Dr. Jacoby discusses how medical management and surgical management for diabetic neuropathy differ.
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Medical Vs. Surgical Management For Diabetic Neuropathy The medical management of diabetic neuropathy has been the mainstay in the United States and the world for the last 50 years and the reason is because most of the medications that were used do take care of some of the pain that is associated with diabetic neuropathy, but it’s a two-edged sword. It takes care of the pain, but we want pain. If we don’t have pain we don’t know there’s a problem. So if a process is attenuated, so to speak, by medication, let’s use a metaphor – if you had a brain tumor and took aspirin you would never get the proper treatment. So the peripheral neuropathy is the same process. If you take the pain away you will never get the proper treatment and the process will go on and on and on until you lose your leg and that’s why we have ten thousand amputations a month, every month in the United States. We have the wrong paradigm. Which specialists should be seen by diabetics with circulation problem? Well I think they’d go to their podiatrist first. I think they are the mainstream in the treatment of diabetic neuropathy or diabetic polyneuropathy, as we like to call it, and vascular problems can first be detected by the podiatrist. They are the most well- equipped from a professional standpoint, from their training and their equipment that they have in the office. When we detect a vascular problem, we refer them to a vascular doctor. Vascular doctors really are not in the business of what we call triaging, looking at a lot of patients, looking for vascular issues. They are in the business of finding patients who already have that disease and intervening in that disease process.

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