FREQUENTLY ASKED QUESTIONS

What conditions does the Institute specialize in?

We specialize in the treatment of Peripheral Neuropathy, regardless of the cause.  We also specialize in most types of surgery of the Hand, Arm, Leg, Foot as well as Peripheral Nerves.

What are the symptoms of Peripheral Neuropathy?

Typically, the symptoms may include one or more of the following in the hands, arms, legs or feet:  a burning or tingling or similar sensation; mild to extreme pain, and/or loss of sensitivity or sensation.

Could I have PN even if I have never been diagnosed with Diabetes?

Yes, even though Diabetes is the leading cause of Peripheral Neuropathy (“PN”) there are over 100 known causes of Peripheral Neuropathy.   Sometimes the cause is unknown, in which case the PN is referred to as “Idiopathic” Peripheral Neuropathy.  Some other causes of PN, for example, are undiagnosed diabetes, repetitive motion injuries, sports injuries, trauma, chemotherapy for cancer treatment, occupational exposure to toxins, and various environmental exposures.

Why is it important to treat PN if it is “not really bothering me”… what is the optimal timing for intervention?

In our experience and that of many experts in the field, many symptoms of PN are due to nerves that have swollen (due to diabetes or other factors) or otherwise become “compressed” as they travel through certain narrow anatomical tunnels, in the arms, legs, hands and feet, similar in many ways to Carpel Tunnel Syndrome.  As these swollen nerves pass through these tunnels, they are “pinched off”, thereby cutting off the flow of oxygen and other vital nutrients (“ischemia”) to the part of the nerves coming out of the tunnel (“proximal nerve”).  The symptoms of burning, tingling, pain, loss of sensation, etc. are signs that the nerves are being deprived of oxygen and nutrients, etc. and that the nerves may be in some stage of dying or death.  It is important to treat PN early to prevent too much nerve tissue from dying.  Once a certain amount of nerve tissue has died, it is difficult or not possible to reverse the symptoms.  Left untreated, PN may lead to  infections, ulcers, amputation and disability in some patients.  The optimal time to be seen by our specialists is when you first notices you have any of the above symptoms for an extended period of time.  However, we have successfully treated patients at later stages of PN.

What are the treatments generally available to treat PN?  What are the options? 

In our experience, the only option offered by most physicians is medication to help ease pain.  As a matter of fact, according to one recent report, over 98% of patients have been told by their doctors that nothing could be done to help them, except the use of pain medication.
                                                                                                      
You may also come across several ”novel” or “alternative” treatments involving different types of gadgets that are unproven, and are probably a waste of your time and money.  None that we have seen are backed by what we consider to be responsible medical doctors.

However there is a procedure available called “nerve decompression”  which we find is highly effective in treating the pain, loss of sensation and other symptoms associated with PN in most patients.  It is a straight forward procedure, similar in many ways to the well known “Carpel Tunnel Procedure” that takes about ninety minutes, and the patient goes home the same day.  It is done in a hospital or on an outpatient basis.

How does the nerve decompression procedure work?

It is known that in the majority of patients with PN (except sometimes  in the case of PN due to injury for example) the peripheral nerve fibers that run between your spine and your hands, or your spine and your feet , become “swollen”.  For example, in the case of PN caused by Diabetes, the nerves become swollen due to osmotic pressure from higher than normal (non-diabetic) blood sugar levels.

As these swollen nerves pass through certain fixed anatomical bony narrowings or “tunnels” in the arms and legs (i.e. in the elbow, wrist, behind the knee, in the ankle or the foot) the Peripheral Nerves can become “Compressed” against the inner “walls” of the tunnels if the nerves become swollen.  As the nerves are essentially “choked off”, the amount of oxygen and nutrients traveling to the nerve past the "choke point” can become limited; therefore resulting in the symptoms of pain and loss of sensation as the nerve fibers start to become compromised and eventually start to die.  By opening up these tunnels, with a minor surgical procedure similar to a Carpel Tunnel Procedure, the affective nerve fibers become ”decompressed” and the flow of oxygen and nutrients is restored to the nerve fibers; which then leads to satisfactory resolution of the symptoms of pain and loss of sensation, etc. in most patients.

Where was the Decompression Procedure Developed?

At Johns Hopkins University Medical School, in Baltimore, Maryland, by Professor Lee Dellon, M.D.  over 12 years ago.  It is also therefore known as  the “Dellon Procedure”.

Future Treatments for Peripheral Neuropathy:

We are constantly monitoring the medical literature and communicate with many experts on PN around the world, in order to stay up to date on the development of any new treatments that are safe and effective in treating PN; and you can be assured, if they make sense, we will make them available to patients at the Institute as they become available.

One treatment that may provide useful in the future for patients with mild or early stage neuropathy, is a class of drugs known as “Aldosterone Inhibitors”.  In clinical trials, these medications seem to be somewhat useful in preventing the swelling of the nerve fibers in early stage neuropathy, thereby preventing compression.  Whether or not these medications will be commercially available is not known, but we will offer them to appropriate patients as soon as they become available.
                     

Why is the nerve compression procedure better that other currently  alternatives?

Because the only other generally available treatment that is offered is pain suppression with medication.  These pain medications often do not work to relieve neuropathic pain adequately, and in many patients, they have adverse side effects.  But maybe the most important reason is that unlike these pain medications, the nerve compression procedure seems to prevent the PN from progressively getting worse, loss of sensation may lead to ulcers, amputations and other complications and disabilities.

How effective are the treatments?

Nationally, in a study of over 1,000 patients, over 85% of patients reported good to excellent results.  And, to the best of our knowledge,  not one of these patients has gone on to require amputation since the beginning of the study 12 years ago.  Statistically, if these patients had not had the procedure, many of them would be expected to have required amputation(s).

Because of the particular level of expertise available at the Institute, our patients have over a 95% level of satisfaction.

Where are the procedures performed?

In an ambulatory surgical center or at the hospital adjacent to the Institute.  No overnight stay is required in most cases.

How long does the treatment take to perform?

Usually about 90 minutes to 2 hours depending on existing nerve damage caused by the compression.

What can I expect during the recovery time after the procedure?

In most cases, you will require the use of crutches or a walker for about a week.  You should be able to resume your normal routine in about 2 – 3 weeks.

Do you take insurance?  Which Insurances?

We accept Medicare or cash .  Most insurance companies will reimburse you for some or all of the costs of the procedure.  We will give you the appropriate papers to file with your insurance company. 

What if I do not have insurance?

We can work out a payment plan, and in some cases, the fees may be reduced for hardship reasons.

Can I make arrangements for treatment if I am not living in California?

Certainly, please call our office for more information.

How can I schedule an appointment? 

Call us at (818) 758-0200

We Look Forward to Hearing from You.