Before we start an examination, we require some information just as with any doctor’s office. The neuropathist will, generally, either send by mail or email, a questioner to a new patient (or have them fill it out upon their first visit) in which they will ‘detail’ their medical history.
Often we hear:
“Why do you need to know this information, isn’t it rather ‘personal’ to ask about my medical history and medications; or if I have had any kind of injuries or diseases?”
Frankly, no… it’s not too personal, when we are attempting to find out “why” the patient hurts! It is not out of line to ask for a patient’s medical history, or even ask other so-called ‘personal’ questions, if one is trying to determine the type of neuropathy a patient might have… or, even to determine if the patient even HAS a true neuropathy (remember from past blogs, some issues like IBS may actually be autonomic neuropathy, or carpal tunnel, may or may not)! Patients, most likely, wouldn’t go into a doctor’s office and tell the doctor “guess what is wrong with me,” they are going to give the doctor, hopefully, as much information as possible so he/she can make a good, educated determination as to the problem or disorder. The same is with the neuropathist!
Of course, most patients don’t mind or expect the obvious questions: “Do you have High Blood Pressure, are you a Diabetic, have you had any operations or injuries, and etc.” But many times, questions don’t seem appropriate to the patient. What kind of questions do people find ‘objectionable?’ “Have you ever been in the military?”
“What would that have to do with anything,” we are often asked. Well, if someone happens to be in their 60’s or so, it can help to determine ‘the reason’ for ones neuropathy. Was the patient in Viet Nam? “Yes?” Now, the possibility of exposure to Agent Orange comes into play! Was the patient a pilot or airplane crew member during the war? It gets rather cold high up in the sky… frostbite is not unheard of by pilots.
Other questions; “Are you or were you a skier?” Same thing… possible frostbite at one time. “Are you or were you a smoker?” Lots of objections on this question. Again, we hear, “what does that have to do with anything? My lungs are not the issue here… it’s my feet that hurt!” The issue is, that most peripheral neuropathy is caused by hypoxia, a lack of oxygen to the nerves and tissue via the blood. The hypoxia can have many root causes; but if one is a smoker, oxygen is being depleted to the tissue with every ‘puff’ the patient takes. This can be easily seen in some smoker’s legs and feet. The tissue takes on a ‘blue’ or ‘purple’ coloration. This is poor circulation, pure and simple; and poor circulation means less oxygen to the tissue. To reiterate, hypoxia may be the ‘root of the problem’ for the neuropathy; but ‘smoking’ may be the ‘root of the problem’ for the hypoxia!
Questions about legal and illegal drugs, now, need to come into play. Again, we are not being nosey, nor are we looking to ‘turn in’ anyone one for illegal drug use. But, we NEED to know about any self-medicating issues, as so many drugs can cause neuropathy; and/or treatment for drug addiction can also be responsible (not surprisingly, with ‘Baby Boomers, doctors and surgeons are finding that some patients still have drug addictions stemming from back in the 1960’s; and those addictions must be taken care of before surgery or treatment can take place. We neuropathists see the same issues… and, the addiction can be the ‘root issue,’ once again.) for many symptoms.
As an added feature to treatment, however, if we know the patient has a drug addiction, we can possibly help with that as well – or, help the patient find the help they need. In the same sense, if one is taking legal or prescription drugs, we need to look at the side effects of those compounds to see if they contribute to ones neuropathy. Statin drugs for high cholesterol are very common culprits of this; but luckily, there are plenty of ‘natural statin’s’ one can take to reduce ones cholesterol. In addition, depending upon some modalities, they might help to reduce not only cholesterol, but blood sugar or blood pressure as well. If we know exactly what the patient is taking, again, we can make a more informed determination as to the best modality to use or what issue to address; as well as how to best address nutrition.
One more question that people seem to have an objection to sharing, especially if a younger patient, is: if one has a pacemaker or defibrillator or not. Older patients don’t seem to mind answering this one, but younger ones do, as they seem to feel there is something of a ‘stigma’ of some kind associated with it. Of course, there is not; but we do need to know, as there are certain contraindications (meaning it could be unwise to do) that accompany the patients’ device.
Next, is probably the most embarrassing: ‘bathroom habits!’ No, we really don’t want to know… but we may HAVE TO know to make certain determinations. For example, many patients present with, not only, a idiopathic neuropathy diagnosis, but with irritable bowel syndrome as well. “How long have you had the Neuropathy or diagnosis of Neuropathy” we ask? Then, “how long have you had the Irritable Bowel syndrome?” If their answer is “20 or more years,” then we look at that irritable bowel just a bit differently. We consider the possibility of, the afore mentioned, autonomic neuropathy – in other words, neuropathy of the internal organs; which brings about even more questions for the Intake! “Do you get diarrhea when you go out to eat? Do things like Thousand Island Salad Dressing bother you? Does Gluten bother you?” If the answer is “yes” to those questions, the person is more likely – not definitive, but more likely – to actually have irritable bowel syndrome. If not, and the diarrhea appears at any time, or after eating just about anything… and/or incontinence is involved, we then start looking towards meds to make sure “loose bowels” are not a side effect from certain medication.
It is only through a complete Intake, and medical history, that we can make proper determinations as to the patients neuropathy and treatment. It’s not being “nosey”… we have a genuine “need to know!” And, because of that need to know, we are more likely to find the correct ‘modality of treatment’ for your neuropathy!
Next Blog: Examination and Testing
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