SEVERE PNEUMONIA MAY PERMANENTLY DAMAGE HEART

Severe pneumonia may permanently damage your heart as pneumonia bacterium leaves tiny lesions in the heart, a study suggests.

The researchers found proof that Streptococcus pneumoniae, the leading cause of community-acquired pneumonia, actually physically damages the heart.

The researchers detected tiny lesions that the bacterium leaves in mouse, rhesus macaque and human autopsy tissue samples.

"If you have had severe pneumonia, this finding suggests your heart might be permanently scarred," said study senior author Carlos Orihuela, associate professor of microbiology and immunology at The University of Texas Health Science Center at San Antonio, US.

Streptococcus pneumoniae in the blood invaded the heart and formed lesions in the myocardium, the muscular middle layer of the heart wall, the researchers showed.

The team identified mechanisms by which the bacterium is able to spread across endothelial cells in cardiac blood vessels to travel to and infect the heart.

"Fortunately, we have a candidate vaccine that can protect against this," Orihuela noted.

The candidate vaccine acts to stop both the movement of the infection into the heart and the toxin that kills heart muscle cells called cardiomyocytes.

The vaccine protected immunized animals against cardiac lesion formation, the study showed.

The study appeared in the journal PLoS Pathogen

Can Exercise Repair Nerve Damage

It's very difficult to know what to make of the information in today's post from sciencedaily.com (see link below). When you read about studies being carried out on mice leading to conclusions for neuropathy patients, you can sometimes feel that you're pretty far removed from the science. What's more, turning mice-studies into practical end-product help for a patient is often hugely time-consuming. However, this one does back up what neuropathy patients are frequently told...we need to exercise. However unpalatable and painful that advice sounds for many people with nerve damage, it does seem sensible and logical, if only to avoid muscular atrophy.
This study from two American universities however, suggests that exercise can help regenerate damaged nerves in certain situations; ie nerve damage caused by physical injury and not disease or drug side-effects. In the past this has been thought to be possible if done quickly enough after the injury. The question is, does exercise have any relevance for long-term neuropathy patients, in terms of nerve regeneration? The article doesn't give enough information regarding other forms of neuropathy but if we know we have to exercise anyway to maintain muscle tone and strength, we'll keep trying. If it helps in any other way with our nerve damage then that's a bonus. This study is interesting but we need more information to know whether it's relevant for a wider neuropathy population or not.

Study Sheds Light On Role of Exercise and Androgens Such as Testosterone On Nerve Damage Repair
ScienceDaily (Oct. 15, 2012)

A study by researchers from Emory University and Indiana University found that the beneficial effects daily exercise can have on the regeneration of nerves also require androgens such as testosterone in both males and females. It is the first report of both androgen-dependence of exercise on nerve regeneration and of an androgenic effect of exercise in females.

"The findings will provide a basis for the development of future treatment strategies for patients suffering peripheral nerve injuries," said Dale Sengelaub, professor in the Department of Psychological and Brain Sciences at IU. "And they underscore the need to tailor those treatments differently for men and women."

The researchers discussed the study on Monday at the Neuroscience 2012 scientific meeting in New Orleans.

Injuries to peripheral nerves are common. Hundreds of thousands of Americans are victims of traumatic injuries each year, and non-traumatic injuries, such as carpal tunnel syndrome, are found in even higher numbers. The researchers previously showed that two weeks of moderate daily exercise substantially improves regeneration of cut nerves and leads to functional recovery in mice, though different types of exercise are required to produce the effect in males and females. They now report that these beneficial effects of exercise require androgens such as testosterone in both males and females.

In the study they conducted, they exercised three groups of male and female mice. Nerves of the three groups were cut and surgically repaired. Once group received the drug flutamide, which blocks the androgen receptor. A second group received a placebo treatment. The third group was unexercised. Regenerating nerve fibers in the placebo group grew to more than twice the length of those in unexercised mice in both males and females. In flutamide-treated mice, the effects of exercise were blocked completely in both sexes.

The study, "Enhancement of peripheral axon regeneration by exercise requires androgen receptor signaling in both male and female mice," will be discussed from 11 a.m. to noon on Monday in Hall F-J. Co-authors are Arthur W. English and Nancy Thompson, both from Emory University.

http://www.sciencedaily.com/releases/2012/10/121015122205.htm

New Research Into Healing Nerve Damage

Today's article from neurologywestla.com (see link below) is another interesting piece of research that is years away from being applicable to patients but is nevertheless evidence of the new impetus in nerve damage research that can only be good for the future. It talks about the discovery of a protein (Retinoblastoma) which is present in nerve cells. This protein normally acts as a 'stopper' to nerve growth. It's thought that by inactivating this protein in some way, damaged nerves will be able to regenerate and grow again. That of course is a very simplistic summary and the research is still at an early stage where it's being carried out on animals. However, most people will get the idea and be able to follow the logic. Now we have to wait ten years until it's proved to be a successful process in humans.

Peripheral Neuropathy And Injuries Causing Nerve Damage May Be Healed With New Technique
New Technique for Peripheral Neuropathy
By Susan Scutti | Apr 22, 2014
Posted by npatel on May 1, 2014 

Canadian scientists discovered a crucial molecule, a protein called Retinoblastoma (Rb), that directly regulates nerve cell growth and may be helpful someday in healing peripheral neuropathy.

Many people with diabetes experience neuropathy, a painful form of nerve damage that cannot always be treated effectively with drugs. In their research of the condition, scientists at University of Calgary’s Hotchkiss Brain Institute discovered a mechanism that promotes growth in damaged nerve cells. In fact, the team of researchers discovered a crucial molecule that directly regulates nerve cell growth. “We made the surprising discovery that a protein called Retinoblastoma (Rb) is present in adult neurons,” said Dr. Doug Zochodne, a professor in the Department of Clinical Neurosciences, and author of the study. “This protein appears to normally act as a brake — preventing nerve growth. What we have shown is that by inactivating Rb, we can release the brake and coax nerves to grow much faster.”

Neuropathy, which creates a tingling or burning sensation, is a direct result of nerve damage. Peripheral nerves, which connect the brain and spinal cord to the body, help us feel sensation and also enable movement. Peripheral neuropathy, which causes numbness and pain in your hands and feet, may be the result of any number of factors, including injuries, infections, and even exposure to toxins. Cancer patients, for instance, experience peripheral neuropathy during or following toxic chemotherapy. About 60 to 70 percent of people with diabetes also encounter this condition, with the risk rising with age and duration of their illness. All too common, diabetic neuropathy is more prevalent than multiple sclerosis, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS) combined. Although for some people, the symptoms of peripheral neuropathy may improve over time, this is not the case for all and for this reason, researchers would like to understand how exactly it works.

Based on his understanding of cancer, Zochodne and his research team decided to look for Retinoblastoma in nerve cells. “We know that cancer is characterized by excessive cell growth and we also know that Rb is often functioning abnormally in cancer,” explained Zochodne in a press release. “If cancer is able to release this brake and increase cell growth, we thought we’d try to mimic this same action in nerve cells and encourage growth where we want it,” he said.

In their experiments using cells and animals, the researchers shut down Retinoblastoma in the peripheral nervous system for a short span of time and carefully observed the results. As hypothesized, they saw new growth without any apparent negative effects. Now, they are wanting to advance their experiments to the point of working with humans and in so doing, they hope their work may lead to safe treatments for patients suffering from neuropathy and other forms of nerve damage.

Source: Christie KJ, Krishnan A, Zochodne D, et al. Enhancing adult nerve regeneration through the knockdown of retinoblastoma protein. Nature Communications. 2014.

http://neurologywestla.com/peripheral-neuropathy-and-injuries-causing-nerve-damage-may-be-healed-with-new-technique/

Nerve Damage Whats Going On

Very short and simple but very useful for people new to neuropathy, todays post from interohealthcare.com (see link below) sums up nerve damage and which nerves are involved in a nutshell. Thanks to the complex nature of neuropathy, it's so easy to forget the basic details of what's happening to your body. This short article is a useful refresher for everybody living with neuropathy.

Neuropathy and Nerve Damage 
Info from WebMD: Never Damage
 
Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.
There are three types of nerves, or neurons, in the body: 

Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.

Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.

Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Nerve pain and nerve damage can be mild. But, because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.
What Are the Symptoms of Nerve Pain and Nerve Damage?

With nerve damage there can be a wide array of symptoms. Which ones you may have depends on the location and type of nerves that are affected. Damage can occur to nerves in your brain and spinal cord. It can also occur in the peripheral nerves, which are located throughout the rest of your body.

Autonomic nerve damage may produce the following symptoms:
 
inability to sense chest pain, such as angina or heart attack
too much sweating (known as hyperhidrosis) or too little sweating (known as anhidrosis)
lightheadedness
dry eyes and mouth
constipation
bladder dysfunction
sexual dysfunction

Damage to motor nerves may produce the following symptoms: 
 
weakness
muscle atrophy
twitching, also known as fasciculation
paralysis

Sensory nerve damage may produce the following symptoms:
 
pain
sensitivity
numbness
tingling or prickling
burning
problems with positional awareness

In some instances, people with nerve damage will have symptoms that indicate damage to two, or even three, different types of nerves. For instance, you might experience weakness and burning of your legs at the same time.
 
 http://www.interohealthcare.com/conditions-helped-2/nerve-damage/

Common Signs That You May Have Nerve Damage

Today's post from prevention.com (see link below) is a good one to start the new year for people experiencing strange, new symptoms that they can't explain. It's a good reference to use before going to your doctor because if you're suffering from these physical symptoms, then at least you'll have a pretty good idea that they're nerve related and possibly evidence of nerve damage...or neuropathy. What's most useful about this list of symptoms is that it doesn't just concentrate on the most commonly known pain, tingling or numbness in the feet but also looks at a wide range of symptoms which indicate 'autonomic' neuropathy. Autonomic neuropathy is where nerve damage has affected some or all of the involuntary functions of the body we take for granted (such as breathing, digestion, sexual performance, and many others and can be a source of great confusion for both patients and doctors alike, who assume those symptoms indicate other conditions. With over 100 sorts of neuropathy and over 100 causes, it remains one of the most frustrating and life-changing ailments, so this list is a place from which to begin your questions and research, even before going to see the doctor. No reason to panic but a little knowledge goes a long way when faced with a new medical problem!

8 Signs You Might Have Nerve Damage
By Crystal Harlan November 7, 2016
 


Sebastian Kaulitzki/Shutterstock

There are tens of thousands of nerves in your body. Most of them, your peripheral nerves, are like branches of a tree that spread out all over and transmit messages back to the "trunk"—your brain and spinal cord. When everything goes smoothly, your brain gets the info it needs so that you can move your muscles, recognize pain, and keep your internal organs working properly. But when peripheral nerves get damaged, it's another story: Walking could become challenging, you might experience unrelenting pain, or you could end up with a serious injury because you had no idea how hot that stove was.

An estimated 20 million Americans suffer from peripheral nerve damage, aka neuropathy, according to the National Institute of Neurological Disorders and Stroke. "Diabetes is the No. 1 cause. Bad luck [meaning you inherited an anatomical defect] is number two. Repetitive motion and Lyme disease follow," says Andrew Elkwood, MD, a surgeon who specializes in nerve reconstruction at The Institute for Advanced Reconstruction in New York and New Jersey.

Other causes include aging, vitamin deficiencies, exposure to toxins (including alcohol and cancer medications), and infections and autoimmune disorders like hepatitis C, diphtheria, HIV, Epstein-Barr, rheumatoid arthritis, and Guillain-Barré Syndrome. Meanwhile, about 30% of neuropathy cases are "idiopathic," meaning there's no known cause.

The good news is that nerve damage generally develops slowly, says Isha Gupta, MD, a neurologist at IGEA Brain and Spine in New York and New Jersey. That means you might be able to treat it before it worsens—but getting the right diagnosis isn't always easy. Your best shot? See a doctor right away if you have any of the following symptoms. (Make 2017 YOUR year by taking charge of your health and jump-starting your weight loss with the Prevention calendar and health planner!)


You have numbness, tingling, or burning.

1/8 memorisz/Shutterstock

You have numbness, tingling, or burning.


This sensation may radiate from your hands or feet into your arms or legs. "Compression of sensory nerves (often while sleeping) is relatively common, and symptoms such as numbness or tingling can be temporary," says Gupta. But if the pins-and-needles feeling doesn't go away, get it checked out.

It's difficult or impossible to move part of your body.

2/8 Mycteria/Shutterstock

It's difficult or impossible to move part of your body.


"If motor nerves are affected, then weakness or even paralysis may occur," says R. Glenn Smith, MD, PhD, a neurologist at Houston Methodist. These same symptoms could also indicate that there's an underlying issue that needs urgent attention, so it's best to head to the ER. If it turns out that you're actually having a stroke, you'll need medical attention ASAP.

You have pain running down just one leg.

3/8 Sebastian Kaulitzki/Shutterstock

You have pain running down just one leg.


A constant sharp pain, burning, or tingling that starts in the lower back and travels down the back of your leg could mean that you have sciatica—meaning that your sciatic nerve has become compressed, perhaps thanks to a slipped or worn down disc in your spine.

 You're way clumsier than usual.

4/8 jiw ingka/Shutterstock

You're way clumsier than usual.


Suddenly stumbling and falling a lot? "If large nerves affecting sensation are damaged, then lack of coordination and failure to sense position of the body can lead to falls," says Smith. It might also turn out that you have a condition like Parkinson's, in which the nerve cells in your brain have become damaged.

You're running to the bathroom all the time.

5/8 Momoforsale/Shutterstock

You're running to the bathroom all the time.


Damaged nerves can send your bladder faulty messages, so you feel like you have to pee a lot or have trouble making it to the restroom in time. You have a higher than average risk of this problem if you gave birth to a child vaginally or have diabetes.

You get brief, intense headaches that feel like electric shocks.

6/8 andrei simonenko/Shutterstock

You get brief, intense headaches that feel like electric shocks.


You may have something called occipital neuralgia, a condition that can occur when a nerve in your neck gets pinched. You may need a nerve block—an injection that temporarily blocks the troublesome nerve from transmitting pain signals.

You're sweating too much or too little.

7/8 werayuth tes/Shutterstock

You're sweating too much or too little.


It might be a sign that the nerves carrying info from your brain to your sweat glands have become compromised. Your doctor might order tests to measure your sweating and heart rate.


You got injured because you didn't feel something you should have.

8/8 Corbac40/Shutterstock

You got injured because you didn't feel something you should have.

Sensory nerves are supposed to tell your brain that a surface is dangerous in some way, and if they're not doing their job properly you could seem more accident-prone. If you have burns, cuts, or other trauma because you didn't realize that you were touching something hot, sharp, or otherwise uncomfortable, see your doc, says Smith.

http://www.prevention.com/health/8-signs-you-might-have-nerve-damage/slide/8

Check Your Antibiotics For Nerve Damage Side Effects!

Today's post from healthycanadians.gc.ca (see link below) returns to the subject of the commonly prescribed antibiotics called fluoroquinolones (among others:ciprofloxacin (CIPRO, CILOXAN) enoxacin (PENETREX)  levofloxacin (LEVAQUIN) moxifloxacin (AVELOX) norfloxacin (NOROXIN, CHIBROXIN) ofloxacin(FLOXIN, OCUFLOX) and their dangers, especially to patients prone to, or living with nerve damage. This article backs up FDA warnings in the States and others across the world stating that these drugs are dangerous. It couldn't be clearer in that and yet doctors across the world, (pushed by pharmaceutical reps) continue to issue these drugs like M&Ms, with scant regard for their potential for serious side effects (including nerve damage). If your doctor suggests one of these antibiotics as a cure for an infection, please discuss it with him or her first and try to arrange one of the various safer alternatives. There are other articles here on the blog on the same subject. Using the Search box, type in 'fluoroquinolones' and check out the evidence for yourself.

FLUOROQUINOLONES - Risk of Disabling and Persistent Serious Adverse Reactions
January 23, 2017 Posting date:

Dear Healthcare Professional Letter Subcategory: Drugs Source of recall:
Health Canada Issue: Important Safety Information 
 Audience:Healthcare Professionals, General Public Identification number: RA-61900
Issue
Who is affected
Report health or safety concerns
Related AWRs
 
Audience

Healthcare professionals

Key messages
 
Rare cases of disabling and persistent serious adverse reactions including tendinopathy, peripheral neuropathy, and central nervous system disorders have been reported to Health Canada for fluoroquinolones when used systemically (i.e. taken by mouth or by injection). 

Healthcare professionals are reminded to:
Consider the potential for disabling and persistent serious adverse events when choosing to prescribe a fluoroquinolone.
Avoid fluoroquinolones in patients who have previously experienced serious adverse reactions associated with them.
Stop fluoroquinolone treatment if a patient reports any serious adverse reaction. Patients should be switched to an alternative treatment with a non-fluoroquinolone antibacterial drug, if needed, to complete the treatment course.
Health Canada is currently working with manufacturers to strengthen the prescribing information for these drugs.

Issue

Canadian and international cases of disabling and persistent serious adverse reactions including tendinopathy, peripheral neuropathy, and central nervous system disorders have been reported in patients treated with oral and injectable fluoroquinolones.

Products affected

FLUOROQUINOLONES (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin), oral and injectable dosage forms.

Background information

Fluoroquinolones are a class of antibacterial drugs used in the treatment of various gram-negative and gram-positive bacterial infections, including respiratory and urinary tract infections.

Health Canada conducted an assessment to examine the safety of systemic fluoroquinolones. This was prompted by the findings of the United States Food and Drug Administration benefit/risk assessment on systemic fluoroquinolones and the occurrence of disabling and persistent adverse reactions.

Health Canada’s safety review focused on already known and labelled adverse reactions associated with the use of fluoroquinolones that resulted in persistent disability. Health Canada has received reports of a small number of these cases over time.

The reported adverse reactions in Canada associated with persistent disability mostly involved the musculoskeletal system (e.g., tendonitis and Achilles tendon rupture), peripheral neuropathy and central nervous system disorders (e.g., depression, anxiety, dizziness and confusion).

Health Canada’s assessment concluded that fluoroquinolones are associated with rare cases of disabling and persistent serious adverse reactions such as tendinopathy, peripheral neuropathy, and central nervous system disorders.

Health Canada consulted the Scientific Advisory Panel on Anti-Infective Therapies (SAP-AIT) on the use of fluoroquinolones for treating certain infections, considering their potential association with disabling and persistent events. The SAP-AIT recommended labelling updates to all systemic fluoroquinolones to include information on the severity and persistence of these adverse reactions.

Who is affected
Information for consumers

Fluoroquinolones are a class of prescription antibacterial drugs that are used to treat several types of bacterial infections.

Fluoroquinolones are generally well tolerated but they have been associated with rare serious side effects that were disabling and persistent, including tendon damage, nerve damage in the hands and feet, and central nervous system disorders. These side effects can occur hours to weeks after exposure to fluoroquinolone treatment.

Patients should inform their healthcare professional if they think they have previously experienced a side effect related to fluoroquinolone use. Patients should immediately consult a healthcare professional if they experience serious side effects, such as joint and muscle pain, swelling or rupture of a tendon, tingling, numbness, weakness, or other alterations of sensation, tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, suicidal thoughts.
Information for healthcare professionals

It is recommended that the potential for disabling and persistent serious adverse events be considered when choosing to prescribe a fluoroquinolone.

Fluoroquinolones should not be prescribed to patients who have experienced serious adverse reactions during or after prior treatments.

Healthcare professionals are advised to stop systemic fluoroquinolone treatment if a patient reports a serious adverse reaction. The patient’s treatment should be switched to an alternative treatment with a non-fluoroquinolone antibacterial drug if needed to complete the treatment course.

Healthcare professionals should be aware that some adverse reactions associated with the use of fluoroquinolones can occur within hours to weeks after exposure to the treatment.
Action taken by Health Canada

Health Canada is working with the manufacturers to update the fluoroquinolone Canadian Product Monographs. Health Canada continues to monitor the situation and will take further action as deemed necessary.

Health Canada is communicating this important safety information update to healthcare professionals and Canadians via the Recalls and Safety Alerts Database on the Healthy Canadians Web Site. This communication update will be further distributed through the MedEffect™ e-Notice email notification system.
Report health or safety concerns

Managing marketed health product-related side effects depends on health care professionals and consumers reporting them. Any case of serious or unexpected side effects in patients receiving fluoroquinolones should be reported to Health Canada.

You can report any suspected adverse reactions associated with the use of health products to Health Canada by:
Calling toll-free at 1-866-234-2345; or
Visiting MedEffect Canada's Web page on Adverse Reaction Reporting for information on how to report online, by mail or by fax.

For other health product inquiries related to this communication, contact Health Canada at:

Marketed Health Product Directorate

E-mail: mhpd_dpsc@hc-sc.gc.ca

Telephone: 613-954-6522

Fax: 613-952-7738
Related AWRs

Information Update - Fluoroquinolone antibiotics may, in rare cases, cause persistent disabling side effects


2017-01-23 | Health products

http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/61900a-eng.php

Nerve Damage As A Result Of Cancer Treatment

Today's post from cancernetwork.com (see link below) discusses the neurological consequences of cancer treatment, especially neuropathy, which seems to be occurring more and more frequently according to which chemotherapy drugs are administered. Unfortunately, whatever other medical complications we may have, we're all at risk of cancer of one form or another, therefore neuropathy is showing up more and more as a co-morbidity problem in that area. That said, once it is established that you have nerve damage, the treatment progression is pretty much the same whatever the cause of the nerve problems. This is why neuropathy patients are such a diverse group - there are over 100 causes and over 100 forms but in the end we all face the same treatment regimes, which won't cure the nerve damage but may keep the symptoms under control.
 

Managing Treatment-Related Neurotoxicity
By Michelle Bragazzi, BS, RN May 01, 2015 | ONS 2015
 
Understanding treatment-induced neurotoxicity can be difficult when treating patients with central nervous system (CNS) malignancies. This was a topic of discussion at the Oncology Nursing Society (ONS) 40th Annual Congress, held April 23-26, in Orlando, Florida.

Using a case-based approach, clinical nurse specialist’s Mary Elizabeth Davis, RN, MSN, AOCNS, and Wayne Quashie, MSN, RN, ACNS-BC, AOCNS, both from the Memorial Sloan Kettering Cancer Center in New York, explained how nurses can effectively manage the signs and symptoms of CNS toxicity and disease.

Surgery, radiation, and/or chemotherapy may cause acute or delayed CNS issues such as necrosis, encephalopathy, intracranial hemorrhage, and myelopathy. Neuropathy—a common symptom associated with chemotherapy—would be considered a peripheral nervous system (PNS) disorder. While all require intervention, treatment options may vary, depending on the extent of the toxicity.

How do you distinguish between toxicity and disease symptomology?

It can be tricky to distinguish tumor recurrence from neurotoxicity. Metabolic imaging and perfusion scans may help decipher between the two. Pathological analysis would be the best way to confirm this, but obtaining another biopsy in a patient with brain cancer can be risky.

Radiation necrosis of the cerebral hemispheres and spinal cord is related to the administration of radiation treatment—especially with higher doses. Patients generally present with cognitive dysfunction, personality changes, increased intracranial pressure (which may result in brain herniation), paresis, and other neurological deficits. While radiation necrosis can be difficult to manage, there are treatment options available:

• Corticosteroid therapy (standard of care)

• Surgery

• Hyperbaric oxygen therapy

• Bevacizumab

It’s important to keep in mind that while steroid use in patients with CNS tumors is the standard, patients can develop what’s commonly referred to as, “steroid psychosis.” Patients receiving high doses of steroids, those with a psychiatric history, blood-brain barrier damage, and cytochrome P450 inhibition are at risk.

Another toxicity to consider is chemotherapy- and radiation-induced neuropathy. Many patients experience peripheral neuropathy from drugs such as bortezomib, vinca alkaloids, taxanes, and platinum-based therapies. Patients typically complain of a numbness and tingling sensation in the extremities, specifically in the fingers, toes, and feet. Autonomic neuropathy can also occur and causes symptoms such as constipation, erectile dysfunction, bladder retention, and orthostatic hypotension.

Radiation patients may experience neuropathic side effects as well. For patients receiving radiation, specifically to the sacral plexus (colorectal cancer, gynecological cancers) or to the brachial plexus (upper airway cancers), are at risk for developing radiating neuropathic pain.

Currently, there are no established agents available to prevent neuropathic toxicity, but there are pharmacological and non-pharmacological treatment options available:

• Duloxetine

• Anticonvulsant drugs (gabapentin, pregabalin)

• Tricyclic antidepressant drugs (nortriptyline, amitriptyline)

• Compounded topical gel containing baclofen, amitriptyline, HCL, and ketamine)

• Refer patients to occupational medicine

• Cognitive and behavioral modifications such as guided imagery for pain control

• Educate patients on safety measures in the home such as water temperature, clutter, and wearing shoes

Lastly, another neurotoxic adverse event that’s referred to as, “chemo brain/chemo fog,” is a form of cognitive dysfunction that healthcare practitioners generally relate to cancer treatment. These patients have difficulty resuming their precancer lifestyle, and it can significantly impact their quality of life. Fatigue, the inability to concentrate and learn new skills, and memory loss are the typical symptoms. Pre-existing conditions and direct neurotoxic effects are associated with chemo brain.

Research studies suggest that cancer patients with undiagnosed, pretreatment cognitive impairment via imaging studies (white and gray matter abnormalities) are at a higher risk of developing chemo brain—especially those receiving high-dose chemotherapy. Pre-existing conditions (existing comorbidities, cognitive dysfunction) are some of the indirect factors contributing to chemo brain. The direct effects from treatment, such as chemical toxicity, inflammatory factors, vascular injury, blood clots, and defects in neural repair, are other possible etiologies.

Nurses need to be diligent about screening cancer patients for chemo brain. Imaging studies and neuropsychological testing should be performed at all patient visits. There are treatment options to also consider for these patients:

• Investigate confounding factors (medications, nutrition, sleep disorders)

• Consider neuropsychiatric evaluation

• Consult occupational therapy

• Administer psychostimulant drugs if necessary (last line of therapy if other interventions have failed)

• Encourage physical activity, but rest periods as well

• Urge patients to limit alcohol or other substances that may alter cognition

• Encourage patients to use memory aids (planners, to-do lists, etc)

Oncology nurses are in a great position to help identify signs and symptoms of neurotoxicity early on. Immediate intervention will maximize the patient’s quality of life, and possibly reduce the need for excessive drug administration.

http://www.cancernetwork.com/ons-2015/managing-treatment-related-neurotoxicity

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FDA Advice For Doctors About Nerve Damage From Antibiotics

Today's post from topclassactions.com (see link below) is the latest article warning of the dangers of nerve damage from fluoroquinolone antibiotics. This time the warning comes from the FDA themselves. Last year they instructed the pharmaceutical companies to put warning labels on the boxes of these drugs and now they are advising doctors who prescribe these antibiotics, to be especially alert to symptoms of nerve damage in their patients (at which point of course, it could be too late). There's no doubt that this has been the hot topic in neuropathy circles for some time now but with good reason. If your doctor prescribes antibiotics for you, ask him or her if they belong to the fluoroquinolone group and if they do, don't leave the surgery until you have had a serious discussion as to whether they're going to harm you or not. There are alternatives but successful marketing campaigns have made these drugs the most popular antibiotics around. However, if you're prone to neuropathic problems or have them already you really need to question their value for you.

FDA Advises Doctors to Monitor Antibiotic Users for Nerve Damage 
By Amanda Antell January 13, 2015

Due to the mass concern of fluoroquinolone side effects, the FDA recently announced that it wants healthcare professionals to watch for the risk of peripheral neuropathy in patients prescribed these antibiotics.

As of Aug. 15, 2013, fluoroquinolones had become a major concern for the FDA for a number of reasons, but this particular warning surrounded the devastating side effect peripheral neuropathy, which can cause nerve damage, burning pain, paralysis and more.

The agency advises prescribing physicians to closely monitor patients who are prescribed any members of the fluoroquinolone family, which include the antibiotics levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive).

In its announcement, the FDA reiterated its requirement for manufacturing companies to have their medications’ labels include peripheral neuropathy on their list of side effects, and emphasized the danger with a recent toll of injuries. If not diagnosed in time, this condition can cause severe to permanent damage.

According the FDA’s Center for Drug Evaluation and Research Trade press team, the agency made the decision to update the warning for fluoroquinolone peripheral neuropathy due to the number of injury reports the agency had received. While the agency decided against withdrawing fluoroquinolones from the market, the FDA did revise its systemic benefit and risk evaluations regarding these antibiotics.

A recent review of the FDA’s Adverse Event Reporting System (AERS) Database had identified 83 cases of fluoroquinolone peripheral neuropathy between Jan. 01, 2003 and Aug. 01, 2012; this was the report discussed in the Aug. 15, 2013 FDA warning. Each of these patients had become disabled due to some degree of antibiotic nerve damage, which furthered the FDA’s concern of this possible correlation.

Antibiotic Nerve Damage a Concern for Years

The concern of peripheral neuropathy being associated with fluoroquinolones started in 2004, when the FDA required all fluoroquinolones to carry this risk on their list of side effects.

While the complication of antibiotic nerve damage is a frightening thought, it’s the fact that the injury reports indicate that the condition could start within a few days of starting the medication, and continue for years after stopping it, that has many so concerned. Even in 2015, the FDA and other medical institutes have not managed to identify what exactly causes peripheral neuropathy from antibiotics, but it appears not to be related to age or duration of medication use.

Additionally, during their August 2013 warning, FDA MedWatch stated that physicians should give patients a medication guide for every fluoroquinolone prescription, and patients should be instructed to contact their physicians if they show signs of peripheral neuropathy. While suddenly ceasing medication is not advisable without a physician’s consultation, the FDA generally recommends that the medication should be switched with a non-fluoroquinolone antibiotic, unless the risks of the new antibiotic outweigh the benefits.

Medical experts state that a majority of peripheral neuropathy reports indicate that it is not linked with diabetes, thyroid conditions, vitamin deficiencies, or environmental factors. It is important to note that the risk of peripheral neuropathy is still a relatively recent concern, but remains prevalent because there are no known prevention methods.

Overview of Quinolone Peripheral Neuropathy

Fluoroquinolones are among the most popularly prescribed antibiotics in the United States, and are used to treat a variety of bacterial infections. In 2011, over 23 million patients were prescribed a member from this antibiotic family to treat their conditions. As mentioned before, peripheral neuropathy has been listed as a side effect for fluoroquinolones since 2004, with patients reporting long-lasting or permanent disability, allegedly in direct consequence of using this medication.

Peripheral neuropathy is a condition where the nerves that send signals from the brain and spinal cord become damaged, which disrupts communication with the rest of the body. Symptoms of peripheral neuropathy will vary depending on which nerves are affected. Generally speaking, the symptoms are in the arms and legs and include numbness, tingling, burning, or shooting pain.

It is important to note that peripheral neuropathy symptoms start quickly, and spread just as fast, so it is vital that patients see their physicians immediately.

 http://topclassactions.com/lawsuit-settlements/lawsuit-news/47255-fluoroquinolone-peripheral-neuropathy/

Making Personal Choices About Nerve Damage Treatment

Today's post from livinginalimitedworld.com (see link below) is the personal story of someone living with PRMS (Progressive-relapsing Multiple Sclerosis) but it is also the story of someone making their own choices when it comes to symptoms, severity of symptoms, doctors and the medications they prescribe. There are wise lessons for all of us living with neuropathy here and although the article doesn't talk about neuropathy as such (MS is also a serious neurological illness), it suggests a way of approaching the way our disease is treated and how much we need to take some of the control for ourselves. Well worth a read.

Body science
Posted on May 15, 2016 

I seem to have the twitches today. Not the normal ones that I live with, this is more like a shudder that is travelling through my entire body, but only, in the parts of me that are actually moving. If any part of me is motionless, then I don’t feel a thing. Should I move my hand and say my foot at the same time, the shudder is there identically in both. It’s not only bizarre but it is also mildly upsetting. I know that I have felt it before, exactly when or what caused it then or now, I don’t have the slightest idea. It’s one of those things like so many others, appears, disturbers me for a while and vanishes. Admittedly, it doesn’t cause me any pain, it doesn’t do me any harm, but the same can be said for much of what happens in my body and possibly yours. Yet all of us go on daily, living with these things that no one really cares about because they aren’t going to kill us. Tell your doctor, and they might give you some kind of medicine that might possibly help, but they probably aren’t any more sure about it than we are, plus, they don’t have to live with their side effects.

I learned a long time ago that I had to gauge for myself, just how important it is for me to be rid of this or that symptom. To begin with, I was more than happy to take whatever drug they threw at me. I have and still do have amazing trust in my doctors, but I learned not to have the same trust in their medications. The problem I now know has a huge amount to do with my condition. I didn’t know it then, but I do now, that PRMS is notorious for not responding to any of the range of MS medications. When I was first diagnosed, according to the internet, PRMS didn’t exist. I even questioned my consultant as to why no one had heard of it. Apparently, it was rare, that rare, that the world wasn’t interested and that included the pharmaceutical industry. There are no drugs that are out there, not even the ones designed for MS patients that will ever help me with any of it other than the pain. Both of us, were in a world of discovery as my body was only going to respond if it suited it, not because it worked for others. In the first five years, I was changing drug after drug searching for the ones that would work the best. Then I called a halt to it. I worked out a hit and miss list, I ditched all the meds that didn’t work for me, regardless what my doctors said, and I kept the ones that I could live with. That was my first rule, “It had to work for me”.

That decision was closely followed by the one that said, “Can I live with this symptom, or do I need help”. It is so easy to run to our doctors every time that something happens that is different. Just because it is something that the average person would find terrifying, doesn’t mean it is something to be terrified by. My test mark is to say, “Is this symptom impairing my life”. This tremor or probably more accurately, this quiver, doesn’t stop me doing anything. It slows me down, but it doesn’t actually stop me doing things, therefore, I don’t need a doctor, and I don’t need medication for it. In fact, the only time I really turn to my doctor is when I am in pain. If it hadn’t been for the pain my intercostal muscles and diaphragm were causing me, I wouldn’t have been diagnosed with COPD when I was. Not being able to breathe was something I had grown used to, not being able to breathe and being in pain, was something I didn’t like at all.

The medications that I do take, I don’t know if they work for anyone else, or have even been tested on animals, but they have been tested on me. My small selection that I am on now, may not be the standard for MS, but they work for me and that is what matters. People ask me all the time if I have been on this drug or that one. Partly, because of my bad memory, I’m not always able to say, but I always question, why they are asking me, and are not testing them on themselves. Yes, I have a rare condition that is known not to respond as others do, but I honestly believe whatever our condition, the only way to find out if it’s going to help us, isn’t to read about it, or talk to others about it, it is quite simply to try it, and to remember, you can come off it again as easily as you started it. Our doctors can only advise us and suggest what they think will help. Unless they happen to share your condition, they won’t have tried it personally, and don’t even assume they have prescribed it to anyone else either, remember, all forms of MS are reasonable rare. After many years of practice, when my GP read my diagnosis, he told me I was the first person ever on his books to have the condition. Most of the time, our doctors are offering us a drug they know nothing about, other than what they have read. If it doesn’t work for you, well they always seem to have another one to offer, if you truly believe you really need it.

All of us have different body chemistries and every drug will work slightly differently for almost all of us. Hence those stupid lists of “possible side effects”, so many people miss that word “possible” and assume they will get them all. To date, I have only been aware of a handful of drugs that have ever caused me any issues, and they were really not worth mentioning.

https://livinginalimitedworld.com/2016/05/15/body-science/