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How often does your T1D health care provider screen for neuropathy with a monofilament, tuning fork or pin prick on your bare feet?
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She hasn’t since I’ve only seen her via teleheath since fall of 2020. My doc who I had before did it at every visit.
Other. 4 or 5 years ago the answer would have been always. Then a diagnosis of peripheral neuropathy was rendered. So, currently, the answer is never.
My question for those of you knowing more about this than me is: Is this standard medical practice to not use filament testing once diagnosis is determined?
Don’t think I know any more, just my experience. Once it was determined I had severe neuropathy in my feet and started seeing podiatrist routinely for it, no more testing deemed necessary. I’ve got it and don’t expect it to go away, ha!
Yep – once the sensation/feeling is diminished and gone, the sensations of normal feeling is replaced with the altered sensations of weird numbness that comes with long duration neuropathy.
My old endo did it every time. The new one does it maybe every 6 months.
My current endo checks once a year.
I see a podiatrist every 3 months. My Endo referred me there.
My doctors did these tests regularly up to about 1985. At that time I was registering no reaction to either test. My peripheral neuropathy had progressed so far that there seemed to be nothing to measure. (Original diagnosis of diabetes was in 1963.) Doctors have tried again when we moved and engaged new health providers.
due to Covid restrictions, haven’t seen anyone in over three years
Used to be every appointment but my numbers are so stable with A1c always below 5.8 they have cut down. I always have a list of questions so they know I am involved and would mention any problems
2 Endo’s ago, he did it every time. Now 3 or 4 visits later with 2 different endo’s it has not been done. However, my PCP does it on my annual physical.
My endocrinologist does not check my feet. I see a podiatrist every year.
I used to get checked 1x a year. Haven’t been checked in 3
My question is: what purpose does this test serve? Is there anything that can be d one if there is a loss of sensation? Or is this just another way to document our decline? Does it serve to motivate the patient? We already know about the value of good control…..
It is used and performed as an obligatory screening test to determine nerve peripheral nerve damage and how far it progresses over time. Does nothing to heal or change the condition. Serves as a tool for providers to check the feet, determine any progressive changes, document any subtle or significant changes, and check a box in your medical record that they did it. ADA Standards of Care recommend that it be done at least once a year, if not at every diabetes focused f/u visit.
It varies very highly… I moved back to Minnesota in November 2018 and started seeing my current Doctors in 2019.
In 2019, it seemed like they were doing that foot test on every appointment.
In 2020 my PCP and Endo each did that testing at only one appointment each.
In 2021 neither of my doctors even glanced at my feet once over the year.
This year my PCP did that test once when I went for the antibiotic-resistant bacterial/fungal infection I developed on April 3 and still haven’t fully recovered from, my Endo retired, but the person taking over for my Endo did that foot testing on my appointment in February..
Never but I see a podiatrist every 3 months.
We already know I have neuropathy in my feet, so there is not as much need to do it every time. The numbness/burning and tingling have been better since they started me on the Metanx supplement.
When the appointments are inperson. It’s kind of hard to do via Zoom.
I answered “At about 1/2 of my appointments.” But the truth is, almost all of my appointments since 2020 have been on Zoom. I went for an office visit 2 months ago, and she used a pin to check my feet, which was done often previously. I’ll probably do Zoom again in June with the uptick in Covid again.
The toes on both my feet are numb (tarsal tunnel syndrome) and I also have dyspareunia. But neuropathy reflects badly on the institution, so it is never identified. My feet are very sensitive. A small grain of cat litter feels like a stone, a hair like a sharp object, so I always feel the monofilament, so their concerns are alleviated.
Cat litter and Legos were invented to impress people who insist on going barefoot in the middle of the night. Sigh!
I had this happen twice. I had a dog with hair similar to a labs but a little shorter than that. Twice I got his hair in my feet which felt like slivers in my feet. Very strange to think hairs could be imbedded in skin in that manner.
I selected “Rarely, less often than once per year”, but that’s because I have confirmed perpheral neuropathy as well as autonomic neuropathy. (I haven’t been able to feel my feet and lower legs for about the last 20 years.)
I receive an annual “screening” by my podiatrist, though this is mostly not within the 12 months stipulated, and this also includes a test with a tuning fork to see if I can ‘pick up’ vibrations, as well as a doppler test to check blood flow to my extremities, as well as a review of my medications.
It was every appt, same with my primary doctor. Now, since I was diagnosed with Neuropathy, they both leave it with my Neurologist.
She does occasionally but I lost all feeling in my feet and hands in Sept. 2017 while on chemo for Stage 3 breast cancer.
Once a year
He does it every in-person appointment, but since COVID started most of my appointments with him have been telehealth.
At least once a year. In between endos currently.
I only see my Endo once a year. She usually checks at that appointment, but not always.
ADA Diabetes Care 2022;45:S188 recommendation is to check once per year. My current Endo hasn’t checked in 2.5 years since I have been seeing her. It is one of the many reasons her practice is substandard. However at this time I don’t need to spend the $8000/year required to access a better endo in my corner of the US. Part of the problem is Tenet Health’s 15 minute endo appointment standard. For those interested in what the minimum there doctor should be checking with regards to neuropathy in the US, this link is the ADA 2022 standards of care chapter 12
https://watermark.silverchair.com/dc22s012.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAswwggLIBgkqhkiG9w0BBwagggK5MIICtQIBADCCAq4GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM0-UYoFGkkDGftBpdAgEQgIICf23rv20tkOCd1oFoVgzVa-RAUG4xr_DxG6PsKadKiQ6VXG0Q-Lwqw4cu50gjuD3EtEffpwTHE3anA6XYf563lp3i1MQrpbPN8v4YmuxLZqPWM2OuKjeWYQ9bZ4R2LpXZWivk_FfXNB2MtmGsnFc4KiJHsly5h4k2e-1N3jJLKDNdK7A9Qm10UrNnZKRL4zTawHzH3RKYerJm5pYp_ldKCGJgPaUxDzFiRzNb1RDoJduA8FEJnX490KWb_leuos2fD_G6-X7bvxU47m6JuB8VGZax1aNCf2uAndl6UFN8rKdH05VfgCNZHHtrhKGSLcR7kJsmwlvGnizXfeaCtwllGnNyoqHCA_LQou3D-mzX-skLwzFDBE1HwL3I05lfM1SCUemW3Q16y8U8khZMyLc5aIsDfugzxT3LUGwZqPHs6XnBfcl1M6WpOiWBVhXBzLKdpLnQW8hNr2L9uxgzD6MKAutdgEg5_-PrRSLfUfRmmdgWHvoFmNohZToZruKIknCq45-pehq2OyaqrXOBFgnUSRYn1nZf7pZaVKLmCPiixmUs8-QONSTVWzYaYPwFi4fftmJarM5BBuD1MxyIYB_-KwypAiZBbOu9Te5aTL3B5svThQxQPlapfOcBBNXGDk36HljdAL-lmH4nK0PZdxSs194pD8j2mWbQYa3amUPcCzotSmBYXnkLilsgX0-aZtvqj370KShlgXKeOS3VIUzlPDgUXXINrlZ85AbnLJUr_QipfGZepwvvIXPureU_nquGDcN2m1XxjexfEDG5RTvn9VlS2u5sTbEGeM1Zmd3ChjGpzjFbNHRYfrvN4RUiotV-BiZGKfRpKU0yeQlUXU3zOw
My doc used to check at every appointment, but then when COVID hit, appointments were done by phone, so not done. So I guess, every appointment that is in-person?
At my in person appts
I just started with a new endo and he said something like, “Let’s check your feet,” in a tone that implied this is something he does regularly. So, I am guessing that it will be every appointment.
My old endo never checked in the 4 years I was seeing him. In fact, when this new endo brought it up, I hadn’t realized how long it had been since someone checked!
Even before covid, it had been years and years since anyone had tested my feet… I don’t have a podiatrist who is checking… just me and the weird stuff my cats leave around the house!
My previous endo did it on every visit , ,current endo has never done it
Not only my Endo., but my Podiatrist also screen for neuropathy with a monofilament at every visit.
I am advised to see a chiropodist at least once a year. I finally broke down and made an appointment where my feet were examined with filament and with tuning fork. I was given a very thorough examination and given a copy of the results to share with my endocrinologist and my GP. I was asked to return in two months.
I’ve only had one appointment with an endocrinologist and he did not check for neuropathy. He recommended I start seeing a podiatrist and ophthalmologist.
Neuropathy is advanced and documented way beyond the monofilament.
He checks the pulses in my feet.
Once a year
Once per year at annual checkup. But some years I may have more than that one appt w/ primary care physician.