Treatment

Treatment for peripheral, or other neuropathies can vary; depending upon the type of neuropathy (long or short nerves involved), the kind of neuropathy (autonomic, diabetic, proximal, focal, sensorimotor, etc.), if the patient has an implanted device (pacemaker, defibrillator, insulin pump, or etc.) and/or if the patient can personally handle any particular type of modality (artificial knees, not allowing whole body vibration, or the patient simply does not like a particular ‘feeling.’) This last is, probably, the most important as it directly affects patient compliance; as if someone doesn’t like something, they, probably, won’t continue with it!

After examination and testing is all finished, it’s time to start with whatever treatment which is best associated with the type of neuropathy the patient has. If they suffer from long nerve damage, we will, probably, treat with 7.83 Hz as a neuromuscular stimulation frequency. Treatment begins with placing electrodes in the particular part of the foot which is most affected; for example, if the ball of the foot hurts the most (has the most serious symptoms) an electrode of particular size is placed on it. An electrode is place bilaterally on the other foot; this way, the 7.83 Hz can ‘travel’ through the foot, up the leg, across the hips and lower back and down the other leg before reversing polarity and going back the other way. This both stimulates the foot itself (offering some pain relief, via, and underlined TENS signal.  PLEASE NOTE: NMES is not TENS therapy; but might have an underlined signal included as well!)

If other symptoms are present, such as edema in the foot and ankle, or ‘spotty’ numbness in the legs, another electrode may be placed in other areas of the leg or even opposite leg; again, should other issues be present, like polyneuropathy. In the case of drop foot, for example, multiple electrodes may be placed on the calf muscles as well as the ankles and foot. (Again, this is why a good Intake, Exam and Testing is so important!)

There is yet another way to treat with this frequency and sine wave; that is, to treat ‘wet.’ We will take tanks filled with warm electrolyte and water, appropriate for the size hands or feet, and place carbon/rubber electrodes in them. The DC current is then applied; which is amplified by the water. This helps to Vasodilate the tissue as well; meaning, bringing more blood/oxygen to the tissues, while electronic pulsations cause the muscles to contract and relax. At the same time, the small vascular valve in the back of the calf is forced open so that ‘pooled’ blood in the feet and lower legs can be sent back up to the heart, where is it ‘re-oxygenated,’ and sent back down to the feet again; thus, ‘feeding’ the myelin sheathing of each individual nerve. The synoptic junctions of the long nerves are, also, ‘fed,’ so to speak, by bringing more blood/oxygen to them… causing them to grow back closer together and naturally reduce symptoms.

With short nerves, we generally use a different frequency, 44 Hz, to help stimulate the Schwann cells to generate new myelin growth. This is an AC treatment, so it is never used ‘wet!’ If other symptoms are present, such as edema, muscle atrophy or again, drop foot, we may use multiple electrodes to treat each individual muscle group. Circulation is greatly improved and excess edema (fluid) is moved out.

One advantage electronic treatment has over, say massage, which too, can increase circulation, is that it also stimulates the brain to release endorphin’s; natural opiates/pain killers; which is ‘why’ people tend to feel better during or after treatment. In fact, patients often tell us during treatment, “I don’t know what you are doing to my feet… but my tennis elbow feels great!”  There is nothing in Endorphin’s which says, “Only go to the feet!” They go all over the body… so, it is only natural that ones ‘sore elbow’ or other issue would ‘feel better’ as well!

What else can be done?  Many things –  to much, in fact to go into detail in this single Blog; such as far wave (FIR) infrared light, acupuncture, acupressure, Acukoryo hand therapy, pressure point therapy, trigger point therapy, certified massage, lymphatic massage, localized vibration, whole body vibration, CES therapy, hypnotherapy, sensorimotor stimulation, nutrition, diet, vitamins, minerals and more! Each of these issues will be taken up on these pages, on a more individualized basis. Prescription drugs, however, is the one modality we don’t recommend. In fact, we attempt to work with the patient to get them off the prescription drugs… as many can actually cause the very neuropathy it is seeking to treat!

Many times, several of these modalities are combined for treatment; such as, the neuromuscular stimulation and far wave (FIR) infrared light. Both, will add comfort, while treating the muscles and nerves; however, the light helps the tissue create nitric oxide as well; which will help with oxygen and circulation.

When other issues, such as depression, PTSD, anxiety, stress, insomnia or added pain are an issue, we might add CES therapy as well; as it is FDA approved to treat such disorder. And frankly, I don’t know anyone who wouldn’t have at least some of these other disorders when having peripheral or some other neuropathy. With neuropathy of any sort, there is nothing to be happy about!

 

Next Blog: Cranial Electro Therapy Stimulation for Pain Control and Other Issues

 

 

Advertisements

Patient Compliance

What is patient compliance; and why is it so important? Patient compliance is directly responsible for our office success rate of 90%; as it is the ‘negative people,’ who don’t follow through or continue treatment, whose results do not get counted in the first place. When it comes to ‘success’ in the field of neuropathy, it is only the patients who are truly motivated to succeed who will do so. If someone is not willing to ‘help themselves,’ we tend to ask them to leave our office. Isn’t this rather harsh? Not really. Patients whom are unwilling to help themselves, cannot be helped by us either; and treating them when we know treatment isn’t going to help, is not only a waste of time and the patients money, but can only give us a bad reputation! Simply put, patient compliance is the ‘patient complying with treatment plans;’ such as keeping appointment schedules, and following directives such as taking vitamins, nutrients, changing their diets, exercise, home sensorimotor stimulation and etc. which has been prescribed for their particular type and symptoms of neuropathy.

In actuality, only 50% of those who walk in our doors complete or even start treatment; as, unfortunately, they are simply not willing to make changes in their lives which will help… such as exercise, better diet or stop smoking. Sure, it can be for a number of reasons as well… financial, time, distance and etc., but the BIG issue is compliance – they simply, do not wish to make any changes or participate in their own recovery!

I will give my patients several items or directives to use or follow at home. When they come into my office for treatment, however, we end up with a conversation something like this:

            “So, did you do your Sensorimotor Exercises this week?”

            “No.”

            “How about taking your B Vitamins and Omega 3’s?”

            “No.”

            “Did you do your Stretching Exercises?”

            “No.”

            “How about record your results?”

            “No.”

            “You know, you are not going to get any better if you don’t follow my recommendations at home!”

I generally hear back:

            “Well, you just said it… they are ‘recommendations.’ I shouldn’t have to follow them if I don’t want to. Besides, I’m                            paying YOU to fix my neuropathy…, not to do it myself!”

If the patient doesn’t at least attempt to meet the neuropathist ‘half way’ in their own treatment, then they are wasting not only their money and time, but the neuropathists time as well! Unfortunately, I can’t help anyone who is unwilling to help them self.

Think of it this way, if a doctor prescribes a medication for a condition like blood pressure, but the patient is not willing to take that medication, the blood pressure is not going to improve no matter how much both the doctor and the patient might like it to. The patient has to comply and actually INGEST the blood pressure medication before it will work! Unfortunately, I have seen way too many patients unwilling to do this! I don’t know how they expect to ‘get better,’ if they are not willing to follow the direction/recommendations of the doctor and/or the neuropathist.

So, if we have a “90%” success rate, who are the 10% treatment doesn’t work on? The highest number of people, unfortunately, are the aged. The longer one might have neuropathy, the harder it is to reverse nerve damage.  We have seen, however, patients as old as 92, whom have had peripheral neuropathy for as long as 57 years achieve substantial reductions of symptoms. Others, tend to be the truly ‘idiopathic’ patients; who we don’t have any reason for their neuropathies… and they simply don’t get better.  Others, it can be from injury or trauma to the back, for example. If the back cannot be repaired, the neuropathy cannot either.

Unfortunately, the next largest number of people, are the ones whom are ‘self medicating;’ meaning, they are drug addicts or alcoholics.  One man, for example, has been a faithful, loyal patient of mine for years; we have substantially repaired his feet – but, his hands are another matter.  Once ‘balanced,’ he can easily go one or two months between treatments. His hands, however, see very little change. One reason, is that he has arthritis in his hands which complicates the neuropathy.  Treatments actually help his arthritis substantially; but when it comes to his peripheral neuropathy, he cannot make any headway at all.  His problem?  He is an alcoholic and does ‘recreational’ drugs.  By ‘self-medicating’ with alcohol and drugs, he counteracts any efforts we make with Neuromuscular Stimulation.

Of course, we have made the recommendation to him that he ‘quit’ his drinking and drug use; but, even with all the edema, pain, numbness and burning he experiences in his hands and fingers, nor, the fact that he has had several DUI’s while driving, he is simply not motivated enough to work on his addiction. Drug and alcohol addiction is very difficult to reverse; but it is possible… but one must WANT to quit before actually doing it.

I have told this man, what I have told others like him; “I’m not your Mama, so I am not going to lecture you! But, when you are ready to quit drinking – which you know is what is, mainly, causing your neuropathy – then I am willing to help you at that time.” What can we do for drug or alcohol addiction? Generally, I like to refer to a specialized program to help with such issues. But, if nothing else, we use a CES device (Cranial Electrotherapy Stimulation). Placed on a specific area of the ear, it works like acupuncture to cut down on the ‘cravings’ by the alcoholic or drug addict.

This treatment works so well, that in our town, one judge in particular, has told some of my patients; “either purchase and use the device and seek treatment as well, or go to jail!” Most, of course, will see us for treatment and purchase a CES device as well. Again, this is considered, ‘patient compliance;’ as the patient is motivated enough to continue treatment or purchase equipment. And, “Yes,” in this case, the motivation is ‘legal’ rather than medical… but, “whatever works,” in my opinion!

More on Cranial Electrotherapy Stimulation in another post.

 

 

Next Blog, Treatment.

Berg Balance Testing

Part of every exam for neuropathy, is asking the question, “so… how are your balance issues? How is your walking gait?” Most patients will indicate that they have, at least some, balance issues. Even more, indicate that they cannot get up out of a chair without arms, at least, without some assistance. (This, is one reason, we don’t have arms on the chairs in our waiting room… they become part of the test!) But, if the patient indicates they “fall over or down a lot, stagger or have difficulty getting up and down,” we will give them what is known as a Berg Balance Test.

Developed by Katherine Berg (of whom it is named) and others, the test tests the static and dynamic balance abilities, of the patient. Scoring will indicate how ‘likely’ the patient is to end up in a wheelchair, or if they need to walk with assistance or can walk without much risk of falling. (Research shows, that if a patient – especially, an elderly one – falls and can get back up on their own within 15 minutes or less, they are more likely to be able to continue to live on their own. The longer it takes for the patient to get up, or if they need assistance, the more likely they will end up in assisted living or convalescent care).

The patient, depending upon their age, is scored on their ability to:

  1. Sitting to standing
  2. Standing unsupported
  3. Sitting unsupported
  4. Standing to sitting (without using arms on a chair or pushing up with hands on knees)
  5. Transfers
  6. Standing with eyes closed
  7. Standing with feet together
  8. Reaching forward with outstretched arm
  9. Retrieving object from floor
  10. Turning to look behind
  11. Turning 360 degrees
  12. Placing alternate foot on stool
  13. Standing with one foot in front
  14. Standing on one foot

Each task must be completed within a certain amount of time; and, is scored accordingly. These scores helps the neuropathist judge, not only what the ‘risk of falling’ is for the patient, but the extent of their neuropathy as well; in other words, the lower the score, the more likely to fall; and, most likely, the more severe the neuropathy.

Taking these scores and combining them with Toronto Clinical Scoring results, as well as examination of other parts of the body and information from Intake, all help determine the type of neuropathy the patient has; and ‘WHAT‘ issues need to be addressed first and foremost! For example, if a patient scores really well on the Berg test, we are not as concerned with treating muscle atrophy as we would someone with a low score. In the same sense, if Intake and examination indicate possible diabetic neuropathy, but the patient has stated he “trips over his own feet and falls a lot,” we might wish to look at drop foot or even send the patient to be checked for MS; if the muscles have not noticeably atrophied.

In other words, if we see a neuropathy with certain symptoms which are not common, we may refer out to neurologists to ‘look’ for other reasons besides, simple neuropathy for the symptoms.

 

Next Blog:  Patient Compliance.

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