Leprosy Mailing List, January 8th,
2009
Ref.: Management
of reactions and nerve damage in leprosy
From: Srinivasan H.,
Chennai
,
India
Dear Dr Noto,
I do not
agree with Dr Theuvenet (LML Dec. 30th 2009) that "no
one has ever found a regimen that is really effective in restoring
nerve function up to a functional level."
In my
experience innumerable patients have had their nerve function restored
to a 'functional level', although not all had been restored to
absolute normalcy. The
problem is two fold: 1)
many patients are under-treated, with too small a dose, for too short
a period and without the benefit of surgical nerve decompression at
the optimal time even when it is attempted; 2) many times the nerve status
is not assessed carefully until it is too late, by which time the
nerve has been destroyed (irrecoverably damaged). A reason
for this state of affairs is the “tyranny” of the necessity of
"field management” which heavily dilutes the quality of
management of this potentially difficult clinical condition.
The above statement does not mean that we do not need alternative and
more effective treatments, drugs and programmes, of course we do. By all means, let us be on the
look out for them. But we
should also at the same time try much harder to find out ways of
improving the efficiency of our existing treatment programmes so that
they become more effective.
My New Year Greetings to all in the LML group.
H. Srinivasan
Reconstructive Surgeon (Retired)
25 first Seaward Road
Valmiki Nagar
Chennai 600 041
India
