Are you Diabetic?
Do you suffer from PAINFUL, BURNING, TINGLING and NUMBENSS in your feet?

Neuropathy (nerve damage) usually presents in the Diabetic as a painful, burning, tingling and numbing sensation in the feet. According to the American Diabetes Association approximately 17 million people suffer from Diabetes and half of them will develop some degree of neuropathy. Unfortunately, diabetic neuropathy is the leading cause of ulceration and infection which may result in amputation. Traditionally, good sugar (glucose) control, pain medications (narcotics, anti-depressants) and some topical medications (capsascian) were the only treatments physicians had to help their patients with this painful condition. Annual testing for neuropathy in the diabetic patient has become the standard by the American Diabetes Association; however, these tests have been shown to be inaccurate and non-quantitative. In addition, these traditional tests measure myelinated nerves and are invasive, resulting in discomfort to the patient while testing.

PSSD (Neurosensory Testing)
The PSSD (pressure-specific sensory device) is a non-invasive, reliable, computer assisted testing device which will help determine the level at which a patient is experiencing neuropathic symptoms. In addition, the PSSD will also help determine whether a patient is a candidate for specific nerve decompressions which has been shown to have 80-90% success with reversing the symptoms associated with diabetic neuropathy.

NERVE DECOMPRESSION PROCEDURE
The operation is performed in an outpatient setting. The procedure is done through three small soft tissue incisions, taking approximately 1-2 hours. Patients return home the day of the surgery with a walker for assistance for the first 2 weeks post-operatively. 80% will return to a sneaker at 2-3 weeks. The majority of patients will have significant neuropathic pain reduction in the first hours following the operation. However, some patients may not have full pain and sensory recovery for up to 1 year.

If you suffer from Diabetic Neuropathy and are interested in being evaluated with the PSSD to see if you are a candidate for this new, out patient surgical technique, please do not hesitate to contact Dr. Rick Delmonte, DPM, FACFAS at the office of Belvedere Podiatry: (212) 874-3578.

Also, click here to see Dr. Delmonte's September 2005 interivew with WCBS Channel 2 News New York.

Patient Testimonials

Joseph Goldin, New York City, New York, July 2004
"I have been a diabetic for over 20 years. In that time, I started experiencing neuropathy in my toes, that gradually encompassed my feet, ankles and lower legs, and is now starting to manifest in my hands. The pain involved is incredible, words like burning, cramping, numbness only start to describe these feelings. I have seen neurologists, orthopedic surgeons, and at least six podiatrists in that period. I tried neurontin, which helped me sleep, but knocked me out for too much of the next morning. In the last few years, I have had complications due to the diabetes: charcot joint, hammer toes, infections, osteomyelitis etc. These problems have caused the need for numerous operations, prolonged hospitalization and extended convalescence at home. When Dr. Rick J. Delmonte explained to me about neuropathy decompression procedure, and the possible success rate, I elected to have it done. Dr. Delmonte and Dr. Greenberg performed the operation on June 3rd. For me there was no overnight miracle, but I have regained some feeling, and hope that as time goes by, this will increase. Even if there is no further increase in feeling, if I had even this much a few years ago, I would probably have not lost over 100K in income, and medical expenses that cost the insurance companies in excess of half a million dollars."

Alan Wolfer, New York City, New York, June 2004
"I am a non-diabetic whose heel and later foot pain began about one year prior to my recent successful surgery by Dr. Delmonte.
First I developed soreness along the inside area of my left foot, and I was given an orthotic to wear by my first podiatrist. Then he inserted a pad to cushion the area. The soreness turned to pain which increased in intensity with time. Injections came next, three over a period of six months. The diagnosis became plantar fascitis. From that point came, exercises, ice, more injections. the pain spread to my entire foot. A sheet touching my toes caused pain. Standing and walking became acutely painful.
I went to a second podiatrist, had a new orthotic made, continued home exercise, and began three months of PT, whirlpool, tens unit, ultrasound, massage, exercises targeted to strengthening the muscles, ligaments, etc., and finally a night splint. The general foot pain subsided but I was left with acute pain focused at the outer portion of the heel adjacent to the ankle. Common sense suggested that with a focal point there had to be nerve involvement. I thought to seek a new approach and was referred by an old and trusted friend (in whose debt I will be for a long time) to Dr. Rick Delmonte, in New York City.
Dr. Delmonte and his partner Dr. Paul Greenberg concluded, after doing neurosensory testing, that the pain was coming from the calcaneal nerve being constricted. Surgery to relieve the constriction was recommended. The surgery was done on April 22, 2004, using the technique developed by Dr. Dellon in Baltimore. The rest is history. I will be sevety-five (G-d willing) in July and once again look forward to what I have always enjoyed, a good walk, aerobic exercise, and therefore being able to enjoy a few more calories.
You have made it possible for many of us to do more than just go on living. I hope, Dr. Dellon, that your smile is as big as that on Dr. Delmonte's face when I next waltz into his office."
Sincerely,
Alan Wolfer

Alan Wolfer, New York City, New York, April 2004
My Soul
What purpose does G-d for my Spirit provide,
except to make my Soul arise;
Why rise, my Spirit asks G-d for me,
enough it makes me smile within;
Not good enough does G-d reply,
except it makes another smile
(written April 23, 2004 the day after surgery by Rick Delmonte, DPM of New York City, N.Y., and written to Dr. Delmonte as he has made it possible to relieve his chronic foot pain.)

Anthony Ferone, Westchester, NY, September 2005
"I am a 70 year old retiree who has suffered from Diabetic Neuropathy for the better part of ten years. Initially, I lost feeling in my feet and ankles. As the years went on, the numbness was accompanied by a constant feeling of “pins and needles” and pain in my feet. I became so uncomfortable and lost so much sensation that I had to give up an enjoyable part- time job as a school bus driver as I feared that my driving had become impaired.
I spent the last three years searching for something that would end my discomfort. I consulted a renowned neurologists who attempted to treat the neuropathy with drugs and electrical stimulation. These treatments were not successful. I tried putting “magnets” in my shoes as there was research that indicated magnetic force would relive the numbness, pain and tingling I experienced on a daily basis. The magnets did not help . I even participated in a clinical trial for a new drug that was supposed to relieve the symptoms of diabetic neuropathy. Unfortunately, this new drug did not help me either. It appeared that I had exhausted all options that modern medicine had to offer.
Fortunately, as I was reading my daily New York Post, I saw Dr. Delmonte’s add for a new treatment called Nerve Decompression Surgery that would relieve the symptoms of diabetic neuropathy. At first I was skeptical, as I thought my doctors had advised me of all possible treatments that existed. But my pain and discomfort was getting worse, so I decided to call Dr. Delmonte and make an appointment to see what this procedure was all about.
I made the trip from Westchester into Manhattan a week later. Dr. Delmonte , who I found to be kind and patient , explained the procedure to me and indicated that I may be a candidate. I made necessary appointments and the test were completed. Dr. Delmonte indicated that he would perform the surgery. Finally I had real hope that I could be helped.
I am now one month post surgery on my right foot and I am glad to report that I am experiencing noticeable improvement. I now have movement in my ankle and increasing sensation in my foot. I look forward to increasing improvement and plan to have the procedure performed on my left foot within the next month.
I would encourage anyone who has suffered as I have to consider meeting Dr. Delmonte and consider having this procedure. All you have to lose is the pain.

Merwin S. Goldsmith, New York City August 29, 2005
"It's been 6 months since you performed the 3 zone nerve decompression operation on my foot and leg. I am happy to report that it's healing beautifully and I no longer have the burning, tingling pain in that limb. There is a considerable amount of sensory improvement too. My balance has improved and I can't wait to have this performed on my right leg in November. This has changed my life and I'm grateful for your work. Many, many thanks for the relief. I expect to be dancing the Russian "kazatske" very shortly.

-Merwin

Raymond Williams, New York City, June 2005 and September 2005
Like most Type-two diabetics I didn't know that I had it until it was too late. I'm sixty-six years old and I've probably had it since my early twenties and can state that with a high degree of certainty because for as long as I can remember I was always warned by physicians (mostly during annual employment check-ups) that my "sugar was spilling over into my urine" and that I should have it looked into. Like most know-it-all young men I was sure that 'they' didn't know what they were talking about so I did nothing! I paid no attention to what I was stuffing into my mouth; I didn't exercise and I ate sweets like they were going out of style. As you can guess this eventually caught up to me with a vengeance.

Immediately upon my retirement in June of 1999 I started with the early, classic symptoms of diabetic neuropathy: numbness in the balls and toes of both feet. It wasn't too bad at first but I looked into it by visiting a neurologist (I should mention that I was somewhat active with regard to physical exercise but not terribly religious about it). Tests were taken and we agreed to keep a close eye on it. About eight months later I received my first visit from the 'beast'. The 'beast' is what I identify with as the burning sensation in my feet and accompanied by violent spiking in both lower shins and ankles. At that point in time I revisited my neurologist and he mentioned that a major pharmaceutical company was doing a 'blind' trial test on a new drug for epilepsy but it was believed that it would also address the pain from neuropathy. I was in luck (or so I thought) and I was enrolled into the test and requested to keep a 'pain' diary for two weeks. But because I didn't score high enough on the pain scale I was jettisoned from the trial.

Seven months later I was ready to hang myself as the 'beast' reached new levels of torture, with burn/spiking sensations that were off the charts, so to speak. Because of this I was allowed reentry into the 'trial' and I received actual medication (or placebo) for sixty-four weeks. To make a long story short, the drug worked less-than marginally and after the sixty-four weeks (with no meaningful success) I left the trial study and graduated to Neurontin. I started with three hundred milligrams per day and this was slowly and steadily increased to a daily dosage of eighteen hundred. The laws of diminishing returns now kicked into effect: I was taking more medication but getting less relief. Neurontin was however; very successful in making me sleepy and lethargic but was never fully successful in relieving the burning pain. I should not forget to mention that this ordeal was also wreaking havoc on my wife. She was constantly worried about me and our conversations seemed to focus on "how were your feet today?" Furthermore, this was becoming contagious within our circle of friends and relatives and I didn't want people looking at me and thinking of my feet.

It was at this point that I could only achieve short-term relief by aggressively increasing my exercise workouts. Most likely, any relief was attributable to the increased circulation to my feet. But because of this aggressiveness my glucose became so low that I started experiencing lightheadedness and I decided to have that checked by my regular physician. And here is where my good luck to hold. During this routine check-up I was informed of good work being done in the field of neuropathy by a podiatric foot surgeon named Rick DelMonte of St.Luke's hospital. I called his office to schedule a pre-PSSN sensory test and a week later I took the test. At this juncture I was given a surgical 'green light' by Dr. DelMonte and a second pre-op' evaluation exam was scheduled with his co-surgeon, Will Samson. Doctor Samson's evaluation was necessary and they performed the first operation to my left foot on June 16th, 2005 at St. Luke's hospital. I was discharged the same day and sent home for rest and recuperation. Surgery to my right foot was performed twelve weeks later on Sept. 15th, 2005.

In my case the healing process was the same for both feet: one to two weeks of bed rest with the operated foot being elevated higher than the level of my heart with minimal walking. I should mention that during the first two weeks there was never any serious pain whatsoever. Of course there was some soreness to my ankle but only to my ankle.

The third week commenced with some walking and light 'toe-tapping' assisted by crutches. After the sutures were removed (by the end of the third week) I was able to hobble around the house, using only a cane. By the end of the fourth week I returned to my health club, resuming a light exercise schedule. At the end of week five I returned to my three weekly Pilates classes and by week seven I was back to my normal exercise schedule: bike riding, treadmill, etc.

The results of my surgery are that I am free of burning/spiking pain altogether. Other than the medication that I was given for post-operation discomfort (and that was minimal to my surprise) I haven't taken any Neurontin since September 15th and feeling to my feet is returning in a rapid manner. To me this sensation is akin to having one's foot fall asleep in a movie theater and then reawaken at the end of the show. I have noticed that since my last operation (September 15th) that sensation is subsiding and I'm optimistic that this phase will end soon. Additionally, I reach new plateaus weekly with the most recent being a greater sense of balance.

I will finalize this testimonial with some hindsight: Initially, I wondered if I were too old for this surgical procedure. To my everlasting pleasure that was not the case. I'm sixty-six years old and I handled this very well. If anything, using crutches helped me develop upper-body strength to an area that was getting a little soft. My second thought was that I could forego the operation, increasing my dosage of Neurontin to combat an ever-increasing level of pain. This would have been a mistake; one that I would have regretted for the rest of my life. Lastly, this process required that I expend about six months of minimal hardship in order to enjoy the rest of my life pain-free. I'm sure that any rational person would agree that the good returns of this surgery surely outweigh the time spent during recuperation. And last but not least, I (and my wife) have had the pleasure of coming into contact with two very fine surgeons- Doctors who've changed my life and we will be indebted to them forever.

Stephanie Haen, New York, December 2005
Before meeting Dr. Delmonte, I spent the better part of a year going from provider to provider trying to find an accurate diagnosis and treatment for my medical condition. After doing some research of my own, I discovered Dr. Delmonte. On my first visit to his office, he took the time to get to know me and began to work systemically in looking for the cause of the pain I was experiencing. He was always upfront and honest with me throughout the process and always took the extra time needed to answer my questions.

After ruling out all other possible causes, I was diagnosed with idiopathic neuropathy in both feet, an unusual condition for a young person who does not have diabetes. Dr. Delmonte encouraged surgery, but only as a last resort after trying multiple other treatment options. At this point, I couldn’t stand for more than a few minutes without severe pain.

I underwent the first nerve decompression surgery in January of 2005. Though the recovery process was a gradual one, my quality of life vastly improved. Not only was I able to return to work without fears of how I would get through the day, but I was also able to dance for the first time in three years on my wedding day in October of 2005! A year later, I am still noticing improvement.

I am currently recovering from a second decompression surgery in my other foot and I am hopeful because of the improvements I am feeling each day! Without Dr. Delmonte’s help, I don’t know where I would be right now. Thank you, Dr. Delmonte, for taking the time, having the patience, and going the extra step in helping me to understand and improve my condition.

Josephine Castillo, New York City 5/2005 (left leg), 12/2005 (right leg)
Dear Dr.Delmonte,
I'm writing this letter of thanks to you for saving my mother's legs. My mother Josephine Castillo suffered for a long time in pain because of the poor circulation in her legs because of her diabetes. Before we came to know you, previous doctors suggested that my mom have her foot amputated. Since I was always taught to get a second opinion,you were my second opinion and you gave us hope that you could save her legs and you did it!!! Your new procedure was smooth all the way and with not alot of pain after the surgery. My mom can walk now and because of your caring manor in treating patients. I have my mother back all because of you. I strongly urge you to continue your work in this path in the fight against diabetes and change the minds of theses doctors who are not open to change. Amputating legs of people is not the only answer it should be the last and only resort. In closing, again many thanks to you and your staff.
Sincerely, Andrea Principe

Anna Cannistraci, Valley Stream, NY January 2006
Just recently, I've had the opportunity to have surgery by Dr. Rick Delmonte. The following will describe my experience with Peripheral Neuropathy.

For the past number of years, I have been seen by four doctors, who have told me there was no hope for my relief of the pain and discomfort. As a result, pain killers were the only remedy to create some sort of comfort. In addition, I was very discouraged and depressed. After seeing a special medical report on Dr. Delmonte on CBS news I quickly called for an appointment. The report showed how through surgery, people with my condition have hope. Dr. Delmonte examined me and I began to believe that I was going to be free from my suffering. I went in with tears and left with a smile. He explained what I had and how the surgery can eliminate the tingling, burning and shooting pain caused by type 2 diabetes. A computerized test was used to show the severity of my condition, and an appointment was made for surgery. Dr. Delmonte and Dr. Samson were very professional and dedicated. Their care and concern made me feel comfortable.I am proud to say that I am pain free, no discomfort, and wearing shoes again. There was restoration of sensation at the bottom of my feet. No more tingling, burning or shooting pain. The tip of my left toe is numb, which was caused by a prior surgery which I had years back by a previous doctor.

I thank Dr. Delmonte and Dr. Samson for their dedication and commitment in helping people with neuropathy.

" You have taken steps beyond your field for the care of your patients."

Thank You,
Mrs. Anna Cannistraci

Gilbert Snowden, Greenwich, CT December 2005
As a type II Diabetic with severe neuropathy, I am extremely happy to have been introduced to Rick J. Delmonte and Dr. William Samson and the procedure known as Nerve Decompression.

Approximately 6 years ago, I experienced a serious health condition that attacked my auto immune system and unfortunately resulted in the onset of Type II Diabetes. The auto immune problem was resolved but the Diabetes was something I would have to live with for the rest of my life. That was tolerable but what was not at all tolerable was the neuropathy that I had. I had no feeling from my toes to my knees and suffered with cramping and tingling and burning twenty four hours a day, seven days a week. Although I actively sought relief, I was constantly told that the neuropathy was something I would just have to live with. Wow, what a way to live! Constant discomfort and the fear of hurting yourself and not even knowing it. How does one cope? Quality of life is fair at best. You learn to cope and make adjustments to how you perform everyday activities and grin and bear it! The nights were the worst time of the day for me. Constantly rubbing my calves would only sooth the discomfort and allow me to fall asleep. My wife can tell stories about how she would watch me rub my legs while I was asleep; it was part of my life. Whenever I could remove my shoes I would rub my feet and calves for some soothing comfort, it was a horrible situation. After having a friend tell me about a CBS Health Watch segment he saw that included an interview with Dr. Delmonte and one of his patients who had the Nerve Decompression procedure I immediately set up an appointment. I met with both Dr. Delmonte and Dr. Samson and went thru the required testing and “YES” I was a candidate for the procedure. Excited and anxious with some apprehension I was scheduled for the procedure on 12/29/2005. The celebration of the New Year was the best I could have ever had!

The nerve decompression surgery that Dr.’s Delmonte & Samsom performed was what I consider to be a miracle. The procedure was totally painless and 100% successful for me. Unfortunately, I had a slight set back in my recovery with a wound problem but even with that I had immediate relief and feeling in my foot, toes and calf. What a wonderful thing it is to not have cramps and pins and needles in my leg and foot. I have warmth and a normal pink coloring in my right leg and foot. It’s quite nice now to actually feel the shower water on my foot. I have not had warm feet in years!

I, without hesitation, recommend this procedure to anyone who has diabetic neuropathy. I am anxious to have my other leg/foot done the results are so fantastic.

Not only was I pleased with the procedure I was equally pleased with both Dr. Delmonte & Dr. Samson. I found both of them to be professional, thorough, cautious, concerned, caring and dedicated. Both doctors have a wonderful bedside manner and were very accessible to me as the patient. As I mentioned earlier, I had a wound problem and Dr. Delmonte was in constant contact with me even on the weekend. What more could someone ask for? It was obvious to me that both doctors are truly dedicated to helping individuals with diabetic neuropathy. It was a refreshing experience to have had two such wonderful and professional physicians.

**The information contained here is not meant as a substitution for direct medical advice. Please see your doctor if you are experiencing any troublesome symptoms.**

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