Daniel Seidler, MSPT, was a trained medical professional who felt powerless to do his job. His patients were suffering, yet there was no way to ease their pain. The more they pleaded for relief, they more they demanded solutions, the more frustrated Seidler and his patients became. Despite his years of physical therapy experience, all Seidler had at his disposal was a pair of trained hands that only brought short-term comfort. In essence, his hands were tied and he saw no light at the end of the tunnel.
When Seidler opened his first Westchester Square Physical Therapy (WSPT) facility in the Bronx, NY, 3 years ago, patients suffering from the effects of diabetic peripheral neuropathy simply saw no end in sight. Diabetic peripheral neuropathy damages the nerves of the limbs, with the feet being the most vulnerable. Common symptoms include numbness or tingling; sharp pains or cramps; sensitivity to touch; and a loss of balance and coordination. Although diabetes is one of the most common types of peripheral neuropathy, there’s nothing common about the havoc it can wreak in a patient.
If a patient can’t feel heat, cold, or pain, damage to the feet often cannot be detected. At other times, however, the feet may become so sensitive that even the slightest touch produces excruciating pain.
“What was really frustrating from a therapy point of view was that there was not much we could do,” admits Seidler, a 1996 graduate of the Columbia University College of Physicians, New York. “You could do massage or you could try to treat the secondary symptoms, which are balance, ambulation, and functional issues. But there was no way to increase some of the sensation or decrease the pain without the assistance of medication.”
Medications, however, only provided temporary relief, which is one reason Seidler says pharmaceutical companies are hard at work on the “Holy Grail of Medicine” they someday hope will provide permanent relief from diabetic peripheral neuropathy.
“We have patients who can’t sleep because the pain is too intense and other patients who can’t feel their feet even if you’re pounding on them,” Seidler says. In some cases, misdiagnoses by orthopedic physical therapists leads to diabetic peripheral neuropathy going undetected altogether, maintains Seidler.
“An orthopedic physical therapist may look at things from a certain angle or his point of view,” explains Seidler. “But oftentimes, the real mistakes come when patients have multiple dysfunctions or diagnoses. Right now, we have patients who have spinal spinosis and neuropathy, meaning they have nerve problems caused by orthopedic issues or musculoskeletal issues around their spine that could be pinching on their nerve or spinal cord; and at the same time, they could have neuropathy caused by diabetes.
“So as you do all these treatments for the back, a lot of the symptoms are relieved,” he relates. “The patient is increasing his function, yet he still has all the neuropathy systems, which the therapist mistakes for the symptoms related to the spine.”
This is not the legacy Seidler wanted to leave when he chose physical therapy as a career. As a soccer player at the University of Vermont (Burlington, Vt), Seidler was introduced to the discipline after suffering a variety of on-the-field injuries, the most serious of which was a ligament tear in a knee.
“Physical therapy seemed like a very cool profession,” notes Seidler, who graduated from Vermont with a degree in business administration. “First, you are dealing with people who, for the most part, are active. And I liked the scientific aspect of it; there’s a lot of physics, a lot of geometry involved.”
Still, all the medical equations in the world failed to provide Seidler with a comprehensive solution to the problem of diabetic peripheral neuropathy. With massage effective for only brief periods and medications that addressed the symptoms but ignored the cause, physical therapists were left with more questions than answers.
The light at the end of the tunnel
When Seidler heard of a new treatment involving low-intensity infrared light, he knew he owed it to his patients to investigate it. The result has been one of the single most important discoveries related to diabetic peripheral neuropathy treatment in recent memory.
Seidler said he needed a brisk 15 minutes of in-service instruction from the manufacturer’s rep to learn how to use the infrared unit. He and the three other physical therapists on the Westchester Square Physical Therapy staff also spent another 2 hours reading background literature so they could answer patients’ questions and allay their fears. With something as serious as diabetic peripheral neuropathy, patients needed to know Seidler and his staff were on their side.
“I find that when patients feel comfortable with me and know I have their best interests at heart, it makes a huge difference in terms of how receptive they are to treatment,” Seidler maintains. “The more experienced and the more knowledgeable the physical therapist is, the more respect and trust you’re going to get from the patient. That makes a huge difference in any section of the medical field.
“If you go to a medical professional and he seems shady or appears to be someone you can’t trust, you’re not going to have much faith in that person,” adds Seidler, a native of Long Island, NY. “Care is all about trust; and that’s vital, especially in an ongoing situation like physical therapy.”
Seidler insists that unless the patient believes that the physical therapist has his best interest at heart, he won’t be as receptive to new or experimental treatment. He maintains that some facilities put the bottom line first and the patient second.
“It is our responsibility to make the patient’s physical therapy experience pleasant and rewarding,” notes Seidler, who was a senior advanced clinician at the Bronx’ Weiler/Einstein Hospital after graduating from Columbia University. “But that’s not always the case everywhere. A lot of places are really set up as ‘mills.’ PTs refer to this as ‘shake and bake.’ They’ll get patients in, and their first objective is to get patients out.”
Seidler says the physical therapy facility has a choice: It can either treat patients with respect and dignity, or it can run them in and out without regard for care and comfort.
“It’s a lot like the practice of turning tables in a restaurant,” he adds. “If [our facilities] were a restaurant, we’d be trying to have the patient appreciate their experience every time they come in, with the objective of achieving the goals they came in for in the first place.”
Once WSPT purchased a pair of eight-pad units at a cost of $6,500 each, the facility was well on its way to providing welcome relief to patients suffering from diabetic peripheral neuropathy. There were finally answers to the questions, and relief to the sufferers.
Each unit can be used on any limb affected by the peripheral neuropathy, although most of the treatments are concentrated on the lower legs, feet, and toes. Originally used by the military for wound care, the low-intensity infrared light helps the body release nitrous oxide from damaged nerve tissue. This, in turn, replenishes the skin and helps the nerve tissue recover feeling and movement.
Seidler has used the infrared therapy on 20 patients in the past 3 months and reports “dramatic functional improvement” in those suffering from diabetic peripheral neuropathy (see sidebar, page 14). In fact, he has noticed not only a cessation of symptoms, but also, in some cases, a reversal of the debilitating effects caused by this illness.
“The patients have reported dramatic improvements in the amount of pain they are suffering,” reports Seidler, whose two northeast Bronx facilities see between 20–30 patients per day. “And as far as the amount of numbness or paresthesia, you can see dramatic functional improvement. We’ve had some great success stories already.”
Age appears to have no bearing on the treatment’s effectiveness, Seidler explains. “We’ve had some patients who’ve been in their 70s or 80s, and some who are in their 40s whose condition are as bad as anyone’s—worse, actually.”
Seidler, who recently opened a 2,000-square-foot practice also in the Bronx, has created a treatment protocol that goes well beyond merely using infrared light. Also included in his total treatment curriculum are massage, stretching and range-of-motion exercises, strength training, and balancing exercises.
Companies manufacturing infrared therapy units are encouraging patients to purchase home units, which cost $3,000 per unit. However, Seidler says that insurance companies have been willing to cover as much as 80% of the cost of home units.
“Insurance companies aren’t going to pay for [physical therapy facility] treatments forever,” he admits. “But with Medicare agreeing to pay for all but about $500 of the home unit, that’s a pretty good deal. You’ll be able to use it every day of your life and know you won’t have to feel your neuropathy anymore.”
The only side effect, Seidler adds, is a slight burning on the area of the skin where the pad is placed, which can happen if the unit is left on too long or if the intensity is turned on too high. Diabetics using the infrared unit also notice hypoglycemia, or a slight drop in their blood sugar level. However, this is not the fault of the unit, but rather a pleasant by-product of the patient feeling so much better he wants to increase his physical activity level.
There was a time when worrying about the effects of being too active was the last thing on the minds of those suffering from diabetic peripheral neuropathy. But thanks to low-intensity infrared light, the light at the end of the tunnel is growing brighter by the day.
Dave Cater is a contributing writer for Physical Therapy Products.
Case Studies
Daniel Seidler, MSPT, has used infrared therapy on 20 patients suffering from diabetic peripheral neuropathy. Here are three success stories.
Great Feeling
After undergoing chemotherapy for more than 1 year, Earl Jones was informed that the numbness he’d been experiencing in his feet for the past 9 months would likely last another 2 years—after his chemotherapy sessions ended.
There had to be a better way, Seidler insisted. The better way, in this case, involved infrared light therapy. After just 4 weeks of treatment, Jones began regularly experiencing sensation in his feet.
“It’s been great to be able to feel my feet after being told it would be at least 2 years [before experiencing that sensation],” Jones exclaims.
Sensation Returns
Joe (last name withheld) was diagnosed with diabetes 1 year ago and began experiencing neuropathy 6 months later. The neuropathy progressed so rapidly that he soon lost tactile sensation below his knees. The 49-year-old patient also was experiencing such a high degree of pain he no longer could sleep.
Once Seidler used infrared light therapy on Joe, the patient immediately reported a reduction in pain and increased movement in his lower extremities. “I can finally sleep through the night, and I’m walking much better since starting this treatment.”
In Remission
Matthew Donohue, 69, has been suffering from diabetes for nearly 2 decades. Neuropathy recently cost him the feeling in his feet, which in turn caused him to frequently lose his balance. Without treatment, there was no hope, he was told.
However, after receiving infrared light therapy from Seidler, Donohue’s neuropathy appears to be in remission. “The therapy has dramatically increased my sensation and awareness of my feet,” he reports.
Daniel Seidler, MSPT, was a trained medical professional who felt powerless to do his job. His patients were suffering, yet there was no way to ease their pain. The more they pleaded for relief, they more they demanded solutions, the more frustrated Seidler and his patients became. Despite his years of physical therapy experience, all Seidler had at his disposal was a pair of trained hands that only brought short-term comfort. In essence, his hands were tied and he saw no light at the end of the tunnel.
When Seidler heard of a new treatment involving low-intensity infrared light, he knew he owed it to his patients to investigate it. The result has been one of the single most important discoveries related to diabetic peripheral neuropathy treatment in recent memory.
“It is our responsibility to make the patient’s physical therapy experience pleasant and rewarding,” notes Seidler, who was a senior advanced clinician at the Bronx’ Weiler/Einstein Hospital after graduating from Columbia University. “But that’s not always the case everywhere. A lot of places are really set up as ‘mills.’ PTs refer to this as ‘shake and bake.’ They’ll get patients in, and their first objective is to get patients out.”
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