DO YOU REALLY NEED THAT MRI

Too many tests at the doctor's office could cost you more than just dollars. In addition to the huge hit to your wallet, there's also the potential harm of false positives, and just because a test has traditionally been done for a condition doesn't mean it's the best way to treat it

U-M neurologist Brian Callaghan, M.D., M.S., is helping lead a national push to determine what neurologic tests or services are performed more than they should be.

It comes out of a campaign called Choosing Wisely, an initiative of the ABIM Foundation, which works with more than 70 medical specialty societies to encourage conversations between clinicians and patients about avoiding wasteful or unnecessary medical tests, treatments and procedures. Each society, including the American Academy of Neurology (AAN), got together to identify an initial list of five medical services that may be unnecessary. Many societies have returned with second, or even third, lists of five.

Callaghan's neurology group started by looking into the AAN's list, and then went further to identify a whopping 74 items to look into from other recommendations that addressed neurological care, such as from the American Academy of Sleep Medicine and the American Academy of Neurological Surgeons. Many were duplicates, which might indicate a consensus of areas to focus on.

"The two biggest areas that might be done more than they should are imaging for low back pain and imaging for headaches," Callaghan said. "It's a big problem and it costs a lot of money -- we're talking a billion dollars a year on just headache imaging."

The other test/treatment appearing most often was opioids, or pain medications.

The diseases/symptoms that appear most often are

·         Low back pain

·         Dementia/delirium

·         Headache

·         Concussion

·         Stroke

Callaghan and his colleagues aren't encouraging you to say no if your doctor wants to image your low back pain or headache, but instead, they hope to inspire more thought and discussion about the specific purpose of a test.

"Ordering an MRI for a headache is very quick, and it actually takes longer to describe to the patient why that's not the best route," Callaghan said. "These guidelines are meant for physicians and patients both, to trigger a conversation."

The next step is to get the doctor-patient discussions going, so Callaghan's group is now researching how to make it easier for physicians to follow the guidelines.

"These are all areas where lots of physicians agree that you're more likely to get harmed by doing the procedures," Callaghan said.

The team also came up with areas that need more recommendations, including movement disorders, neuromuscular disease, epilepsy and multiple sclerosis.

How Do You Cope With Neuropathy

Today's post from cancerconnect.com (see link below) will go over old ground for some people but provide very useful information for others. It talks about neuropathy from a cancer patient's point of view but whatever the cause of your neuropathy, you may recognize much of what is described. The description is well written and goes on to discuss why neuropathy happens and what some of the common treatments are. Personal accounts are always useful because they can reassure you that you're not alone in dealing with this disease and show you how others are coping.

Coping with Peripheral Neuropathy

By Eleanor Mayfield

It began with numbness and tingling in her feet. The numbness made it difficult for her to maintain her balance, especially in the dark. Gradually, the discomfort worsened. Sometimes she had sharp, burning pains in her feet. “Sometimes it would feel like I was walking on rocks.”

What Jacqueline Cohen, PhD, is describing are some of the classic symptoms of peripheral neuropathy (PN). Dr. Cohen, a 64-year-old professor at Carnegie Mellon University in Pittsburgh and a four-year survivor of chronic myeloid leukemia, has developed PN as a side effect of Gleevec® (imatinib mesylate), the drug she takes daily to keep her cancer in check.

Dr. Cohen is one of thousands of cancer patients and survivors across the country who are coping with PN, a side effect associated with many chemotherapy drugs.

What is peripheral neuropathy?

Neuropathy means “disease of the nerves.” The brain and the spinal cord make up the central nervous system. The peripheral nerves are those that branch out from the spinal cord into the trunk and the extremities (arms and legs).

“The peripheral nervous system is like the body’s electrical wiring,” says Tina Tockarshewsky, executive director of the Neuropathy Association, a New York–based national voluntary organization serving patients with neuropathy resulting from cancer treatment or other causes. “When the peripheral nerves are damaged, the electrical system goes haywire. Sometimes there are sparks, and sometimes the lights go out.”

Pain and numbness, particularly in the hands and feet, are hallmark symptoms of PN. The condition can also cause a wide variety of other symptoms, depending on which nerves are damaged.

These symptoms may begin during or after cancer treatment. They tend to worsen over time, and they may persist for a year or more after treatment is completed. For many patients, damaged nerves do eventually heal and symptoms clear up. For others, however, the nerve damage—and the symptoms—may be permanent.

How is peripheral neuropathy treated?

No medications have been approved by the U.S. Food and Drug Administration to treat PN related to cancer treatment. Doctors may prescribe anti seizure medications or antidepressants to treat painful neuropathy in cancer patients, says Frank S. Lieberman, MD, an associate professor of neurology and medical oncology at the University of Pittsburgh Cancer Institute. Dr. Lieberman recently prescribed Lyrica®(pregabalin), an anti seizure drug, to Jacqueline Cohen, who says the medication has helped relieve the pain in her feet.

Other treatments that patients with painful neuropathy may find helpful, says Dr. Lieberman, include anesthetic skin patches, opioid pain relievers, acupuncture, and transcutaneous nerve stimulation (a procedure in which low-voltage electric current is passed through electrodes adhered to the skin).

Arthur D. Forman, MD, an associate professor of neuro-oncology at the University of Texas M. D. Anderson Cancer Center in Houston, says he recommends to his patients supplements of alpha-lipoic acid (ALA), an antioxidant. In people with PN symptoms caused by diabetes, some studies have shown that ALA may provide relief. A study is currently under way to test its effectiveness in patients with PN caused by cancer treatment. Other supplements whose effectiveness is being studied are vitamins B6 and B12 and acetyl L carnitine.

Dr. Forman advises against using supplements called “growth factors” that may be marketed as promoting nerve healing. “Nerves need time to heal,” he says. “Trying to make them heal quickly may do more harm than good.”

Patients should know, Dr. Forman adds, that even as damaged nerves begin to heal, PN symptoms may continue to worsen for a while because the new nerve cells are “irritable.”

Can peripheral neuropathy be avoided?

Doctors can adjust the way chemotherapy is delivered to minimize or reduce the risk of PN, says Dr. Lieberman. For example, smaller, more frequent doses of chemotherapy may result in less PN than larger, less frequent doses. Taking a time out from chemotherapy—that is, stopping treatment for a while and then restarting it—may also help reduce PN.

What can patients do to cope with the symptoms of peripheral neuropathy?

Understanding what causes PN symptoms can reduce feelings of fear and panic and help patients feel more in control, says Dr. Forman. In addition, some simple lifestyle changes can help patients deal with its effects on daily life.
Use a night-light to reduce the risk of stumbling in the dark.
Install grab bars in the shower or sit on a stool while showering.
Sleep with the head elevated 30 degrees to reduce dizziness on rising.
Use specially designed utensils to make it easier to eat with numb fingers.

Tips from a Patient

Audrey Youngelson hasn’t let either metastatic breast cancer or peripheral neuropathy slow her down. “I have cancer,” Audrey says, “but cancer doesn’t have me.” The 72-year-old travel agent from New City, New York, recently returned from a trip to Egypt, where she toured the pyramids on a motorized folding scooter.

“It doesn’t matter where I am—I have neuropathy,” she says. “So why not enjoy life as much as I can?”

Audrey developed PN symptoms after being treated for breast cancer with surgery and radiation therapy in 1985. Whether her treatment caused the neuropathy has never been clear—officially, it is considered idiopathic, or of unknown cause.

She offers this advice to other cancer patients affected by PN:
Talk to your healthcare providers about your neuropathy symptoms. Be assertive in asking to be referred to a neurologist who is an expert in PN.
Keep trying treatments until you find one that works for you.
Make use of adaptations and assistive devices to help you function. Unable to operate a car’s foot pedals because of painful neuropathy in her feet, Audrey drives a car equipped with hand controls.
Don’t hesitate to ask others for help when you need it.
Join a support group where you can share your experiences and learn from others coping with the same condition.

Symptoms of Peripheral Neuropathy

Depending on which nerves are damaged, symptoms of peripheral neuropathy may include the following:

Blurred vision
Constipation
Cramping, pain, or weakness of muscles
Decreased sensitivity to heat or cold
Difficulty with fine motor tasks (such as buttoning, picking up small objects, and turning pages)
Difficulty passing urine
Dizziness, loss of balance, stumbling, or tripping when walking
Hearing loss or ringing in the ears (tinnitus)
Increased sensitivity to pain
Loss of feeling (numbness) in the extremities (fingers, toes, hands, feet, arms, and legs)
Loss of sensitivity to heat and cold
Muscle cramping, pain, or weakness
Painful, electric shock–like sensations in the spine
Tingling or burning sensations in the extremities (“pins and needles”)

Medications That May Be Prescribed to Treat Painful Neuropathy

Antidepressants Aventyl,® Pamelor® (nortriptyline)

Cymbalta® (duloxetine)

Effexor® (venlafaxine)

Elavil® (amitriptyline)

Antiseizure medications Lyrica® (pregabalin)

Neurontin® (gabapentin)

Tegretol® (carbamazepine)
Local anesthetics Lidoderm® (lidocaine patch)
Opioid analgesics Kadian® (morphine extended release)

OxyContin® (oxycodone extended release)

Percocet® (oxycodone/acetaminophen)

Ultram® (tramadol)

A Resource for Patients
Neuropathy Association

The Neuropathy Association is a nonprofit organization providing patient education and support, volunteer-led support groups, and advocacy for patients with neuropathy.

www.neuropathy.org

http://news.cancerconnect.com/coping-with-peripheral-neuropathy/

When Do You Start Feeling Pregnancy Symptoms

Three Sisters Poem

Three Sisters Poem

Thevar Peravai Thiruvadanai

Two Anti Depressants For Nerve Pain How Did They Do

Today's short post from alert.psychnews.org (see link below) reports that a new study has shown both Duloxetine (Cymbalta and others) and Venlafaxine ( ‎Effexor, Trevilor, Lanvexin, others) to be reasonably effective treatments for nerve pain. Well reasonable in the sense that they performed better than other pills...when compared to placebos. These two serotonin-norepinephrine reuptake inhibitors (anti-depressants) are already widely prescribed for neuropathic pain but as we know, what works for one patient, doesn't necessarily work for others, which leads to patient frustration and difficulties for researchers and studies to come to definitive conclusions. The article also states that pregabalin is FDA approved for neuropathic pain - it's not! The FDA goes as far as to demand that warnings about the side effects be placed on boxes. It's a minefield for patients wondering whether what their doctor has prescribed is a)going to work and b) going to be safe. It is safe to say that almost all drugs prescribed to limit neuropathic pain can have side effects and therefore it's vitally important that you have a serious discussion with your doctor before embarking on a course of drugs. Together you need to weigh up the benefits and risks and even then there's no guarantee that your symptoms will diminish. However, maybe that shouldn't stop you trying - anything is better than that relentless pain...right! But your doctor should monitor your progress on any given drug, with great care and if necessary change the treatment.
 

Duloxetine, Venlafaxine May Be Most Effective at Reducing Diabetic Nerve Pain
Posted by Psychiatric News Monday, March 27, 2017

The serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine appear to have the best evidence for being effective at reducing nerve pain in people with diabetes, according to a meta-analysis published in Neurology. Duloxetine is FDA-approved for treating pain in diabetic neuropathy, though venlafaxine is not.

The researchers pooled together data from 106 clinical studies published between 2011 and 2015 examining the effectiveness of pharmacologic approaches to improving pain in patients with diabetic peripheral neuropathy. The analysis compared outcomes in patients taking 21 different medications, though the authors were unable to draw conclusions for any head-to-head drug comparisons due to insufficient evidence.

The researchers found moderate evidence to suggest that duloxetine and venlafaxine were more effective at reducing neuropathy-related pain than placebo. Tricyclic antidepressants, botulinum toxin, the opioids tramadol and tapentadol, and the anticonvulsants pregabalin and oxcarbazepine were also found to be more effective than placebo, but the evidence base for these medications was weak.

In contrast, the anticonvulsant gabapentin, mood stabilizer valproate, and capsaicin cream were all found to be no more effective than placebo; these findings run contrary to guidelines for treating diabetic peripheral neuropathy published by the American Academy of Neurology in 2011, which listed all three agents as probably effective.

“Our findings generally support the effectiveness of the three drugs approved by the Food and Drug Administration (FDA) for the treatment of pain in diabetic peripheral neuropathy: duloxetine, pregabalin, and tapentadol,” wrote Julie Waldfogel, Pharm.D., of the Johns Hopkins Hospital and her colleagues. “Additional studies evaluating longer term outcomes are needed to better inform clinical decision-making, patient choice, and clinical practice guidelines.”

http://alert.psychnews.org/2017/03/duloxetine-venlafaxine-may-be-most.html

Do You Feel Believed When Youre In Pain

Today's post from the ever reliable pain-topics.org (see link below) looks critically at how other people's (and thus patients') pain is judged. Neuropathy sufferers will be well aware of how this can work and how you can feel disbelieved by both doctors and those around you. There is no sensation like neuropathy pain, tingling or numbness and unless the other person understands that, it can be difficult convincing them that your suffering is genuine. Doctors are just as guilty of making judgements based on body language, especially if the patient tries just a little too hard to convince them that what they're feeling is real. People with neuropathy need to find ways of describing their symptoms in a way that is relevant to the listener (the 'walking with a sock full of wet sand' is a good one for the numbness; or 'like walking on bare bones' for neuropathic aching; or 'like being connected to the mains' for the tingling. The actual pain you feel is more difficult but if you feel you are being doubted by a doctor, ask him or her directly then at least you'll know if you still have work to do. Most doctors will hear the story and symptoms of a neuropathy patient and immediately know what's going on - the symptoms are pretty unique - but friends, family and colleagues may take a bit more persuading. Don't give up; you have the right to be taken seriously.

Pain Doubted if Medical Basis is Missing
Posted bySB. Leavitt, MA, PhD Tuesday, December 11, 2012

Many chronic pain sufferers often feel that their maladies are misunderstood, disbelieved, or unaccepted by others. New research confirms that if there is no clear and convincing biomedical cause identified to satisfactorily explain the pain other people tend to discount it and have little sympathy toward the patient.

Researchers at Ghent University in Belgium conducted a pair of studies to investigate the impact of medical and psychosocial information on estimations of another person’s pain, along with observers’ emotional responses and their behavioral tendencies toward the person with pain [De Ruddere et al. 2012]. Study participants were recruited from the community: Study 1: N = 29 women, 10 men; Study 2: N = 29 women, 12 men.

Participants variously viewed photographs of 4 alleged patients (2 men, 2 women; ages 44 to 57 years) described as having shoulder pain conditions. With each photograph there was a written brief vignette describing 2 of 4 different circumstances: either the presence or absence of a medical explanation for the pain, along with either the presence or absence of psychosocial influences attributed to the pain experience.
For example, pain was medically explained as associated with either “a little fracture,” “an inflammation,” or a “muscle strain”; in the no-cause condition the vignette simply stated that “based upon medical examination there appeared to be no injury to the shoulder.”

Psychosocial influences were described in Study 1 vignettes from the patients’ perspectives: eg, “[Fictitious patient name] reports having more pain when experiencing job stress” or “…more stress at home.” In Study 2, these influences were more authoritatively attributed to medical opinion: eg, “…the doctor decided that psychosocial factors have an impact upon the pain, in particular job stress and feelings of anxiety” or “…in particular relationship problems and a depressive mood.”

If psychosocial influences did not exist, in Study 1 they simply were not mentioned. In Study 2, however, there was a more explicit declaration that “…the doctor decided that psychosocial factors do not have an impact upon the pain.” Thus Study 1 and 2 were similar, except for a much stronger attribution of psychosocial factors, or lack thereof, in the second study.

After examining each vignette/photo, study participants were shown a brief video segment (8 seconds) displaying the respective patient having his/her shoulder examined and expressing facial signs of moderate pain. Then, on 4 different 100mm visual analog scales (VAS), participants rated each patient’s pain, their own distress upon viewing the patient in pain as well as their sympathy toward the patient, and their inclination to help the patient.

Writing in the December 2012 edition of the Journal of Pain, the researchers report that, in both Studies 1 and 2, results indicated significantly lower ratings on all measures when medical evidence for pain was absent. That is, when a medical explanation for a patient’s pain was missing, participants rated the pain as lower and their own distress at viewing the patient as lower, as well as less sympathy toward the patient and less willingness to help.

Surprisingly, there was no overall effect found on any of the 4 outcome measures due to claimed psychosocial influences on patients’ pain. The one small exception was in Study 2, in which participants indicated feeling less personal distress when psychosocial factors were explicitly indicated (ie, noted by examining physicians as having an impact).

The researchers conclude that the findings suggest pain is taken less seriously when there is no medical evidence to help explain it, and psychosocial influences on the patient — eg, stress at work or home, anxiety, relationship issues — are not considered as important contributors to pain. This line of investigation is important, the researchers note, for better understanding how patients’ pain for which there is no clear medical explanation is interpreted and judged by other persons.

COMMENTARY: Research in the social psychology field is often most interesting when it confirms — more or less scientifically — what most people already think they intuitively know. This present study confirms what many patients already have expressed in prior comments to various UPDATES articles; that is, when chronic pain is unexplained by a diagnosis of some severe biopathology patients often face significant obstacles to being taken seriously by their families, friends, and healthcare providers.

In the study by De Ruddere et al. it was somewhat puzzling that psychosocial factors appeared to have so little influence on participants’ perceptions. It seemed that medical evidence for the pain superseded all other information when judging the genuineness of pain and consequent feelings of sympathy or helpfulness toward the patient.

As often is the case in the pain management field, more research is needed before leaping to any firm conclusions. For one thing, patients in the video segments displayed what had been determined as representing moderate pain; expressions of more severe pain might have had much greater impact on assessments — evoking higher ratings of pain (whether or not medically explained) and greater empathy by study participants.

Another important limitation was that participants had no personal relationships or direct interactions with the fictitious patients; completely unlike what would be the case in clinical settings or among family/friends. Essentially, the researchers attempted to create a laboratory setting for assessing human variables that are far more complex in everyday life or clinical practice.

Participant-group sizes — Group 1, N= 39; Group 2, N=41 — were probably adequate to provide reasonable statistical power for detecting significant differences, avoiding Type II (false negative) findings. [Readers should note that numbers of participants indicated in the study abstract and the article text itself are grossly discordant; we are using numbers from the text.]

However, composition of the participant groups must be considered: overall, the two groups were unequally balanced toward women, average participant age was significantly lower than the test patients (roughly 28 vs 51 years), and approximately half of participants were college students. So, generalizing the findings at this time to how older persons, healthcare providers, or family/friends might react could be erroneous.

Therefore, there are still unanswered questions about how the qualities of patients and those interacting with them, as well as available information about patient medical condition and/or psychosocial influences, affect judgments when it comes to pain assessment, sympathy, and helping behavior. The researchers, themselves, acknowledge most of these limitations; yet, this study is an important step toward a better understanding of several factors that might significantly bias perceptions of patients’ pain and impact the care that they receive in medical settings and at home.

REFERENCE: De Ruddere L, Goubert L, Vervoort T, et al. We Discount the Pain of Others When Pain Has No Medical Explanation. J Pain. 2012(Dec);13(12):1198-1205

http://updates.pain-topics.org/2012/12/pain-doubted-if-medical-basis-is-missing.html

Autonomic Neuropathy And Exercise Take Care What You Do

Today's post from neuropathydr.com (see link below) is a cautionary tale for those neuropathy patients who have been diagnosed as having autonomic neuropathy. A reminder for all those who are unaware what that is: it is a form of nerve damage that affects all the involuntary functions of the body that you normally don't have to think about and as such, is a dangerous but unfortunately relatively common form of neuropathy. This article warns such patients to be more aware when they decide to take on exercise as a part of their treatment - it may not be the best option in your case and needs to be carefully thought about before starting. Now this blog is (reluctantly) all for exercise for neuropathy patients but it's no easy option at the best of times! People with autonomic neuropathy need also to be aware of their limitations thanks to that form of neuropathy and should seek advice from their doctor or therapist. A useful article.
 

Exercising Caution With Autonomic Neuropathy
Posted by john on February 9, 2017

If you’ve been diagnosed with autonomic neuropathy, you know you’re at risk for some serious medical issues. Autonomic neuropathy (i.e., nerve damage to the autonomic nervous system) can affect every system in the body, especially:

• Cardiovascular – your heart, blood pressure and circulation

• Respiratory

• Gastrointestinal – your digestion, ability to ability to empty your bowels

• Genitourinary – erectile dysfunction and loss of bladder control

• While you’re dealing with some or all of these issues, exercise may not be on your radar.

But it should be.

Exercise can help control the symptoms of your underlying illness (whatever caused your autonomic neuropathy) and by doing that, you can help lessen the symptoms of your autonomic neuropathy.

But a word of caution is in order here.

The very nature of your autonomic neuropathy can affect the systems that are most sensitive to the effects of exercise. Any exercise program you begin should be designed and monitored by a medical professional well versed in the effects of autonomic neuropathy, like your NeuropathyDR® clinician.

Use Vs. Disuse

When you’re thinking about starting an exercise program and you’re thinking about how dangerous it can be, you also need to consider the effects of not starting an exercise program. The effects of not exercising are called “disuse syndrome”. We’ll discuss more about “disuse syndrome” in our next post.

What You Need To Think About Before You Start Exercising

Think about what happens to your body when you exercise. Your heart rate increases, your breathing becomes labored, you sweat.

Every single one of those results is controlled by the autonomic nervous system. Autonomic neuropathy can seriously impact how your body responds to the stimulus of exercise. And your body may not react as it should.

• Heart rate – If your autonomic neuropathy affects your cardiovascular system, you need to make sure that your exercise program is designed and monitored by your NeuropathyDR® clinician. Your autonomic neuropathy can lead to abnormal heart rate, inability to properly regulate blood pressure and redistribution of blood flow. Your cardiovascular autonomic neuropathy may cause you to have a higher resting rate and lower maximal heart rates during exercise.

• Blood pressure – Blood pressure response with posture change and during exercise is abnormal in patients with cardiovascular autonomic neuropathy. Postural hypotension, defined as a drop in blood pressure may be seen. This can mean that the blood pressure doesn’t react normally during exercise. Symptoms are similar to hypoglycemia and may be mistaken for a drop in blood glucose even though it’s actually a drop in blood pressure. Patients should be alerted to the potential confusion in these symptoms and instructed to check blood glucose before treating for hypoglycemia.

• Sweating and Disruption of Blood Flow – Autonomic neuropathy may reduce or even eliminate your ability to sweat. The loss of sweating, especially in your feet, can cause dry, brittle skin on the feet and you can develop skin ulcers. It can also make it more difficult for your body to respond to cold and heat. You need to make sure that you’re taking proper care of your feet before and during any exercise program. Make sure your shoes fit properly and examine your feet regularly to make sure you don’t have any sores, cracks or ulcers.

Autonomic neuropathy can have a serious effect on the very systems in the body that are directly affected by exercise. Make sure you talk to your local NeuropathyDR® clinician before you start an exercise program and let them monitor your progress.

For more information on coping with neuropathy, get your Free E-Book and subscription to our newsletters at http://neuropathydr.com.

http://neuropathydr.com/autonomic-neuropathy-4/

Why Do Our Hands And Or Feet Tingle

Today's post from webmd.com (see link below) is a thorough answer to the question why our hands and feet tingle. Many people ask this question long before having heard the word neuropathy and for many people, the symptoms are temporary but equally, for millions across the world, the symptoms never go away and become progressively worse. They then have a form of neuropathy or nerve damage. This article will set you on the right path as regards opening information; after that, you need to discuss your problem with your doctor and do as much further research of your own until you have built up sufficient knowledge to be best able to live with the disease.

Tingling in Hands and Feet
WebMD Medical Reference View Article Sources
Reviewed by Varnada Karriem-Norwood, MD on September 26, 2014

Tingling hands, feet, or both is an extremely common and bothersome symptom. Such tingling can sometimes be benign and temporary. For example, it could result from pressure on nerves when your arm is crooked under your head as you fall asleep. Or it could be from pressure on nerves when you cross your legs too long. In either case, the "pins and needles" effect -- which is usually painless -- is soon relieved by removing the pressure that caused it.

In many cases, however, tingling in the hands, feet, or both can be severe, episodic, or chronic. It also can accompany other symptoms. such as pain, itching, numbness, and muscle wasting. In such cases, tingling may be a sign of nerve damage, which can result from causes as varied as traumatic injuries or repetitive stress injuries, bacterial or viral infections, toxic exposures, and systemic diseases such as diabetes.

Such nerve damage is known as peripheral neuropathy because it affects nerves distant from the brain and spinal cord, often in the hands and feet. There are more than 100 different types of peripheral neuropathy. Over time, peripheral neuropathy can worsen, resulting in decreased mobility and even disability. More than 20 million Americans, most of them older adults, are estimated to have peripheral neuropathy.

It's important to seek prompt medical evaluation for any persistent tingling in your hands, feet, or both. The earlier the underlying cause of your tingling is identified and brought under control, the less likely you are to suffer potentially lifelong consequences.

Causes of Tingling in the Hands and Feet

Diabetes is one of the most common causes of peripheral neuropathy, accounting for about 30% of cases. In diabetic neuropathy, tingling and other symptoms often first develop in both feet and go up the legs, followed by tingling and other symptoms that affect both hands and go up the arms. About two-thirds of people with diabetes have mild to severe forms of nerve damage. In many cases, these symptoms are the first signs of diabetes.

In another 30% of peripheral neuropathy cases, the cause is unknown or "idiopathic."

The remaining 40% of cases have a variety of causes such as:

Nerve entrapment syndromes. These include carpal tunnel syndrome, ulnar nerve palsy, peroneal nerve palsy, and radial nerve palsy.

Systemic diseases. These include kidney disorders, liver disease, vascular damage and blood diseases, amyloidosis, connective tissue disorders and chronic inflammation, hormonal imbalances (including hypothyroidism), and cancers and benign tumors that impinge on nerves.

Vitamin deficiencies. Vitamins E, B1, B6, B12, and niacin are essential for healthy nerve function. A B12 deficiency, for example, can lead to pernicious anemia, an important cause of peripheral neuropathy. But too much B6 also can cause tingling in the hands and feet.

Alcoholism. Alcoholics are more likely to have a thiamine or other important vitamin deficiencies because of poor dietary habits, a common cause of peripheral neuropathy. It's also possible that alcoholism itself can cause nerve damage, a condition that some researchers call alcoholic neuropathy.

Toxins. These include heavy metals such as lead, arsenic, mercury, and thallium, and some industrial and environmental chemicals. They also include certain medications -- especially chemotherapy drugs used for lung cancer -- but also some antiviral and antibiotic drugs.

Infections. These include Lyme disease, shingles (varicella-zoster), cytomegalovirus, Epstein-Barr, herpes simplex, and HIV/AIDS.

Autoimmune diseases. These include Guillain-Barre syndrome, lupus, and rheumatoid arthritis.

Inherited disorders. These include a group of disorders collectively known as Charcot-Marie-Tooth disease.

Injury. Often related to trauma, nerves can be compressed, crushed, or damaged, resulting in nerve pain. Examples include nerve compression caused by a herniated disc or dislocated bone.

Diagnosis of Tingling Hands and Feet

If you seek care for your tingling hands or feet, your health care provider will do a physical exam and take an extensive medical history addressing your symptoms, work environment, social habits (including alcohol use), toxic exposure, risk of HIV or other infectious diseases, and family history of neurological disease.

He or she also may perform additional tests such as:
Blood tests. These can include tests to detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity.
An examination of cerebrospinal fluid. This can identify antibodies associated with peripheral neuropathy.
An electromyogram (EMG), a test of the electrical activity of muscle
Nerve conduction velocity (NCV)

Other tests may include:
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Nerve biopsy
Skin biopsy to look at nerve fiber endings

Treatments for Tingling Hands and Feet

Successful treatment depends on an accurate diagnosis and treatment of the underlying cause of the tingling. As long as the peripheral nerve cells have not been killed, they have the ability to regenerate.

Although no treatments are available for inherited types of peripheral neuropathy, many of the acquired types can be improved with treatment. For example, good blood sugar control in diabetes can slow the progression of diabetic neuropathy; vitamin supplementation can correct peripheral neuropathy in people with vitamin deficiencies.

General lifestyle recommendations include maintaining an optimal weight, avoiding exposure to toxins, following a doctor-supervised exercise program, eating a balanced diet, and avoiding or limiting alcohol consumption. Recommendations also include quitting smoking, which constricts blood supply to blood vessels supplying nutrients to peripheral nerves.

In some cases, tingling and other symptoms of peripheral neuropathy may be reduced with prescriptions originally developed for treating seizures and depression.

http://www.webmd.com/brain/tingling-in-hands-and-feet

How Much Do You Believe Someones Pain

Today's post from pain-topics.org (see link below) is a close examination of how we react to other people saying they are in pain. It's very easy to jump to the wrong conclusions based on our own assumptions and as we can never 'feel' someone else's pain directly, it's very easy to discount it or minimise it. the article is based on  Belgian studies and makes interesting reading for those who themselves have chronic pain issues and those around them who often react intuitively.

Pain Doubted if Medical Basis is Missing

Posted bySB. Leavitt, MA, PhD: Tuesday, December 11, 2012

Many chronic pain sufferers often feel that their maladies are misunderstood, disbelieved, or unaccepted by others. New research confirms that if there is no clear and convincing biomedical cause identified to satisfactorily explain the pain other people tend to discount it and have little sympathy toward the patient.

Researchers at Ghent University in Belgium conducted a pair of studies to investigate the impact of medical and psychosocial information on estimations of another person’s pain, along with observers’ emotional responses and their behavioral tendencies toward the person with pain [Ruddere et al. 2012]. Study participants were recruited from the community: Study 1: N = 29 women, 10 men; Study 2: N = 29 women, 12 men.

Participants variously viewed photographs of 4 alleged patients (2 men, 2 women; ages 44 to 57 years) described as having shoulder pain conditions. With each photograph there was a written brief vignette describing 2 of 4 different circumstances: either the presence or absence of a medical explanation for the pain, along with either the presence or absence of psychosocial influences attributed to the pain experience.

For example, pain was medically explained as associated with either “a little fracture,” “an inflammation,” or a “muscle strain”; in the no-cause condition the vignette simply stated that “based upon medical examination there appeared to be no injury to the shoulder.”
Psychosocial influences were described in Study 1 vignettes from the patients’ perspectives: eg, “[Fictitious patient name] reports having more pain when experiencing job stress” or “…more stress at home.” In Study 2, these influences were more authoritatively attributed to medical opinion: eg, “…the doctor decided that psychosocial factors have an impact upon the pain, in particular job stress and feelings of anxiety” or “…in particular relationship problems and a depressive mood.”

If psychosocial influences did not exist, in Study 1 they simply were not mentioned. In Study 2, however, there was a more explicit declaration that “…the doctor decided that psychosocial factors do not have an impact upon the pain.” Thus Study 1 and 2 were similar, except for a much stronger attribution of psychosocial factors, or lack thereof, in the second study.

After examining each vignette/photo, study participants were shown a brief video segment (8 seconds) displaying the respective patient having his/her shoulder examined and expressing facial signs of moderate pain. Then, on 4 different 100mm visual analog scales (VAS), participants rated each patient’s pain, their own distress upon viewing the patient in pain as well as their sympathy toward the patient, and their inclination to help the patient.

Writing in the December 2012 edition of the Journal of Pain, the researchers report that, in both Studies 1 and 2, results indicated significantly lower ratings on all measures when medical evidence for pain was absent. That is, when a medical explanation for a patient’s pain was missing, participants rated the pain as lower and their own distress at viewing the patient as lower, as well as less sympathy toward the patient and less willingness to help.

Surprisingly, there was no overall effect found on any of the 4 outcome measures due to claimed psychosocial influences on patients’ pain. The one small exception was in Study 2, in which participants indicated feeling less personal distress when psychosocial factors were explicitly indicated (ie, noted by examining physicians as having an impact).

The researchers conclude that the findings suggest pain is taken less seriously when there is no medical evidence to help explain it, and psychosocial influences on the patient — eg, stress at work or home, anxiety, relationship issues — are not considered as important contributors to pain. This line of investigation is important, the researchers note, for better understanding how patients’ pain for which there is no clear medical explanation is interpreted and judged by other persons.

COMMENTARY: Research in the social psychology field is often most interesting when it confirms — more or less scientifically — what most people already think they intuitively know. This present study confirms what many patients already have expressed in prior comments to various UPDATES articles; that is, when chronic pain is unexplained by a diagnosis of some severe biopathology patients often face significant obstacles to being taken seriously by their families, friends, and healthcare providers.

In the study by Ruddere et al. it was somewhat puzzling that psychosocial factors appeared to have so little influence on participants’ perceptions. It seemed that medical evidence for the pain superseded all other information when judging the genuineness of pain and consequent feelings of sympathy or helpfulness toward the patient.

As often is the case in the pain management field, more research is needed before leaping to any firm conclusions. For one thing, patients in the video segments displayed what had been determined as representing moderate pain; expressions of more severe pain might have had much greater impact on assessments — evoking higher ratings of pain (whether or not medically explained) and greater empathy by study participants.

Another important limitation was that participants had no personal relationships or direct interactions with the fictitious patients; completely unlike what would be the case in clinical settings or among family/friends. Essentially, the researchers attempted to create a laboratory setting for assessing human variables that are far more complex in everyday life or clinical practice.
Participant-group sizes — Group 1, N= 39; Group 2, N=41 — were probably adequate to provide reasonable statistical power for detecting significant differences, avoiding Type II (false negative) findings. [Readers should note that numbers of participants indicated in the study abstract and the article text itself are grossly discordant; we are using numbers from the text.]

However, composition of the participant groups must be considered: overall, the two groups were unequally balanced toward women, average participant age was significantly lower than the test patients (roughly 28 vs 51 years), and approximately half of participants were college students. So, generalizing the findings at this time to how older persons, healthcare providers, or family/friends might react could be erroneous.

Therefore, there are still unanswered questions about how the qualities of patients and those interacting with them, as well as available information about patient medical condition and/or psychosocial influences, affect judgments when it comes to pain assessment, sympathy, and helping behavior. The researchers, themselves, acknowledge most of these limitations; yet, this study is an important step toward a better understanding of several factors that might significantly bias perceptions of patients’ pain and impact the care that they receive in medical settings and at home.

REFERENCE: Ruddere LD, Goubert L, Vervoort T, et al. We Discount the Pain of Others When Pain Has No Medical Explanation. J Pain. 2012(Dec);13(12):1198-1205

http://updates.pain-topics.org/2012/12/pain-doubted-if-medical-basis-is-missing.html

 

Maybe Time To Chuck Out The Old Sneakers And Do Your Feet A Favour

Today's post from bestshoesforwalking.com (see link below) follows on from yesterday's post about the perils of Winter for neuropathy patients and takes a comprehensive look at footwear expressly designed for people with nerve damage in their feet. Now don't expect high fashion here - there are no Jimmy Choos or Louboutins - but let's face it, tottering along the street in 5 inch heels is not for the average neuropathy patient! It may be worth taking a look at this article, if only to see what's on offer and why it may be suitable for you. If you're like me and have 5 year old sneakers that you wear day in day out because they're sooo comfortable, you may not be doing your feet any favours at all and be storing up problems for the long term. On the other hand, orthopedic shoes can be the ugliest footwear on earth but manufacturers are seeing the size of the market and adapting their styles accordingly. The list here is by no means exclusive but may give you an idea of what to look for. By the way; the article may be aimed at the diabetic foot but as we all know, it still applies to all forms of neuropathy in the feet.

Best Shoes For Diabetic Neuropathy in Man and Woman
December 10th 2016 


Walking is considered to be the entire useful exercise, to assist control blood sugar levels, that suits people of all ages. Accordingly, a diabetic person who begins to use walking as a method to control blood sugar need choose a suitable walking diabetic shoe that must meet specific criteria’s, in order to protect his diabetic foot. Below the best shoes for diabetic neuropathy in man and woman review that must be helpful or needed for your health, body and fitness. Below the recommended shoes are help to stop swelling on your feet.
Diabetic Walking Shoes:

For somebody with diabetes, walking can be very beneficial to health. In addition to reducing cholesterol and reducing the risk of cardiovascular disease, walking for diabetic activity also lowers blood sugar level and develops circulation to the legs and feet. Being a diabetic walker, you will require paying careful consideration to prevent foot problems such as injuries and calluses. Walk-related foot injuries tend to happen when a walker wears a shoe that is unless the incorrect type of shoe or a cheap fit for their feet. Luckily, most diabetic foot problems can be prevented by buying a pair of suitably adjusting diabetic walking shoes and paying proper care to diabetic foot care.

Tips for Purchasing Shoes with Diabetes:

* Have feet measured periodically, because feet turn over time?

* Shop later in the day, because feet swell during the day, particularly if you have heart disease or kidney problems.

* Have shoes matched with the socks you’ll be wearing with these particular shoes? That process you’ll know they will fit accurately.

* The range between your longest toe and the tip of the shoe should be ½ of your thumb’s width, so you have the benefit amount of space to fit your feet.
When you bargain a new pair of shoes, break them in before wearing them for a long period. Wear them for one-two hours, then inspect your feet for any cuts or injuries. Wear them three to four hours the next day, and so on, until they feel comfortable.
Better Shoes Delivers The Best Results:

Only a uniquely designed diabetic walking shoes can protect and not hurt your feet although walking. People with diabetes must be careful when it comes to even a mild activity such as walking, as even the inadequate pressure can lead to an injury when it comes to a sore foot.
When you are walking for a higher period with lower quality shoes, the consequences can be severe, in many cases, simply having fulfilling shoes can help amazingly ease the pressure on your feet.
WHAT IS NEUROPATHY?

Neuropathy is a collection of complications that happen when nerves of the peripheral nervous system are damaged. The condition is referred to as peripheral neuropathy. Neuropathy typically causes pain and numbness in the hands and feet. It can occur from traumatic injuries, infections, metabolic sicknesses, and exposure to toxins. One of the common critical difficulties of neuropathy is diabetes.

Of the American with diabetes, 25% increase foot problems related to the disease. This is essentially due to a condition called neuropathy. Diabetic Neuropathy is a difficulty of diabetes that affects the nerves. The most common figure of diabetic neuropathy is called external neuropathy and attacks the peripheral nerves. Peripheral tissues are the nerves that go out from the brain or spinal cord to the muscles, skin, internal organs and glands. Peripheral neuropathy impairs the proper functioning of these sensory and motor nerves.
Diabetic Neuropathy Foot Care-

Diabetic Neuropathy (diabetic nerve destruction) of the foot is a moderate complexity of diabetes. In its initial stages, diabetic neuropathy may create diabetic foot pain. As the disease advances, it may lead to loss of feeling in diabetic feet. There are many various types of neuropathy, each with different symptoms. The significant common type of neuropathy that affects diabetic feet is peripheral diabetic neuropathy.

If you have been diagnosed with peripheral diabetic neuropathy, you need to make diabetic foot care is the recent priority. As diabetic neuropathy progresses, the consequences of carelessness to the health of your feet will become frequently severe. People with diabetes with advanced diabetic neuropathy of the foot are at the significant risk of developing diabetic foot ulcers and other difficulties that can lead to amputation if left untreated.
Diabetic Neuropathy – Prevention is the Best Remedy:

Prevention is the best method now available for diabetic neuropathy. Though pain and pain can be controlled with medication and medical therapies, impairment of nerve function cannot be reversed. Favorably, once diabetic neuropathy has been detected, steps can be taken to prevent any further improvement of the disorder.

Maintaining average blood sugar levels is the most important step to take when trying to prevent and control diabetic neuropathy. Shielding your feet by using diabetic shoes and diabetic socks at the full time and making healthy lifestyle choices such as not smoking, regularly, eating a balanced diet, exercising and having healthy blood pressure are also key factors in reducing the risk of diabetic neuropathy development or advancement.



Shoes, name Shoes, Image, Shoes, Price
Drew Shoes London Women’s Therapeutic Diabetic Extra Depth Shoe Check Price
Orthofeet Women’s Comfort Diabetic Extra Depth Sandal Check Price
Dr. Comfort Carter Men’s Therapeutic Diabetic Shoe Lycra Velcro Check Price
Dr. Comfort Women’s Bonita Camel Diabetic Slippers- Check Price
Diabetic Relief Slippers Check Price
Orthofeet Chelsea Neuropathy Women’s Comfort Diabetic Shoes Check Price
Acor River Walk Diabetic Walking Shoes Men’s Women’s Black Bone Mocha Check Price
Advance Diabetic Comfort Walking Shoes Men’s Black Check Price
Women’s Extra Diabetic Wide Width Adjustable Slippers Check Price

The Value of a Proper Shoe Fit:

To avoid irritation, stress, and pressure sores, you must need shoes that fit properly. For optimal comfort, make sure your shoe matches the length and width of your foot and that it provides a fitting heel counter. Also, assure that there aren’t any obtrusive seams or stitching inside because this will make rubbing and chafing against your foot. For people with diabetes with an existing foot disease, therapeutic footwear is often prescribed by a doctor or podiatrist and provided by a qualified podiatrist.
Below the best shoes for diabetic neuropathy in man and woman review .

Drew Shoes London Women’s Therapeutic Diabetic Extra Depth Shoe-

The Drew London women’s slip-on shoes give all the comfort features of a Drew so that you can move in and walk with amazing all-day support. Double depth with two detachable insoles creates space for custom orthotics or easily some extra toe room. Drew shoes are breathable, perfect with stretch fabric vamp and greatest padding where you need it most. The shoes offer our best fit still, with a soft, fabric covering. Check Latest Price

Orthofeet Women’s Comfort Diabetic Extra Depth Sandal-

Orthofeet Sarasota Beach Women’s shoes offer anatomical arch support, non-binding comfortable fit, and maximum stability against pressure points. The Gel Orthotic insole with the ergonomic, cushioning foot soften step, enhance resistance, and help natural foot movement. The deep toe box design provides the foot to ease and spreads out naturally for added comfort. Check Latest Price

Dr. Comfort Carter Men’s Therapeutic Diabetic Shoe Lycra Velcro-

Dr. Comfort Carter style shoe for men is a device washable, double-depth diabetic shoe. Built of lightweight extent Lycra with a two-way Velcro closure for more flexibility, this shoe is designed to provide foot damages such as bunions or hammertoes, yet keeps its shape after hours of washing. Our Men’s Double Depth Set features our most popular styles improved with extra depth providing the excellent fit for people who need extra volume. Check Latest Price

Dr. Comfort Women’s Bonita Camel Diabetic Slippers-

A tight heel slipper for women, with a unique rubber outsole perfect for indoor/outdoor usage. This lightweight slipper arrives with a Dr. Comfort gel insert and has a toe box for extra protection. The microfiber upper with dual flexible goring makes it accessible to slip them on your feet. The fleece lined interior assures a snug fit, reducing the chance of abrasions. With a Scotchgard shielded outer material, the slippers are great for going outside to grab the paper or decreasing in your house. Check Latest Price

Diabetic Relief Slippers-

Therapeutic Relief Slippers are a blessing for diabetic foot difficulties, swelling and bunions! Cloud-soft, plush fleece insulation and cushiony memory foam crib feet in comfort and give shock absorption. Hook loop strap closure makes them simple to put on or take off and improve fit. High ankle cut provides you great support. Plus, non-skid protection soles and weather tight P/U nubuck upper lets you use them indoors and outdoors. Check Latest Price

Orthofeet Chelsea Neuropathy Women’s Comfort Diabetic Shoes-

Orthofeet Chelsea Women’s shoes offer anatomical arch assistance, non-binding relaxed fit, and best protection against pressure points. The Easy Slip-on design facilitates easy access to the shoe and an adjusted fit with a Velcro strap closure. The Gel orthotic-insole along by the ergonomic, cushioning sole relax step, enhance stability, and aid natural foot motion. Best Shoes for Neuropathy. The deep toe box design enables the foot to relax and spreads out naturally for continued comfort. Chelsea shoes are managed to help reduce Foot Pain, Arch Pain, Knee Pain, Heel Pain, Forefoot Pain, Metatarsal Pain, Low Back Pain, also to enhance comfort for Diabetic Feet, Arthritic Feet, Plantar Fasciitis, Sensitive Feet, Pronation, Metatarsalgia, Morton’s Neuroma, Bunions, Corns, Hammer Toes. Check Latest Price

Acor River Walk Diabetic Walking Shoes Men’s Women’s Black Bone Mocha-

Acor River Walking Shoes. River Walk shoes combine the science of walking with the comfortable style of modern design, bridging a long-standing gap within functional fit and style. The Line-of-Progression outsole imparts stability and comfort to each phase of the walking cycle. The insole method is lined with a silver technology called X-Static. This shoe has the Tandem Closure System. This system provides you the choice of usual lace-up or two methods of the hook on loop attachment. Check Latest Price

Advance Diabetic Comfort Walking Shoes Men’s Black-

The Men’s Advance Comfort Footwear last fits a medium depth fit for a wide range of feet, and particularly for the low-risk foot in need of just a little more room. Advance Support shoes come with two different insoles for a comfort of adjusting the fit. Check Latest Price

Women’s Extra Diabetic Wide Width Adjustable Slippers –

The Best Extra Wide Fit Women’s Slippers with VELCRO brand fasteners accommodate even the most swollen feet and swollen ankles in fabulous comfort. These Extra Wide Womens Bedroom or House Slippers are excellent for comfortable casual use in the home and home care settings. A great option for elderly with bunions, corns, foot edema, hammer toes, diabetes, and podiatry foot problems. The wide slipper opening features VELCRO brand fastener closures. Skid-resistant non-slip slipper soles. Memory foam insoles for the ultimate in comfort! Terrific for those with disease or lowered hand dexterity. These soft wide width slippers make the real diabetic slipper for women. Extra-roomy deep, wide width slippers for swelled feet and ankles are great for patients in hospitals, post surgery, nursing house patients residents and retirement houses. Check Latest Price

Overall, When buying for diabetic slippers, you need a pair that’s flexible and comes with a flexible closure. The adjustable closure will surely come handy as diabetic feet can eventually change in shape and size. You also need diabetic slippers whose outsoles are beefed up with extra traction; pull tabs at its heels; warm wool uppers; or sturdy construction. If you want to know more about walking shoe, so visit here now- Best shoes for walking

http://bestshoesforwalking.com/best-shoes-diabetic-neuropathy-man-woman/

How Early Do Pregnancy Symptoms Start

Thank You Birthday Cake

How soon can you start seeing signs and symptoms that you are pregnant? From as early as a week past conception, find out about how soon the signs of pregnancy begin..Find out the early signs and symptoms of pregnancy, For most women who have morning sickness, the symptoms start around six weeks after their last period..Question How soon after conception can you start getting pregnancy symptoms?.When do pregnancy symptoms start? When Do Pregnancy Symptoms Typically Start? Not all pregnancy symptoms start early..A Timeline of Early Pregnancy Symptoms; Internal reproductive organs are developing. Muscles have begun to form, too, so the embryo may start making movements..So, i have a question how early do pregnancy symptoms start from when you have like how many days after should the symptoms start I'm just .Early pregnancy symptoms vary woman to woman, is a pregnancy symptom which can also start as early as the first week after conception..Learn the common early signs of pregnancy from WebMD. Do All Women Get Early Symptoms of Pregnancy? so some women mistake them and the bleeding for the start .Symptoms of pregnancy: What happens first. Do you know the early symptoms of pregnancy? From nausea to fatigue, know what to expect. By Mayo Clinic Staff.The onset and degree of pregnancy symptoms will vary within women. Many women experience them within days of conception, others take a few weeks before pregnancy .

Underwear Fashion Women

Nolina Texana

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