Intake

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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Ask the Neuropathist!

Welcome to Ask the Neuropathist.

Neuropathists treat pain, burning, numbness, tingling and other issues; generally, associated with Peripheral, Autonomic, Proximal, Focal or Sensorimotor neuropathy; however, there are many more forms of neuropathy with other symptoms as well.

This page offers two ways to ask questions: either, questions in general for us to put into our Blog, or “Quick/Short Questions;” for “Ask the Grumpy Neuropathist!”

This site is not intended to diagnose or give medical advice in any way, shape or form. It is strictly to be used as an informative site to help explain some of the ‘myths’ regarding neuropathy, and actual treatments/modalities which are available through some doctors, neuropathists or physical therapists.

 

The New Neuropathy Patient

OK, you have seen your doctor or neurologist and he/she says “you have peripheral neuropathy!” Most likely, he has prescribed some sort of medication such as Gabapentin (Neurontin), Cymbalta (Duloxetine) or Lyrica. There are other drugs, but these are the primary ones to treat peripheral neuropathy – or ‘nerve pain,’ that is. Gabapentin, or its generic equivalent, Neurontin are anti-convulsive agents, and Lyrica, and Cymbalta are anti-depressants. Like other common neuropathy drugs, like Topamax, they can be used for many other issues besides what they were designed for. Unfortunately, these agents, like most drugs, have certain negative side effects; the thing neuropathists are concerned with is the fact that they ALL can cause neuropathy symptoms.

What was that? Was that a misprint? Neuropathy meds can CAUSE neuropathy? Absolutely! It doesn’t seem logical that one takes an agent which causes neuropathy to treat ones neuropathy, does it? Let’s step back and look at the big picture again; are these agents useful for neuropathy pain? Absolutely! I have taken them myself before I was diagnosed as having neuropathy – my doctor thought my issue was my former back injury. (In my case, however, I gave up the Gabapentin after only three days as I was unable to drive, work was difficult, as was my ability to even think while taking it. And, the Lyrica CAUSED depression in me.) But, even though I was a working neuropathist, I thought I should at least try what my competition was offering for neuropathy. (Frankly, my nerve pain in my feet was so severe that if someone had suggested “shoving beans up my nose” would have helped… I would have found myself with a nose full of beans!) It wasn’t until I had a visit from a patient in my office, that I made the decision to stop my meds – which, I’ll talk about in a moment.

I found that whereas my own treatments helped, the meds simply did not; at least, not the way I wanted them to. They caused many side effects with me that I didn’t like. Weight gain, depression, sleep issues, anxiety and stress to say the least. Did they help with the pain in my feet? They certainly did – but, I found there was nothing in the drugs which directed them to ONLY go to my feet. They went all through my body; aiding with pain in my back and elbow, but NUMBING my brain where I couldn’t think or work well. I had trouble making decisions or holding conversations, and certainly, my reflexes were adversely effected. When I drove, I was all over the road! In addition, my feet went from hurting, to having major burning and numbness. Before the meds, I had only a little numbness in my toes, but now my feet were totally numb.

Of course, my neurologist told me; “Oh, you can’t have pain and numbness at the same time.” But, as many of my own patients had told me, I certainly did have both pain and numbness – not to mention burning and swelling. In addition, I was informed by the neurologist, “You are only going to get worse. You will soon be in a wheelchair.”

As it happened, a long time patient came in to see me about this time, and was surprised to see me walking with a cane. He had just been given a prescription for Gabapentin for his neuropathy. “What do you think of this,” he asked me? “Now Ed,” I responded, “Gabapentin is great for nerve pain, but you’re only symptom is numbness! Why would you want to take something that causes numbness to treat your numbness?” I had to look at myself for a moment. I could ask myself this same question! Taking my own advice as a neuropathist, I discontinued my meds and pursued an upgraded plan for myself. (You see, even we neuropathists want to listen to our doctors – but we have to make an educated judgment as to pursue the recommended treatment or not!)

The first thing I did, was to have someone in my office perform a test on me – what I had only performed on diabetics up until that time. A Toronto Clinical Scoring Test. I knew that a new biopsy, as suggested by my neurologist, would be inconclusive; as we have TRILLIONS of nerves in our feet and legs – and just happening upon ONE nerve which told the whole store would be a trillion times more difficult than just picking an ‘Ace of Spades’ out of a deck of cards. I hadn’t had neuropathy very long, so there wasn’t much damage to my feet and legs. A nerve conduction test was next ordered. Again, how conclusive would this test be, as my feet were still new to the damage? Plus, so many times, I had seen ‘so-called’ dead nerves begin to respond after as little as two minutes of neuromuscular stimulation. Not surprisingly, the test was inconclusive; as was, the nerve biopsy which I was talked into and soon followed. The Toronto Test showed that my nerves were quite good in both legs and feet. I had my technician check my hands. Same thing. No sign of neuropathy in hands or arms. My symptoms appeared to be totally of a ‘long nerve’ issue. So, being a long nerve issue, I knew that this issue had to come about because of hypoxia – in other words, a ‘lack of oxygen’ to the synoptic junctions of the long nerves.

My schooling reminded me, that whereas I was now diabetic, I did have some damage to my lower back; so I couldn’t rule out my back as being at least partly at fault for my neuropathy and lack of oxygen to the synoptic junctions. But, be that as it may, I would proceed as if I was just a diabetic with neuropathy; then, after keeping strict records, analyze and change modalities as necessary.

I stepped up therapy on myself using a neuromuscular device which put out a low amount of Hertz – one, which was approximately the same as the frequency that my own body had… 7.83 Hertz. Along with daily treatments, I started keeping a closer eye on my blood sugar; not only taking my readings on a regular basis, but now supplementing my diet with cinnamon with chromium. Two to three thousand milligrams seemed to be the correct dosage for me (everyone needs to check with their doctor or nutritionist before starting any vitamin or supplement program, which I will go into more detail in later Blogs). After a few weeks, my feet started getting better; and, I was able to go for a longer period of time between treatments. I reached a plateau, however. The same plateau I had reached with several patients. We would reach a point where the feet could ‘hold their own,’ but not continue to get any better. Through additional research and study, I found that if I added a new modality of whole body or localized vibration, my patients and myself could bypass that plateau and proceed to further recovery.

Our office motto has always been to REDUCE, MANAGE and MAINTAIN symptoms, and now we were doing better with more options. I now incorporated another modality which my patients had found so helpful – especially, when it came to ‘burning’ of the feet and toes; vitamins and supplements. I have always known that my diabetic patients were short on vitamin D, but apparently most of my other patients were as well. In addition, we found that most of our patients were deficient in the B vitamins; particularly, B1 and B6. As with my patients, my nerves became more conductive with the addition of a B complex, and symptoms continued to improve – especially, when an omega 3 was added. I then added ALA (alpha lipoic acid, as it is known). When mixed with the vitamin B1, my burning symptoms totally went away.

Cut to several years later, and my feet seldom bother me anymore. YES, I still have neuropathy; and I still, occasionally, give myself a neuromuscular treatment. In addition, I still take daily vitamins and supplements and my daily diabetic medicine to keep my blood sugar as normal as possible. If I could somehow find a cure for my diabetes, I’m sure my neuropathy would clear up as well; but until that time, I have to be willing to accept the ability to REDUCE, MANAGE and MAINTAIN my symptoms. Treatment is generally only once every two or three months.

Next Blog: Intake