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Diabetes and Chemotherapy Neuropathy

We all have patients that end up in Chemotherapy for different Cancers. Did you know some of the newest and best cancer fighting drugs have a side effect of chemotherapy-induced neuropathy. A. Lee Dellon, MD shows that the same treatments for diabetic neuropathy will work for these patients.

Diabetes and Chemotherapy Neuropathy

A. Lee Dellon, MD, Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University, Director of the Dellon Institutes for Peripheral Nerve Surgery

Patients with diabetes know all too well that they are susceptible to problems with their peripheral nerves. The most common problem is nerve entrapment, like numbness in the fingers from carpal tunnel syndrome. The next most common problem is the diffuse numbness and pain that is due to peripheral neuropathy, which begins in the feet and moves up into the legs. Neuropathy can also affect the hands, but not usually until the late stages. For the person with diabetes who develops cancer, some of the newest and best cancer fighting drugs have a side effect which, too, is related to the peripheral nerves, chemotherapy-induced neuropathy. The diabetic, already at risk for nerve compression and neuropathy, is more likely to be prone to this chemotherapy side effect.

The chemotherapy drugs currently in use that have a high risk for causing neuropathy are those related to the compound cisplatin and those related to the compound taxol. For those patients with the cancer called multiple myeloma, the drug thalidomide, highly effective for this cancer, unfortunately also causes neuropathy.

In the August issue of Plastic and Reconstructive Surgery, there is a report from the Dellon Institute for Peripheral Nerve SurgeryÔ that offers hope to the patient with chemotherapy-induced neuropathy (Chemotherapy-induced neuropathy: treatment by decompression of peripheral nerves, Dellon, A.L., Swier, P., Maloney, C.T.Jr., Livengood, M.S., Werter, S., Plastic Reconstructive Surgery, 114:478-483, 2004). In 1994, A. Lee Dellon, MD, Director of the Dellon Institutes published a study in which diabetic rats, with blood sugars of 400 for one year, were prevented from developing neuropathy by decompressing the tibial nerve in the tarsal tunnel. Colored paint on their feet permitted measurement of the neuropathy, by making their walking tracks visible. These animals walked with footprints that were no different from non-diabetic rats of the same weight! (Dellon, E.S., Dellon, A.L., Seiler, WA, IV, The effect of tarsal tunnel decompression in the streptozotocin-induced diabetic rat, Microsurgery 15:265-268, 1994.)

In the year 2000, Dellon’s group used a similar model to evaluate the effect of nerve decompression in rats given cisplatin chemotherapy. Using the painted footprint approach, it was demonstrated that rats given chemotherapy with cisplatin will develop neuropathy, and once they develop the abnormal walking tract pattern, then they can be helped by surgical decompression of the tibial nerve in the tarsal tunnel (Tassler, P.L., Dellon, A.L., Lesser, G.J., Grossman, S., Utility of decompressive surgery in the prophylaxis and treatment of cisplatin neuropathy in adult rats, J Reconstructive Microsurgery, 16:457-463, 2000). In the recent article in the Plastic Surgery literature, Dellon has extended this basic science research into patient care.

Patients with symptomatic chemotherapy-induced neuropathy in their hands and legs were relieved of their symptoms after decompression of multiple peripheral nerves. The surgery, which is an outpatient procedure, takes about one and one-half hours per limb. The surgery is usually done with about three months between one leg and the other leg, or between one hand and the other hand. A patient with neuropathy who was disabled from her job, after chemotherapy for ovarian cancer is shown downhill skiing in the photo below. She was four years after chemotherapy and cancer free, but disabled by her neuropathy. The approach that the Dellon Institutes developed for the treatment of diabetic neuropathy (dellonipns.com) can now be successfully applied to patients with chemotherapy.

 

The newest Dellon Institute for Peripheral Nerve Surgery opened in Boston in September , 2004, directed there by Virginia S. Hung, MD, a Harvard-trained Plastic Surgeon.

 

 

A. Lee Dellon, M.D. is the founder of The Dellon Institutes for Peripheral Nerve Surgery®. He is an accomplished Plastic Surgeon as well as a Professor of Plastic Surgery and Neurosurgery at the prestigious Johns Hopkins University School of Medicine, at the University of Maryland in Baltimore, Maryland and at the University of Arizona, Tucson, Arizona.

He specializes in the treatment of diabetic neuropathy as well as other painful peripheral nerve disorders and has trained many surgeons worldwide in the procedures he has developed to relieve pain.

Dr. Dellon completed his BS at John Hopkins University and received hi Medical Degree from Johns Hopkins University School of Medicine in 1970. He Completed General Surgery, Plastic Surgery and Hand Surgery Residencies at Columbia Presbyterian Hospital, John Hopkins Hospital and Union Memorial Hospital respectively. He has been in practice since 1978 and has been on the faculty of Johns Hopkins since that time.