Autonomic Neuropathy What To Look Out For

Today's very short post from mayoclinic.org (see link below) responds to a frequent question here on the blog: "How do I know if I have autonomic neuropathy?" First let's reiterate what autonomic neuropathy is. If you find that your neuropathy symptoms begin to affect the bodily functions which we call 'involuntary. (you have no control over them - they function automatically) such as breathing, digestion, sexual response, sweating, eyesight etc, then it's possible you have autonomic neuropathy. As a general rule, you will already be experiencing neuropathic symptoms in your feet, legs or hands but may notice that other aspects of your life don't function as they should any more. That's the time to ask your doctor if your nerve damage is affecting other areas of your body. This post lists the most common symptoms of autonomic neuropathy and should serve as a starting point for further investigation. The problem is of course, that there could be any number of other reasons why this is happening. That's why it's important to seek advice as soon as you realise something's wrong. Autonomic neuropathy can seriously affect your quality of life, so delaying seeing your doctor could make things worse.

Autonomic Neuropathy Symptoms
By Mayo Clinic Staff

Signs and symptoms of autonomic neuropathy vary based on the nerves affected. They may include:

Dizziness and fainting when standing caused by a sudden drop in blood pressure.

Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.

Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men and vaginal dryness, low libido and difficulty reaching orgasm in women.

Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.

Sweating abnormalities, such as sweating too much or too little, which affects the ability to regulate body temperature.

Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.

Exercise intolerance, which may occur if your heart rate stays the same instead of adjusting in response to your activity level. 

When to see a doctor

Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes and it's poorly controlled.

If you have type 2 diabetes, the American Diabetes Association (the Association) recommends annual autonomic neuropathy screening for people with type 2 diabetes as soon as you've received your diabetes diagnosis. For people with type 1 diabetes, the Association advises annual screening beginning five years after diagnosis.

http://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/basics/symptoms/con-20029053

Autonomic Neuropathy whats that

You may hear or read the term 'autonomic neuropathy' and this may cause confusion. It causes a problem for doctors too because the symptoms are easily identifiable with a whole range of conditions and you may also have had some or all of them for some period of time before your peripheral neuropathy was diagnosed. For an general explanation, see the blog website (www.neuropathyandhiv.nl) and click on the Site in English button but this description from the New York Times of May 20th 2011 gives you a good idea of how it works.

Autonomic neuropathy is a group of symptoms that occur when there is damage to nerves that regulate blood pressure, heart rate, bowel and bladder emptying, digestion, and other body functions.


Autonomic neuropathy is a form of peripheral neuropathy. It is a group of symptoms, not a specific disease. There are many causes.

Autonomic neuropathy involves damage to the nerves that run through a part of the peripheral nervous system. The peripheral nervous system includes the nerves used for communication to and from the brain and spinal cord (central nervous system) and all other parts of the body, including the internal organs, muscles, skin, and blood vessels.

Damage to the autonomic nerves affects the function of areas connected to the problem nerve. For example, damage to the nerves of the gastrointestinal tract makes it harder to move food during digestion (decreased gastric motility).

Autonomic neuropathy affects the nerves that regulate vital functions, including the heart muscle and smooth muscles.

Damage to the nerves supplying blood vessels causes problems with blood pressure and body temperature.

Autonomic neuropathy is associated with the following:
Alcoholic neuropathy
Diabetic neuropathy
Disorders involving scarring and hardening (sclerosis) tissues
Guillain Barre syndrome or other diseases that inflame nerves
HIV and AIDS
Inherited nerve disorders
Parkinson's disease
Surgery or injury involving the nerves
Use of anticholinergic medications


Symptoms vary depending on the nerve(s) affected. They usually develop gradually over years.

Symptoms may include:

Digestive tract
Constipation
Diarrhea
Feeling full after only a few bites (early satiety)
Nausea after eating
Swollen abdomen
Unintentional loss of more than 5% of body weight
Vomiting of undigested food

Heart
Blood pressure changes with position
Dizziness that occurs when standing up

Urinary tract
Difficulty beginning to urinate
Feeling of incomplete bladder emptying
Urinary incontinence (overflow incontinence)

Other symptoms
Abnormal sweating
Fainting
Heat intolerance, induced by exercise
Male impotence


A medical history and general physical exam are critical. A brain and nervous system (neurological) examination may show evidence of injury to other nerves. However, it is very difficult to directly test for autonomic nerve damage.

Signs of autonomic neuropathy include:
Abnormal sounds in the abdomen, indicating decreased gastric movement (motility)
Decrease of blood pressure upon standing up (postural hypotension)
Sluggish pupil reaction in the eye
Swollen (distended) abdomen
Swollen (distended) bladder

Occasionally, other symptoms may indicate a problem in the function of the autonomic nervous system, including:
Difficulty swallowing
Excessive sweating
Irregular heart rhythms
High blood pressure
Rapid or slow heart rate

Special measurements of sweating and heart rate are called "autonomic testing" and can assist in diagnosis and treatment.

Other tests include:
Measurement of blood pressure lying down, sitting, and standing
Measurement of changes in heart rate
Upper GI
Esophagogastroduodenoscopy (EGD)
Isotope study
Voiding cystourethrogram (VCUG) or other tests of bladder function

Other tests for autonomic neuropathy are based on the suspected cause of the disorder, as suggested by the history, symptoms, and the way symptoms developed.

Treatment is supportive and may need to be long-term. Several treatments may be attempted before a successful one is found.

Various strategies may be used to reduce symptoms in the feet, legs, and arms. These include:
Florinef and salt tablets to increase fluid volume in blood vessels
Fludrocortisone or similar medications to reduce postural hypotension
Medications to help with salt and fluid retention
Proamatine to prevent a drop in blood pressure when standing
Sleeping with the head raised
Use of elastic stockings

Treatments for reduced gastric motility include:
Medications that increase gastric motility (such as Reglan)
Sleeping with the head raised
Small, frequent meals

Diarrhea, constipation, bladder problems, and other symptoms are treated as appropriate. These symptoms may respond poorly to treatment. Drugs that block bladder contractions may be used to help with urinary control problems.

Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.


The outcome varies. If the cause can be found and treated, there is a chance that the nerves may repair or regenerate. The symptoms may improve with treatment, or they may continue or get worse, even with treatment.

Most symptoms of autonomic neuropathy are uncomfortable, but they are rarely life-threatening.

http://health.nytimes.com/health/guides/disease/autonomic-neuropathy/overview.html

Gastroparesis An Autonomic Neuropathy Stomach Problem

Today's post from blog.diabetv.com (see link below) looks at a specific symptom of autonomic neuropathy (nerve damage where the involuntary functions of the body are affected) that many neuropathy patients may suffer from but have no idea what it is and why it happens. It's called Gastroparesis and basically means that, due to nerve damage in the digestive system, food either stays too long in the stomach, or is not properly digested, leading to a whole raft of problems. One of the problems is that the tests for this are not pleasant, some might say 'invasive' and I would hazard a guess that most doctors won't take the trouble to carry them out because there are so many other possible causes of the symptoms that first come to mind. Read this short article and if you think you may fall into this category, be as persuasive as you can in getting yourself tested. Autonomic neuropathy is one of the worst forms of nerve damage to diagnose because it can affect so many bodily functions at the same time but that doesn't mean that it shouldn't be taken seriously.

AUTONOMIC NEUROPATHY: HOW IS GASTROPARESIS DIAGNOSED?
Posted by Dr. Leonel Porta

Autonomic Neuropathy is one of the most common types of Neuropathy in diabetics. As the name implies, the autonomic nervous system is responsible for monitoring the functioning of the organs that act largely unconsciously and regulates bodily functions such as the heart rate, digestion, and respiratory rate.

When stomach function is impaired due to this nervous complication in diabetes, Gastroparesis (a condition in which your stomach cannot empty itself of food in a normal fashion) occurs. Today, we will focus on how to know if you have Gastroparesis and which tests will help the doctor diagnose this diabetic complication.

In DiabeTV we’ve talked about Gastroparesis and its complications, however, it is important to remember that Gastroparesis is a condition that consists of a delayed gastric emptying, that is, the stomach takes too long to empty its contents. What causes this? It’s caused by a damage to the vagus nerve, which controls the movement of food through the digestive system.

When a diabetic patient has complications such as Autonomic Neuropathy which are affecting the vagus nerve, the muscles of the stomach and intestines do not work properly, so that the movement of food is stopped or delayed. Remember, that when blood glucose levels remain raised for a prolonged time, damage occurs to the blood vessels that carry oxygen and nutrients to the nerves. Also, chemical changes can occur within nerves which alter their structure and function.

Some of the many symptoms that give indications of Gastroparesis, are nausea, vomiting of undigested food, poor appetite, weight loss, premature feeling of fullness when eating, bloating, heartburn, gastroesophageal reflux, and stomach spasms.

The tests that the doctor carry out to diagnose Gastroparesis are varied and depend on the severity of symptoms and conditions of the patients. These include:

Barium X-Rays: This test consists of an X-ray done after drinking a substance (barium) that allows the anatomy of the small intestine to be hightlighted and outlined. The presence of a blockage in any part of the small intestine will result in the accumulation of the barium solution which shows the gastric delayed emptying.

Gastric Emptying Scan: this is a nuclear medical test that shows whether the solid and liquid foods remain for too long in the stomach caused by a lowered emptying rate. The patient ingests a radiolabeled test meal food and by using a scanning technique the rate of gastric emptying is measured.

Gastric manometry: This is a test to measure the electrical and muscular activity of the stomach during the digestive process. For this test, an endoscope is inserted through the mouth into the stomach. This provides information about the strength and frequency with which the stomach muscles contract under fasting or feeding conditions.

Upper Gastrointestinal Endoscopy: this examination allows an screening of several causes Gastroparesis which appear as symptoms. Under an anesthesia a thin flexible probe is introduced via the mouth into the stomach. The endoscope allows an inspection of the upper gastrointestinal tract, looking for possible ulcers, swelling, tumors, hernias, or other abnormalities. If necessary, samples for biopsies may be taken.

Like the upper endoscopy, an ultrasound or a blood test will allow your doctor to rule out other possible causes of delay in gastric emptying, different from Autonomic Neuropathy.

Treatments for Gastroparesis include the use of insulin, oral medications, changes in the diet, and modifying eating schedule. In more severe cases, feeding tubes orally or intravenously insertes can be used. Gastroparesis associated with diabetes is an entirely preventable complication. The priority of all diabetic patients should always be to control their blood glucose levels. Only then they will avoid unnecessary complications and ensure their own welfare.

http://blog.diabetv.com/autonomic-neuropathy-how-is-gastroparesis-diagnosed/

Autonomic Neuropathy Learning To Understand It

Today's post from simplytiffanyblog.wordpress.com/ (see link below) can be looked at in two ways: either shock and fear that this could happen to you; or as a learning exercise to help you understand the diagnosis you've been given. However, this story is an extreme case of autonomic neuropathy (sometimes called polyneuropathy) and our sympathy goes out to this lady but it doesn't mean that your autonomic neuropathy will develop in the same way. Nevertheless, the realisation that the neuropathy has changed from simply having tingling or unfeeling toes and feet, or even burning as you walk, to something that affects the involuntary functions of the body can be quite a shock. Just as you're beginning to learn to live with the unpleasant physical sensations of nerve damage, your body starts to dysfunction in all sorts of other ways. Learning about this particular form of neuropathy is the first step to understanding what's going on and taking the best possible measures to reduce its effects on your daily life. One way of helping, is to read other people's stories and experiences. Well worth a read.
 

Living With Autonomic Neuropathy (and How Long It Took To Be Diagnosed) Written by simplytiffanyblog 2016
 
  You know, one thing I feel is not talked about enough is the effects of autoimmune diseases. In fact, I didn’t know they had existed until I was diagnosed with one: autonomic neuropathy. It is a rare neurological disorder that can greatly affect a person’s quality of life, although every case varies. I live in a bed. I have been using a wheelchair for ten years now, and have been unable to be out of bed for about five years. I can barely walk, and when I do it is with a walker and the assistance of two people, and only for a very short distance. I want so badly to raise awareness for this disorder and how it affects people, because even my closest relatives – including those who tend to my daily needs and personal care – just can’t fully comprehend what day-to-day living is like for those suffering from autonomic neuropathy.

*Another reason I hoped to find the courage to touch on the subject is the possibility of helping someone else who may have an autoimmune disease and has yet to be diagnosed with it. I had spent many hours searching the web, reading other people’s stories and symptoms similar to mine, as an attempt to diagnose myself while my doctors kept saying that my tests were normal. This is not an illness that is easy to diagnose – and I’m not sure there is a test to clarify that one has it.* It is a matter of ruling out other possibilities based on your symptoms, and finding a doctor who is knowledgeable on the subject.

Autonomic Neuropathy has changed my life.

I could almost say it has ruined my life. All of my hopes and dreams I had of the future could very well be crushed. As previously stated, I live in a bed. It is a daily struggle to find the strength to sit in my wheelchair for 30 minutes, and even more of a struggle to leave the house, which I rarely do. Many doctor appointments have been cancelled at the last minute, and I know the offices who tend to my care get perturbed with me for all the cancellations I cause. Just last month, I made it to a specialist’s office, but could not talk to him because I was vomiting in his trash can throughout my allotted appointment time. I have had three separate specialists tell me that this is the worst case they have ever seen, and they were all astonished that I have encountered such an illness at a young age. Not a comforting thought.

Allow me to briefly explain what this disorder is. Autonomic Neuropathy. Neuro = nerves. Pathy = disorder. So simply put: it’s a nerve disorder. Autonomic is referring to the autonomic nervous system. You know the nervous system that automatically controls the body’s organ functions? When the nerves stop controlling the body’s natural organs and functions, it spells trouble.

A description from online states: “Autonomic neuropathy is a group of symptoms that occur when there is damage to the nerves that manage every day body functions such as blood pressure, heart rate, sweating, bowel and bladder emptying, and digestion.”

I encounter so many separate symptoms from this disorder, that it is hard to remember them all without really pondering the thought. (Then again, the doctors have told me that poor memory could be from my medication.) Let me go into the symptoms that I personally have encountered, although every case varies greatly from patient to patient. Even the organs affected could bring on different symptoms. Imagine having chills in July, and needing to be in front of an air conditioner in February from badly sweating. Imagine your bladder so full it is ready to burst, yet you have no urge to urinate on some days.While on other days, you’re relieving your bladder constantly, even while not drinking as much. Imagine not being hungry most days and therefore not eating that second slice of pizza you are craving. Imagine being perfectly calm one second, then having a full-blown panic attack the next, even when you’re not worrying or feeling fearful in that moment. Imagine at least fifteen migraines a month, and not enough medicine to get you through. There are no triggers for these migraines, they just happen. Imagine never knowing whether your blood pressure is going to be high or low – because it fluctuates immensely between both extremes. Imagine having diabetes and never being able to have your glucose levels controlled. Your stomach won’t digest the way it should, which means your levels will drop and stay low for hours because you took insulin but the stomach decided to not digest the food properly. When it does finally digest, the insulin has already passed through the bloodstream, and your glucose levels consequently spike from having not enough insulin to cover what the body is finally digesting. When to take insulin can’t be guessed, because digestion happens at various times. Therefore insulin must be taken right before your meal. Imagine being so light-headed almost every day that you can barely stand up, and you can’t sit up in bed for long periods of time before you’re dizzy and vomiting. Because your arteries aren’t constricting as they should resulting in a lack of blood flow to the brain, this debilitating symptom can never be cured. Your body has grown used to being in a horizontal position. I can confirm that all of these symptoms have become a part of me. Then there are emotional consequences as well. Can you imagine lying in bed and inviting a friend over to visit? I didn’t spend nearly enough time with my best friend before she moved because of how embarrassing it was to have her see me like this. Not to mention, this really limits what I could do with her. I am thankful to the Lord for allowing me to attend a few years of school, and introducing me to a friend who was even willing to come sit at my bedside, knowing I may get sick and ask her to leave, which has occurred more than once. All we could do was watch TV or talk, but that seemed to be enough for her. Alas, we teenagers became adults and God led her in a new direction, but we still keep in touch when we can.

This all started back when I was ten years old. That was fifteen years ago, and it just gradually progressed over the years. Autonomic neuropathy doesn’t happen instantly. It comes gradual, and there is no cure to reverse nerve damage. It is a rare illness and not often thought of. I couldn’t begin to count all the physicians and clinics I have visited in the past fifteen years! Oddly enough, it wasn’t until my fifteenth year of having this that it was finally diagnosed – just a few months ago actually. Some doctors I had seen told me it was “all in my head”. Some said I was faking this to get out of going to school. I was even accused of sneaking snack food to increase my blood glucose levels while my parents were sleeping. Really?? I am not sure the teachers at school believed me, although I hope they did. I had to skip recess and gym class most days. Field trips became less and less frequent. I started to miss a lot of school days, and it got to be so many that, starting in seventh grade, I had to be home-schooled. I only had one friend from school who stuck by me after that, which is understandable because it is incomprehensible to a child when another child becomes ill.Eventually I stopped going to the mall. It has been six years now since I have been to a movie theater or a Wal-mart. I missed out on my best friend’s graduation, bought concert tickets as her graduation present, but had to ask her to choose another of her friends to go with her because I was too sick. I stayed home and cried that night. I continuously miss my cousin’s chorus concerts in school, was never able to be the “big sister” I had wanted to be. I haven’t participated in family Christmas gatherings or reunions for years! I am passionate about baking and do so on my ‘good days’, but my version of baking is having the ingredients brought to my bed and I make what I can right here. I lost my spacious and beautifully decorated (for a teenager, that is) bedroom in 2009 when I suddenly had to stop climbing stairs. Now I live in a small den connected to my grandma’s living room, with no privacy.Life just never seems to play fairly. It’s a complicated life. An unpredictable life. An often depressing life. An eye-opening life.

If you or someone you know is suffering from unexplained symptoms, even when doctors say all the testing is normal and maybe they don’t even believe you feel the way you do – when you feel that all hope is lost, remember that there is still hope. Don’t you ever give up. I had to wait fifteen years before visiting a doctor who not only learned to believe me, but was able to define the illness causing the strange symptoms I have been facing. And I must be truthful here. When the doctor looked at me and said softly, “There is no way to reverse nerve damage. There is nothing we can do to make this better.”, it was depressing. Yes, I felt hopeless and devastated. But quite honestly: it is a comfort to have a name to match my strange symptoms. There is an odd comfort in simply knowing. If you are suffering from something like this, reach out. Do some research online, find support groups for undiagnosed diseases, surely someone out there has the same undiagnosed disorder as you do. Don’t lose hope.

Appreciate every little thing you have in your life and take nothing for granted, because you never know when you might lose it.

So needless to say, my life isn’t going the way I had planned. I may never fall in love, hold a job, live on my own, have children, or do normal things that we all spend our childhood endlessly dreaming about and waiting for. But if I have learned anything from all of this heartache and sickness, it’s that you should never take anything for granted. I believe that God is in control. Time and chance happen to us all as Solomon wrote in Ecclesiastes, and sometimes we may never find out why — not on earth, anyway. I know for sure that I do not like the hand that I was dealt, but I can’t go back and reshuffle the cards.

If we trust in GOD and HIS promises, I am certain there will be a better life to come. Whatever you are dealing with, please know that you are not alone. There are people online now who you can reach out to. It’s so simple these days! You may even meet someone who is going through a similar situation as you are. Take one day at a time, pray about it, trust God, and never give up! Keep on fighting and hoping for better days to come, I know I will. With God as your captain, you never know when or how the wind may redirect your sail.

I can’t pretend to be an optimist. I’m usually quite the pessimist about this. There are days when I cry, scream, feel angry as if I just can’t take this for another day. And it is in those moments, that we need to remind ourselves of what Mr. Thomas Jefferson once said: “When you reach the end of your rope, tie a knot in it and hang on.”

https://simplytiffanyblog.wordpress.com/2016/09/12/living-with-autonomic-neuropathy/