Dr. Jacoby describes the research he is conducting on diabetic neuropathy and shares the early findings.
I think they are very interesting. We had 16 patients so far entered into our study. We have operated on two patients and the first results I think are rather startling results. What we did, and let me go through the study, what it is first, we were doing a triple nerve release A Lee Dellon from Johns Hopkins who invented this procedure, the decompression of multiple nerves in lower extremity for diabetic polyneuropathy.
Let me explain what that means. When patients have numbness, tingling, loss of feeling, burning, or even balance problems, it’s an indicator that the nerves are not functioning. Most common form of non-functioning nerves in the United States is diabetes and it is a direct result of compression of the nerves.
All the original studies that were done by Dellon and some people in his group and also from the Cleveland Clinic centered on how did the nerve respond. Our study was to see how the blood flow responded and this is the first study that’s ever been done. My results are rather startling, I think, on this first patient. We measured the distal aspect of the foot after we did the decompression and most people assumed we were going to get better blood flow distally in to the toes, and we didn’t.
We measured it with a laser Doppler, which is a very sensitive instrument for measuring the amount of blood that gets into the skin, but proximally in the thigh we had tremendous increase of blood flow, greater than 20%, at least on this first patient. So what does that mean? I think it means is that when we take away a compression distally we are going to get better flow proximally. That’s a huge implication for peripheral vascular disease.
Presently, stents that are used in the arterial system of leg only are effective for about 50%. In other words, they restenose rather rapidly and they have to be redone. I think it’s going to make a dramatic change in restenosis rates.
And also the study I think will show that distally in the skin, that there’s another mechanism besides blood flow, and this is what I have always thought, that the biochemistry of the skin is different in diabetics. Without getting too technical it basically means this – when you do not have enough protein, i.e. amino acid L-arginine, in your diet you are not going to produce enough nitric oxide.
Nitric oxide is the essential ingredient that dilates blood vessels, and if you don’t dilate your blood vessels you won’t be able to get enough oxygen and therefore, these are the patients who are going to lead to a diabetic ulcer and/or amputation; ten thousand amputations done every month in the United States – amazing number.
So I think our study is going to show that not only do we have to put more blood into the limb, but we have to change this nutritionally. We have to do a lot of things to get the skin to accept the blood. If we have that process complete I think we are going to reduce our amputations rate by a tremendous amount.
I have been doing this procedure for about ten years. We haven’t had an amputation yet in a very, very large series of patients. But going forward, I think we are going to have to do a massive change on the nutritional content of diabetics.
I think this study is going to show conclusively that the link between blood flow and amputation rates is real. Not only is the blood flow to the proximal, to the large vessels, but to the skin. I think we are very close in solving the whole mystery.
About Dr. Richard Jacoby, D.P.M.:
Dr. Richard Jacoby, D.P.M., graduated from the Pennsylvania College of Podiatric Medicine. He completed his residency at Parkview Hospital, Philadelphia, specializing in foot and ankle surgery. Board certified by the American Board of Podiatric Foot and Ankle Surgeons, he is currently president of Valley Foot Surgeons in Scottsdale, Arizona. In addition, Dr. Jacoby is chairman of the board of Healthcare Networks of America.
Dr. Jacoby has been named the 2010 President of The Association of Extremity Nerve Surgeons.