Peripheral Neuropathy A Doctors Analysis

Ever wondered how the doctors or neurologists assess you and come to their conclusions? Today's post from medical-illness.blogspot.com (see link below) is a doctor's summary of a patient's condition after examination. His conclusion is neuropathy, probably caused by diabetes. It's interesting to look at this particular case study and see the bigger picture and maybe see similarities with our own general health. There may be a few warning pointers to look out for!
 

Diabetic Peripheral Neuropathy Personal history

Tuesday, November 4, 2014

 A known diabetic patient male patient, 46 years old, from ……….…., ………..……, married and has 3 off spring, the youngest is 16 years old, heavy smoker with no other special habits of medical importance, he is Rt. handed.

4 c/o
Loss of sensation in both hands and feet of 15 years duration.

4 HPI
The condition started 15 years ago by nocturnal burning painassociated with tingling, numbness started in both feet then progressed, one year later , to involve both hands then the patient developed gradual loss of sensation in both hands and feet, and he felt as if he walkedon cotton.
4 years later, the patient experienced weakness associated with flaccidity, falling of hair, brittle nails with no wasting or twitches. This weakness started in L.Ls then progressed, one year later, to involve both ULs. It's more in distal than proximal muscles, in extensor more than flexor muscles, in adductor more than abductor muscles. The patient also suffers from unsteadiness during eye closure with no involuntary movements.

The condition was associated with diminutionof vision, visual field defects, disturbance of color vision, ptosis in both eyes for which the patient was investigated and treated by laser photocoagulation more than once. The patient can't close his eyes firmly, with accumulation of the food behind both cheeks, no symptoms of other cranial nerve affection.
The patient has organic impotence with lost morning erection with no history of drugs known to cause erectile dysfunction.

The patient developed unsteadiness during standing with palpitation, nocturnal diarrhea, gustatory sweating and dyspepsia.

No symptoms of increased I.C.T.
No speech disturbance.
No symptoms suggesting other system affection.

4 Past history
- There is past history of D.M started 20 years ago manifested by polyuria, polydypsia, polyphagia. The patient is on insulin treatment and his blood sugar is out of control.

- There is past history of HPN started 15 years ago manifested by headache, blurred vision. The patient is on capoten and his hypertension is not controlled.
- Appendectomy operation was done at the age of 20 years.
- No history of other drug intake.
4 Family history
- No similar condition in family.
- No consanguinity.
- No common disease in family.

4 General exam
- Temperature: 37.2o c.
- Bl. Pressure: 140/80 (Recumbent position), 100/60 (standing position).
- Pulse: regular, 110 beat/minute, average volume, no special character, vessel wall not felt, equal in both sides with absent dorsalis pedis, anterior and posterior tibial and popliteal pulsation with intact femoral, radial, brachial and axillary pulsation.
- Mentality: The patient is fully conscious, well oriented for time, place and person. Average mood and memory. The patient is co-operative with average intelligence.
- Head: Examine for Retinopathy, teeth (Artificial teeth).
- L.L: Trophic ulcer, diabetic dermopathy.

4 Sensory:
- Superficial sensations: above knee and elbow level stock and glove anesthesia. Circumferential comparison must be done to exclude diabetic radiculopathy.
- Deep sensation:
§ Joint sense lost on both sides.
§ Vibration sense lost at level of peripheral nerve (medial malleolus, radial styloid process) with intact vibration sense at the level of posterior column (ASIS, clavicle).
§ Muscle sense lost (Calf muscles).
§ Lost nerve sense (Ulnar and lateral popliteal nerves).
§ +Ve Romberg's test.
- Cortical sensation : can't be examined due to loss of superficial sensation.

4 Examination of Speech: Normal.


4 Examination of Cranial Nerves:
- Optic Nerve is affected in the form of: diminution of visual acuity (Rt. eye : can count fingers at one meter, Lt. eye :blind), Tubular visual field defect .
- Ocular nerves
§ Inspection: bilateral ptosis (thumb test >> can't elevate his eye lids),pupils are dilated and irreactive to light or accommodation with no squint.
§ Power: loss of eyeball movements in all direction denoting paralysis of recti and oblique muscles of the eye.
N.B: nystagmus and conjugate eye movements can't be examined b because of loss of eye movements on examining each eye separately .
§ Reflexes: absent light and accommodation reflexes.
- Facial nerve
§ Inspection: symmetrical forehead, obliterated nasolabial folds on both sides with no tearing, no drippling of salive, no mouth deviation
§ Power: patient can't close his eyes firmly, can't elevate his eye brows , can't whistle, can't show his teeth, can't blow his cheeks
§ Reflexes: absent glabellar reflex à (bilateral LMNL).

4 Examination of Motor System :
4Inspection__
- There is wrist and ankle drop, trophic ulcer in L.L, loss of hair and brittle nail in U.L,L.L.
- No muscle wasting, no skeletal deformities, no involuntary movement.

4 Examination of Tone__
- Bilateral symmetrical hypotonia in both upper and lower limbs.

4 Percussion__
No fasciculation or myotonia.

4 Examination of Muscle Power
- Bilateral symmetrical Weakness in both upper and lower limbs. It is distal more than proximal, abductors more than abductors, extensors more than flexors.
- Abdominal muscles: weakness may be attributed to trunkal neuropathy or related to myopathy as the patient gives history of thyrotoxicosis.

4 Coordination
Coordination cannot be examined on both upper and lower limbs because of weakness.

4 Reflexes

- Deep reflexes: Areflexia in both upper and lower limbs.
- Superficial reflexes: lost plantar reflex in both L.L., lost abdominal reflex (trunkal neuropathy).
N.B: lost planter reflex may be due to loss on sensation on the sole of the foot, LMNL at S1, weakness in muscles of the big toe or skeletal deformities in big toe).

4 Back: No deformity, no swelling, no scars .
4 Gait: stamping (may be high steppage).
4 other system examination (search for autonomic neuropathy):

1- Cardiovascular system:
- Absent respiratory sinus arrhythmias.
- Persistent sinus tachycardia (already examined with pulse, and ask for palpitation).
- Painless myocardial infarction.
- Postural hypotension (already examined with pulse).

2- Genitourinary:
- Bladder disturbances (incontinence à ask for it)
- Impotence (psychic and organic à ask for it)

3- Marked sweating specially with meals (gustatory sweating à ask for it )


4- Gastrointestinal:
- Gastroparesis diabeticorum (ask for dyspepsia).
- Diabetic enteropathy (ask for nocturnal watery diarrhea and constipation).

4 pathogenesis
Sorbitol pathway.

4Investigation
- For diabetes: Bl. Sugar level with HBA1C, ECG, RFTs, blood lipid profile (cholesterol, HDL, LDL, TG)
- For P.N: Nerve Conduction velocity.

4 Treatment
- For diabetes: tight control.
- For the P.N.: Tegretol, gabapentin, vitamins, aldose reductase inhibitor
(disappointing results).


4 Diagnosis :
Diabetic Peripheral Neuropathy

4 N.B.

Lost abdominal reflex in this case may be due to trunkal neuropathy.
Abdominal muscles power can't be examined by resistance because of proximal myopathy à the patient has history of Thyrotoxicosis.
Lost knee reflex à not related to high stock level as lost superficial sensation has nothing to do with deep reflexes but is related to lost deep sensation at the level of the knee (evidenced by lost vibration sense at the knee and may be due to amyotrophy due to femoral neuropathy).
No muscle wasting à mainly sensory.

http://medical-illness.blogspot.com/2014/11/diabetic-peripheral-neuropathy.html

Peripheral Neuropathy 101

Today's post from mollysfund.org (see link below) is more or less a neuropathy 101 guide to the disease and is especially useful to people new to the condition or the symptoms, or those who wish to brush up on their basic knowledge. The information is drawn from various sources but is pretty much entirely accurate, according to current medical opinion. Certainly worth a read, using as a reference, or as a recommendation to others.

What is peripheral neuropathy?
Article by : Karrie Sundbom February 2015 

Peripheral neuropathy is a general term for a series of disorders that result from damage to the body’s peripheral nervous system. The body’s nervous system is made up of two parts; the central nervous system (CNS) and the peripheral nerve system (PNS). The CNS includes the brain and the spinal cord. The PNS connects the nerves that run from the brain and spinal cord to the rest of the body. This includes the legs, arms, hands, feet, joints, eyes, ears, mouth, nose and skin. These neurons transport signals about physical sensations back to your brain.

An estimated 20 million people in the United States have some form of peripheral neuropathy, a disorder that results from damage that occurs to your peripheral nerves. These damaged or destroyed nerves can no longer send out messages, or they send incorrect or distorted information, between the brain and spinal cord and the skin, muscles or other parts of the body. Generally speaking, this often causes unusual sensations, burning, numbness, weakness, loss of balance, and even pain. The symptoms usually occur in your hands and feet, but other areas of your body can also be affected. There are three types of peripheral nerves and all of them can be affected by peripheral neuropathy. Peripheral neuropathy is also categorized by the size of the nerve fibers involved, large or small.

The three types peripheral nerves are:
Sensory Nerves: These connect to your skin
Motor Nerves: These connect to your muscles
Autonomic Nerves: These connect to your internal organs.

It can be scary to get diagnosed with any disease, especially one with a ominous sounding name like peripheral neuropathy. We hope that by providing information in this blog, about the symptoms, diagnosis, treatment, prevention and some potential causes of peripheral neuropathy, you will feel more empowered, and armed with the information that will help you live your best life with this condition. Back to top

What causes peripheral neuropathy?

There are many causes of neuropathy. Approximately 30% of neuropathies are “idiopathic,” meaning that the cause is unknown and in another 30% of cases, diabetes is the cause. According to some studies, nearly 60 percent of diabetics have some sort of nerve damage. This damage is often due to high blood sugar levels, and the risk for neuropathy increases for diabetics who are over the age of 40, have high blood pressure, or are overweight. Having a family history of peripheral neuropathy increases the chances of developing the disorder. However, a variety of factors and underlying conditions may also cause this condition.

Some other causes of peripheral neuropathy may include:
 
Autoimmune disorders: Diseases in which the immune system attacks the body’s own tissues can lead to nerve damage. This can include disorders such as systemic lupus erythematosus, Sjögren’s, rheumatoid arthritis, etc.
Infections: This can include certain bacterial or viral infections such as Lyme disease, shingles, Epstein Barr virus, hepatitis C, leprosy, HIV, and diphtheria.
Heredity: Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
Tumors: Peripheral neuropathy can occur as a result of tumors or growths putting pressure on nerves.
Nutritional imbalances and vitamin deficiencies: B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are crucial to nerve health, imbalances and deficiencies can lead to peripheral neuropathy.
Traumatic injury: Traumatic injury from sports or vehicular accidents can sever or damage peripheral nerves. Pressure on nerves may also result from having a cast, using crutches or repeating a motion many times, such as typing (this is often referred to as carpal tunnel syndrome, a type of peripheral neuropathy).
Exposure to poisons or toxins: This includes those that contain heavy metals or chemicals, lead, mercury, and arsenic. In addition, neuropathies have also been known to have been caused by certain insecticides and solvents.
Certain medications: The medications used to treat cancer (chemotherapy) can cause neuropathy. In addition, anticonvulsant agents (medications used to reduce seizures) and even some medications prescribed to treat heart and blood pressure can cause peripheral neuropathy. In most cases, when these medications are discontinued or dosages are adjusted, the neuropathy resolves.
Disorders of the bone marrow: Peripheral neuropathy may also be caused by lymphoma, disorders that include abnormal protein in the blood, some forms of bone cancer, and amyloidosis (a disorder where amyloid, an abnormal protein that is usually produced in your bone marrow builds up in any tissue or organ).
Other diseases: These could include connective tissue disorders, liver disease, kidney disease, liver disease, and an underactive thyroid (hypothyroidism), vasculitis.
Alcoholism: Heavy alcohol consumption is a common cause of peripheral neuropathy. Chronic alcohol abuse often leads to certain nutritional deficiencies (particularly thiamine, B 12, and folate) that are linked to neuropathy. Damage may not be reversible but if the person stops drinking alcohol, the symptoms may lessen.

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What are the symptoms of peripheral neuropathy?

Symptoms of peripheral neuropathy may be experienced over a period of days, weeks, or years. They can be acute or chronic. In acute neuropathies, the symptoms will appear suddenly, rapidly progress, and resolve slowly as damaged nerves heal. In chronic forms of neuropathy, the symptoms often begin subtly and progress slowly. Some people may have periods of little symptomatic activity (remissions) followed by periods of increased symptoms (flares). Others may reach a stage where symptoms stay the same for many months or even years. Many chronic neuropathies worsen over time. Although peripheral neuropathy may be potentially debilitating, very few forms are fatal.

The specific symptoms of peripheral neuropathy will vary depending on whether motor, sensory, or autonomic nerves are damaged. These are some of the most common symptoms:
Tingling in hands and/or feet
Pain described as sharp, stabbing or burning
Loss of balance
Numbness in hands and/or feet
Heavy feeling in the arms and/or legs, sometimes described as feeling like your legs or arms “lock” in place
The feeling of wearing tight gloves or socks when you are not
Buzzing, vibrating or shocking sensation in muscles

Often the symptoms are symmetrical involving both hands and/or both feet. Because these symptoms occur in areas covered by gloves or stockings, peripheral neuropathy is often described as having a ‘glove and stocking’ symptom distribution. In many cases these symptoms improve with treatment especially if the underlying cause or condition is treatable.
Here are the symptoms that might be experienced when the different types of nerves are involved:

Motor nerve damage symptoms: The motor nerves control voluntary movement of muscles such as those used for walking, grasping things or talking. If these motor nerves are damaged, the following symptoms might occur:
Muscle weakness
Cramping
Decreased motor skills
Atrophy (shrinking) of the muscles
Twitching
Cramping
Slower reflexes

Sensory nerve damage symptoms: The sensory nerves have a broad range of sensory functions. Any damage to these nerves might cause a person to experience these symptoms:
Decreased sensations of touch. This can lead to not experiencing the pain from a cut or injury, or the feeling of wearing gloves or stocking when they are not.
A loss of ‘sense of position’ which can make coordinating complex movements like walking or buttoning a shirt very difficult. Balance might also be affected.
Difficulty in transmitting temperature sensations which could lead to burns. This loss of pain sensation can be a very serious problem for those suffering from diabetes and may contribute to a high rate of lower limb amputations among this group.
Increased sensation of pain is often a debilitating symptom of neuropathy. Instead of numbness, it can produce the opposite effect of an increased sensation of pain or feeling severe pain from stimuli that would normally be painless. It can severely affect quality of life, ability to sleep, emotional well-being, and the ability to work.

Autonomic nerve damage symptoms: If the autonomic nerves are involved, nearly every organ can be affected. The autonomic nerves control the functions of the body that happen automatically. Autonomic neuropathy can have symptoms that affect the loss of control of some of these functions. Symptoms may include:
Problems with heart rate
Difficulty with the body’s ability to regulate blood pressure which may cause dizziness or light-headedness
Problems with digestion (this may include diarrhea, or constipation)
Loss of bladder control
Inability to sweat normally which could lead to heat intolerance or overheating
Difficulty eating or swallowing

Seek medical care right away if you notice unusual pain, weakness or tingling in your hands or feet. Early diagnosis and treatment offer the best chance for preventing further damage to your peripheral nerves and controlling your symptoms. Back to top


How is it diagnosed?

Peripheral neuropathy is not a single disease, but rather describes damage to the nerves that produces varying symptoms. Because there are many potential causes for peripheral neuropathy, your doctor will need to examine where the nerve damage is in your body and attempt to determine what may be causing it. A neurologist is typically the type of doctor who will diagnose and treat neuropathy.

A diagnosis of peripheral neuropathy usually requires: 
 
Complete medical history: Your physician will first review your medical history, this will include discussions of any current or past medical conditions, your lifestyle, any exposure to toxins, your drinking habits, and any family history of nervous symptom diseases.
Physical exam
Neurological exam: Your physician will check your reflexes, muscle tone and strength, ability to feel sensations, coordination and posture.

Blood tests: Blood tests can detect vitamin deficiencies, liver or kidney dysfunction, diabetes, other metabolic disorders, and/or any signs of abnormal immune system activity
Diagnostic and imaging tests: This may include CT or MRI scans to show muscle quality and size, look for tumors, herniated discs or any other abnormality that might be causing your symptoms. Electromyography involves inserting a fine needle into a muscle to record electrical activity when muscles are at rest and when they contract. This can determine if your symptoms are being caused by muscle or nerve damage.
Nerve biopsy: This is where a small portion of a nerve is examined to determine the cause of your specific nerve damage.
Skin biopsy: A skin biopsy would be taken to observe the number of nerve endings in the skin. A reduction of nerve endings can signal neuropathy.
Other tests to analyze nerve function: Sweat tests to record how your body sweats, autonomic reflex screen test that will record how the autonomic nerve fibers are functioning, and other sensory tests to indicate how you feel touch, temperature changes, and vibrations.

If your lab and other diagnostic tests do not indicate any underlying condition, your doctor may recommend ‘watchful’ waiting to see if your neuropathy symptoms improve. If either exposure to toxins or alcohol consumption are the suspected causes of your condition, your doctor will recommend avoiding those substances to see if your symptoms improve before prescribing any medications or developing a treatment protocol. Back to top

How is it treated?

Peripheral neuropathy can be very uncomfortable and debilitating. Fortunately, treatment can be very helpful in the management of neuropathy symptoms. But before any treatment can begin, the most important step is to determine the underlying cause of the neuropathy to plan the correct course of treatment.

Some of the treatments for peripheral neuropathy may include:
Medications
Over-the-counter or non-prescription pain relievers: Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including acetaminophen, ibuprofen, aspirin, etc. can be very helpful in relieving mild or moderate symptoms. For more-severe symptoms, your doctor may recommend prescription painkillers. Because these drugs can affect your liver or stomach function, it is very important to avoid using them for an extended period of time, especially if you regularly drink alcohol.
Prescription medications: Medications containing opioids can lead to dependence and addiction and are therefore generally prescribed only when other treatments fail. These drugs can include tramadol, oxycodone, conzip and others, COX-2 inhibitors, etc.
Steroid Injections: Corticosteroid injections can help with pain and inflammation
Anti-seizure medications: Medications developed to treat epilepsy may also relieve nerve pain. These medications can may cause side effects that include drowsiness and dizziness.
Capsaicin: Capsaicin is a substance naturally in hot peppers and can cause modest improvements in peripheral neuropathy symptoms. Doctors may suggest you use this cream with other treatments. However, some people can’t tolerate it and side effects such as skin burning and irritation may occur (these often lessen over time). Topical lidocaine, an anesthetic agent might also be prescribed for localized chronic neuropathic pain such as pain from the shingles virus. Their helpfulness in the treatment of diffuse chronic diabetic neuropathy is limited.
Antidepressants: Certain antidepressants have been shown to interfere with the chemical processes in the brain and spinal cord that cause the body to feel pain. These medications may include tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor).
Immunosuppressant medications: Medications to reduce the immune system’s reaction, such as prednisone, cyclosporine (Neoral, Sandimmune, others), mycophenolate mofetil (CellCept) and azathioprine (Azasan, Imuran), may also help people with peripheral neuropathy associated with autoimmune conditions such as [lupus] and [RA].
Other medications: Pregabalin (Lyrica) is a medication that is used for the treatment of postherpetic neuralgia (postherpetic neuralgia is a complication of shingles) and diabetic peripheral neuropathy. Duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy. 

Therapies

Various therapies and procedures may help ease symptoms of peripheral neuropathy.
Intravenous immunoglobulin and plasma exchange: This treatment is also very common in the treatment of chronic inflammatory demyelinating polyneuropathy (a disorder characterized by progressive weakness and impaired sensory function in the legs and arms) and other inflammatory neuropathy. In immune globulin therapy, you receive high levels of proteins that work as antibodies. This helps to suppress immune system activity. Plasma exchange (called plasmapherisis) involves removing your blood and then removing antibodies and other proteins from the blood. The blood is then returned to your body.
Transcutaneous electrical nerve stimulation (TENS): TENS is a non-invasive intervention used for pain relief for a range of conditions, and a number of studies have described its use for neuropathic pain. In TENS, varying currents of gentle electrical current is delivered through adhesive electrodes placed on the skin. It is recommended that TENS should be applied for 30 minutes daily for about one month.
Physical therapy: Physical therapy can help improve your movements and counteract muscle weakness. Assistive medical devices such as canes, walkers, hand/foot braces might also be needed and helpful for those with mobility issues related to neuropathy.
Surgery: If pressure on the nerves is being caused by tumors for example, surgical intervention might be required and recommended to reduce the pressure. In carpal tunnel, where there is typically injury to a single nerve, surgery may be an effective solution. Some surgical procedures reduce pain by destroying the nerve when other treatments have failed to provide relief. Typically, diabetic neuropathy is not treated with surgical intervention.
Nerve block: A nerve block is an injection of anesthetics directly into the nerves.

Many treatments can bring relief to neuropathic symptoms and can help you to return to your regular activities. Often, a combination of lifestyle adjustments, treatments and therapies may work best. Back to top

Alternative treatments and self-care options

Complementary and alternative treatments have been shown to provide relief of peripheral neuropathy symptoms. The following therapies have shown some promise despite the fact that researchers have not studied these techniques as thoroughly as they have most traditional pharmaceutical medications. Some of these complementary and alternative treatments may include:
Fish oil supplements:These supplements, which contain omega-3 fatty acids, may reduce inflammation, improve blood flow and improve neuropathy symptoms in people with diabetes. Check with your doctor before taking fish oil supplements if you’re taking anti-clotting medications.
Herbs: Certain herbs, such as evening primrose oil, may help reduce neuropathy pain in people with diabetes. Some herbs may interact with medications or make some medications less effective, so please discuss any herbs or supplements that you are considering adding to your diet with your doctor.
Acupuncture: Acupuncture, which involves inserting thin needles into various points on your body, may reduce peripheral neuropathy symptoms. Multiple sessions might be required before any significant symptom improvement is noticed. Always be sure find a certified acupuncture specialist using sterile needles.
Chiropractic care: This can include massage, muscle stimulation, ultrasound therapy and manipulation.
Massage
Alpha-lipoic acid: This antioxidant has been used as a treatment to help reduce symptoms of peripheral neuropathy in Europe for years. Blood sugar levels may be affected by this antioxidant, so please discuss using alpha-lipoic acid with your physician. Other side effects could include skin rash and stomach upset.
Amino acids: In people who have undergone chemotherapy and in people with diabetes, amino acids, such as acetyl-L-carnitine, may help improve peripheral neuropathy. Side effects may include nausea and/or vomiting. 

Some suggestions to help you self-manage peripheral neuropathy

Quit smoking: Cigarette smoking can affect circulation by constricting the vessels that supply nutrients to the peripheral nerves, increasing the risk of foot problems and other neuropathy complications.
Exercise: Ask your doctor about starting an exercise routine. Regular gentle exercise, such as walking, or swimming may reduce neuropathy pain, control cramping, improve your muscle strength, prevent the muscles from atrophy, and help control blood sugar levels. Yoga and tai chi might also help.
Eat a balanced diet: Healthy eating is especially important to ensure that you get essential vitamins and minerals. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but also talk to your doctor about B-12 supplements. Speak with your doctor about using various dietary strategies to improve gastrointestinal symptoms from neuropathy.
Avoid excessive alcohol: Alcohol may worsen peripheral neuropathy.
Meditation
Monitor your blood glucose levels: Monitoring your blood glucose levels, if you have diabetes, will help keep your blood glucose under control and may even help improve your symptoms of neuropathy.
Take good care of your feet, especially if you have diabetes: Wash and inspect your feet daily for any injuries, blisters, cuts or calluses. Help to keep the skin moist with lotion. Timely treatment of injuries can help prevent permanent damage. Wearing soft, loose cotton socks and shoes with padded inserts may also help. To keep bedcovers off of hot or sensitive feet and provide a better night’s sleep, you may wish to use a semicircular hoop. These can be found in medical supply stores. 

Making Your Home Safe

If you have peripheral neuropathy, you are potentially at greater risk for accidents in the home due to muscle weakness, loss of balance, decreased sensitivity to sensations of pain, etc. Here are few things to keep in mind to make yourself safer in your home and decrease your chances of injury:
Protect your feet by always wearing shoes.
Things laying around on the floor can be a tripping hazard, so try to keep your floor clear.
Use your elbow, not your hand or foot to check the temperature of your bath or dishwater.
Installing handrails in your bathtub or shower, as well as anti-slip bath mats can reduce the odds of falling or slipping and injuring yourself.
For those whose work involves sitting for long periods of time, make the effort to get up and move around a few times each hour to improve circulation. It is important to not stay in one position for too long.

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In Conclusion

Peripheral neuropathy, while it cannot be cured, can most likely be well-managed if it is caused by a treatable underlying condition. The best way to prevent peripheral neuropathy is to manage those conditions that may put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. Even if you have a family history of this disorder, you may be able to prevent its onset by taking the following precautions to lower your risk:
Being aware of any toxins that you might be exposed to at work or at school
Protecting your feet during sports, especially those that involve kicking
Never inhaling toxins like glue to get high
Managing your alcohol intake
Avoiding tobacco and smoking
Maintaining a healthy weight and lifestyle
Avoiding factors that may cause nerve damage such as repetitive motions, staying in one position for long periods of time, staying in cramped positions

The goal of treatment and therapy for peripheral neuropathy is targeted at treating the underlying disease and improving the symptoms with the right combinations of medications and therapies. Finding a knowledgeable and experienced neurologist who listens and supports you, and makes you feel more comfortable can greatly improve your quality of life. It is very important to find a neurologist as soon as you notice any of the above-listed symptoms. This will provide the opportunity for you to receive the necessary treatment that can stop the disease before it has a chance to cause permanent damage help to ensure your best possible health.

Neuropathy, fibromyalgia, lupus, rheumatoid arthritis and many other conditions are considered invisible illnesses meaning they cannot be seen, but they exist. Being misunderstood and judged are two of the most common frustrations with those suffering from invisible illnesses. In addition to educating yourself about peripheral neuropathy, you might find it helpful to provide your family, friends and co-workers with information as well. Sharing this blog might be a good start! We want you to know that you are not alone as you learn to navigate living with a chronic and invisible illness. Our Facebook community is a great place to share and get great support from others who know exactly what you are experiencing and our online support groups are also a great way to get connected. We are here for you.
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Article by : Karrie Sundbom Karrie is the Digital Marketing Manager at Molly's Fund and responsible for innovating content for all of Molly's Funds online communications, creating memes and graphics, writing the MFFL Newsletter and main lupus blogs, as well as developing and managing the content for all of our social media platforms. Connect with Karrie on LinkedIn and Google+ .

http://www.mollysfund.org/2015/02/peripheral-neuropathy/

Living with Peripheral Neuropathy Part 1

Part One of a two part, American TV programme about living with neuropathy (Part Two tomorrow).
It talks mainly about neuropathy as a result of diabetes and every few minutes you feel like saying, 'What about us?' but that said both videos are interesting because they look into the basics of neuropathy presented by both doctors and patients. It does us no harm whatsoever to learn how diabetics are affected by neuropathy, if only to understand the differences with HIV-related neuropathy. You also get to hear personal experiences of people affected by different forms of neuropathy and compare their situations to your own.

It was posted on a neuropathy support network blog on July 5th, 2011 by LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS (see full link below)and this is what he said:

PBS – WMHT – HEALTH LINK, ALBANY, NEW YORK produced a video “Living with Peripheral Neuropathy”. This is the best video I have ever seen on Peripheral Neuropathy as Dr. James Wymer, MD, PhD and Neurologist from Albany Medical College shares insights into the many issues surrounding Peripheral Neuropathy. He is joined by Dr. Robert Busch, MD, Endocrinologist and a panel of Peripheral Neuropathy patients from the local Albany Support Group and by Peripheral Neuropathy patients who called into the panel discussion. What makes this video of great value is the greater depth of insight and the seriousness given to the epidemic of Peripheral Neuropathy as a major health issue. Discussed are the facts, types, causes, symptoms of Peripheral Neuropathy beyond diabetes while addressing this major cause. The critical point of the video is the FACT that the patient MUST seek to find the cause of their Peripheral Neuropathy, as this is the only way of addressing the disease beyond treatment of symptoms and/or pain to prevent severe disability. A must see at any Neuropathy Support Group meeting.

Watch the full episode. See more Health Link.

http://neuropathysupportnetwork.org/blog/category/peripheral-neuropathy/

What Happens in Peripheral Neuropathy

As a follow up to yesterday's post describing the range and progression of symptoms associated with neuropathy, today's post is a little more specific in helping us understand what's going on in our nervous system. It is once again taken from the excellent Medifocushealth site (see link below)and explains clearly the effects of neuropathy on different nerve types.
Please note, they are very careful to use the words, 'can' and 'may' as often as possible because as we know from previous posts, every individual case of neuropathy can take its own course.

What Happens in Peripheral Neuropathy?

Peripheral neuropathy develops as a result of injury or damage to any of the three types of nerves in the peripheral nervous system. Symptoms of an individual's peripheral neuropathy depend upon which types of nerves are injured, for example:

• Sensory nerves - Damage to sensory nerves can produce symptoms such as pain, numbness, tingling, burning, or a loss of sensation or feeling. The pain usually begins in the hands or feet and progresses towards the trunk of the body. Lack of sensation can cause other complications relating to recurrent injuries that may go unnoticed, (e.g., awareness of cuts or burns to the skin) and can lead to ulcers or poor healing of wounds. The nerve damage in sensory peripheral neuropathy may be found in either large fibers or small fibers. The symptoms of sensory peripheral neuropathy can be intermittent or continuous and can significantly interfere with quality of life.

• Motor nerves - Damage to motor nerves results in decreased movement or control of muscles. Since movement is important for the health of many organ systems (such as promoting increased blood circulation), damage to motor function can also lead to abnormal changes in muscle, bone, skin, and other organs. Symptoms of damage to peripheral motor nerves usually begin as weakness or heaviness of the hands and/or feet and may deteriorate over time.

• Peripheral nerves that link to the autonomic nervous system affect involuntary body functions and damage can result in:
◦cardiac symptoms (e.g., heart rate irregularities, orthostatic hypotension (drop in blood pressure when standing up from a sitting position)
◦impaired ability to regulate body temperature
◦blurred vision
◦reduced sweating
◦dizziness
◦bowel/bladder dysfunction
◦sexual dysfunction

There are many types of neuropathy included under the category of peripheral neuropathy and the etiology, symptoms, progression rate, pattern of symptoms, recurrence, and response to treatment vary widely.

http://www.medifocushealth.com/NR021/Introduction-to-Peripheral-Neuropathy_What-Happens-in-Peripheral-Neuropathy-.php

Cancer Treatment And Peripheral Neuropathy Why

Today's post from mdanderson.org (see link below) looks at why cancer patients and patients undergoing cancer treatment, are susceptible to neuropathy. Most of you will have heard that cancer treatment is one of the more common causes of neuropathy, even if it's not the case with yourself but not many people know why this happens. This article doesn't go into impenetrable detail but does give a good general description of what's going on. Useful for cancer patients and their friends and family and also for everyone else living with neuropathy. Unfortunately none of us are immune to cancer and it can strike at any time. Worth a read.

Peripheral neuropathy in cancer patients
By Laura Nathan-Garner on June 18, 2014 

For many of our patients, peripheral neuropathy is among the unexpected side effects of cancer treatment.

It's caused by damage to your peripheral nerves -- that is, the nerves that are farther away from your brain and spinal cord. Certain complications of cancer or cancer treatments can cause or worsen neuropathy. So can some health conditions, such as diabetes, alcoholism, AIDS, hypothyroidism, rheumatoid arthritis and carpel tunnel syndrome.

We recently spoke with Julie Walker, advanced practice nurse in Neuro-Oncology, about peripheral neuropathy. Here's what she had to say.

What causes peripheral neuropathy in cancer patients?
The nerve damage that causes peripheral neuropathy may be the result of many different factors, including some chemotherapy drugs using vinca alkaloids, platinum compounds, taxanes and thalidomide.
Tumors themselves can cause nerve damage as well if they grow close to and press on the nerve.

And, patients with cancers of the nervous system -- such as brain tumors, spine tumors and skill base tumors -- are more likely to develop peripheral neuropathy due to nerve damage resulting from the tumor.

What are common peripheral neuropathy symptoms?
Symptoms depend on the type(s) and location(s) of the damaged nerves. The most common peripheral neuropathy symptoms include:

numbness
tingling
shooting pain or burning, especially in your fingers or toes. Other peripheral neuropathy symptoms include:

loss of balance, difficulty walking or frequent falls
clumsiness
difficulty picking up objects or buttoning your clothes
facial pain
hearing loss
loss of sensitivity to hot and cold
stomach pain
constipation


What can cancer patients do to relieve peripheral neuropathy?
If the neuropathy is related to something you can control, try to control the cause.

If your neuropathy is chemo-related, your oncologist can decide whether it's beneficial to reduce your chemotherapy dosage or switch to a different treatment regimen.

If it's related to diabetes, you can often slow down or stop the progression of peripheral neuropathy with better blood sugar control.

Beyond that, physical activity can help by keeping blood flowing in the affected areas. Some people also try acupuncture.

Over-the-counter pain relievers and prescription medications like carbamazepine and Lyrica may help in some cases. Non-prescription-type treatments -- such as acetyl l-carnitine, alpha lipoic acid, glutamin, calcium and magnesium -- may help, too. But more research is needed to better gauge their effectiveness. Be sure to speak with your health care provider before trying any of these.

What can cancer patients do to lower their chances of developing peripheral neuropathy?
If you have other health conditions, such as diabetes, that can make the neuropathy worse, manage them appropriately. Limit alcohol use. Maintain a well-balanced diet. And, discuss your neuropathy risks with your health care provider.

How long do peripheral neuropathy symptoms last?
Every case is different. Because neuropathy is caused by nerve damage, it depends largely on how well your nerves recover. And, that depends on the length of your treatment, extent of the damage and, in the case of chemotherapy-induced neuropathy, dosage intensity.

It's usually possible to manage peripheral neuropathy up to a certain point, but for many people, it never goes away.

As the nerves heal, some people may actually experience more tingling in the affected area. Speak with your health care provider to find out if a prescription might help relieve symptoms during this time.

People with peripheral neuropathy lose the ability to feel pain or extreme temperatures in the affected areas.

What can cancer patients with peripheral neuropathy do to avoid burning or injuring themselves?
Always wear shoes to protect your feet from an injury. Also, make sure you examine your feet every day to look for any wounds or sores that aren't healing.

Be careful when using sharp utensils or avoid them altogether. Likewise, since neuropathy typically inhibits your fine motor movements, be cautious around or avoid dangerous machinery.

Before touching water with your hands or feet, feel the water with a part of your body -- such as the underside of your forearm -- that can sense how warm it is. And, avoid using heating pads and hot water bottles.

Any other advice for cancer patients who are experiencing neuropathy?
People with neuropathy are more prone to falls because they struggle to feel the ground beneath them, especially in the dark or an enclosed space. So:

use a nightlight
keep clutter and throw rugs off the floor
use handrails when taking the stairs
put handrails in the shower
use skid-free shower and bath mats

Neuropathy also makes the body more prone to infection since circulation is decreased and wounds don't heal as well. So it's a good idea to keep your skin moist to prevent cracking and, in turn, infection.

The most important thing you can do, though, is to speak with your health care provider as soon as you start to experience neuropathy symptoms. Together, you can hopefully find ways to manage your symptoms.

http://www2.mdanderson.org/cancerwise/2014/06/peripheral-neuropathy-in-cancer-patients.html

What Is Peripheral Neuropathy

Today's post from gloshospitals.nhs.uk (see link below) is another general article describing peripheral neuropathy, its causes and its treatments. It's very useful as a starting point for people new to the condition; or family members and friends, trying to understand what's happening to the patient. It's compiled by a hospital group in the UK and can be trusted although there just isn't room in this sort of article for 100% coverage of the disease (people love to point out the smallest details that are missing from this sort of piece). Worth a read for everybody coming into contact with neuropathy.

Painful Peripheral Neuropathy
Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia 
What is it?

Peripheral neuropathy, a result of nerve damage, is a common cause of numbness and pain in the hands and feet. In some cases this can also be associated with pain which can be very distressing. People typically describe the pain of peripheral neuropathy as tingling or burning, while they may compare the loss of sensation to the feeling of wearing a thin stocking or glove. Because the nerve fibres affected include those involved in telling us where our joints are in space (proprioception) people with peripheral neuropathy often describe problems with balance and may have a tendency to fall.

One of the most common causes is diabetes. Peripheral neuropathy can also sometimes result from problems such as traumatic injuries, infections, metabolic problems such as vitamin deficiencies and exposure to toxins including some drugs: however, in non-diabetic patients it is most common that no other cause can be identified and it can best be described as an ageing process of the nerves. The longest nerve fibres are most readily affected, which is why the feet and hands are most commonly affected.

In many cases, peripheral neuropathy symptoms improve with time — especially if the condition is caused by an underlying condition that can be treated. A number of medications often are used to reduce the painful symptoms of peripheral neuropathy.

What symptoms can it cause?

The nerves of your peripheral nervous system carry information from your brain and spinal cord (central nervous system) to and from all other parts of your body. Several groups of nerves may be affected by peripheral neuropathy:
Sensory nerves that carry sensations back to your Central Nervous System such as heat, pain or touch
Motor nerves that carry impulses to make your muscles contract
Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder function

Most commonly, peripheral neuropathy starts in the longest nerve fibres — the ones that reach to your toes. Symptoms vary, depending on which types of nerves are affected. Signs and symptoms may include:
Gradual onset of numbness and tingling in your feet or hands, which may spread upward into your legs and arms. This may be insidious in its onset so that many patients may not be aware of it.
Burning pain
Sharp, jabbing or electric shock-like pain
Extreme sensitivity to touch, even light touch (termed allodynia)
Lack of coordination and balance
Muscle weakness or paralysis if motor nerves are affected
Bowel or bladder problems if autonomic nerves are affected

Peripheral neuropathy may affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy).

Causes

Apart from Diabetes, in many patients it is not possible to identify a cause for cause of peripheral neuropathy. Despite this, a number of factors that can cause neuropathies should be considered:
Alcoholism. This may relate both to the alcohol and because many alcoholics also have vitamin deficiencies.
Autoimmune diseases. These include lupus, rheumatoid arthritis and Guillain-Barre syndrome.
Diabetes. When damage occurs to several nerves, the cause frequently is diabetes. At least half of all people with diabetes develop some type of neuropathy.
Exposure to poisons. These may include some toxic substances, such as heavy metals, and certain medications — particularly those used in cancer chemotherapy.
Infections. Certain viral or bacterial infections can cause peripheral neuropathy, including Lyme disease, shingles (varicella-zoster), Epstein-Barr, hepatitis C and HIV/AIDS, and the leprosy bacillus.
Inherited disorders.
Trauma or pressure on the nerve. Traumas and injuries (including surgery) can injure peripheral nerves. Nerve pressure can result from using a cast or crutches..
Tumours. Growths can form directly on the nerves themselves, or tumours can exert pressure on surrounding nerves. Both cancerous (malignant) and noncancerous (benign) tumours can contribute to peripheral neuropathy.
Vitamin deficiencies. B vitamins — B-1, B-6 and B-12 — are particularly important to nerve health. Vitamin E and niacin also are crucial to nerve health.
Other diseases. Kidney disease, liver disease and an underactive thyroid (hypothyroidism) also can cause peripheral neuropathy.
Drugs. A number of drugs, notably some of those used in cancer chemotherapy, can cause peripheral neuropathy.

Complications

Complications of peripheral neuropathy may include:
Risk of injury. Because parts of your body may be numb, you may be less likely to feel temperature changes or pain. This can make you more susceptible to burns or skin injury.
Infection. Make sure to check your feet, as well as any other areas lacking usual sensation, regularly so that you can treat minor injuries before they become infected. This is especially important for people with diabetes, who tend to heal more slowly.

Potential treatments

One goal of treatment is to manage the condition causing your neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. Another goal of treatment is to relieve the painful symptoms.

Medications
 
Many types of medications can be used to relieve the pain of peripheral neuropathy, including:
Simple analgesics. Mild symptoms may be relieved by over-the-counter pain medications. We would normally be cautious about using strong opioid type pain medications because of potential side-effects, though sometimes these may be tried. Opioid drugs may have some benefit but this has to be considered against the potential adverse effects of these drugs.
Anti-epileptic medications. Drugs such as gabapentin, pregabalin and carbamazepine were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects may include drowsiness and dizziness.
Capsaicin. A cream containing this naturally occurring substance found in chilli peppers can cause modest improvements in peripheral neuropathy symptoms. This is further discussed at the linked page.
Lidocaine patch. More details are given on a linked page on our site.
Antidepressants. Tricyclic antidepressant medications, such as amitriptyline and nortriptyline, were originally developed to treat depression. However, they have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. The serotonin and norepinephrine reuptake inhibitor (SNRI) duloxetine also has proved effective for peripheral neuropathy caused by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite and constipation.

Therapies
 
Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. TES is discussed further at the linked page.

The following suggestions can help you manage peripheral neuropathy:
Take care of your feet, especially if you have diabetes. Check your feet daily for signs of blisters, cuts or calluses. Tight shoes and socks can worsen pain and tingling and may lead to sores that won't heal. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet.
Exercise. Ask your doctor about an exercise routine that's right for you. Regular exercise may reduce neuropathy pain and can help control blood sugar levels.
Stop smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and possibly amputation.
Eat healthy meals. If you're at high risk of neuropathy or have a chronic medical condition, healthy eating is especially important to ensure that you get essential vitamins and minerals. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Drink alcohol in moderation, if at all.
Avoid prolonged pressure. Don't keep your knees crossed or lean on your elbows for long periods of time. Doing so may cause new nerve damage.

Links

a good summary page on different aspects of peripheral neuropathy is given at the National Institute of Neurological Disorders and Stroke website.

You may also find the www.patient.co.uk page on diabetic neuropathy helpful, as well as the page on the NHS Chices site on this topic.

The Foundation for Peripheral Neuropathy website.

For professionals, the American Academy of Neurologists have published guidelines on the Treeatment of Painful Diabetic Neuropathy. A detailed BMJ review of Painful Diabetic Neuropathy is a useful resource.

http://www.gloshospitals.nhs.uk/en/Wards-and-Departments/Departments/Pain-Management/Different-Pains/Nerve-Pain/Types-of-Nerve-Pain/Painful-Peripheral-Neuropathy/