New Optimism For Patients with Neuropathy
Quantitative Sensory Testing
QST is a preventative and restorative medicine!
Have you ever stopped to think about how important your feet are?
They connect you to the earth, move you around, and play host to a variety of sensations: cool water, a sandy beach, or tickling fingers, to name a few. For those who suffer from diabetic neuropathy, the world can be a dangerous place, devoid of these and many other sensations.
If you are a diabetic, then you have probably heard from one of your doctors about the complications of diabetes. Among the most common and severe side affects is neuropathy, which will occur in approximately 50% of diabetics even with controlled blood sugar. Diabetic Neuropathy is a lack of sensation that affects the diabetic's extremities. Typically the lower extremities are affected first.
Symptoms of neuropathy
Symptoms of neuropathy are the lack of normal sensation that affects extremities. Patients may have a noticed weakness or loss of balance. Numbness, tingling and pain of the heel, the arch, the ball of the foot and the bottom and tips of the toes occurs. Lack of feeling to the diabetic foot is the leading cause of ulcerations, infections, and slow healing wounds and in advanced cases amputation of the toes, feet and legs.
Causes of diabetic neuropathy
The first reason a diabetic nerve becomes compressed is that the nerve is swollen as a result of sugar from the blood stream entering the nerve. This sugar called glucose, which gives the nerve energy is converted into another sugar called sorbitol. Sorbitol's chemical formula makes it attract water molecules. This water that is drawn to the nerve causes swelling. The swelling in areas that are already anatomically tight causes compression of the nerve.
Another reason for neuropathy in a diabetic is the failing transport system. This system sends chemical messages within the nerve. When this system is failing, the nerve loses its ability to send and relay these messages. Thus when damaged by compression, the nerve is not able to repair itself.
Treatment of diabetic neuropathy
In the past, physicians were limited on treatment for patients with diabetic neuropathy. Medication to dull the nerve sensation to make the patient more comfortable was the primary treatment protocol.
With today's latest technology, physicians have the tools necessary to accurately determine the degree of neuropathy and pinpoint the specific nerve(s) affected. Quantitative Sensory Testing (QST) assists doctors at Center for Podiatric Medicine Physicians and Surgeons to reverse and even stop the progressive symptoms of diabetic neuropathy. This testing process aids the surgeons in determining which patients are candidates for nerve decompression surgery. This test is the first step in determining a proper treatment protocol.
Decompression surgery is the procedure to open up tight areas through which the nerve passes, by dividing a ligament or fibrous band that restricts the nerve from functioning properly. This gives the nerve(s) more oxygen and better blood flow. The current statistical success rate is 80% for the lower extremities.
The surgery does not change the underlying metabolic process that makes the nerve susceptible to compression in the first place. When decompression is done in the early stages, restoration of blood flow to the nerve will stop the numbness and tingling, and enables a patient to recover some lost strength. If the decompression is done later in the course, when nerve fibers have begun to die, the decompression allows for the diabetic nerve to regenerate.
Who is a candidate?
This treatment protocol is right for you if you are a diabetic who is beginning to experience the symptoms of numbness, tingling in the feet and who may have noticed weakness, loss of sensation or loss of control of some of the muscles in the feet. In addition, overall health is taken into consideration with coordination of care with your primary physician.
Procedure
Generally this procedure is done under "twilight" anesthesia in an outpatient surgical setting. The surgeon wears magnified operating glasses to perform the operation. The special technique utilized in nerve compression surgery usually takes about one and a half hours but can vary depending on the individual patient.
We would like to thank Dr. A. Lee Dellon of The Institute for Peripheral Nerve Surgery, Baltimore, MD., for the training and education on his approach to diabetic neuropathy.
"I was afraid that I was going to lose my toes, or worse, and now I can actually move my toes and it feels normal"
A. Negron
"I had problems for so long and no one in the medical community offered to help until I found Dr. Jones"
J. DeSanto
"I am 100% better and I am back to work a couple of hours per day," "I don't have pain like I had before", "I am very happy that I had the surgery done".
D. Risseeuw
"After the anesthetic wore off I began to have sensations in my foot that I haven't had for years", "I was impressed".
S. Kalosky
For more information or to schedule yourself for an examination and Quantitative Sensory Testing, call our office.