Treating Neuropathy and Nerve Painthe Feet
Let me start with I'm a diabetic. I developedneuropathy, which basically you lose all sensationthe feet, but it's over a period of time.It was very painful. I would have sensationsmy feet like I was standing on fire, walkingon glass. Last October it got so bad that I couldn't sleep at night. Then I met Bullard, because he's just a great physician. I wouldn't think twice, I'd recommendhim to anybody. Very compassionate, very thorough, I can't say enough about Bullard. He'sjust a great physician and I don't know if there's anything he couldn't do hecould probably move mountains if he wanted to!Glen, probably one of the biggest questions
people are asking you is what'd we do, what'shappened. Of course, you had a tremendous improvementyour pain and the tinglingand the numbness. Easiest explanation is, to tell everybody, that this big nerve here,which is on the inside part of your left foot, was getting strangled. There was a noose aroundit. What we did is we wentand loosened the noose, and that allows that nerve to beginto function and work like it's supposed to.Now, the sensation is coming back, it's something that's going to take time butI can feel more. My quality of life has greatly improved since I had the procedure done by Bullard. There's no other physician
that I would recommend.Glen,the next couple weeks, what we're going to do is make sure that the swellingis improving, hopefully begin to transition you out of your compression socks, becauseI know it's kind of hot right now, and then look at making sure that your shoe gear andthings like that are where they're supposed to be, fitting you well, protecting your feetand stuff. Ok? Very good. Thank you, I appreciate it, havea good weekend! You do the same. Alright, see ya.
HIV Neuropathy Screening Exam with Grading Reflexes
These are the instructions for evaluating perceptionof vibration. Use a 128 hertz tuning fork. SOUND Hit the tuning fork hardenough so that the sides touch. And make sure that the subjectknows the type of sensation. Do you feel this asa vibration or a buzzing? gt;gt; Vibration. gt;gt; As a vibration, very good.
Now repeat the procedurein the feet. Again, strike the tuningfork hard enough so that the sides touch andimmediately put the tuning fork on the distalinterphalangeal joint. Count the number of seconds. Ask the subject to tell youwhen the vibration stops. gt;gt; Now. gt;gt; It stopped now?
Good. And repeat the procedureto the opposite side. Again, the tuning fork goeson the distal interphalangeal joint. Make sure you strikethe tuning fork hard enough so that the sides touch. For evaluating deeptendon reflexes, with the subject seated,examiner should use the hand
to gently dorsiflex the footat about 90 degrees. Press upwards slightlyon the sole of the foot. Use a reflex hammer, preferablya longhandled reflex hammer. A tomahawk hammeris also acceptable. And strike the Achillestendon just behind the heel. Contraction of the gastrocnemiusmuscle will be both seen and felt. Repeat the procedurewith the opposite leg.
Have to do now is showthe discrepancy between the knee reflex and the ankle reflex. Many patients with HIVdisease have both central and peripheral nervoussystem disease. So one may see a mix ofhyperreflexia at the knee and reduced reflexes,or hyporeflexia or areflexia at the ankles. So now we'll attemptto demonstrate this.
So here first for the patellareflex, the knee reflex, this would be graded as a 3plus, there is hyperrefelxia and spread of the reflexto other muscles. In the same patient,ankle reflexes are reduced significantly outof proportion to knee reflexes. So these are the differentgradings for ankle reflexes. Absent means that with a strongpercussion of the Achilles tendon, there is no contractionof the gastrocnemius.
Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interestingcondition because it consists typically of just burning, numbness, pain of the feet,sometimes the hands later on without necessarily having any abnormalities on your EMG or nerveconduction study. So what I tell patients and actually residents or students who trainunder us is that a normal nerve conduction study does not exclude a neuropathy. And wewill confirm this by doing additional testing, specifically the nervous the the examinationat the bedside asking patients about their symptoms, for example, loss of sensation tocool or or hot temperatures, loss of pain sensation and also doing skin biopsies wherewe look at nerve densitiesthe skin both
from the calf and the thigh as well as doinga special test that looks at sweat function bothyour footin the legs as well asthe feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typicallywill progress unless the underlying cause is identified and reversed. Diabetes of coursebeing the most common cause is always screened for. But once the more common causes are excludedand the focus becomes on excluding any underlying secondary disease process but also controllingpain because if patients' symptoms of pain are generally controlled they tend to do prettywell and really have no other major functional deficits. I've really become interested overthe years is how interconnected neurology
and rheumatology are and one thing I oftendo on patients who have unexplained small fiber even autonomic neuropathy is have themsee rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren's orsarcoid and sometimes even if we are not directly involvedtreating the patients, this canbe the first sign of an underlying connective tissue disorder that can then be brought tothe attention of rheumatology and adessed from their standpoint.