01/29/2024    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 5

RE: New PSSD Diagnostic Device (Cynthia Cernak, DPM)

From: Allen Jacobs, DPM

 

The 2023 guidelines published by the American Diabetes Association suggest the evaluation of temperature perception (for small fiber neuropathy) and vibratory perception (for large fiber neuropathy) by standard manual and clinical examination. PSSD is not recommended within the 2023 guidelines. Guidelines of the American Association of Neurology similarly fail to endorse routine PSSD testing as needed for the evaluation of diabetic neuropathy.

 

The potential benefits of QST are increased sensitivity and to a lesser extent specificity. However, the question to be addressed at the practical clinical level is whether the additional cost of on average $300 or more is justified. It has been demonstrated that diabetic neuropathy may be accurately diagnosed in 87% of patients with standard history and rather simple examination. If a patient demonstrates signs and symptoms of neuropathy, does quantification by QST alter the management beyond theoretical propositions? The rental of the PSSD equipment typically exceeds $1,500 a month.

 

Abuse of this technique is a concern. Given a patient with symptoms of neuropathy, an examination confirming peripheral neuropathy, clinical exclusion or inclusion of superimposed entrapment neuropathy, how does PSSD testing alter my care for the average patient? The enthusiasm for this technique appears to be within the AENS, “peripheral nerve surgeons”, and their enthusiasm for aggressive decompressive surgical procedures for the management of diabetic neuropathy, an approach generally not embraced by our neurology or endocrinology colleagues.

 

The theoretical benefits of QST (for a price) remind me of a Mark Twain quote, “Data is like garbage. You better know what you are going to do with it before you collect it." Or, as Albert Einstein noted, “there is the theoretical and the practical. And sometimes the theoretical is not practical."

 

Allen Jacobs, DPM, St. Louis, MO

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11/28/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 5

RE: Ageism  (Bruce Smith, DPM) 

From: Robert Kornfeld, DPM

 

Kudos to Dr. Smit. As we age, it’s imperative to nurture your passions. I went back to music (my first love as well) and wrote and produced many songs. I’m currently in a fantastic blues band. We’re writing our own songs and doing covers as well. We recorded an album last year, and we play gigs around the Long Island and NYC area. I feel like a teenager again. 

 

Robert Kornfeld, DPM, NY, NY