Patient: D. A.
Age: 76
Presenting Complaint:
R. A. presented on 03/03/2023 with pain and numbness in his hands and feet resulting from peripheral neuropathy in his feet for the past 8 years and in his hands for the past 18 years. His symptoms significantly interfered with his sleep and his ability to walk. When he presented for his initial evaluation, he was using a walker with a sling seat so he could sit and scoot around because of his difficulty walking. He and his wife were deeply concerned about him losing his independence and needing a caregiver.
Initial Evaluation:
Nitric oxide levels were assessed and found to be low. Thermal imaging was performed and demonstrated significant loss of circulation in both feet. Sensory testing was performed utilizing several different stimuli to assess the function of the different sensory nerve fibers. The result of the sensory testing was as follows:
- 87.1% sensory loss in the right foot
- 92.9% sensory loss in the left foot
- 28.6% sensory loss in the right hand
- 34.3% sensory loss in the left hand
The sensory loss in his feet was considered by medical standards to be permanent damage.
Thermal Imaging 03/03/2023
Sensory Testing 03/03/2023
Treatment Plan:
In-office treatment 2x/week for 4 weeks, followed by 1x/week for 8 weeks.
In-office treatment consisted of:
- Class 4 deep tissue laser therapy to the cervical spine, forearms, and hands to decrease pain, promote angiogenesis, promote oxygenation of the tissues, and accelerate soft tissue healing.
- Class 4 deep tissue laser therapy to the lumbar spine, legs, and feet to decrease pain, promote angiogenesis, promote oxygenation of the tissues, and accelerate soft tissue healing.
- Standing whole body vibration therapy to promote circulation and balance.
Home treatment consisted of the following to be performed 2x/day:
- Low level infrared therapy to promote angiogenesis.
- Specialized electrical stimulation to promote reeducation of the damaged nerve fibers.
- Nutritional supplementation to support nitric oxide production and circulation, decrease oxidative stress, and decrease inflammation.
Results:
- A. had monthly reassessments during the 3-month in-office treatment period, followed by a re-assessment 6 months following commencement of treatment.
At his 3-month assessment, R. A. no longer used a walker to assist with ambulation. He was able to sleep through the night without interruption from pain. His nitric oxide level had returned to normal. Thermal imaging demonstrated significant improvement of circulation in both feet. However, there was still decreased circulation. The result of the sensory testing was as follows:
- 12.9% sensory loss in the right foot
- 14.3% sensory loss in the left foot
- 2.9% sensory loss in the right hand
- 7.1% sensory loss in the left hand
At this point, his sensory loss was considered to be mild in all extremities.
Thermal Imaging 05/31/2023
Sensory Testing 05/31/2023
At his 6-month assessment, his nitric oxide level had remained normal. Thermal imaging showed normal scans of both feet. The result of the sensory testing was as follows:
- 8.6% sensory loss in the right foot
- 14.3% sensory loss in the left foot
- 2.9% sensory loss in the right hand
- 2.9% sensory loss in the left hand
Thermal Imaging 09/13/2023
Conclusion:
His sensory improvement had improved as follows:
- 78.5% improvement in the right foot
- 78.6% improvement in the left foot
- 25.7% improvement in the right hand
- 31.4% improvement in the left hand
The treatment protocol combining state-of-the-art laser therapy and whole-body vibration along with the home treatment regimen and nutritional supplementation has greatly improved R. A.’s quality of life, allowing him freedom and independence.
