Leprosy Mailing List – January 5, 2017
Ref: (LML) Silent neuritis. Nerve damage. Disability and deformity. Prevention and management.
From: Grace Warren, Sidney, Australia
This letter from Robert Jerskey is interesting - especially that he has sets of MF to be given free. However, there is no way we can provide MF testers to every paramedical in the endemic countries.
That is why the use of pentips or similar is excellent especially for village workers-- they are easily available. I personally often use an unwrapped paper clip that when partially unrolled provided a rough and a smooth surface and this is easier to test and the misdetection of if it is rough or smooth, and the patient pointing to the wrong site of touch , gives nice early indications of nerve malfunction. Such paper clips are easily available and often already in their equipment.
I appreciate the need to detect early nerve damage- and having worked in many Asian countries where the basic diet it polished rice (or other grains in which the husk is removed). I am very conscious of the need to supply Vit B1 or at least ensure the patient gets enough. In one country we often had non leprosy patients coming in with symptoms suggestive of Vit B1 deficiency. IM injection of Vit B 1 relieved their symptoms within a few hours and the use of 10mg B1 daily prevented recurrence. Hence, in many of these countries we provided Vit B1 10mg daily and where indicated treated other possible deficiencies such as anaemia, and advised a healthy diet if practical.
In fact over the last twenty years I have given many patients with neuropathy due to many causes other than lepros. The basic medications to support nerve function with excellent results. Often the use of a good Multivit and mineral tablet is adequate if it has 10mg on B1 in each tablet. Many tablets give less but it has been shown that 10mgs of B1 is required for good nerve health. Of course it may be possible to get them to improve their diet as well, and as a routine we try to do that at the first visit, as well as treat any other problems.
So yes I agree everyone needs to look for the early signs of nerve involvement, but prevention is better than cure!
Grace Warren, Previously Superintendent of Hong Kong Leprosarium ( 1960-75) and “Travelling advisor in Leprosy for the Leprosy Mission”( 1975-1990).
LML - S Deepak, B Naafs, S Noto and P Schreuder
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