PEOPLE WITH DIABETES, PERIPHERAL ARTERY DISEASE AT INCREASED RISK OF GANGRENEI have heard that a stubbed toe can lead to gangrene in some individuals. Is that true? What are the signs of gangrene, and how can it be avoided?Gangrene, which refers to tissue death caused by a severe shortage of blood supply or serious bacterial infection, occurs in lower extremities. It is more common in the toes than other parts of the body. Gangrene tends to happen more often among people with peripheral artery disease, a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. People with diabetes and peripheral artery disease are especially vulnerable to complications such as gangrene, because, in addition to poor blood circulation, they often have decreased sensation in their feet due to nerve damage. If an injured toe goes unnoticed and blood supply is inadequate to help heal the wound, tissue death may occur.Gangrenous tissue typically becomes discolored, ranging from pale purple to black. The skin may become dry, hard and shriveled, with a clear line separating the dead tissue from healthy tissue. If an infection is present, the area may look swollen or form blisters filled with fluid on the skin. Thereís often a foul-smelling odor.These signs and symptoms require immediate care, as they quickly can lead to loss of limbs and death ó at times quickly ó due to sepsis. Treatment may involve taking antibiotics for infection, re-establishing blood flow to the area and removing the dead tissue.See your health care provider if you have leg pain or numbness, sores that wonít heal on your feet or legs, or changes in the color of the skin around your legs or feet. Peripheral artery disease, which often accompanies diabetes and coronary artery disease, is strongly associated with smoking.If you have diabetes, maintain careful control of your blood glucose level and take good care of your feet. Always wear protective footwear that properly accommodates your feet. Do a daily check for redness, calluses and wounds. If you find any of these problems, treat your feet promptly and adjust your activity. If youíre a smoker, stop. Regular exercise and a healthy diet can keep peripheral artery disease, diabetes and heart disease in check, thus minimizing your risk.Karen L. Andrews, M.D., Director, Vascular Ulcer/Wound Healing Clinic, Mayo Clinic, Rochester, Minn. (Adapted from Mayo Clinic Health Letter) BLEEDING SHOULD BE CHECKED OUT BY DOCTORI am 52 and had recently gone 10 months without a period. I assumed I was postmenopausal. But, over the past few months, Iíve had light spotting. Does this mean Iím not past menopause? Do I need to see my doctor?Itís possible you havenít reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you donít quite meet that threshold. But itís also possible that you are postmenopausal, and the bleeding is a result of something else. It would be a good idea to make an appointment to see your health care provider and check your condition.Menopause is the natural process that marks the end of a womanís reproductive years when menstrual cycles stop. It typically happens in the 40s or 50s, with the average age of menopause in the United States at 51.Skipping periods as you approach menopause, a stage sometimes called perimenopause, is common and expected. During that time, menstrual periods often skip a month and return, or skip several months and start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they may be closer together than is typical for you.Ten months between periods is longer than usual in the perimenopause stage. But it is possible, and the spotting youíve noticed may not signal anything other than the fact that your body isnít to menopause at this point. However, if you have gone through menopause, then the bleeding could be cause for concern.Bleeding after menopause is not normal, and it must be evaluated. Postmenopausal bleeding can have various causes.One of the most serious underlying conditions that could lead to this type of bleeding is cancer. For example, cancer that begins in the uterus, called endometrial cancer, often triggers abnormal vaginal bleeding. For many women with this form of cancer, bleeding is their only symptom. Thatís why it is so important to have postmenopausal bleeding evaluated as soon as possible.If your health care provider suspects endometrial cancer, she or he may recommend removing a sample of tissue from your uterine lining with a procedure called endometrial biopsy. The tissue thatís removed then is examined in a laboratory for signs of cancer. An endometrial biopsy may be performed in your health care providerís office, and it usually doesnít require anesthesia.Less common kinds of cancer that also could cause abnormal bleeding are cancer of the cervix or vagina, as well as uterine sarcoma. Other underlying medical concerns that may lead to vaginal bleeding after menopause include conditions that thin the tissue that lines the uterus or the vagina, called endometrial atrophy and vaginal atrophy. In some cases, uterine fibroids or polyps may trigger bleeding, too.The bleeding also could be the result of a condition known as endometrial hyperplasia, in which there is a precancerous overgrowth of cells that make up the uterine lining. An infection, injury or other pelvic trauma, as well as certain medications, also have been known to cause postmenopausal bleeding.Despite this list of disconcerting possibilities, please know, too, that the bleeding you are experiencing may be harmless. At this time, you should see your health care provider to find out whatís going on. Jamie Bakkum-Gamez, M.D., OB-GYN, Mayo Clinic, Rochester, Minn.Mayo Clinic Q & A is an educational resource and doesnít replace regular medical care. Email a question to [email protected] For more information, visit mayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.