When you had originally presented to the office,you presented with chronic numbness, tingling, burning,the hands and the feet. It limitedyour ability to walk, limited your ability to sleep, your ability to relax. We've completeda course of treatment here with the Davis neuropathy program, how have you done withthe treatment and how are you feeling today? I feel wonderful. I have to tell you thatthe treatment, I was on both programs. Before I came in, all that I knew that I had wasperipheral neuropathy after your exam, after you examined me. We found out that I had alsospinal stenosismy spine. I have followed your program, both of your programs, the DRSprogram and the peripheral neuropathy program,
and I am doing beautifully. I can now walkwithout assistance which I was having to hold my husband's hand or somebody's hand whenI was shopping or doing anything. I could not ive by myself. I feel like a whole personnow. Well congratulations on your results and we're very proud to have you here as apatient. What else would you like to have me tell you? If you have another questionI could certainly, I would like to tell a little bit about your people that you haveworking for you. They are wonderful, young, professional people. I don't know what kindof a program you put them on, but I love each and every one of them. They're an asset toyour office. Well thank you so much for the
kind words and we look forward to seeing youagain soon. You're welcome.
we know that onefour people withdiabetes will develop foot compliions. These compliions can be serious and can limit you and what you want to do with your life the Joslin al guidelinesrecommend that you have a thorough foot exam by your physician atleast once a year one of the things that can cause foot problems:people with diabetes they result from twomajor problems. The first is neuropathy. diabetes can affect the nerves over time
and as the nerves are affected you may lose the sensationyour feet this may not cause you any discomfort,your feet may feel fine, but not being able to sense problemsyour feet puts them at risk. A second problem is circulation diabetes can affect circulationtheheadthe heart but also affects circulationyour feet. With the circulation decreased, any problem that occursyour feet
will resolve more slowly; infections heal more slowly and you are prone to more compliions. this combination of neuropathy and circulation problems are why your physician needs to carefully examine you feet at least once a year when he or she examines your footthey're going to look at three different things they'll visually inspect your foot tosee if there's any deformities,
they'll look carefully the skin to see if there's any cuts, any sore spots, any lesions thatshould need attention between your toes as wellas the top of the bottom of your feet the physician will also take a look atyour circulation by feeling for pulses at certain spotsyour feet where we know the the pulsesshould be strong and last, they'll check for signs of neuropathy by using either tuning fork or something called a ten gram fibersmall wis
you should be able to sense and if youcan't it means you're especially high risk for problems with yourdiabetes smoking is obviously a problem for anyone's health if you have diabetes smoking isespecially damaging so he can affect the circulation inparticular the circulation to your feet we know that the majority of ourpatients with diabetes who have foot problems have had smoking intheir past
so what can you do to keep your feethealthy? we just talked about stopping smoking ifyou're doing that if you have neuropathy or have had foot problems, examining your feet by yourself everyday looking at the skin is very important keeping your A1c, your blood pressure,your cholesterolcontrol will also decrease your chance of compliions. And remember,
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.