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Reversing Nerve Damage
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By John McIntosh
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Diabetes Focus
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Up to 90 percent of people who have surgery on peripheral
nerves that have been damaged by chronically high blood sugar levels
regain sensation and become pain free.
TRUE! And the reasons are as simple
as A, B, C:
A. Diabetic neuropathy occurs when chronic high blood sugar
causes damage—such
as swelling and stiffness—in the peripheral nerves that are typically
located in the hands and feet. This results in pain, a decrease in motor
skills, numbness and even paralysis.
B. Peripheral nerves—the nerves that branch out from the central nervous
system of the brain and spine into the arms and legs—can be repaired. These
nerves have the ability to recover from injury.
C. By using a technique called decompression surgery, doctors are able to reduce
pressure on peripheral nerves in the extremities, alleviating a great amount
of physical discomfort.
To be a candidate for this surgery:
- You must have neuropathy, as confirmed by a diabetes specialist.
- You must have good circulation in your extremities.
- You must be able to undergo an operation. People on certain medications,
or who have other complications, may not be able to have the surgery.
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“What has been shown,” says
Michael Rose, M.D., a board-certified plastic and reconstructive surgeon and
partner at the Plastic Surgery Center in Shrewsbury, NJ, “is that once
you release the pressure on a peripheral nerve, a significant amount of regeneration
happens. That is starkly different from the central nerves of the spine. The
nerves of the peripheral nervous system regenerate all the time.”
Until recently, Dr. Rose didn’t think it was possible to treat any kind
of diabetes-related nerve damage surgically. But about three years ago he accidentally
fixed a patient’s neuropathy when he operated on one of her nerves. After
she got better, he looked into the phenomenon. He found a doctor
who had been successfully treating neuropathy with surgery for about 15 years—A.
Lee Dellon, M.D., professor of plastic surgery and neurosurgery at Johns Hopkins
University in Baltimore and director of the Dellon Institutes for Peripheral
Nerve Surgery.
“Dr. Dellon is responsible for figuring out all of this,” says Dr.
Rose. “He identified these tunnels in the arms and legs where pressure
develops, and he was able to relieve symptoms of diabetic neuropathy. He expanded
our understanding of nerve entrapment syndromes.”
So Dr. Rose called Dr. Dellon and went to his clinic. There he was able to learn
Dr. Dellon’s techniques. “Now I lecture at his annual scientific
meeting and am slated to assist him with the courses that he teaches for other
surgeons,” says Dr. Rose. “Our whole thing is that we have seen people
turn their lives around after having this surgery, and we are trying very hard
to get the word out.”
Dr. Rose has done over 100 of these procedures, and he says Dr. Dellon has done
nearly 1,000. Currently there are approximately 200 doctors in the United States
who perform this surgery.
Decompression surgery is a procedure that relieves pressure on the peripheral
nerves as they pass through three different passageways or tunnels on their way
to each extremity.
The procedure is probably best explained by using as an example the tunnel that
most people are familiar with: the carpal tunnel. It is found in the palm of
the hand and is the tunnel through which the peripheral nerve passes as it extends
from the forearm to the wrist and into the hand. High glucose levels may cause
that nerve to swell and stiffen, which in turn causes pressure inside the carpal
tunnel.
Dr. Dellon found that opening up the tunnel alleviates pressure on the nerve,
and sensation in the hands,
as well as range of motion, can be restored. “The surgery is relatively
straightforward,” says Dr. Rose. “It takes about an hour and fifteen
minutes. It’s done on an outpatient basis and can be done under either
local or general anesthesia.
“Essentially what we do is open up the skin at the different compression
points in order to get to the tunnels where a nerve is sandwiched between a ligament
and a bone. We cut away the roof of the tunnel, releasing the swollen, damaged
nerve. The nerve has room to ‘breathe’ and is no longer compressed.”
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