Neuropathy

Peripheral – means beyond the brain and spine.

Neuro – means related to nerves.

Pathy – means disease.

Neuropathy is a complicated problem of damaged or diseased nerves, usually involving Peripheral Nerves, those nerves that are outside the Central Nervous System and the other main nervous systems. The Peripheral Nerves usually stand alone, but can be a bundle of nerves too, i.e., Bell’s Palsy, carpal tunnel syndrome, ulna tunnel syndrome (elbow), tarsal tunnel syndrome (ankle), and radial peripheral neuropathy (radial nerve damage).

Peripheral Neuropathy means nerves that carry messages back and forth to the brain and spinal cord from and to the rest of the body are damaged or diseased. There are a few things we know about Peripheral Neuropathy.

· It is a common condition, believe it or not, it is estimated that upward of 20 million Americans suffer from it. It can be a complication of different medical conditions and can occur at any age, but is usually found in people age 55 or older.

· ‘There are terms for how severe the nerve damage is. Mononeuropathy Mononeuropathy is damage to a single peripheral. Physical injury or trauma such as from an accident is the most common cause. Prolonged pressure on a nerve, caused by extended periods of being sedentary (such as sitting in a wheelchair or lying in bed), or continuous, repetitive motions, can trigger a mononeuropathy.

· Carpal tunnel syndrome is a common type of mononeuropathy. It is called an overuse strain injury, which occurs when the nerve that travels through the wrist is compressed. People whose work requires repeated motions with the wrist (such as assembly-line workers, physical laborers, and those who use computer keyboards for prolonged periods) are at greater risk.

· ‘Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). In some cases, it can affect internal organs, such as the heart, blood vessels, bladder, or intestines. Neuropathy that affects internal organs is called an autonomic neuropathy. This rare condition can cause low blood pressure or problems with sweating.

· Polyneuropathy

· Polyneuropathy accounts for the greatest number of peripheral neuropathy cases. It occurs when multiple peripheral nerves throughout the body malfunction at the same time. Polyneuropathy can have a wide variety of causes, including exposure to certain toxins such as with alcohol abuse, poor nutrition (particularly vitamin B deficiency), and complications from diseases such as cancer or kidney failure.

· One of the most common forms of chronic polyneuropathy is diabetic neuropathy, a condition that occurs in people with diabetes. It is more severe in people with poorly controlled blood sugar levels. Though less common, diabetes can also cause a mononeuropathy.’ (WebMD)

· There are three types of nerves that can be involves; autonomic nerves, motor nerves and the sensory nerves.

· Physical trauma (like my car accident), repetitive injury (as in carpal tunnel syndrome), infection (strep, mono, shingles, Lyme disease, HIV), metabolic problems (malnutrition, etc.), exposure to toxins and some drugs can all lead to neuropathy.

· Diabetes has the most cases of neuropathy, especially if the sugar levels are not under control. What is sad is that up to 50% of people with this may be completely free of symptoms.

· When you have Diabetes, you need to do a foot check at least once a year, as well as an eye check. This is something you should have been told when you were diagnosed. I bet they didn’t tell you that you should also be checked for neuropathy as well. If not, that should be part of your routine Diabetes check.

· Neuropathy can’t be treated; however, the Doctor should not just say you have Neuropathy and stop there. He/she needs to keep searching to find the source of the problem.

· Now as for toxins, you need to identify what they are and then remove them from your life. If it is a drug, you need to stop it before it can cause any further damage. Some of these drugs, however, some you might not want to stop, i.e., chemotherapy medication or medicines used to treat HIV. There are 40 drugs known to cause neuropathy! For example, in my case I can’t take Neurontin because I completely lose the use of my body from the waist down. If I continued to use it, I would end up a paraplegic.

There are also other conditions that can cause neuropathy.

· B12 of folate vitamin deficiencies as well as Vitamin D, Zinc and other vitamins and minerals. In other words, poor nutrition and vitamin deficiencies. You need to get your blood tested every 3 months to be sure that your levels where they need to be. Nutrition is so important in so many ways.

· Poisons (toxins) such as insecticides and solvents.

· Cancers such as lymphoma and multiple myeloma.

· Alcohol excess can not only damage your liver, but high alcohol levels in the body can cause nerve damage. (Alcoholism)

· Chronic liver disease

· If your kidneys are not functioning normally, for whatever reason, an imbalance of salts and chemicals can cause peripheral neuropathy.

· Thyroid disease that has not been diagnosed or is not being treated properly.

· Infections as I’ve already mentioned. Guillain-Barré syndrome is the name given to a specific type of peripheral neuropathy triggered by infection.

· Connective tissue diseases like rheumatoid arthritis, Sjögren’s syndrome and systemic lupus erythematosus.

· Some inflammatory diseases including celiac disease, especially if it isn’t diagnosed and handled well.

pregnant woman avoiding bread and gluten because of celiac disease

· Inherited diseases

· Then in about 30% of cases there is just no known cause for the peripheral neuropathy.

I have Radial Peripheral Neuropathy on my right forearm next to where my original injury is and even though my RSD/CRPS is sleeping, but that area is still active, especially if I have been typing too much. It feels like I have my arm in a vise and someone is tightening it and they will not stop. It is, at times like this, that I cannot stand to have even a fly land on that area. I cannot stand any kind of wind or air movement on that area. That section of my arm has atrophied and caved in. It is hard to the touch and if you feel it, you can feel the two arm bones easily. All of the muscle seems to have disappeared. There it really bothers me when I type, so either I have to take a break, type slower (which is hard for me) or use what I have learned with my holistic methods. Sometimes I have to wear a compression leg sock on my arm. I just cut the heel off. I have to get a small. The compression sock confuses my brain because of the over-sensation being sent to it and so the pain stops. Then it protects it from the air and insects. When I have that sock on, people can touch that arm and it doesn’t bother me at all. I discovered this when I had RSD/CRPS and I used to wear prom gloves. It became quite the thing for the people who knew me in the RSD community.

I also have ulnar carpal syndrome in both elbows. I had to wear a thick sleeve with heavy padding on the outside of the elbow for a year. It was so hot in the summer. However, if I didn’t my little finger, ring finger, and half of my middle finger would be totally numb. It helped some, but my arms and hands will still go to sleep. Sometimes, when I wake up one arm or hand will be asleep and I can’t even move my fingers. I have no idea what I hit my elbows on. I did have steering marks on the underside of each arm, but the peripheral nerve damage is on the top and left side of my right arm. I have no idea what I hit the top of my arm on either. I passed out for a while.

The symptoms are similar to Fibromyalgia, but there are differences.

Sensory Neuropathy

Tingling and numbness.
Pins and needles and hypersensitivity.
Increased pain or the loss of ability to feel pain.
Loss of ability to detect changes in heat and cold.
Loss of co-ordination and proprioception.
Burning, stabbing, lancing, boring or shooting pains - which may be worse at night.
Skin, hair or nail changes.
Foot and leg ulcers, infection and gangrene

gangrenegangrenegangrene

Motor Neuropathy

  • Muscle weakness - causing unsteadiness and difficulty performing small movements such as buttoning the shirt.
  • Muscle wasting.
  • Muscle twitching and cramps.
  • Muscle paralysis.

Autonomic Neuropathy

  • Dizziness and fainting (because of sudden changes in blood pressure).
  • Racing heart.
  • Reduction in sweating.
  • Inability to tolerate heat.
  • Loss of control over the bladder function leading to incontinence or retention of urine.
  • Bloating, constipation or diarrhea.
  • Difficulties in achieving or maintaining an erection (impotence).

How Do You Get Diagnosed?

First you go to a good neurologist. This isn’t something you leave to your family doctor, although he/she will need to refer you to one. Make a list of all of your symptoms, when they started, what you were doing within a week before they started, i.e. a car accident, a fall, an illness. Take all of your medications, including those you have recently stopped. Include in your medication list marijuana if you use it for pain. List any poisons or toxins to which you have been exposed. Talk to your family so that you have a history of any family members with neuropathy. Once you have done all of this you are ready for your appointment. Make sure you remember to take your list. You might even put it on your phone.

The first thing the neurologist is going to do is ask you lots of questions and you will have all the answers if you did your homework I listed in the above paragraph. He/she will also probably ask about your general health, alcohol consumption, and your sexual history. Now with Fibromyalgia, you probably don’t have much of one, but be truthful. Also, be truthful about your alcohol consumption, recreational drug use, that kind of thing.

The next thing the neurologist is going to do is a thorough examination. If it hurts, don’t keep it inside like so many of us do, but let him know. How can he help you if you keep your pain from him?

· He is going to look at your skin to see the condition of it.

· He is going to check your pulse. Now if you have Diabetes, don’t be surprised if he/she has a hard time finding a pulse in your ankles. That is what has happened to me. He also has a hard to time getting reflexes on my knees. I have Diabetes II.

· He is going to check your ability to feel/sensations. My doctor does pin pricks on the bottom of my feet and takes the end of the tuning fork and runs it along the length of my feet. He will also take the tuning fork and check to see how you feel sensations with that.

Next, he will probably run some tests. I will tell you right now these are not fun, especially when you are already in pain, but you need to have them done to get to the cause of the problem. These are how they discovered my radial peripheral neuropathy.

‘Nerve Conduction Studies:

Nerve conduction studies check the speed with which nerves send messages.

Special electrodes are placed on the skin over the nerve being tested.

These electrodes give off very small electrical impulses that feel a bit like a small electric shock which stimulate the nerve.

Other electrodes record the electrical activity of the nerve.

The distance that the impulses travel to the other electrodes and the time that this takes allows the speed of the nerve impulse to be calculated.

In peripheral neuropathy, this speed is reduced.

Electromyography:

  • This test looks at the electrical activity of the muscles.
  • A very thin needle with an electrode attached is inserted through the skin into a muscle.
  • This is connected up to a recording machine called an oscilloscope.
  • The way that the muscle responds when it is stimulated by nerves can then be monitored using the oscilloscope and recorded.
  • In peripheral neuropathy, the electrical activity will be abnormal.

Nerve Biopsy:

This is the removal of a small part of a nerve so that it can be examined under a microscope.

Skin Biopsy22

  • This is a new technique that has been developed to examine the peripheral nerves.
  • It can be used to look for early peripheral neuropathy and also to monitor progression of neuropathy and response to treatment.
  • Amongst other things, the density of nerve fibers in the area of skin is measured.
  • In peripheral neuropathy, the density of the peripheral nerves is reduced.’ (Medical News Today (www.medicalnewstoday.com, Newsletter. Written by Dr. Helen Webberley, 18 March 2016)

Treatment

Left untreated, nerve damage may worsen over time. It usually starts in the nerves farthest from the brain and spinal cord -- like those in the feet and hands. Then it may move up into the legs and arms. However, if you get treatment for the medical condition causing the nerve damage, you may be able to stop the damage -- and even reverse it.

In addition to working with your doctor to find treatment that works, you can take other steps to fight chronic pain. Getting regular exercise, keeping a healthy weight, and improving your diet may help.

Improve your diet! Improve your nutrition by taking 100% all natural vitamins and minerals. Not a one a day vitamins, but really good vitamins with no fillers in them. These you aren’t going to find in a store, but will have to buy from an individual who will be a distributor and give you personal care and attention.

Get your sugar levels to a good level. Work with your doctor and a nutritionist if you have to in order to get this done. This is something that you have to do though, no one can really do this for you. You have to discipline yourself. Get your carbs down too because carbs turn into sugar.

Get tested for Thyroid. The tests you need are: total T4, free T4, total T3, free T3, TPO antibody, thyroglobulin. Once your Thyroid gets treated correctly, the nerve damage should stop progressing.

The best way to control your pain is with holistic management. There are epilepsy drugs that can help (they all have terrible side effects, so be watchful.) There are antidepressants called serotonin and norepinephrine reuptake inhibitors that can with both depression and nerve endings receptors (again they all have side effects, so be careful.) If you have urinary symptoms such as bladder control, talk to your Doctor for help. As far as pain medication, it is available, but with your Fibromyalgia, it is not recommended because pain medication causes Fibromyalgia to get worse, plus the longer you are on them, the more problems they cause.

Drink plenty of water to flush out toxins. Take your weight, divide it by half and that is the amount of water in ounces that you need to drink every day. Just plain water. Anything else you drink is above that. Stop drinking pop/soda, coffee and caffeine. Lower the amount of sugar you eat and don’t substitute it artificial sweeteners. Lower the amount of carbohydrates you eat because they turn into sugar.

Try to find clothing that is less irritating. Cotton breathes and is all natural with no synthetic material mixed in with it. Therefore, it will be cooler to wear and won’t cling to your body.

Stress certainly causes pain to increase. You need to destress your life as much as you can. A psychologist can help you with this. You can try acupuncture which can help you with not only with relaxation, but also with pain. Learn how to meditate and how to do yoga.

Move, move, move. I know many of you find that difficult, but you can start slowly at home. Even if you start out just sitting in your chair, lift your arms up as far as you can with a full water bottle in each hand. Lift them up 10 times. Then do curls bending your elbows, bringing your hand with the bottles to your shoulders and do that 10 times. Bend every joint in your hands and bend your wrist back and forth holding that for 10 counts and then side to side. If you can walk for 5 minutes 3 times a day. If your hips hurt, go ride a stationary bike. I know that sounds wrong, but your hips probably hurt because you aren’t using them. I know. When I broke my hip and went to therapy, it hurt to move my hip. Now if my hip hurts, I go to the gym and ride the bike and by 30 minutes the pain is gone for weeks. Now that is because I’ve done the work. For you, start physical therapy to get started.

Deb Lundquist
 

After 18 years of living with this as a roommate, I feel I know Fibromyalgia well. Now, it is my passion to help people with Fibromyalgia and chronic pain take back control of their lives.