Peripheral neuropathy; monoclonal gammopathy

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gitadalal
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Joined: Thu Dec 26, 2019 8:25 am

Peripheral neuropathy; monoclonal gammopathy

Post by gitadalal » Thu Dec 26, 2019 2:58 pm

Caucacian 64 year old male for recertfication DOT exam.

Diagnosed with peripheral neuropathy (sensory) with IgM monoclonal gammopathy in 2015.

Now stable. Has been given a 1-year card in the past.

Treated with: IVIG once a month
Gabapentin 600mg QHS
Elavil 50mg QHS

How would you proceed?

Thanks,
Dr Dalal



Robert Swotinsky MD
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Location: Sudbury, MA

Re: Peripheral neuropathy; monoclonal gammopathy

Post by Robert Swotinsky MD » Thu Dec 26, 2019 4:06 pm

Peripheral neuropathy is a tough one for reasons that include:

- An older version of the FMCSA DOT Medical Examiner declared it as disqualifying. This was an FMCSA guideline that I believe was not adhered to by many medical examiners.
- Many truck drivers report peripheral neuropathy.
- The severity of peripheral neuropathy varies and is not readily determined by clinical exam.

The prescription for Elavil and gabapentin suggest the peripheral neuropathy is being treated, i.e., has some clinical significance. You might want to look at the most recent office note or two from the PCP or, if the patient has seen a neurologist, a neurology note. Or, you might want to issue a 1 year card if the DOT physical exam was normal. It takes a lot of neuropathy to prevent someone from controlling the foot controls and safely climbing in and out of the truck.

Sorry I can't offer more exact advice. It's an inexact condition.

The gammopathy is not an issue w/re: to truck driving except that it can cause peripheral neuropathy.

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