The Growing Problem Of Neuropathy And Cancer Vid

Today's post from livestrong.org (see link below) is directed at people living with neuropathy as a result of cancer treatment. Normally this blog prefers to address all neuropathy sufferers, irrespective of the cause but in this case, cancer has become such a pervasive problem in this day and age, that it can affect anybody with other health problems as well. There has to be space to address cancer-related neuropathy. Much of the information in this article also applies to other neuropathy patients but there is no doubt that cancer-related nerve damage is a growing problem as the cases of cancer rise (better diagnosis and risky  lifestyle habits). Such a shame that the current treatments of cancer can have such devastating side-effects - as if cancer alone wasn't a big enough problem - but we have to live with the cards we are dealt and until chemotherapy is refined to exclude nerve damage, then there is a real possibility that it will cause nerve damage too.
 

Neuropathy
2016 Livestrong


Neuropathy causes tingling or numbness, especially in the hands and feet. It affects about one to two percent of Americans and is caused by damage to a single or multiple nerves. There are different types, but peripheral neuropathy is the most common in those with cancer. 


Peripheral neuropathy may develop at any phase of the cancer journey, even some time after treatment is finished. Knowing what some of the causes are and being able to describe your symptoms to your health care team can help you manage neuropathy. Symptoms are often ignored by both patients and health care professionals. If you have symptoms of neuropathy, it is important to discuss this with your health care team as soon as possible.

Symptoms of Neuropathy

Peripheral neuropathy can affect the nerves that tell you the position of your hands or feet that let you sense hot or cold or that senses pain. You can experience a tingling or numbness in certain areas of the body, commonly the hands and feet. These sensations can range from mild to painful and are almost always greatest at night. 

Common signs and symptoms include:

Numbness or tingling, especially of the hands or feet.
Pain or cramping, especially of the hands, feet or calf muscles.
Sensitivity to touch or temperature.
Loss of reflexes.
Muscle wasting in the hands and feet.
Weakness, especially in the feet or hands.
Clumsiness.
Loss of balance, particularly in the dark.
Dizziness, especially when getting up from a bed or a chair.
Sexual dysfunction.

It’s not easy to deal with neuropathy. If you notice symptoms, talk to your health care team immediately.

Factors that Increase Risk of Neuropathy

Neuropathy may occur from cancer or the treatment received. Cancer types with higher risk of neuropathy include: lung, breast, ovarian, myeloma, lymphoma and Hodgkin's disease and testicular. 

Life factors that may increase the chances of developing neuropathy:

Advanced age.
A family history of neuropathy (such as with familial diabetes).
Malnourishment.
Excessive use of alcohol.
Having a preexisting medical condition such as diabetes or thyroid dysfunction.
Some medications (including chemotherapy medications) also increase risk.
Medications that may increase the risk of neuropathy:
Platinum compounds.
Taxanes.
Vinca alkaloids.
Thalidomide.
Velcade.
Cytosine arabinoside.
Misonidazole.
Interferon.

Discuss all of these risks with your health care team. 

Treatments for Neuropathy

The peripheral nerves have a great ability to heal. Even though it may take months, recovery can occur. However, in some situations, symptoms of neuropathy may lessen but not completely go away. For example, nerve injury caused by radiation often does not recover well. Neuropathy caused by chemotherapy is also difficult to cure, and recovery may take 18 months to five years or longer. During recovery of platinum-induced neuropathy, patients may suffer increased symptoms.

Treatments for peripheral neuropathy depend on the cause. For instance: 
 
If it is related to nutritional deficiencies, supplements may help.
If the neuropathy is related to a medical condition, such as diabetes or thyroid dysfunction, treating the condition can sometimes reverse the neuropathic symptoms.
For neuropathy related to chemotherapy, most treatments are supportive and designed to improve symptoms and function.
If problems develop during treatment and you continue to receive chemotherapy, the neuropathy can get worse.
Clinical trials research shows promise in some treatments with medications that help peripheral nerves to heal and prevent the neuropathy associated with chemotherapy from occurring or being as severe.
Recovery may be helped by:
Good nutrition including foods rich in thiamine, protein and antioxidants.
Controlling and correcting contributing conditions such as diabetes or hypothyroidism.
Appropriate pain medications.
Physical and occupational therapy.

How Neuropathy Affects Your Life

Pain from neuropathy can greatly affect your daily activities and quality of life. Symptoms of neuropathy can range from mild to severe. Each survivor's experience will be different. However, with appropriate treatment, the effects of neuropathy can be limited. 

If you have neuropathy, you may have:
Difficulty standing for long periods or walking without assistance.
Problems with balance and an increased risk of falling.
Difficulty with activities like buttoning and tying laces or ties.
Sensitivity to heat or cold.
Numbness or lack of pain sensation.
Pain.

Survivors with temperature sensitivity should avoid extreme temperatures, and use protective clothing as needed. If there is numbness or an inability to feel pain, it is important to pay careful attention to the skin on the hands and feet because there could be an undetected wound or a break in the skin.

If there is pain, day-to-day activities such as putting on shoes or using covers over the feet at night can be difficult. Keep in mind that there are treatments that can lessen the pain. Talk with your health care team about potential treatments as soon as possible.

If neuropathy affects your ability to feel the foot pedals of a car, you should not drive unless your car is adapted for hand controls. Slowed reaction time in moving your foot from the accelerator to the brake pedal may cause an accident. If you lose the ability to drive, you may feel you are losing your independence. However, consider the increased risk to your safety and to the safety of others.

Ask your health care team to provide suggestions and special equipment to make daily tasks safe and easier to manage. The suggestions may include night lights, grab bars and other home safety measures to help reduce the risk of falling. Physical and occupational therapists can assist survivors with physical exercises that can help them maintain physical abilities.

For some, neuropathy can lead to physical and mental stress. Watch for signs of depression, and seek immediate help from your health care team. Together, you can deal with peripheral neuropathy.

https://www.livestrong.org/we-can-help/finishing-treatment/neuropathy

Colon Cancer Drug may cause Neuropathy

It's of course pretty well known that chemotherapy can leave patients with neuropathy as a side effect but how does this have anything to do with HIV- patients, besides the normal percentage who unfortunately contract a form of cancer?
One of the fastest growing cancers, especially for HIV positive men, is colon or rectal cancer and this associated with the alarming rise in HPV infections means that significant numbers of HIV patients are needing cancer treatment.
One of the best known drugs aimed specifically at colon cancer is Oxaliplatin and its success rates make it more and more popular but there's a sting in the tail and that is permanent and debilitating neuropathy. Once more HIV patients are being faced with unexpected extra problems, something we're long used to but the reality is that neuropathy is the price that sometimes has to be paid for extending your life. This article from sciencedaily.com (see link below) explains the pros and cons of using Oxaliplatin. Once again, a serious discussion with the oncologist, neurologist and hiv-specialist is necessary - don't be palmed off without the facts - in that way you avoid nasty surprises!

Popular Colorectal Cancer Drug May Cause Permanent Nerve Damage, Study Suggests
ScienceDaily (Sep. 28, 2011)

Oxaliplatin, a platinum-based anticancer drug that's made enormous headway in recent years against colorectal cancer, appears to cause nerve damage that may be permanent and worsens even months after treatment ends. The chemotherapy side effect, described by Johns Hopkins researchers in the September issue of Neurology, was discovered in what is believed to be the first effort to track oxaliplatin-based nerve damage through relatively cheap and easy punch skin biopsies.

The Johns Hopkins investigators emphasize that the drug therapy clearly improves length of survival in advanced cancer by months to years, and that the goal of their new study is to find ways of preventing or slowing the damage through nerve-protective therapies identfied through simple skin testing.

Many patients who take oxaliplatin report bothersome neurological side effects, including pain in the hands and feet and a numbness or tingling in the throat that affects swallowing, according to study leader Michael Polydefkis, M.D., M.H.S., associate professor of neurology at the Johns Hopkins University School of Medicine and director of the EMG Laboratory and Cutaneous Nerve Laboratory at Johns Hopkins Bayview Medical Center. Though these symptoms develop over time in the majority of patients, some report neuropathies as early as when the drug is first infused.

To get a better sense of how oxaliplatin affects nerve cells, Polydefkis and his colleagues recruited eight cancer patients about to begin oxaliplatin treatment at The Johns Hopkins Hospital. All had been diagnosed with advanced colon cancer.

Before their first oxaliplatin infusion, each patient underwent a comprehensive neurological examination, including nerve conduction testing, a clinical exam to look for signs of nerve damage, and a punch biopsy that removed tiny (3-mm diameter) portions of skin near their knees and ankles. Once oxaliplatin treatment began, consisting of infusions over two days once every two weeks for 12 cycles, the researchers performed the same tests after 30, 90 and 180 days. Another 180 days after they finished with treatment, the patients received one final exam.

Test results showed that each of the patients' nerve function and neuropathy symptoms worsened over time and that results from the punch skin biopsies neatly mirrored the side effect arc. Using a microscope, the researchers saw that nerve cells' long extensions, called axons, degenerated over the course of oxaliplatin therapy. This progression persisted after treatment stopped. Even 180 days after their last doses, seven out of the eight patients' axons continued to wither.

"This drug has rapidly become the standard of care for people with advanced colon cancer, but we really knew little about how oxaliplatin affects nerves over time," he says. "With people living longer lives on oxaliplatin, it's important to know more about these neurological side effects so patients and their physicians can make educated choices on how this drug is used, and perhaps suggest ways to limit the damage."

The new study strongly suggests that punch skin biopsies could be an easy and inexpensive way to follow nerve cell degeneration, a crucial prerequisite for testing the effectiveness of drugs currently in development to trace, prevent or slow nerve damage.

"Skin biopsies can be done pretty easily, uniformly and cheaply anywhere, including hospitals, doctors' offices and clinics, and those places can have the tissue sent to Hopkins for analysis," Polydefkis says. "High-quality neurological testing isn't nearly as easy or economical to do, so it's possible that the biopsies could play a pivotal role in bringing neuroprotective drugs to fruition."

Other Johns Hopkins researchers who participated in this study include Ahmet Z. Burakgazi, M.D., Wells Messersmith, M.D., Dhananjay Vaidya, M.D., Ph.D., Peter Hauer, B.S., and Ahmet Hoke, M.D., Ph.D.

http://www.sciencedaily.com/releases/2011/09/110928105911.htm

Neuropathy And Cancer Treatment Vid

Today's YouTube video (see link below) is a very useful podcast discussion of neuropathy as a result of cancer treatment and chemotherapy. After diabetes, cancer treatment is one of the main causes of neuropathy and as more and more cancer cases are successfully treated with chemotherapy, more and more patients are faced with neuropathic symptoms as an unexpected side effect. An interesting discussion, well worth a listen.


 Neuropathy and other nerve problems during cancer treatment
MD Anderson Cancer Center Published on 26 Jan 2015


Download from iTunes: https://itunes.apple.com/us/podcast/n... During cancer treatment, adverse nerve and muscular side effects are common. Unfortunately, there is no treatment that will prevent these conditions, but there are therapies to help relieve these side effects. Ivo Tremont, M.D., and Karin Woodman, M.D., both assistant professors in Neuro-Oncology at MD Anderson Cancer Center, discuss some of the common neurologic and muscular disorders that patients may experience during cancer treatment, and what can be done to help.

 
https://www.youtube.com/watch?v=_BPUOyxWM4w