Diabetic peripheral neuropathy

The patient is a very pleasant 67-year-old insulin-dependent diabetic with progressively worsening numbness in her hands and feet. She states that the paresthesias to her hands have gone on for approximately five years and that her distal lower extremity and foot paresthesias have been on and off for the last six months. She has vascular path and has COPD and congestive heart failure and is on three different diuretics. She has had a right carotid enterectomy in addition to CABG x2 as well as multiple cardiac stents.

She presents today for evaluation of her suspected neuropathy and to assess whether or not there may be appropriate treatment options for her. Of note is that she is on Plavix.

This is a 67-year-old insulin-dependent diabetic who currently uses a scooter for mobility with paresthesias in the hands greater than legs consistent with diabetic peripheral neuropathy.

1. Upper and lower extremity diabetic peripheral neuropathy.
2. Vasculopath.
3. Chronic Plavix use.

I had a lengthy visit with Ms. today and we discussed her treatment options. First, I would like to get her set up for bilateral upper and lower extremity EMG studies. Secondly, I will order her a compounded topical cream to try on her hands first prior to her legs. I would like her to forward the imaging reports and she states that she had MRI of her spine when she was there five years ago. Ultimately, the best interventional type treatment for her may be P-stim. I have asked her to google that so we can discuss that at her follow-up visit.

She was very happy with her visit today and I will see her back in the next few weeks to discuss the results of her EMG and discuss what pain treatments may be best for her.


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