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Medical Forum / Diseases and Disorders / Diabetes / April 2007Foot sensitivity test... did not pass with flying colors :-(
Yesterday, at my regular checkup, my doc did a different foot sensitivity test than usual (or at least different than I remember). The old tests that he and other docs used to do consisted of poking me with two sharp things at varying distances until they determine how far apart I can feel them. There was also a test where they poked me with skinny fishing line and see if I can feel the sensation before the fishing line bends. I'm not sure if I did "well" on all those previous tests over the past 25 years, but they never really noted that I didn't respond in a perfectly normal way. This time, it was a kind of vibrating gizmo where he put it on the knuckle of my big toes and asked me when I can't feel it vibrating anymore. He tells me that he thinks I'm beginning to lose some sensation through that test (although I don't remember having that particular test before... but there have been hundreds of checkups over the past 25 years with different docs and different tools and they almost always do something with my feet, so maybe I have!) The vibrating gizmo is kind-of weird, at least some of the sensation seems to be through bone conduction. Does anyone else know the names of these tests? My doc and I talked about them as the "two sharp pointy things test" and the "fishing line test" and the "vibrating gizmo" test, but those were all my words, and I don't know the official names of any of them. He also wants me to work harder on bg control, and he's no longer semi- satisfied with A1C's in the low 6's, he definitely wants me in the 5's (which I sometimes, maybe even often, but not always hit) all the time. Maybe I'll have to change jobs to get into a work situation where I never (instead of just rarely) have to drive or work at midnight etc. Tim. On Apr 12, 5:21 am, sho...@trailing-edge.com wrote: > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 34 lines] > > Tim. Hi Tim, I can't help you with the test names--although you described them quite well. I'm a T2, so my T1 knowledge is by no means complete, but I always thought the low 6's on an A1c for T1s was pretty good. I remember from previous conversations that you are concerned about hypos when driving and prefer your BGs to run in the 130-140 range before starting out. Very responsible. So did your doctor give you any ideas how to achieve tighter control without putting yourself in danger of having hypos? Best regards, Michelle C., T2 diet & exercise > So did your doctor give you any > ideas how to achieve tighter control without putting yourself in > danger of having hypos? My thought to him was: cut out doing anything that might require me to keep my bg elevated above the >100 levels. Means (probably) even less driving. And then he said: if that doesn't work, we'll go to a pump. He doesn't micromanage my diabetes, but is concerned that when I first started seeing him I was consistently in the 5's but have had some 6's and even a 7 in the past year. In other words, as long as I'm doing very well, he won't micromanage :-). And he knows me well enough that I will do anything I can to avoid somebody else micromanaging me! In my 25 years as a type 1, I've had several docs tell me "well, now that you've had it two, five, ten, fifteen years, you have to get serious about control, the first years were easy." My current doc didn't put it quite in those terms, but trying to manage the 3 kids, the job, driving, etc., is becoming very taxing and all those responsibilities mean I never want to go hypo and will raise my bg pre- emptively under many circumstances. I'm going to be trying to remove/ reduce the need for those circumstances. Tim. On Apr 12, 12:32 pm, sho...@trailing-edge.com wrote: > > So did your doctor give you any > > ideas how to achieve tighter control without putting yourself in [quoted text clipped - 22 lines] > > Tim. Sounds like you are already well on your way to new strategies. :-) Michelle C., T2 diet & exercise > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 34 lines] > > Tim. There is a discussion of the neurological testing on http://www.diabetic-talk.org/dpn.htm As far as I know, the names are pinprick test, monofilament test, and tuning fork test. The little hammer used to test the Bubinski reflex is called a Taylor hammer, the pinwheel that looks like a docking wheel used in dressmaking is a Wartenburg wheel, and I've always heard the two probe/contact tester called a "Sparkie". They always remind me of the Mel Brooks' Frankenstein movie. Jim : Yesterday, at my regular checkup, my doc did a different foot : sensitivity test than usual (or at least different than I remember). : The old tests that he and other docs used to do consisted of poking me : with two sharp things at varying distances until they determine how : far apart I can feel them. : There was also a test where they poked me with skinny fishing line and : see if I can feel the sensation before the fishing line bends. : I'm not sure if I did "well" on all those previous tests over the past : 25 years, but they never really noted that I didn't respond in a : perfectly normal way. : This time, it was a kind of vibrating gizmo where he put it on the : knuckle of my big toes and asked me when I can't feel it vibrating [quoted text clipped - 3 lines] : over the past 25 years with different docs and different tools and : they almost always do something with my feet, so maybe I have!) : The vibrating gizmo is kind-of weird, at least some of the sensation : seems to be through bone conduction. : Does anyone else know the names of these tests? My doc and I talked : about them as the "two sharp pointy things test" and the "fishing line : test" and the "vibrating gizmo" test, but those were all my words, and : I don't know the official names of any of them. : He also wants me to work harder on bg control, and he's no longer semi- : satisfied with A1C's in the low 6's, he definitely wants me in the 5's : (which I sometimes, maybe even often, but not always hit) all the : time. Maybe I'll have to change jobs to get into a work situation : where I never (instead of just rarely) have to drive or work at : midnight etc. : Tim. tim, I think the fishing line test is called filiment test (filiment+ fishing line:-). Was the vibrating gizmo a tuning fork that is struck on something sharp and then vibrates for a while and they put th eend onto your ankle or toe or whatever? I hae had tht test. I have no idea bout the two separate sharp things test as I have never had it. Sorry you are having problems. good luck with trying to get thenumbers down without hypos. Wendy > tim, > [quoted text clipped - 6 lines] > Sorry you are having problems. good luck with trying to get thenumbers > down without hypos. I think he is referring to something else. I had a device used on me that looked like a drill but instead of a bit it had a rubber tip. Don't know what it was called though. It's called a tuning fork. It's real use is in music. > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 34 lines] > > Tim. I was gonna do a study for a nueropathic pill. They hooked up electrodes to the muscles and then timed the reflex action. You had no choice but to move. It was like the jab the elbow into the table accident test. Holy *....* This was either to get aproval or test results, or both. Obviously there is some serious data here. > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 34 lines] > > Tim. I had the tuning fork test done a couple of months ago and I think I flunked. I could feel the fork vibrating very distinctly on my right foot but I could barely feel it on my left foot. I don't know what it means because the doctor just mumbled and scribbled something in my chart. Most doctors and most diabetics would love to see A1Cs in the low sixes. I am not a doctor but it seems to me that getting hypo is a lot more hazardous to your health than having A1Cs in that range. But then I can remember when 7.5 was considered a good number. Then it was 7.0. Then it was 6.5. The standards get tighter every year. Talk about moving the goalpost! Jerry Vrooman > I had the tuning fork test done a couple of months ago and I think I > flunked. I could feel the fork vibrating very distinctly on my right > foot but I could barely feel it on my left foot. In my case I clearly felt it on both feet... but my doc told me that when I lost sensation, that I should've been still feeling it then because the fork was still vibrating. The gizmo he had looked a lot like a compass (the kind used for drawing circles) and I think there may have been some kind of scale on it. > I don't know what it > means because the doctor just mumbled and scribbled something in my chart. My doc also told me that I still have a good pulse in my feet, and all the skin-contact ("sparkie" and "monofilament" tests) show that the skin sensitivity is in good shape. So we aren't really doing anything about it right now, but maybe we can talk about it more the next visit, now that I understand at least the surface of the test and maybe will learn more about the implications. He didn't seem too concerned at the time, and I didn't quiz him about the meaning, but I think I'll take this up with him next time for sure! > Most doctors and most diabetics would love to see A1Cs in the low sixes. > I am not a doctor but it seems to me that getting hypo is a lot more > hazardous to your health than having A1Cs in that range. But then I can > remember when 7.5 was considered a good number. Then it was 7.0. Then it > was 6.5. The standards get tighter every year. Talk about moving the > goalpost! Two years ago this same doc was very happy to have me in the 6's and quizzed/lectured me about hypo risks when I was in the 5's. In this case, I think perhaps not only are the goalposts moving, but in my case I would've previously been in the new goalposts but now no longer was! Of course, my doc also knew I could hit the new goalpost, maybe he was just coaching me in that direction... :-) Tim. > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 25 lines] > test" and the "vibrating gizmo" test, but those were all my words, and > I don't know the official names of any of them. I don't know the name of that test, but I've had it done and I passed it. I should tell you that I have moderate neuropathy in my feet and lower legs, yet I passed it! So I consider the test to be worthless. A better test is one with needles and electrodes, done by a neurologist. You should probably have that done if you suspect nerve damage. > He also wants me to work harder on bg control, and he's no longer semi- > satisfied with A1C's in the low 6's, he definitely wants me in the 5's > (which I sometimes, maybe even often, but not always hit) all the > time. Maybe I'll have to change jobs to get into a work situation > where I never (instead of just rarely) have to drive or work at > midnight etc. Wow! Tough! Sorry to hear that. > > Yesterday, at my regular checkup, my doc did a different foot > > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 31 lines] > one with needles and electrodes, done by a neurologist. You should probably > have that done if you suspect nerve damage. I've been asking around and it seems the vibrating gizmo (which seems to be officially a "128Hz Tuning Fork test") is pretty sensitive for detecting neuropathy according to the papers on the web. The vibrating gizmo looked a lot like a compass (the kind used to draw circles) except it also had a tuning fork attached. I think something on the body indicates the size of vibration. I think all the tests were unfair, because I didn't have time to study for them! > > He also wants me to work harder on bg control, and he's no longer semi- > > satisfied with A1C's in the low 6's, he definitely wants me in the 5's [quoted text clipped - 4 lines] > > Wow! Tough! Sorry to hear that. I've got a pretty sweet job already (how many jobs let a computer-geek eco-hipster-doofus have fun with a $10Billion remote control system, have pretty good health insurance, AND offer a free ride to and from work?) but will see if I can arrange things to my advantage (maybe with my docs help) such that I don't have to drive much anymore. Tim. >Does anyone else know the names of these tests? My doc and I talked >about them as the "two sharp pointy things test" and the "fishing line >test" and the "vibrating gizmo" test, but those were all my words, and >I don't know the official names of any of them. Great descriptions - but no, no "official" names. It was the vibrating thingy that confirmed my neuropathy, and its demise. The filament test didn't work, because I still had surface feeling - it was the deep stuff that had gone. >He also wants me to work harder on bg control, and he's no longer semi- >satisfied with A1C's in the low 6's, he definitely wants me in the 5's Wow! I'm impressed. Do I gather you have good hypo awareness, and aren't too prone to them? Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.5% BMI 25 > Yesterday, at my regular checkup, my doc did a different foot > sensitivity test than usual (or at least different than I remember). [quoted text clipped - 34 lines] > > Tim. I get that done once a year. My endo uses a small tuning fork. http://en.wikipedia.org/wiki/Tuning_fork You *REALLY* have to concentrate or you won't feel it for very long. The first time she did it, I let her know when I thought it had stopped. She said no, I have to concentrate more. The second test was much better. It's almost a close-your-eyes-and-don't-breathe kind of concentration. For me, anyway. The test with the fishing line is called a monofilament test. Vicki > sho...@trailing-edge.com wrote: > > Yesterday, at my regular checkup, my doc did a different foot [quoted text clipped - 45 lines] > It's almost a close-your-eyes-and-don't-breathe kind of concentration. > For me, anyway. Interesting. I didn't try that hard. At the end, as it faded out, it wasn't that I was continuously feeling the vibration and then it abruptly stopped, it was more like it was coming on and off a couple of times. I don't know what that means, will try to do some research, maybe that particular feeling means something bad, or maybe it's normal, I just don't know, and wish that I'd asked while in the office! Tim. |
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