Leprosy
mailing list – April 6th, 2006
Ccn:
all.
Ref.:
Monofilaments for sensory testing
From: Warren G., Sydney, Australia.
Dear Salvatore.
I refer to Dr Hippke’s message (LML
Apr. 4th, 2005). It
is very good suggestion and I think this is something that ought to be
included in the instructions. Certainly
the colours are easy to see where they are available and there is
suitable photocopying. But
we do try and collect figures and stats from round the world these
days so it would be good if the developed world developed something
that was more easily comparable.
I would like to throw in a memory from
the past. I remember when
Monofilaments were first advertised.
They were hailed ad marvellous a method of charting sensation.
HOWEVER Workers must remember that the ability to feel a 5 gm filament
does NOT SAY that sensation is normal.
It merely says that pressure sensation is there. It does nothing to test heat
and pain perception and these often go long before pressure in leprosy
patients.
Yes, it is a good method of charting
the progress or otherwise of sensory deficit- BUT please do not
assume that if the filaments show near normal sensation that the
patient is not at risk of damage from sensory abnormalities.
Following Dr Hippke’s statement
I would like to add that “Years ago” we found that if para-medical
workers use the tip of a ball point pen so that they dimple the skin
about 1cm diameter and record that it is something they can do at
clinics without having to get the special filaments and no need
of coloured pens etc- just a cross if cannot feel or a tick if can.
We always had set sites to test i.e.
fingertip and several on palm, soles of feet- toe tips etc.
And always did the same site so easy to compare. Jean Watson in her book on “Preventing
Disability in Leprosy Patients”, published in 1986, by Leprosy
Mission, deals with this very well.
I have not found a better manual for the simple outpatient
clinics. I often use
this, or for pain perception use an opened oval paperclip so one end
is rough (sharp) and the other is blunt.
Patient shuts eyes and point to the
site and says if sharp or blunt; so it also tests position and often
there is mis-reference showing the nerves are going but not yet
gone enough to be anaesthetic. Yes,
the patient can still feel, but does not really know where he is
touched and may not feel pain! Though
not enough to break the skin, pins and needles not allowed in
these days of AIDS and hepatitis and clinics cannot afford the special
testers developed for diabetes. I
have written on this recently in Tropical Doctor, October 2002. 32 pp
201- 205 in article titled: “Practical management of
neuropathic feet”, which deals with the very aspects of care and is
geared for the simple outpatient clinics. Do it yourself for the
patients as far as possible.
Lets keep feet good as long as we can. If we do not explain to
patients what the problem is, so that they really understand,
they can never really look after themselves. I have exactly the
same problems here in Australia with Diabetic patients themselves. Often told “Oh No, do not do
your feet yourself go to a podiatrist”. “Who is joking who can
afford a podiatrist every week let alone every day, and a check and a
little done every day is the best way to prevent problems! We need a do it yourself
campaign to start the day of diagnosis!
Grace Warren
