If pain medication has proven ineffective or if you are plagued by side effects from those medications, nerve decompression surgery may be an option for you. This form of plastic surgery relieves pressure on the nerves, which is caused by swelling. According to Dr. Rick Delmonte of St. Luke's-Roosevelt Hospital in New York City, people with diabetes have excess blood glucose, which degrades to sorbitol and other sugars. "Sorbitol is hydrophilic; it brings water into the nerve and the nerve swells and gets pinched."
To release this pressure, surgeons, such as Dr. Delmonte and his surgical partner, Dr. William Samson, perform an operation similar to carpal tunnel surgery, which takes less than 2 hours. A cut is made over the compressed nerve thereby releasing the tight area through which the nerves pass. This is done by dividing a ligament or fibrous band that crosses the nerve. Drs. Delmonte and Samson have performed dozens of these operations with great success.
The ideal candidate for this type of surgery has: 1. good control of their blood glucose; 2. already tried medication to control the pain but either has side effects, their cognitive function is disturbed, or the medication has proven ineffective; 3. no swelling in the feet; 4. been medically approved to undergo a 2-hour general anesthetic; 5. a pain level of 5 or more out of 10; 6. evidence on neurosensory testing of large nerve fiber loss; 7. signs of nerve compression upon physical examination.
Studies so far have shown no development of ulceration in patients who have had the surgery nor have there been any amputations. These patients have resumed their mobility within 2 weeks.
Before undergoing surgery, a potential patient must undergo a pressure-specific sensory device test (PSSD), which is a noninvasive computerized exam that determines the remaining nerve function at various anatomical points. The test is not covered by most insurance companies but the surgery itself usually is.
Dr. Lee Dellon of The Dellon Institutes for Peripheral Nerve Surgery was the first to perform this surgery over 10 years ago at Johns Hopkins University. Today only a small number of doctor have been trained in the procedure. To find out more, visit The Dellon Institutes for Peripheral Nerve Surgery.
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...