blank thing exactly like I had a blanky blank tell you, you'll live a longer, healthier life than a normal human being without diabetes. So 60 years later, here I am at age 75, with no complications anyone can find, by my ophthalmologist, who's a retina specialist, and by my cardiologist, who's excellent, um, and my general physician. I I don't have any complications from type 1 diabetes. I have an A1C of less than 7.0%, um, and I've kept it that way. And um type control has kept me going. And it was in 1992, I think, when the first results of a long-term study being done to determine whether type 1 diabetes complicated long-term complications of type 1 diabetes were prevented by type control of diabetes, and they pulled the results and showed that if you're under tight control for the first 10 years after diagnosis, you will not have the long-term complications such as amputation and blindness and heart disease and and uh kidney disease. And it so happens that I went to this first physician who I look at as my savior, um, for exactly 10 years almost to the day after I was diagnosed. So that's my background about type 1 diabetes, and um I'm thankful for every day I live and thankful for my healthy um uh health help help that I have, and um and I realized that why I have such health is this physician who took care of me initially for the first 10 years preached that type control was achieved first and foremost by diet control. He taught diet himself, he didn't leave it to a dietitian or a nurse, he taught everything himself, he didn't trust anyone else at that time. And um, I look back today, and he was so far ahead of his time in his thinking and in his knowledge about uh diabetes and diabetes care.

Dr Andrew Greenland 7:26

Such

Tight Control And A Complication Free Life

Dr Andrew Greenland 7:27

an amazing and inspiring story. Thank you for sharing. So, this obviously going back to 1966, um, and you've mentioned a lot about him talking about tight control. What did that look like at the age of 15 in terms of you know your day-to-day? How did you maintain this tight control from the advice you were given way back then?

Dr Dwight Baker 7:46

The desire to beat the odds, the desire to prove people wrong that tight control could prevent complications, plus, it was only hope I had tight control. So, you know, it's a very good question to ask me because uh why was I why did I behave that way at age 15? Uh I wasn't for I wasn't afraid, I wasn't afraid of this physician. Um, I had tremendous respect for the physician, and uh he was the only one who gave me hope. So I listened to his every word and live by it, and it's paid off.

Dr Andrew Greenland 8:31

Thank you.

Daily Habits Behind Discipline

Dr Andrew Greenland 8:32

So if somebody knew was newly diagnosed with type 1 diabetes today in 2026, what advice would you give them? I mean, is it the the same advice you were given way back then, or is it kind of morphed into something else for 2026? Where do you stand on this?

Dr Dwight Baker 8:47

Well, I would first emphasize to them that diet is the best way, the first and foremost way to control diabetes. Um and then I would direct them to the latest um tech technologies we have for controlling diabetes, which includes the um automated insulin delivery pops, the um continuous glucose monitors, CGMs, and the um and I would also emphasize that exercise is important. You know, it's very interesting that the uh internist who took care of me in the first 10 years, who's my hero and who guided me into medicine, directed me into medicine, and took care of me and the reason I'm here today, did not believe in exercise. He thought it was way overblown. And I cannot tell you how often I experienced hypoglycemia and still do, but not nearly so much now that we have the new technologies, because I refuse to believe him about the exercise portion. I enjoyed exercise, enjoyed playing tennis at that time, and I did a lot of running and jogging um for a long time, but don't now, and um I learned how to live with hypoglycemia. But the the newly diagnosed type ones today, of course, it depends on the age as to what I would tell them, but I would certainly emphasize to them that diet is the reason I'm here. Diet is critically the is the critical basis for control of type 1 and type 2 diabetes, and um and then I would explain to them how they're blessed today to have all these newer technologies, particularly the automated insulin delivery uh systems that are available.

Advice For Newly Diagnosed Today

Dr Andrew Greenland 10:46

So, what misconceptions do patients commonly have about managing a chronic disease such as diabetes in your experience? Would you repeat that question? So, yeah, what what misconceptions do patients commonly have about managing a chronic 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 of patients with type 1 or type 2 diabetes, although I've been uh practicing wound care for the past six years. Also I run into a lot of diabetic patients who are mostly type 2s who are mostly adults. I think back to the time when I was 15 years old, even though 15 is um being younger could help in a lot of ways. Um I think today that if I was diagnosed with type 1 diabetes at age 40 or 50 or 60, which is fairly unusual, or even type 2, it would be more much more difficult for me to become compliant with diet and managing my diabetes. So I have a degree of empathy and sympathy for patients who I see today in the wound care clinic who have the diabetic foot ulcers and the poor control and are not compliant. And I get on to them a bit about compliance, but not too heavily because I think about the fact that if I were diagnosed at their age instead of when I was diagnosed, I would not have the same habits ingrained in me that have helped me be healthy and complication-free. Um, so when you ask that question, it's an open-ending question, that opens up a lot of different areas because it depends on when the patient was diagnosed and whether we're diagnosed with type one and type two. A lot of people don't realize the big difference between type one and type two. And type type one is an autoimmune disease, as we found out. They didn't know that at the time when I was diagnosed. And type two is a is uh related to um some people call it metabolic syndrome and uh poor health habits.

Why Surgery Became The Calling

Dr Andrew Greenland 13:11

Thank you. So you've been talking a lot about your personal journey, but could you maybe talk a little bit more about your professional journey and what drew you into all of this? I know your inspiration was the intern who obviously had an early contact with, but what about um you know general surgery and then later plastic surgery? Talk us about your inspiration and choice to go into those particular specialities.

Dr Dwight Baker 13:36

Well, um I'm not sure what led me. I am sure what led me into general surgery. I love to work with my hands and I'll and I um felt like I could best help people as a surgeon. Um also at the time when I chose to go into general surgery, I was thinking about going back to my small hometown of 5000 in East Central Alabama, um, and being a I wanted to be a physician to everyone and handle all the problems. Um probably I wanted to do everything except deliver babies. And um, and to do that, I felt like I had to be a general surgeon first. And and and frankly, along the way, being a physician and a type one diabetic has led me to read a lot of different uh medical articles outside of the surgical realm, which has helped balance me and I think helped me become a better physician overall. But um uh I started out in general surgery somewhat with that idea, and along the way, I was during my training um introduced more to vascular surgery, so I did general lamb vascular surgery when I practiced. During the nine years I practiced general surgery and vascular surgery, I also took care of a lot of ladies with breast lumps and breast cancer. And um this was in the late 1980s. The plastic surgeons at that time were coming up with ways to reconstruct the breast and a lady after she'd been treated with breast cancer with a mass surgical mastectomy, and that fascinated me. Um, and I'd always been told in my general surgery training that I needed to go on and do something more than be a general surgeon, I need to subspecialize. So I went back to the Mayo Clinic in 1991, the Mayo Clinic in Rochester, Minnesota, and did a two-year plastic and reconstructive residency uh to become a plat, a board certified plastic surgeon. And when I came out my first five years, we did I was in with two others, and we did um everything in plastic surgery. We did reconstructions, we did hand surgery, did we did finger replants, we did um free flaps at that time, and um as well as uh cosmetic procedures. And slowly over about five years, I evolved into a cosmetic breast surgeon for the so the last 20, 20, 23, 24 years of my 28 years as a plastic surgeon. I was doing a lot of cosmetic surgery, particularly cosmetic surgery, the breast and the body. And then along came the bariatric surgery for weight loss, and now the um medications for weight loss. So an awful lot of people come to the plastic surgeon for renovation of their body after massive weight loss. So that was coming along as I retired from the operating room and just devoted my time to wound care a few years ago. But I'd say that breast cancer and reconstruction after breast cancer is what enticed me to make that major change from general surgery to plastic surgery, and I'd never regret it. I've loved every minute of it. The reconstructive and the and the cosmetic part. Thank you.

From Plastic Surgery To Wound Care

Dr Andrew Greenland 17:31

This was I'm curious about the sort of transitions in the different phases of your career, and I didn't quite get what was it that drew you to wound care rather than just retiring completely. What was the kind of switch for you at that point after having done various different um specialisms within surgery to make that final choice into wound 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 general practitioners, what we call them, and that evolved into family practice. And um, that's another reason I went into surgery, is when they started talking about family practice and changing the course of from general practice to family practice, the courses were um, I was just didn't um interest me. Um but I always looked at myself as a physician first, surgeon second, a plastic surgeon third, and uh still do. And uh I looked at um the time when I was retiring from surgery and thinking I don't know, I'm not ready to quit taking care of patients. This is my life, I'm dedicated to this. I want to do this as long as uh God will allow me to do so. And what can I do? And uh my wife turned to me one evening and said, You know, you'd be really good at wound care. I've always thought you'd be good at wound care. And I had two uh mentors a few years older than me that I looked up to in my residency and in my practice. One was an infectious disease specialist, and one was a general surgeon, who was my partner in general surgery before I went back to plastic surgery. And they both said, and they were leaders in the field of wound care in my home state of Alabama, 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 primary care for a surgeon, and um, as a surgeon, I always took care of wounds, and I feel like um that's where I belonged at this stage of my life, so that's where I'm at. And the other reason is because of having diabetes, I can't open my shingle and say, Hey, I'm an endocrinologist, I know how to take care of your diabetes, although I may be able to practically tell people more about the day-to-day ways of taking care of themselves and help them. How can I do that? And I can do that wound care because 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 wound care. And frankly, I quite well enjoy that too.

Dr Andrew Greenland 20:28

Amazing. So, what does your practice look like at the moment? Tell us a bit about your kind of your typical week. Who are you seeing? What are you dealing with? What where are you operating from or working from? Just tell us a bit about your practice.

Dr Dwight Baker 20:41

Well, currently I am not seeing patients. I'm medical director collaborator from nurse practitioners in the wound care center 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 seeing patients in the last three or four months, but in wound care I've been seeing um mostly diabetic foot ulcers and veno stasis ulcers. Uh everything else was kind of like uh surgical wound complications, which with my experience as a surgeon, I knew what to do. And uh but a lot of diabetic foot ulcers and a lot of venous stasis ulcers.

Dr Andrew Greenland 21:33

Thank you. So,

Lifestyle As The Driver Of Healing

Dr Andrew Greenland 21:34

on the subject of wound care that you've just been talking about, how much of successful wound healing comes down to lifestyle factors, in your opinion?

Dr Dwight Baker 21:45

I would say 90 to 95%. Um yeah, um, I look at lifestyle as um Tight control of diabetes. Following a diet that controls your diabetes and taking the medications. To me, that's lifestyle. Being active is lifestyle so that you're not overweight. Venostasis ulcers are a bit different in many ways, but in a lot of ways the same. And the the as you remember the um the the um vein veins have valves in the lower extremities to help avoid blood backflowing, and uh venous stasis ulcers occur from the backflow of blood basically. So um that's a lifestyle situation, but people don't realize that when they're working every day for 40-50 years on their feet. Um, and those who wore compression stockings or elastic stockings to try to avoid their swelling of their feet and legs are the ones who have less Venus ulcers.

Dr Andrew Greenland 23:35

Um on that point, I was just gonna talk about surgeons because we all know surgeons are standing up for much of the time. Um, did any of that um you sort of do anything preventatively during your many years of standing up operating?

Dr Dwight Baker 23:49

When I went back to do plastic surgery, I learned to start wearing uh compression holes or jotes, uh I wore jotes, elastic stockings that were uh of good quality, excellent quality. And um I've worn those as a wound care doctor over the last six years, even though I'm not standing in an operating room. I do a lot of standing. Um I do more walking now than I did as a uh surgeon. Um it's funny, my orthopaedic surgeon, who I actually I've known since he was in high school, I went to him in Birmingham, looked at me, he looked at the x-rays, and he said, You won your joint out standing in the operating room all those years. Um, but I don't have much venous problem. It's because I wore those stockings 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 the biggest barriers that prevent patients from healing? You've talked about some of the preventative things, some of the lifestyle things, but are there any if anything anything else which um prevents or slows patients healing?

Dr Dwight Baker 25:04

Well, again, I go I I I consider it lifestyle, but it's non-compliance with recommendations because a lot of our recommendations are lifestyle recommendations. Elevation of the lower extremities, 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 it below 7%. Um exercise, um, all those things we talked to the patients about, but so many of them are not compliant, and so many of them um well most, if not all of them, are in our wound care clinics with problems because of non-compliance of what people have told them already to do to avoid these complications. Um that's not true 100%, but it's that's a it's it's our greatest, I think it's our greatest challenge in wound care is non-compliance by patients and trying to get them to be more compliant and um help them any help them with that in any way we can. Uh there's just no magic bullet for that, unfortunately.

Dr Andrew Greenland 26:19

I mean, do patients arrive later than they should do, or are they a little better now than they were about you know presenting themselves early? And with that, what impact does delayed treatment have on their outcomes?

Dr Dwight Baker 26:31

Oh, delayed delayed treatment and wound care is uh has all the difference in the world. If they if we get to them early, if we get to them earlier, we can usually prevent further problems, and uh of course all of wound care and diabetic all of wound care and diabetic foot ulcers, particularly is is um related to trying to avoid uh major amputation. Um but yes, getting to the the earlier you get to a wound of any type, anywhere, the the better chance you have of getting it healed and getting it healed without complications. Um on the other side of the fence, the um patients who come in late are the ones who are usually the most uh likely to be compliant with their care in the first place. That's how they got there, and they delay and delay and delay. And as you um may be aware, I'm not sure in Great Britain, like here in the United States, but the socioeconomic part of it is tremendous, and I see it a lot at wound care. The patients can't afford the right foods to eat. Not only do they not know what's right and wrong to eat, they can't afford to eat the proper things. Um, but there are ways around that. It's just you know, we uh I've often said since I went into wound care, I'd look up at the staff and I'd say, you know what we need on this staff is a social worker, someone who can help the patients get to the things they need on a regular basis. Um but the socioeconomic part is a tremendous part that I see in wound care.

Dr Andrew Greenland 28:17

Thank you.

A Life Saved On Call

Dr Andrew Greenland 28:18

Now you must have treated many thousands of patients over the course of your career. Are there any success stories that have particularly stuck with you that you always remember and recount?

Dr Dwight Baker 28:31

There's one in particular. And it goes back to my um perhaps my I think it was my first year in practice in general surgery in 1982. Um I was on call one evening in an emergency room seeing one little emergency after the other, and I just prepared um a laceration of the radial artery in the wrist in the emergency room. And the ER physician grabbed me and said, Hey, could you look at this chest x-ray? I'm puzzled. Um, this patient came in stabbed in the chest, and I thought I needed to put a chest tube in, but I look at the chest x-ray, I don't see a line of um where the lung is collapsed. And uh I look at it, and the first thing I noticed is a pretty narrow um cardiac silhouette, and I looked at him and I said, Where is he stabbed? And he said, in the second, anterior second in a costal space, and I said, What does your jugular vein look like? And he said, Jugular vein, why am I looking at that? And I said, Where is this patient? So he took me in to see the patient, and there was this large, very healthy appearing, 32-year-old African-American gentleman who looked very muscular and athletic, and he had a stab, single stab wound in the second intercaustal space to the left of the midline. His blood pressure was at that point about 85, and he was talking, and I said to the nurses, I said, get me a central line kit and um an empty 1000cc bottle that I can hook up an IV tubing to. In the meantime, I was out in the uh hallway grabbing the phone and calling the whole and said, I gotta bring this patient up and open his chest and fix his heart. And they said, We don't have a pump, we don't do hearts here. And I said, I'm not gonna need that, hopefully. So then I took him up with the catheter in draining the blood, and uh opened his chest that night and repaired a laceration to the um to the mycardium left left ventricle, and it was about a centimeter away from uh uh left anterior descending artery. So he was close to not believing. And um he went home five days later. He had no insurance, and he he he was a painter, but he had no insurance, and he never came back to see me, and I never sent him a bill, never paid me. And about a year later, three patients in a week came in to see me, all with good insurance from the same company, and they said, I always want to know who sent you. And they said, Well, it's this patient you treated one time, and he said you saved his life, and it go to no one else but you for my surgery for my hernia one for gallbladder breast lump. True story, not embellished, didn't make it up. First year in practice, general surgeon, and I would tell plastic surgery patients that, and tell my nurses that when I was a plastic surgeon 20 and 30 years later, and I'd say, you know, that's what I did when I was a general surgeon. But as a plastic surgeon, I also touch a lot of lives because if I have a lady that comes in here depressed about herself and I do a surgical procedure on them, and they come back three months later, smile, makeup, new horror, new wardrobe, and happy. I've made her happy, I've made her significant other happy. If their children, I've made them happy to see their parents happy, and if they work, their co-workers, hey, she is a pleasure to work with again. I'm telling you. It's a great, great feeling to have to help people, and that's 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 you remember that and you recount it. So thank you for sharing that one.

Stem Cells And The Future Of Care

Dr Andrew Greenland 33:53

So, where do you see wound care and chronic disease management going over the next five to ten years 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 cure for a lot of other illnesses, stem cells. I think stem cells are being way underutilized in wound care. I don't know why. I don't know if it's because of cost. I don't know, I don't know um if it's um medical economics overall. I don't I don't know, but um I had a lot of experience with fat grafting in my plastic surgery career. Some very, very successful stories. You're familiar with um with uh fat atrophy from steroid injections into the subcutaneous tissue space, I'm sure. And you come in and you see a patient and they've got a big divot in their contour. And uh I've taken some fat graph, done some fat graphs on some people, take a little fat with a needle from the abdomen and put it into their buttock air where they'd had an injection. Um had a lady who had a facelift and had a theroid injection afterwards, and she had terrible atrophy. And I put this put the fat graphs in, and a few years later, um she was talking to someone about having a scar from facelift, but she couldn't find it, and um it was gone. And I attribute that to the stem cells that are in fat. People really downplay fat in the body, and they don't like to be fat, but they don't realize that fat contains a large supply of stem cells, they can do a lot of different things in the body. Um, and I think that can be done used in uh wound care. Um I've not had any experience with it directly, but I you know, you ask me where things are going, um, I think that's where things will go someday. And probably I hope I hope sooner rather than later, because you see dramatic improvements. Well, I see dramatic improvements in um the fat grafting I've done in plastic surgery for contour deformities mainly.

Dr Andrew Greenland 36:30

Thank you.

Next Steps And Closing Thanks

Dr Andrew Greenland 36:31

And speaking of the future, what does the future hold for you? I guess you're in no danger of wanting to retire anytime soon. So, what are your plans for the future? Um, you know, professionally career-wise.

Dr Dwight Baker 36:41

Well, I've enjoyed being off and being at home with my wife, um, and something I've not been used to for the last 50 years. Um, and I'm doing some consulting work for companies, and I'm finding that there are a lot of areas I could do, and I'm hoping maybe that I can um cut way back on clinical care, although I still want to do some. Um I'd like to do more consulting and work at home, and uh, I have a little bit more time where I control my own time because I've never had that luxury until now. Although uh getting over this hip surgery was uh not a piece of cake the first two or three weeks. Um it's getting better every day, but um you know and I'm ready to go back and see patients now. Uh but I'm looking at doing more uh part-time work, perhaps welcome ten's work and wound care to see patients and then do more consulting.

Dr Andrew Greenland 37:42

Amazing. Well, with that, I'd love to thank you so much for joining me today. It's been a really fascinating conversation. I think your perspective as both a patient and a physician is incredibly valuable, and I'm sure our audience can take away some great takeaways from the conversation we've had. So thank you so much.

Dr Dwight Baker 37:57

Thank you.