Nerve Decompression Study Offers Provocative Findings
- Volume 18 - Issue 11 - November 2005
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However, noting that decompression may not be indicated for all those who have diabetic neuropathy, Dr. Wu cautions DPMs to weigh the risks versus benefits preoperatively and thoroughly review them with the patient. Dr. Dellon notes he does not operate on patients with diabetes unless the diabetes is under control.
Dr. Wu does not think patients with neuropathy would be reluctant to undergo surgery.
“In fact, numerous patients inquire about surgical decompression. With technological advances (such as the Internet), patients are more knowledgeable regarding their pathology and treatment options,” explains Dr. Wu. “I have had numerous patients, frustrated with the lack of complete symptomatic relief from their current treatment regimen, inquire about surgical options for their painful diabetic neuropathy.”
Can Saline Mist Ultrasound Jump Start Wound Healing?
By Brian McCurdy, Associate Editor
The use of ultrasound to treat wounds has been well documented in recent years but a recent randomized, double-blind study shows the efficacy of delivering the ultrasound therapy via a saline mist. Researchers conclude the ultrasound not only has a positive effect on healing but also has an antimicrobial effect.
The study, published in Ostomy/Wound Management, tracked 55 patients with diabetic ulcers. Patients received either 40 KHz of ultrasound delivered by the MIST™ system (Celleration, Inc.) or a placebo treatment. Clinicians also provided all patients with the standard of care, which included facilitating a moist wound environment, debridement and offloading. After 12 weeks, researchers found the rate of wound healing was 40.7 percent in the ultrasound group versus 14.3 percent in the placebo group.
What advantages does ultrasound therapy offer? William J. Ennis, DO, the lead author of the study, cites the four-minute speed of the painless treatment and says there is no contact with the wound bed due to the saline vehicle. Ultrasound therapy also provides benefits such as increasing blood flow to the wound bed, cleansing and debridement, according to Dr. Ennis, the Medical Director of the Wound Treatment Program at Advocate Christ Medical Center in Oak Lawn, Ill.
Dr. Ennis says ultrasound therapy also provides an antimicrobial benefit, citing preliminary data that shows the disruption of methicillin resistant Staph aureus (MRSA) and Pseudomonas. He notes he will be researching the mechanism of the antimicrobial effect next year.
In addition, he notes there are other theoretical benefits that have yet to be proven. Noting that decreased vascular endothelial growth factor (VEGF) may prohibit healing, Dr. Ennis says there may be increased VEGF when tissues are exposed to ultrasound.
Dr. Ennis says the efficacy of ultrasound in treating ulcers is favorable in comparison to treatments such as Regranex, Dermagraft and Apligraf.
“It does seem to be very effective for not only diabetic ulcers but for other wound types,” says Dr. Ennis.
APMA Lobbies For Solutions To Potential Medicare Payment Cuts
By Brian McCurdy, Associate Editor
With potential increases in Medicare patient premiums and potential decreases in physician payments looming on the horizon next year, the American Podiatric Medical Association (APMA) is lobbying legislators for relief.
Patient premiums are reportedly rising 13 percent in 2006 while physician payments may be cut by 4.3 percent. The Centers for Medicare and Medicaid Services (CMS) notes the cut in physician payments is necessary due to a statutory formula that measures substantial overall growth in Medicare’s 2004 spending. Such funding changes will affect both DPMs and their patients, according to APMA President Harold Glickman, DPM.
“Physicians encounter rising practice costs every year. Rent costs more, clinical staff expects a raise and supplies are more expensive,” says Dr. Glickman. “If payments decrease, many physicians may decide they can longer participate in the Medicare program. As a result, many physicians may stop seeing Medicare patients.”