Alan does not need a foot operation!!!
 

Hi, we just got back from Kings Plaza Foot care. Dr. Baird is his podiatrist and he had consulted with Dr. Spindler (who also examined Alan's foot) and they've come to the conclusion that an operation would only cause more problems.. The ulcer that always forms on the bottom of his feet is still healing nicely. It usually does but then it gets aggravated because he has some kind of bone deformity that puts pressure on the ulcer and it sometimes gets worse.

They have decided to do something to the orthotics (right now they have built it up so he's doing fine) but next week they sending them back to the orthotics people to have a revision done.

So there was no need to see if he could have spinal tap done during the operation becasue THERE WILL BE NO OPERATION. At least not for now.

Alan keeps telling me to call and make the appointment for the spinal tap. I said 'will you just wait until you get the results of your latest blood work that you just had done.... the gammablobins, etc.etc.

He just wants to get everything over with. So we'll wait until we get the results of the 3 hour glucose tolerance test as well as the other tests that were done. (I'll post all results here).

Then we'll speak to Dr. Goldfarb and she'll either stick with her original decision to order the lumbar puncture or maybe she'll see something in the blood tests and say "no he doesn't need the LP".

So for now, we wait and see.

Think I'm right????

mel

I think the most interesting result--
 

--given the lack of positive results from the other bloodwork, is going to be the glucose tolerance test, which may diagnose a "pre-diabetic" impaired glucose tolerance or insulin resistance that may well lhave something to do with the neuropathy symptoms. Given Alan's general state of health, I would be surprised if the other immunglobulin tests show a monoclonal result.

Thing is, as Brian has mentioned, if there is a glucose component to this, Alan may have improved his condition, or at least arrested any further deterioration, by exercising, eating better, and losing weight. (And he should remember to thank you, Mel, for much of that.)

I am somewhat confused here. Okay, let me explain. I have always tested Alan's sugar readings all these years (because I'm a diabetic).

Alan has never and I mean never gone over the number 85.

When he got his neuropathy, approx 18 years ago, it was very slight, (in fact he thought he had athlete's foot and said as much to the doctor at Coney Island Hospital) the doctor did an emg and said: "No, you have peripheral neuropathy" That's when they began doing the diabetes testing, the glucose tolerance tests (he once had the 3 hour tests way back when he first got the PN). They said "no, no diabetic condition"

Now am I to understand that he might in fact have a pre-diabetic condition from 18 years ago that gives him neuropathy but that it got better because he diets, exercises and does yoga.

He sat on the bus all the way home from the foot doctor's office and said "boy,today my PN is killing me, the cymbalta is doing nothing".

But when he walks around, and exercises , the PN does not bother him.

So I wish someone would explain how a PN can be a result of a pre-diabetic condition but get better with exercise.

Then, is this auto-immune, or is this from the spinal stenosis. I mean, when he comes home from a visit with Dr. Theirl, this guy can do the macarena, if you know what I mean. Wouldn't tht indicate that it has something to do with his back?


Oh, and do you think he should go for a spinal tap after all. I'm so confused on this subject.

Thanks much.
Mel

Diabetic related neuropathy--
 

--is thought to be mainly ischemic: that is, it results from the inability of smaller blood vessels, which are damaged by impaired glucose tolerance, to get oxygen and nutrients to the nerves and to carry waste products away. This is why the classic presentation of diabtic neuropathy is a slow onset progressive one, with "length dependency"--it takes time for the damage to occur, and it happens first to those nerves in the extremities farthest from the center of circulation. And, it can happen to anyone who has sufficient glucose dysregulation to have that ischemic damage. But, if someone has good blood sugar control, loses weight, increases circulation through exercise, etc., the circulation works better, and the nerve damage can be stopped or even reversed.

Variations in the intensity of symptoms--day to day or even over the course of a day--are very common with neuropathies, especially those of the smaller fibers that control the sensation of pain and temperature; many people report that it gets worse at night, for example (typically when circulation slows down).

Of course, impaired glucose tolerance is only one possible explanation. And it's likely Alan doesn't notice discomfort as much when he's active because his ciruculation has increased and there are other distracting sensations.

One thing that has also occurred to me, which I think you wrote about--Alan was given a workup for peripheral artery disease in his legs (which was negative), correct? Given his circulatory history that would certainly be something to be sure was investigated.

Yes, he just had an arterial duplex and they said "no, no vascular disease in his legs, everything is negative".

So I guess we'll have some answer when we get the results back from the 3 hour glucose tolerance test.

But honeslty, what will that test determine? That he could have had diabetes but no longer has it, that he never had diabetes but had a pre-diabetic condition?? I mean, what exactly are they trying to determine with a 3 hour glucose tolerance test?

thanks, Mel

I was just finishing a post to reply...
 

and PN fingers went 'SPAZZ!' Lost it all.


Soo, good thoughts for now? - j

Mel,
Glenn should probably answer the question, but as I understand it (and I've had the 3 hour test-not the 5 hour one) each reading gives a different rate that the body uses (or misuses) the glucose. By comparing those figures, a good Dx'ng doc can determine at what rate and how the body is either intolerant, or is marginally creeping up to the levels where the pre-diabetic stage occurs. My doc at Hopkins- Dr. Griffin, is a proponent of the theory that PN is onset by a pre-diabetic condition when there is no other obvious causation. (and then there are obvious markers that he believes contribute to the pre-diabetic condition).
We joke about the fact that I could have PN for 50 years and not develop diabetes until year 49 and he would say
"AHA !! See, I told you!". :)
A pre-diabetic condition, as he explains it- does not occur, then go away.
If you are pre -diabetic, you stay pre-diabetic until you develop a case of full blown diabetes. If you don't develop diabetes- you're still considered to be pre-daibetic with the propensity towards developing it. The percentiles may change and the probabilities may alter, but he still considers a pre-diabetic to stay that way until the diabetic condition occurs. (Which may be never, but the odds of developing it at later stages of advanced age, are pretty much in favor of getting a type 2 before the eulogy is read.)