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******** “GOOD NEWS FOR NEUROPATHY SUFFERERS”

Dr. Gregory Still has a special interest in treating the condition known as peripheral neuropathy. This common but often poorly treated condition is most often caused by Diabetes Mellitus but can also have many other causes. For example, chemotherapy, thyroid disease, multiple sclerosis, chemical exposure and alcohol abuse are known causes. Unfortunately, there are also many patients that suffer from “idiopathic neuropathy” which means that their doctors do not know the cause.  In many cases this may be due to compression neuropathy.  The difference between a peripheral neuropathy caused by a disease state and one caused by a compression (entrapment) on a nerve is significant but at times a patient can suffer from both. 

For some patients, there is now more hope in obtaining relief from pain. Nerve conduction velocity and Electromyography (NCV/EMG) testing , often performed by a neurologist, is still the gold standard test in evaluating both compression and peripheral neuropathy.  As an alternative or adjunctive testing method Dr. Still is trained to test the sensibility of the feet in a different way than usual right in the office. This is with the pressure specified sensory device (PSSD). This is also called Neurosensory Testing or Quantitative Sensory Testing.  This is different from the well known testing done for sensation and nerve problems known as nerve conduction velocity testing and electromyography (NCV/EMG that was mentioned above.  sometimes NCV/EMG tesitng for foot and lower leg probelms can be unreliable, especially if a patient has diabetic neuropathy. This is not to say that a NCV/EMG cant be helpful ,often it is but sometimes with neuropathy the more information that is gathered for the patient, the better and more accurate diagnosis can be made.  The pressure specified sensation testing is done with a machine in the office setting and it is not painful and takes about 20-30 mins. for Dr. Still to perform. Most insurance plans cover for this testing. However, Medicare does not cover this test.  Once this testing is completed Dr. Still can evaluate whether a patient might be a candidate for surgery to release compressed nerves in the leg and foot due to a compression  neropathy.

“SURGERY FOR PERIPHERAL NEUROPATHY?”

"The security provided by a long held belief system, even when poorly founded, is a strong impediment to progress.  General acceptance of a practice becomes the proof of its validity, though it lacks all other merit".  - Quote from Bernard Lown, MD , inventor of the heart defibrillator.

It is very important to note that surgical decompression of nerves for patients is controveersial and unproven in patients with diabetes.  It is an option for some patients with both diabetic neuropathy and compression neuropathy. Better studies need to be undertaken with this patient group afflicted with this terribly painful condition.  Prospective randomized controlled trials with outcome measures are needed.  Dr.  Still has had very good to excellent succes with patients with compression neuropathies and 'idiopathic neuropathy' (go to www.drstill.com and view the testimonials under tarsal tunnel syndrome and fibular tunnel syndrome).  it should be made perfectly clear that as stated by A.L. Dellon, M.D. a pioneer in this treatment option is that "every patient with neuropathy should not have a peripheral nerve decompression" (surgery).  "It is reserved for the patient with a neuropathy who has a demonstrable compression of a peripheral nerve in a known site of anatomic narrowing"(tight tunnel). 

Many sufferers of peripheral neuropathy have seen several doctors for their condition and have been told there is not a cure and there is only a small amount of treatments that may be helpful to relieve their pain and/or numbness. Currently there is not agreement amongst physicians about the cause and best treatment options for peripheral neuropathy, especially true when it is caused by Diabetes Mellitus .

As mentioned, this treatment option was developed by Dr. A. Lee Dellon in Baltimore, Maryland many years ago. Dr. Dellon and his staff have trained over 240 surgeons of different specialties from numerous countries in their treatment method for neuropathy. Dr. Still is one of those surgeons that has been trained and currently is only one of three in Colorado trained in this treatment option. The philosophy and science behind ‘surgery for neuropathy’ is centered on the belief that nerves in the arms, hands, legs and feet have an increased diameter due to improper chemical metabolism in the nerve. It is due to an abnormal ‘sorbitol pathyway’. Dr. Dellon is a medical pioneer that has devoted his entire career to research in this field. Despite criticism, on his research his teachings and treatment plans are becoming less refuted and slowly more accepted. Why ? Because for the right patient this treatment works and helps relieve severe pain. In reality it can change a person’s life.  As stated earlier and emphasized again, more studies are needed on this surgical option.

How is the surgery done and how does it help? Surgical intervention for peripheral neuropathy is centered around decompressing certain nerves that are compressed in tight anatomical canals. This is called ‘external neurolysis’, and it frees up bound down, compressed or entrapped nerves. The surgeon ‘opens up tight spaces so that the nerve may have a chance to recover and conduct impulses more normally. For example carpal tunnel release surgery is done to relieve pain due to a compressed nerve in the wrist. Many people suffer from this condition without neuropathy. For patients with diabetic neuropathy the nerves in the hand or foot have a higher chance to encounter problems that are analogous to carpal tunnel syndrome. This is because the disease process caused the nerve diameter to increase dramatically.

It must be emphasized that the treatment option of surgery for neuropathy is only for a select group of patients that have ‘painful’ type neuropathy. It is also is not meant for the patient suffering with diabetes caused neuropathy with a history of problems such as foot ulcers, infections or amputations over a period of time. Unfortunately, there is only a relatively short window of opportunity for patients with neuropathy before the nerves are ‘too damaged’ from the ravages of peripheral neuropathy irrelevant of the cause. In the properly selected patient with neuropathy and pain success rate for this surgical treatment option approaches 69% for the legs and feet according to published literature.

Diabetes is the leading cause of neuropathy and unfortunately Diabetes is increasing worldwide and therefore so is the number of patients suffering from neuropathy. Peripheral neuropathy can affect 35-50% of patients with diabetes mellitus. Some argue that it is a higher percentage. Diabetes is the leading cause of non-traumatic amputation in the world. Problems in the feet are the most common reason for patients afflicted with diabetes to be hospitalized. Therefore treatment of neuropathy is very important and has the potential to change the amount and type of complications due to diabetes dramatically.

It is also must be emphasized that this treatment option is not just for patient with diabetes mellitus. Often this treatment can help neuropathy sufferers due to other causes. That is because those causes also cause nerve damage due to compression and result in pain.  As stated above Dr. Still has had better clinical success with patients that do not have diabetes.  The patients with diabetic neuropathy that can benefit from this type of surgery are only a select few!

If you would like more information schedule an appointment to see Dr. Still. In addition you can visit the following websites www.IPNS.com or www.sensorymanagement.com

PLEASE DO NOT CALL THE OFFICE TO GET INFORMATION, IT IS BEST IF YOU COME INTO THE OFFICE AND CONSULT WITH DR. STILL. THIS IS A COMPLEX PROBLEM TO EXPLAIN AND IT IS BEST EXPLAINED BY A PHYSICIAN AND NOT OFFICE STAFF. WE APPRECIATE YOUR CONSIDERATION IN ADHERING TO THIS REQUEST.