The Peripheral Nervous System Vid

 Today's video is the second of three excellent videos concerning neuropathy, delivered by Todd Levine. The first appeared yesterday and the third will appear tomorrow. They are absolutely worth watching, although you will need to settle down comfortably because they are 30 minutes long. They include information that is of value to everyone living with neuropathy; whatever the type and whatever the cause.


The Peripheral Nervous System
Todd Levine Clinical Assistant Professor, University of Arizona


  
https://www.youtube.com/watch?v=pcdKhKSLca8#t=18

Introduction To Peripheral Neuropathy

Today's post from gobeyondrelief.com (see link below) is another beginner's guide to neuropathy - what it is, what its causes are and how they diagnose it. It doesn't go into treatments or any great details but for the person meeting neuropathy for the first time, it gives you a quick guide and as such is useful. The experienced neuropathy patient will learn nothing new from this short article but may wish to pass it on to concerned friends or family, who don't need to be swamped with detail.

Are You at Risk for Peripheral Neuropathy?
by Dr. Cohen Date unknown
 
Your Risk for Peripheral Neuropathy

The term, Peripheral Neuropathy, describes a disease that includes damage to one or more of the body’s peripheral nerves. That means that messages of sensations that pass between the central nervous system and the peripheral nervous system are disrupted.

The central nervous system includes the spinal cord and brain. Meanwhile, the network of the body’s nerves in all other body parts, like legs, arms, hands, feet, and internal organs, are called the peripheral nervous system. The nerves in this system exist to transmit messages from all parts of the body, up the spine, and then to the brain. When these message are disrupted, for a variety of different reasons, the condition is called Peripheral Neuropathy.

Diabetic Peripheral Neuropathy Symptoms

This health condition is caused by a number of medical health issues, and diabetes is the most common disease associated with it. With diabetics, symptoms may include numbness, itching, a “pins and needles” feeling in extremities, or even pain. Patients may also suffer from muscle weakness and a loss of coordination. Of all of the extremities, the worst symptoms are often felt in the feet and legs.

In some cases, the pain is so bad that doctors prescribe strong opiates to control it, but this is usually a last resort because strong prescription medications can have unwanted side effects. The disease is usually progressive, so minor symptoms often show up before the more serious ones arrive.

Even if the patient does not feel pain, numbness can be very dangerous. For example, many diabetics have to be very careful to always wear shoes and check their feet because they could suffer from foot injuries without realizing it. Many diabetics also need special socks and shoes that help support and protect their feet. 

Other Causes of Peripheral Neuropathy

Even though diabetes is often associated with this condition, it is not the only possible cause. Leprosy and shingles are two other examples of diseases that can cause Peripheral Neuropathy.

Exposure to toxins, certain cancer drugs, and the statin drugs that are commonly prescribed to lower cholesterol also have been linked to this condition. With statin drugs, people will often not experience symptoms, but nerve damage has been diagnosed by doctors.

Other common heath conditions, carpal tunnel syndrome and small tumors, may cause pressure on the nerves and in turn, cause Peripheral Neuropathy. Treatment for these sources of this health condition may be different than it is for other medical conditions.

Auto-immune disease may also cause pain in nerves because of inflammation. In this case, doctors may try to treat the disease along with offering solutions to help reduce the symptoms of Peripheral Neuropathy.

Diagnosis of Peripheral Neuropathy

The first thing a doctor will do is take a complete medical history. This will help the doctor figure out if the patient suffers from any conditions, takes medications, or has had any toxic exposure that may commonly cause this condition.

In addition, he may perform some tests of nerve function, and these can include reflex texts, tests of muscle tone and strength, and tests of ability to feel different sensations. The doctor will also check coordination and posture.

The doctor may also order some additional diagnostic tests, and these are common examples:

* Imaging tests: CT and MRI scans are some common examples.
* Nerve function: Electromyography records electrical signals within muscles.
* Nerve biopsy: A small piece of muscle is removed to get examined for an abnormalities.
* Skin biopsy: A small piece of skin is removed to check for the number of nerve endings.

If you have any symptoms and are concerned that you might have Peripheral Neuropathy, then you should immediately talk to your doctor. We will discuss suggested treatments in a later article.

http://gobeyondrelief.com/peripheral-neuropathy-symptoms-risk-factors/

Sexual Side Effects of Peripheral Neuropathy

It's not always the easiest subject to bring up in front of your doctor, especially if you're already over 50. However, if you have neuropathic problems, it doesn't have to be an 'It's just your age", diagnosis and can unfortunately be yet another symptom of nerve damage. For HIV-patients, it can be yet another reason why not everything works the way you want it but it is important to report it because science is moving so quickly in the sexual health area and you may well be able to be helped. One important old wives' tale to dismiss, is the fact that this is just a man's problem - not at all, on the contrary, women with peripheral neuropathy are just as likely to experience sexual problems caused by interrupted nerve signals. This article from livestrong.com (see link below) explains clearly why these problems occur.

Sexual Side Effects of Peripheral Neuropathy
Jul 12, 2010 | By Matthew Busse

Damage to the nerves of the peripheral nervous system is referred to as peripheral neuropathy. The peripheral nervous system is a network of neurons that connect the spinal cord and the brain to the rest of the body. Peripheral neurons are responsible for transmitting physical sensations, like touch and heat, from the skin to the brain. The peripheral neurons also allow the brain to control many processes throughout the body, such as movement, digestion, heart rate and sexual response. Damage to the peripheral neurons resulting from peripheral neuropathy can cause sexual side effects in both men and women.

Damage to Nerves Controlling the Sex Organs

The sexual organs in both men and women are connected to the brain by peripheral neurons. Sexual arousal occurs when the brain registers an excitatory signal and transmits that signal to the sex organs, explains the Boston University School of Medicine. When the sexual organs receive the excitatory signal, neurotransmitters are released that increase blood flow to the sex organs, causing erections in men and labial, vaginal and clitoral engorgement in women, in addition to stimulation of vaginal secretions. If the nerves that connect to the sex organs become damaged, these signals required for sexual arousal cannot reach the sex organs.

Sexual Side Effects in Men

In men affected by peripheral neuropathy, the neurons that connect the penis to the brain may become damaged. As a result, when the brain experiences sexually stimulating input, it cannot transmit that signal to the penis. An erection results from signals reaching the penis that cause its smooth muscles to relax and allow in increased blood flow. Without the signals from the brain, blood flow to the penis cannot be increased, and there is no erection. However, sex drive in men with peripheral neuropathy may remain unchanged. Alternatively, men with peripheral neuropathy may be able to achieve an erection, but they may experience sexual climax without normal ejaculation.

Sexual Side Effects in Women

Similar to men, women require signal transmission through peripheral neurons between the brain and the sex organs to induce the sexual response. When the brain receives a sexually stimulating signal, that signal is transmitted to the vagina. Similar to men, the signal induces the smooth muscles surrounding the vagina to relax and increase blood flow to the vagina, clitoris and labia. In addition to causing engorgement of these organs, the increased blood flow also stimulates vaginal secretions that lubricate the vagina. Women with peripheral neuropathy may not experience physical sexual arousal, leading to vaginal dryness. Women with damage to the peripheral nerves may also have difficulty achieving orgasm.

http://www.livestrong.com/article/171957-sexual-side-effects-of-peripheral-neuropathy/

Peripheral Neuropathy Reappears Personal Story

Today's post from reasonablywell-julia.blogspot.com (see link below) is a personal story of someone who has more than one neuropathic problem and it highlights the difficulty we often have, of differentiating between neurological problems and their causes. In this case, the original cause was the aftermath of surgery but just as you think you can pinpoint where the symptoms are coming from and why that has happened, other symptoms appear or reappear, showing that the nerve problems have expanded, leading to new difficulties and new medication choices. Many readers will identify with the frustrations felt here. Follow the link to see more of her story.

Peripheral Neuropathy -- Again 
Posted by Julia Oleinik Thursday, January 22, 2015 
 
Guys. I feel like a walking zombie lately.

I've definitely chalked some of my zoned-out spaciness to recovering from our trip; but I think that this particular fogginess has a different quality than my usual post-vacation crash. It's hard to explain but after this many years of autoimmune fatigue and brain fog, I know what THAT feels like. And this isn't it.

I also suspect that I know what's causing it all. It's complicated. Ready for a long story?

Over the past six months or so all sorts of things have happened to this old body of mine, the biggest being the symptoms from spinal stenosis and the laminectomy that followed. As I healed from the surgery and the compression was relieved on those nerves, I realized that the radiculopathy from the stenosis was masking other neurological problems.

Gee. What a treat.

Make no mistake -- I'm thrilled with the results of my laminectomy. I can walk for any length of time without that terrible radiating pain and numbness in my butt and leg and foot. But the neurological problems that I'm having now have nothing to do with those large nerves that exited my T4 and S1 vertebrae.

When the major pain and numbness went away after my surgery, it unmasked other pain that was not caused by the stenosis: peripheral neuropathy manifested by generalized burning and pain in my feet along with the bizarre sensation that the skin of my lower legs is vibrating. Buzzing. Strange. Worse at night just when I'm trying to sleep.

I have been dealing with PN for quite some time, although to a lesser degree than lately. You can read my earlier post addressing this issue written back in January of 2013 here.

The result is that I have added Neurontin (gabapentin) to my medications, and I have to say that it has indeed reduced my symptoms. But unfortunately along with the good, came my dopey sensations. I have let my doctor know about it's effects, and hopefully after continued use the side effects will decrease.

In the meantime, well....don't be expecting many posts that are coherent.

Do you take gabapentin? How has it affected you?

http://reasonablywell-julia.blogspot.com/2015/01/peripheral-neuropathy-again.html

Peripheral Neuropathy And Hepatitis

Today's post from hcvadvocate.org (see link below) is a very useful one for people living with hepatitis C, who also suffer neuropathic problems as a result. You won't find too much information on the net about the two diseases together but this article tries to show why neuropathy can be hepatitis (HCV) -related and once again, it's the treatment of the one disease, that may lead to the other occurring. Unfortunately hepatitis C is a serious problem and the numbers are growing. There are new treatments just coming onto the market but it remains a very difficult viral disease to treat and then with neuropathy on top...well you know the rest. The only light point (if you can call it that) is that the treatment for HCV-related neuropathy is much the same as for most other forms of neuropathy - there are no real deviations just because of the cause and neuropathy patients will recognise the recommendations and suggestions shown here.

HCV – Peripheral 

Neuropathy (PN)

Written by: Alan Franciscus, Editor-in-Chief Hepatitis C Support Project

Foreword

Neuropathy is a medical term for any disease of the nerves. There are

four major forms of neuropathy – polyneuropathy, autonomic neuropathy,

mononeuropathy and the most common form, peripheral polyneuropathy

– more commonly called peripheral neuropathy (PN). Peripheral neuropa

-

thy damages the nerves in the legs and arms. Usually the first area that

PN affects is the feet and legs before the hands and arms. This fact sheet

will discuss the HCV-related form of peripheral neuropathy including the

cause, symptoms, and treatments.

 HCV & PN

The exact cause of HCV-related PN is not completely understood, but

there is some speculation that it could be caused by HCV RNA (viral

load) deposits in blood vessels that supply oxygen to the nerves,

HCV infection of the nerves, an inflammation process in the nerves,

and/or an HCV-related immune disorder. In the past it was believed

that only people with cryoglobulinemia developed HCV-related PN

but it has been proven that HCV-related PN can occur even in the

absence of cryoglobulinemia. Studies have found that up to 15.3% of

the HCV population has PN. If HCV is the cause of PN it would make

sense to treat the cause.

Important note:

Everyone with hepatitis C should be evaluated and receive HCV treatment. Current treatment is very expensive, and some insurance companies and Medicaid/Medicare are restricting HCV treatment to people with the most severe HCV disease. One of the conditions that qualify people for HCV treatment are extrahepatic manifestations. Discuss any symptoms with your medical provider and have them recorded in your medical records. If you are not approved

for the drugs to treat hepatitis C, you may qualify for free drugs or co-pay assistance through a pharmaceutical patient assistance program. More information is available at the end of this fact sheet.

Causes and Risk factors for PN include:

•

Infections such as hepatitis C, Lyme disease, shingles, Epstein-Barr, and HIV

•

The most common cause of PN is diabetes – it is estimated that 34% of the diabetic population has PN. This compares to a prevalence of 2.4 - 8% in the general population

•

Chronic alcohol abuse

•

Vitamin B deficiencies

•

Various autoimmune diseases such as lupus

and rheumatoid arthritis

•

Environmental toxins

•

Medications, such as HIV medications

Symptoms

The most common symptoms of PN are HCV therapy.

 

Self-Care Tips:

A healthy lifestyle can help manage PN and the symptoms associated with it. These lifestyle modifications include:

•

Exercise

– can help to reduce some of the symptoms, increase overall muscle strength,

increase blood circulation, and prevent muscle wasting or atrophy.

•

Nutrition

– Eat a healthy diet that will improve overall health and which may help with the gastrointestinal symptoms people with PN experience.

•

Smoking

– Cigarette smoking constricts the blood vessels that provide oxygen and nutrients to peripheral nerves. Seek professional services to stop smoking.

•

Drinking

– Alcohol abuse is a leading cause of PN. Avoid or greatly reduce alcohol use.

•

Massage

– especially to areas that are affected by PN (hands/feet) will stimulate, relax and may lessen some of the pain

•

Do not put too much pressure on limbs-legs and elbows such as crossing legs for a long period of time.

Foot Care

As discussed earlier PN usually affects the feet and legs first. Because NP can cause loss of sensation to the lower extremities it is very important that people with PN pay special attention to their feet. The loss of sensation caused by PN can lead to unrecognized cuts, blisters and other damage to the feet. If a condition or injury goes unchecked it could lead to infections and ulcerations that may spread to the bone. Severe bone infection can lead to amputation of the infected bone. There are many ways to take care of and protect your

feet. The American Diabetes Association (ADA) recommendations for foot care can be easily adapted to everyone with PN:

•

Check all the areas of the feet every single day. Look for red spots, cuts, swelling and blisters. If you can not see the bottom of your feet, use a mirror or ask someone to inspect them for you.

•

Be more active (exercise and stretching).

•

Wash your feet everyday. Dry them carefully, especially between the toes.

•

Moisturize your feet daily (but not between the toes).

•

Never go barefoot – always wear comfortable shoes and socks. This is because people with PN can cut or damage their feet and may not even notice or feel the pain.

•

Keep toe nails trimmed so that the nails don’t rub or cut nearby toes.

•

Be careful not to expose your feet to hot and cold temperatures.

•

Keep the blood circulating throughout the feet. The ADA recommends wiggling your ankles up and down for 5 minutes – two or three times a day. Don’t cross your legs for long periods of time.

•

Stop smoking cigarettes.

•

Check with your medical provider about the need for special shoes (orthotics).

http://hcvadvocate.org/hepatitis/factsheets_pdf/pn.pdf

Peripheral Neuropathy And Chemotherapy Treatment

Today's post comes from beatingbowelcancer.org (see link below) and is a UK government publication specifically addressed at cancer patients undergoing chemotherapy who go on to develop neuropathy. Most neuropathy patients will  know that nerve damage can quite often occur due to chemotherapy treatment but this article presents information in more depth than most, especially in relation to Oxaliplatin. 

It's amazing how articles about various forms of neuropathy from different causes, end up revealing more or less the same information, especially regarding dealing with the symptoms; so this is worth reading for all neuropathy sufferers. Cancer is unfortunately a possibility for us all. The extra information at the end is directed at UK readers.

Peripheral Neuropathy And Chemotherapy Treatment
Beating Bowel Cancer Forum via Gov.UK July 1st 2013

This factsheet has been written to support bowel cancer patients who are about to embark on a course of oxaliplatin, a common chemotherapy drug, which can cause temporary, and in some cases, more long-lasting side-effects such as tingling or numbness in the hands and feet. It is important that you work together with your hospital team to manage these side-effects and prevent problems in the future.

Oxaliplatin (Eloxatin) is a platinumcompound chemotherapy drug given to bowel cancer patients when their cancer has spread, locally into the lymph nodes or into other organs. It is usually given in combination with other drugs, for example:

with 5FU (FOLFOX)

with 5FU and irinotecan (FOLFOXFIRI)

with capecitabine (XELOX or CaPOX)

Oxaliplatin is given as a slow, intravenous infusion which is repeated at regular intervals, every two or three weeks, depending on the treatment you have been prescribed. Side-effects from oxaliplatin may include: nausea, vomiting and diarrhoea and it can affect normal blood clotting, leading to bleeding gums, nose bleeds and bruising.

Peripheral neuropathy is another, potentially significant, side-effect of oxaliplatin, which causes altered sensations in your hands and/or feet. This is because this drug can affect the nerve endings; the longer the nerve, the more likely it is to be damaged. Nerves going to the hands, feet and lower legs are some of the longest in the body. It can also
affect nerve endings in the chest, neck or throat, causing feelings of tightness in the chest and jaw and a strange feeling in your tongue.

This side-effect is called peripheral neuropathy, because it only affects the nerve ending in the extremities of your body, in particular the hands, feet and lower legs. 

Short-term (acute) neuropathy

Almost everyone who receives this chemotherapy will experience some degree of peripheral neuropathy soon after receiving the treatment. The symptoms begin during or shortly after an infusion of oxaliplatin and usually disappear a few days after treatment ends. As treatment continues symptoms may last longer or become more
noticeable. They are often triggered by eating, drinking, or touching something cold or breathing cold air. Most people cope well with the short-term symptoms of peripheral neuropathy with only a few changes to their lifestyle.

Symptoms include:
A change in sensation; You may have a feeling of heaviness, burning or pins and needles in the affected area. Or, you may notice unusual sensations, such as a feeling of warmth or burning when touching something cold. Or, you may notice a loss of sensitivity or feeling, starting in your feet and fingertips.

Increased sensitivity and pain; For the first 48 hours after your treatment, you will feel much more sensitive to the cold. You may find that even the lightest touch or pressure in the affected area feels uncomfortable or painful. You may experience a sharp, stabbing or burning sensation, or it may feel like minor electric shocks. If the pain becomes more severe, your doctor can prescribe medication to help relieve it.

Difficulty with balance, walking and coordination: If your feet and/or lower legs are affected, this may make it difficult to walk, climb stairs or keep your balance. You may find that you stumble or trip more often, especially on uneven surfaces.

Difficulty with everyday tasks: You may feel clumsy at times and less in control of your movements. If your fingers are affected, you may not be able to do ‘fiddly’ tasks, such as fastening buttons or tying your shoelaces.

Things you can do to help
It is important to protect your hands and feet by keeping them warm at all times. Use gloves when you go out in cold weather and to avoid touching anything cold.

Wear socks to keep your feet warm. Don’t walk around barefoot at home. Wear a scarf or face mask if you must go outside in cold weather.

Don’t eat or drink cold or even cool foods. Eat food that is at room temperature. Don’t sit in an air-conditioned room or car.

Try to go for a walk every day, even for a short distance. This will prevent muscle
weakness, which adds to your general lack of balance. Wear soft shoes and add
padded insoles to make walking less painful.

If it’s a cold day when you have your treatment, bring gloves, a blanket, and warm socks.

Keeping safe with peripheral neuropathy

Always wear gloves when working in the garden and use oven gloves in the kitchen to avoid injury. Take special care with kitchen knives and tools.

Clear your house and garden of things you might trip on such as rugs, slippery surfaces
and clutter on stairs and steps. Make sure rooms are well lit and always put a light on if
you get up during the night.

Always test water with part of your body not affected by neuropathy such as your elbow before you bathe, shower, or wash dishes. Turn your hot-water thermostat to a lower setting. It is easy to burn yourself if you cannot judge the temperature of water. Put a skid-proof mat in the bathtub or shower cubicle, and consider using a shower stool.

If you have problems balancing or walking, ask for a referral to a physical therapist to strengthen muscles, build balance, or prescribe a walking aid. An occupational therapist may be able to help adapt your home so daily activities are easier and safer for you.

Check your feet every day for redness, injuries, or blisters and tell your nurse if you are concerned. It is important to avoid an infection developing.

Long-term (cumulative) neuropathy

As your treatment with oxaliplatin continues, the amount of platinum stored in your body builds up and this increases the risk of a longerlasting sensory neuropathy in your hands and feet. You are more at risk of these effects if you have anaemia, diabetes, or low levels of certain minerals and vitamins. Neuropathy caused by oxaliplatin usually gets better once the treatment is stopped, although some patients will experience a temporary increase in symptoms after treatment ends. However, if you have lingering numbness in your hands and feet between treatments, it is important to tell your medical team, because the cumulative numbness can be long lasting if the drug isn’t stopped promptly. About 10 – 20% of patients will experience these long-term
side-effects, which may persist for up to twelve months after treatment finishes. For a very small percentage of people, the changes will be permanent.

How your hospital team can help

It is very important to let your oncologist or nurse know if symptoms of neuropathy last beyond a few days after a chemotherapy treatment. Keep track of tingling, pins and needles, numbness, pain, or difficulty with normal activities and let your team know if they are getting worse. It is possible to reduce the dose or to change your treatment regime so that oxaliplatin is given less frequently.

There are also several treatments which can be tried to alleviate the symptoms and researchers are looking at how best to relieve this kind of pain. This might include using medications which might usually be used to treat other conditions (which you don’t have) such as:

Anti-depressant medicines, often in smaller doses than are used to treat depression

Anti-convulsant medicines, which are used to help many types of nerve pain.

It may take more than one approach to try to find out what works best for you. Other treatments that can be tried to ease the discomfort and its effect on your life are physical therapy, relaxation therapy, guided imagery, and acupuncture.

If the doctor thinks that you may be deficient in minerals, due to your diet, the amount of alcohol you drink or for some other reason, you may be given an infusion of calcium or magnesium to help reduce the symptoms.

If the oxaliplatin is stopped because of cumulative symptoms, you will continue to receive the capecitabine or 5FU which is given with it. However, if your symptoms
continue to get worse, your oncologist may suggest that you try another type of anticancer drug or decide to give you a break from chemotherapy.

If you are unable to work 

If long-term symptoms make it difficult for you to walk or carry out your normal daily activities, you may be entitled to financial help. If you are aged 16 to 64 you can apply for a Personal Independence Payment (PIP) to help with some of the extra costs caused by your condition. The payment is of up to £134 a week and you will need an assessment to work out the level of help you get. People aged 65 and over can apply for an Attendance Allowance to help with personal care.

Benefit Enquiries

PIP - T: 0800 917 2222
Attendance Allowance - T: 0800 88 22 00
www.gov.uk

Further support
There is more information about managing the side-effects of chemotherapy and monoclonal antibody therapy in these Beating Bowel Cancer publications, which can be downloaded from our website or requested as hard copies:
‘Bowel Cancer Treatment - Your Pathway’
‘Advanced Bowel Cancer - Treating Metastases’
‘Living With Bowel Cancer - Eating Well’

http://www.beatingbowelcancer.org/sites/default/files/page_files/Factsheet%20Peripheral%20Neuropathy%20V1.0%20Jul%202013.pdf