April 6, 2010 in Features

Dr. Gott: Nervous about neuropathy

Peter H. Gott, M.D., United Media

DEAR DR. GOTT: Please comment on neuropathy. How does one get it, what medication treats it, and is it curable? Can it be caused by a broken toe?

DEAR READER: Neuropathy can be defined as a disorder or disease of the nervous system. Because you provide limited information, I cannot determine which form, if any, you might have. Unless your toe fracture was quite traumatic, it’s my guess it’s not likely to have resulted in neuropathy.

Autonomic neuropathy refers to damage to nerves over which we have no control, such as those of digestion, perspiration, blood pressure and heartbeat. Symptoms can include dizziness and fainting on standing (orthostatic hypotension), caused by a drop in blood pressure; gastroparesis (difficulty digesting food), causing diarrhea, constipation, nausea, vomiting, heartburn, loss of appetite and bloating; exercise intolerance, during which the heart rate remains stable despite the level of activity; hypoglycemia (low blood sugar) that presents with palpitations, sweating, an elevated heart rate and shakiness; and diminished pupil reaction that causes problems with adjusting from light to dark. Causes include alcoholism, diabetes, chronic illnesses such as Parkinson’s, nerve injury, atrophy (wasting away of one or more muscle, organ or nerve), medication for IBS or overactive bladder and more.

Peripheral neuropathy is the outcome of nerve damage resulting from infection, injury, toxin exposure, diabetes and high cholesterol. Other possible causes include vitamin B deficiency, alcoholism, kidney, liver or thyroid disorders, specific viral or bacterial infections, HIV/AIDS, hepatitis C and more. The onset of symptoms may be gradual but includes muscle weakness or paralysis, sensitivity to touch, burning, tingling or sharp pain and numb extremities.

Testing might include blood work for thyroid, liver, kidney, glucose (sugar), cholesterol and vitamin levels. Electromyography can measure the electrical signals in the peripheral nerves, and a nerve-conduction study will measure how quickly the nerves carry those electrical signals. A CT or MRI, noninvasive X-ray-like images, can determine whether there is a herniated disk, tumor or other abnormality present.

Treatment will depend on the underlying cause of the disorder that must be addressed for relief. Over-the-counter pain relievers, prescription medication and transcutaneous electrical nerve stimulation might be appropriate. Speak with your physician to determine the cause for your neuropathy and, if appropriate, request treatment. He or she knows your medical history and can assist you better than I can.

In the interim, foot massage will aid circulation, exercise should reduce the pain and help control blood-sugar levels, proper diet will ensure the ingestion of essential nutrients, and discontinuing alcohol and cigarettes may improve circulation. There are a number of topical ointments available that contain capsaicin, a warming ingredient that should improve symptoms.

Because I mention two possible causes for the condition, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Diabetes Mellitus.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my Web site at www.AskDrGottMD.com.

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