Sugar Crush by Dr. Richard Jacoby

Author:Dr. Richard Jacoby
Language: eng
Format: epub
Publisher: HarperCollins
Published: 2015-03-06T05:00:00+00:00

When Is It Time for Surgery?

The time for having the Dellon Decompression Surgical Procedure is when your neuropathy has reached the point of severely limiting your mobility or if you have multiple ulcerations on your legs or feet.

When your nerves are so compressed that your feet and toes are mostly numb, you can’t feel the floor when you walk. Like the cowboy in Chapter 6, this affects your balance and puts you at risk of having a nasty fall (if you haven’t had one already). On several occasions I’ve needed to delay surgery until a patient’s fall-related broken hip, fractured wrist, or concussion healed. Furthermore, when your feet are numb, you can’t feel the pedals in your car. You can no longer drive.

Even if your feet aren’t numb, if they’re painful enough to keep you up at night it’s time to consider decompression surgery. And if cutaneous pressure-threshold testing shows that the large sensory nerves in your feet are seriously deteriorating, surgery can keep them from getting worse and may well restore sensation and relieve the pain.* If possible, the surgery should be done while you still have a positive Tinel’s sign* validating that the nerve is still functioning. That way, we know there’s an 80 percent chance of success.

However, I have had a few patients in such dire condition that the nerve was too damaged for them to feel anything when I pressed on it—they had no Tinel’s sign at all. The only alternative to the Dellon procedure was amputation. Those patients agreed to go ahead with the Dellon procedure even though I couldn’t be sure it would help at all. To my surprise, in addition to a relief of pain, every patient regained some sensation! They probably didn’t gain as much as they would have if we had operated sooner, but the more important point is that their ulcerated feet began to heal and stayed healed. Amputation was avoided.

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