How We Evaluate Peripheral Neuropathy in the Office

One of the major differences in our practice is that we objectively evaluate sensory loss, circulation, temperature changes, and nerve signaling using multiple testing procedures.

The evaluation commonly includes:
• cold sensation testing
• pinwheel testing
• 10g monofilament testing
• vibration testing
• cool and hot sensation testing
• sharp sensation testing
• sway and balance testing

Thermographic Circulation Imaging

One of the most visually powerful assessments utilized in the practice is thermographic imaging.

Thermographic imaging evaluates circulation patterns and temperature distribution involving the hands and feet.

Reduced circulation often appears as cooler blue or purple patterns, while healthier circulation demonstrates warmer yellow or orange patterns.

The thermographic images below demonstrate improved circulation patterns following supportive neuropathy care and circulation-focused therapies.

Sensory Response “Mitt” Evaluation

We also incorporate a pair of sensory stimulation mitts connected to one of the supportive modalities utilized in our treatment protocol.

The intensity is gradually increased while the mitts are applied to either the hands or feet.

Patients with more advanced sensory loss may demonstrate reduced perception of the stimulation.

With patient permission, the mitts may briefly be applied to an area of more normal sensation, such as the face, allowing the patient to compare the difference in sensory perception.

Many individuals are surprised by the degree of sensory loss present in the hands or feet once the comparison is demonstrated.

Family members accompanying the patient are often equally surprised by the degree of sensory loss demonstrated during the evaluation.

Nitric Oxide & Oxygen Delivery

Nitric oxide plays a major role in circulation and oxygen delivery into tissues.

A pulse oximeter measures oxygen circulating within the blood, while nitric oxide physiology helps determine how efficiently oxygen is delivered into tissues and cells.

Nitric oxide depletion may contribute to:
• cold feet
• burning sensations
• tingling
• delayed healing
• impaired circulation

Heart Sound Recorder (HSR) & Circulation Physiology

Another assessment tool utilized in the practice is a digital Heart Sound Recorder (HSR).

The HSR may help identify cardiovascular stress patterns, circulation inefficiencies, and physiologic changes involving blood flow dynamics.

Circulation Observations & Body Signals

Observation is extremely important during the neuropathy evaluation.

Body signals may include:
• blue or purple appearing toes
• thickened toenails
• reduced toe hair
• sock indentations
• hemosiderin staining
• varicose veins
• spider veins
• poor balance or gait instability
• cold hands or feet

The Drugless Doctors Three-Tier Supportive Strategy

The supportive strategy utilized in the practice is designed to improve circulation, support tissue oxygenation, reduce inflammatory stress, improve nutritional stability, and support nerve recovery physiology.

The program commonly focuses on:
• biochemical support
• biovascular support
• biostructural support

Photobiomodulation Support

One of the foundational supportive modalities utilized in the practice is FDA-cleared photobiomodulation therapy using the 15-watt TheraRay device.

Photobiomodulation utilizes specific light frequencies designed to support circulation, nitric oxide physiology, mitochondrial activity, tissue oxygenation, cellular energy production, and microcirculation.

Nerve Damage Severity Chart

The nerve damage severity chart utilized in the practice categorizes sensory loss into acute, moderate, severe, and permanent nerve damage patterns.

The earlier neuropathy is identified and addressed, the greater the potential for circulation recovery, sensory improvement, and stabilization.

Patient Summary

Peripheral neuropathy is often a whole-body circulation, metabolic, inflammatory, and neurologic condition involving impaired oxygen delivery, reduced microcirculation, inflammation, glucose instability, and nerve stress physiology.

The objective is not merely symptom masking.

The goal is supporting circulation, tissue oxygenation, nerve physiology, nitric oxide activity, mitochondrial function, sensory recovery, and long-term metabolic stability.