Ligonier Neuropathy
Ligonier Neuropathy
Did you know Peripheral Neuropathy also interferes with physical coordination and can trigger bladder, digestive, or bowel problems?
Peripheral neuropathy is damage that occurs to the nerves outside of the brain and spinal cord that leaves patients with symptoms such as numbness, tingling, sharp, stabbing, burning pains, and muscle weakness. Neuropathy can also affect the Autonomic Nervous System which can result in other symptoms such as heat intolerance, excessive sweating and changes in bowel, bladder and digestive problems. In order to be properly diagnosed with neuropathy, a complete and full neurological examination and nerve test needs to be performed.There are so many different risk factors for neuropathy, but the most common ones include diabetes, traumatic events, nutritional deficiencies, alcoholism, autoimmune diseases, infections, tumors, certain medications, etc.
The leading Ligonier Neuropathy expert in this treatment, Dr. Larry Wilkins of Wilkins Spinal Care will evaluate your particular condition and recommend a treatment course specific to your needs. He uses state-of-the-art equipment to stimulate nerve health and incorporates nutrition and exercise to positively change blood chemistry.
LIGONIER NEUROPATHY FAQ’S
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1. What is Neuropathy?
A: Dorland's Medical Dictionary defines Neuropathy as a functional disturbance or pathological change in the Peripheral Nervous System (PNS). Sometimes limited to non-inflammatory lesions as opposed to those of neurosis, the etiology (the cause) may or may not be known. Known etiologies include complications of these diseases (such as diabetes) or toxicity states (such as lead or arsenic poisoning). Neuropathy is not a SINGLE disease, but rather a complication found in a number of different underlying medical conditions. It can also be "idiopathic" meaning there is no known cause.
The term Neuropathy is short for Peripheral Neuropathy, meaning nerve damage in the PNS. SO only nerves outside the brain and spinal cord are affected and the Central Nervous System (CNS) is unaffected. Also, it could be a MONOneuropathy (one nerve involved) or a POLYneuropathy (multiple nerves involved).
2. Does everyone who has Diabetes get affected by Neuropathy?
A: No, only about 50-60% of people who have Diabetes will get Neuropathy. But, guidelines for doctors urge them to look out for clinical signs of Neuropathy the first time a diagnosis of Type 2 Diabetes (non-insulin dependent) is made and 5 years after a diagnosis of Type 1 Diabetes (insulin dependent).
So if you have Diabetes and have not yet been checked for neuropathy, give our office a call!
3. How many different causes of Neuropathy are there?
A: According to Dorland's Medical Dictionary, there are 57 causes for Neuropathy. With what we have learned about Neuropathy, there are a great deal more. And not only are there several different causes but also different types of nerves can be affected (see next question). You could have more than one generic cause, such as physical trauma, with a Diabetic Neuropathy or a Toxic Neuropathy with Ischemic Neuropathy. So you can see there's a pretty large number of different causes. The more you read about Neuropathy the more evident this becomes.
4. What nerves are affected by Neuropathy?
A: Three main types of nerves can be involved in Peripheral Neuropathy:
Autonomic Nerves - includes your Sympathetic Nerves and Parasympathetic Nerves, which are responsible for regulating autonomic (unconscious) functions within the body such as heart rate, respiratory rate, blood pressure, sweating, digestion, etc.
Motor Nerves - 31 pairs of nerves that exit spinal column and extend into the periphery (PNS) of the body for conscious, muscular control of the body.
Sensory Nerves - perceive sensations throughout the body (such as heat, cold and pain) and relay these neural messages back to the brain to determine the appropriate response.
Your Cranial Nerves can also be affected by Neuropathy as 10 of the 12 nerves have extensions beyond the brain that can be affected in the periphery. The cranial nerves, along with your motor and sensory nerves make up the Somatic portion of your nervous system - meaning they are associated with voluntary control of body movements via skeletal muscle.
5. What are some of the usual symptoms of Neuropathy?
A: To me, the 3 biggest symptoms of any form of neuropathy is:
1) Pain; 2) Numbness; 3) Loss of balance
Again, must always bear in mind what nerve is affected -
With Autonomic Nerves you may experience heat intolerance, changes in blood pressure or heart rate, stomach problems, and/or bowel or bladder problems.
With Motor Nerves you may experience muscle weakness.
With Sensory Nerves you may experience pain (burning, sharp, stabbing or electrical-like pain), numbness and loss of coordination (3 main symptoms). You can also experience extreme sensitivity to touch and skin, hair and nail changes.
6. Is there an age group or sex that is affected more by Neuropathy?
According to the research, there is no one age group or sex that is more susceptible. However, the literature did mention that Neuropathy symptoms are more likely to begin at age 50 or older.
7. What kinds of treatments are there for patients with Neuropathy?
A: Most of the treatments for Neuropathy are not for the cause but more for managing the symptoms. There are some drugs they use for managing these symptoms and they include:
Gabapentin (Neurotin)
Lyrica (drops used for epilepsy)
Cymbalta & Effexor (antidepressants)
Elavil, Endep, Pamelor & Norpramin (tricyclic antidepressants)
Oxycodone, Tramadol, Ultram (opioid/painkillers)
They are also utilizing different types of surgeries that aim to reduce the pain and numbness/tingling in the arms/hands and legs/feet. According to the patients we have treated who have tried these surgeries, they do no work!
Another consideration when you have Diabetic Neuropathy is to enhance glycemic control by doing things like giving up smoking, cuttingdown on alcohol consumption or not drinking alcohol at all. Also, maintaining a healthy weight and exercising regularly are recommended to help prevent the development of Neuropathy. We will cover specific treatments done in this office in more detail in other questions.
8. What are some of the tests for Neuropathy?
A: The testing most doctors would do for suspected Neuropathy would include a clinical history of the patient followed by a physical exam. They are looking for neurological deficits such as diminished reflexes, loss in muscle strength and tone of skin/muscle, as well as any sensory disturbances such as sharp or light touch. Your posture and coordination should also be checked.
Depending on those findings you would be sent out for 2 types of nerve tests:
An EMG (electromyography) is used to diagnose muscle weakness caused by Neuropathy.
An NCV (Nerve Conduction Velocity) test measures the speed of conduction at which the messages/impules travel through the nerve.
These are the tests most doctors would utilize for a suspected Neuropathy patient.
9. If I have Diabetes, what are some of the things that I can do to prevent Diabetic Neuropathy?
A: As stated before, you have a 50-60% chance of acquiring Diabetic Neuropathy if you have Diabetes. However, there are a few things you can do to help prevent Neuropathy:
- The first is good diabetic management! Watch your glucose levels very carefully! This means paying very close attention to your diet!
- In addition to paying attention to your diet, giving up smoking, cutting down or eliminating alcohol consumption, regular exercise and maintaining a healthy diet are beneficial.
The best advice we can give is to call our office and set up an appointment to go over your blood tests and nutritional intake as there is a very good chance this can help you!
10. What are some of the drugs being used for symptomatic relief of Diabetic Neuropathy?
A: Most of these were covered in Question #7, but we will go into more detail here. The following is a list of common drugs used to treat Diabetic Neuropathy:
* Neurotin, Lyrica, Tegretol - Used to treat epilepsy
* Cymbalta & Effexor - Antidepressants
* Elavil, Pamelor, Norpramin, & Torframil - Tricyclic antidepressants (any group of antidepressants that contain 3 fused rings in their chemical structure)
* Oxycodone, Oxycontin, Tramadol, & Ultrium - opioid pain killers
Opioid's are defined as any synthetic narcotic that has opiate-like qualities but is not derived from opium.
With all these meds and many more, they are only trying to control the pain symptoms of Neuropathy. It does nothing to correct the cause of Neuropathy. The pain meds reduce the pain but allow the numbness and tingling to worsen because the disease continues to progress.
11. What do the term Mononeuropathy and Polyneuropathy mean?
A: Mononeuropathy = one nerve involved
Polyneuropathy = multiple nerves involed
These could pertain to any form of neuropathy that you may have. Bell's Palsy is an example of a Mononeuropathy that affects the face as it targets the 7th cranial nerve.
12. What makes up the Peripheral Nervous System (PNS)?
A: Before we answer that, let us note that the Central Nervous System (CNS) is made up of the brain and spinal cord. Thus the PNS is made up of the nerves and ganglia situated OUTSIDE of the brain and spinal cord. This includes:
1) Cranial Nerves - as stated before, most have extensions beyond the brain and spinal cord affect within the periphery. They are responsible for taste, smell, sight, hearing, etc.
2) Spinal Nerves - connects are CNS with the outside world; they carry sensory and motor information to and from the CNS
3) Autonomic Nervous System - consists of 2 divisions Sympathetic and Parasympathetic and is responsible for blood pressure, heart rate, respiration rate, digestion, etc.
13. How important are my blood tests?
A: We use these a great deal in our office to determine the different causes of Neuropathy and the different organs it may be affecting. When reviewing blood tests the KEY things we look for are A1C levels, anemia, heavy metals, statins, chemical exposure, food sensitivities, diabetes (what type), cholesterol levels, thyroid function, and markers of inflammation. These are but a few of the different things we look for in a blood test.
14. What's the difference between our treatment and the treatment done by your medical doctors?
A: The basic difference as we see it, the medical profession is only working to manage the symptoms of Neuropathy - not with what caused their Neuropathy in the first place. At our office we devise a unique treatment plan based on the patients specific symptoms to treat the root cause - not just the symptoms.
To follow up on this questions, the medications traditionally prescribed are only trying to control the pain symptoms but allow the numbness and tingling to worsen because the disease continues to progress. They do nothing to correct the root cause. At our office we are not trying to control the symptoms; we are trying to correct the cause of your Neuropathy!
15. Could a herniated disc be the cause of my Neuropathy?
A: The short answer is YES! However, we are doctors that love to explain and educate.
How a herniated disc could be the cause of your Neuropathy is the same way it can cause foot drop or sciatica or bowel/bladder dysfunction.... It's the nervous system and is a neurological problem by the disc putting pressure on the affected nerves and can manifest as pain in the back and legs/feet.
These types of cases are solved with 2 types of treatment:
1) Our DRS protocol for herniated discs
2) Our Neuropathy protocol
Please refer back to question 3 and keep in mind that the reasons for Neuropathy are diverse and complicated. The good news to you is we can help!!
16. Could I have a combination of different types of Neuropathy?
A: Almost every person we treat has a combination of different Neuropathies or the same type of Neuropathy but with different nerves involved - either motor, sensory or autonomic. However, we do see patients that have just one cause such as Diabetic, Ischemic or Compression Neuropathy.
To be quite frank, it's usually a combination the patient will present with. It is our job to determine what kind, what nerve and what treatment is needed. This is the reason why we tell patients that they are all different and will be treated as such.
17. What is the A1C test and what is it used for?
A: The A1C test is a common blood test used to diagnose Type 1 and Type 2 Diabetes and then to gauge how well you're managing your Diabetes. The A1C test goes by other names such as Glycated Hemoglobin, Glycosylated Hemoglobin. Hemoglobin A1C and HbA1C.
The A1C test reflects your average blood sugar level for the past 2-3 months. Specifically, the A1C test measures what percentage of your hemoglobin - the protein in red blood cells that carries oxygen - is coated with sugar (glycated). The higher your A1C level the poorer your blood sugar control is and the higher your risk of Diabetes complications.
18. What is a Toronto Test?
A: The Toronto Test is used a lot with patients who have numbness and tingling and loss of sensation in their feet. It's a way of grading how much or how little of Neuropathy the patient has. It is also used in future testing to show improvements the patient may have made with treatment.
The symptoms you are checking for are pain, numbness, tingling, weakness, ataxia, knee and ankle reflexes, pin prick sensation, temperature, light touch sensation, vibration sensation and joint position (proprioception). After the test is completed, it is scored to see if you have Neuropathy and to what degree you have it.
In our office we use this test for every patient suspected of having any form of neuropathy.
19. What does the EMG and NCV show the doctor?
A: An electromyography (EMG) tests the electrical activity of the muscles to evaluate the electrical impulses from the nerves. Dorland's Medical Dictionary defines it as an electro-diagnostic technique for recording the extra cellular activity (action potentials and evolved potentials) of skeletal muscles during voluntary contraction and during electrical stimulation. It is performed using any variety surface electrodes, needle electrodes and devices for amplifying, transmitting and recording the signals.
Nerve Conduction Velocity (NCV) is a test to see how fast electrical signals, or nerve impulses, move along a nerve (nerve damage results in reduced conduction).
Any Peripheral Neuropathy can cause abnormal results. Damage to the spinal cord and disc herniation with nerve root compression can cause abnormal results. It is also important to note that an NCV test shows the condition of the best surviving nerve fibers - meaning this test could be normal and you could still have an underlying problem!
20. What is the Semmes-Weinstein Monofilament Examination (SWME)?
A: The SWME is a non-invasive, low cost, rapid and easy-to-apply test to identify patients at high risk for ulceration or amputation. The monofilaments are applied to test sites on each foot perpendicularly until they bend for about one second. If patient fails to sense monofilament after it bends, the test site is considered to be insensate. The general consensus regarding the definition of loss of protective sensation involves the inability to sense the 5.07/10g Semmes-Weinstein Monoifilament.
The buckling force of this monoifilament, or force felt by the patient when the monofilament bends, is 10 grams. The logarithm of this force in milligrams is the gauge, which is 5.07 for this monofilament. The methods for performing the SWME vary greatly - with differences in the site number of sites and threshold for defining the loss of sensation. Recent meta-analysis of our group has established that a 3-site SWME test involving the plantar aspects of the Great Toe, 3rd Metatarsal and 5th Mettarsal maximizes the sensitivity and specificity of the test in diagnosing Diabetic Peripheral Neuropathy.
21. What is a Pedal Pulse?
A: The Pedal Pulse is an arterial pulse which can be felt on top of the foot and in front of the ankle. It is created by a shockwave that travels along the arterial walls as the heart contracts. The Pedal Pulse is often part of a trauma patient assessment.
In our office, we use it to see if there is blood flowing to the foot. Neuropathy patients have either not enough blood flow or they don't have enough nerves flowing through the feet.
22. What is the primary cause of diabetic foot problems and ulcers?
A: According to Dorland's Medical Dictionary:
Ulcer - A local defect or excavation of the surface of an organ or tissue, which is powered by the sloughing of inflammatory necrotic tissue.
In 41 years of clinical practice, the only time we see these on patients is when they have diabetes - and thankfully we have always been able to heal up the sore(s). What it looks like is an open sore about the size of a quarter that usually starts with a callus. The way we treat these now is with nutrition from the inside out and we also use light therapy as well.
In addition to ulcers, patients may also get neuromas, bunions, and calluses due to the numbness and tingling. Thus, the foot rubbing on the shoe or sock can cause these issues. Most, if not all, of these conditions and symptoms are a result of neuropathy and the fact the patient has very little feeling in the foot. In the U.S., Diabetic Neuropathy is the primary cause of diabetic foot problems and ulcers
Neuroma - a trauma growing from a nerve or made up largely of nerve cells or fibers.
LIGONIER NEUROPATHY
Did you know Peripheral Neuropathy also interferes with physical coordination and can trigger bladder, digestive, or bowel problems?
Peripheral neuropathy is damage that occurs to the nerves outside of the brain and spinal cord that leaves patients with symptoms such as numbness, tingling, sharp, stabbing, burning pains, and muscle weakness. Neuropathy can also affect the Autonomic Nervous System which can result in other symptoms such as heat intolerance, excessive sweating and changes in bowel, bladder and digestive problems. In order to be properly diagnosed with neuropathy, a complete and full neurological examination and nerve test needs to be performed.There are so many different risk factors for neuropathy, but the most common ones include diabetes, traumatic events, nutritional deficiencies, alcoholism, autoimmune diseases, infections, tumors, certain medications, etc.
The leading Ligonier Neuropathy expert in this treatment, Dr. Larry Wilkins of Wilkins Spinal Care will evaluate your particular condition and recommend a treatment course specific to your needs. He uses state-of-the-art equipment to stimulate nerve health and incorporates nutrition and exercise to positively change blood chemistry.
LIGONIER NEUROPATHY FAQ’S
1. What is Neuropathy?
A: Dorland's Medical Dictionary defines Neuropathy as a functional disturbance or pathological change in the Peripheral Nervous System (PNS). Sometimes limited to non-inflammatory lesions as opposed to those of neurosis, the etiology (the cause) may or may not be known. Known etiologies include complications of these diseases (such as diabetes) or toxicity states (such as lead or arsenic poisoning). Neuropathy is not a SINGLE disease, but rather a complication found in a number of different underlying medical conditions. It can also be "idiopathic" meaning there is no known cause.
The term Neuropathy is short for Peripheral Neuropathy, meaning nerve damage in the PNS. SO only nerves outside the brain and spinal cord are affected and the Central Nervous System (CNS) is unaffected. Also, it could be a MONOneuropathy (one nerve involved) or a POLYneuropathy (multiple nerves involved).
2. Does everyone who has Diabetes get affected by Neuropathy?
A: No, only about 50-60% of people who have Diabetes will get Neuropathy. But, guidelines for doctors urge them to look out for clinical signs of Neuropathy the first time a diagnosis of Type 2 Diabetes (non-insulin dependent) is made and 5 years after a diagnosis of Type 1 Diabetes (insulin dependent).
So if you have Diabetes and have not yet been checked for neuropathy, give our office a call!
3. How many different causes of Neuropathy are there?
A: According to Dorland's Medical Dictionary, there are 57 causes for Neuropathy. With what we have learned about Neuropathy, there are a great deal more. And not only are there several different causes but also different types of nerves can be affected (see next question). You could have more than one generic cause, such as physical trauma, with a Diabetic Neuropathy or a Toxic Neuropathy with Ischemic Neuropathy. So you can see there's a pretty large number of different causes. The more you read about Neuropathy the more evident this becomes.
4. What nerves are affected by Neuropathy?
A: Three main types of nerves can be involved in Peripheral Neuropathy:
Autonomic Nerves - includes your Sympathetic Nerves and Parasympathetic Nerves, which are responsible for regulating autonomic (unconscious) functions within the body such as heart rate, respiratory rate, blood pressure, sweating, digestion, etc.
Motor Nerves - 31 pairs of nerves that exit spinal column and extend into the periphery (PNS) of the body for conscious, muscular control of the body.
Sensory Nerves - perceive sensations throughout the body (such as heat, cold and pain) and relay these neural messages back to the brain to determine the appropriate response.
Your Cranial Nerves can also be affected by Neuropathy as 10 of the 12 nerves have extensions beyond the brain that can be affected in the periphery. The cranial nerves, along with your motor and sensory nerves make up the Somatic portion of your nervous system - meaning they are associated with voluntary control of body movements via skeletal muscle.
5. What are some of the usual symptoms of Neuropathy?
A: To me, the 3 biggest symptoms of any form of neuropathy is:
1) Pain; 2) Numbness; 3) Loss of balance
Again, must always bear in mind what nerve is affected -
With Autonomic Nerves you may experience heat intolerance, changes in blood pressure or heart rate, stomach problems, and/or bowel or bladder problems.
With Motor Nerves you may experience muscle weakness.
With Sensory Nerves you may experience pain (burning, sharp, stabbing or electrical-like pain), numbness and loss of coordination (3 main symptoms). You can also experience extreme sensitivity to touch and skin, hair and nail changes.
6. Is there an age group or sex that is affected more by Neuropathy?
According to the research, there is no one age group or sex that is more susceptible. However, the literature did mention that Neuropathy symptoms are more likely to begin at age 50 or older.
7. What kinds of treatments are there for patients with Neuropathy?
A: Most of the treatments for Neuropathy are not for the cause but more for managing the symptoms. There are some drugs they use for managing these symptoms and they include:
Gabapentin (Neurotin)
Lyrica (drops used for epilepsy)
Cymbalta & Effexor (antidepressants)
Elavil, Endep, Pamelor & Norpramin (tricyclic antidepressants)
Oxycodone, Tramadol, Ultram (opioid/painkillers)
They are also utilizing different types of surgeries that aim to reduce the pain and numbness/tingling in the arms/hands and legs/feet. According to the patients we have treated who have tried these surgeries, they do no work!
Another consideration when you have Diabetic Neuropathy is to enhance glycemic control by doing things like giving up smoking, cuttingdown on alcohol consumption or not drinking alcohol at all. Also, maintaining a healthy weight and exercising regularly are recommended to help prevent the development of Neuropathy. We will cover specific treatments done in this office in more detail in other questions.
8. What are some of the tests for Neuropathy?
A: The testing most doctors would do for suspected Neuropathy would include a clinical history of the patient followed by a physical exam. They are looking for neurological deficits such as diminished reflexes, loss in muscle strength and tone of skin/muscle, as well as any sensory disturbances such as sharp or light touch. Your posture and coordination should also be checked.
Depending on those findings you would be sent out for 2 types of nerve tests:
An EMG (electromyography) is used to diagnose muscle weakness caused by Neuropathy.
An NCV (Nerve Conduction Velocity) test measures the speed of conduction at which the messages/impules travel through the nerve.
These are the tests most doctors would utilize for a suspected Neuropathy patient.
9. If I have Diabetes, what are some of the things that I can do to prevent Diabetic Neuropathy?
A: As stated before, you have a 50-60% chance of acquiring Diabetic Neuropathy if you have Diabetes. However, there are a few things you can do to help prevent Neuropathy:
- The first is good diabetic management! Watch your glucose levels very carefully! This means paying very close attention to your diet!
- In addition to paying attention to your diet, giving up smoking, cutting down or eliminating alcohol consumption, regular exercise and maintaining a healthy diet are beneficial.
The best advice we can give is to call our office and set up an appointment to go over your blood tests and nutritional intake as there is a very good chance this can help you!
10. What are some of the drugs being used for symptomatic relief of Diabetic Neuropathy?
A: Most of these were covered in Question #7, but we will go into more detail here. The following is a list of common drugs used to treat Diabetic Neuropathy:
* Neurotin, Lyrica, Tegretol - Used to treat epilepsy
* Cymbalta & Effexor - Antidepressants
* Elavil, Pamelor, Norpramin, & Torframil - Tricyclic antidepressants (any group of antidepressants that contain 3 fused rings in their chemical structure)
* Oxycodone, Oxycontin, Tramadol, & Ultrium - opioid pain killers
Opioid's are defined as any synthetic narcotic that has opiate-like qualities but is not derived from opium.
With all these meds and many more, they are only trying to control the pain symptoms of Neuropathy. It does nothing to correct the cause of Neuropathy. The pain meds reduce the pain but allow the numbness and tingling to worsen because the disease continues to progress.
11. What do the term Mononeuropathy and Polyneuropathy mean?
A: Mononeuropathy = one nerve involved
Polyneuropathy = multiple nerves involed
These could pertain to any form of neuropathy that you may have. Bell's Palsy is an example of a Mononeuropathy that affects the face as it targets the 7th cranial nerve.
12. What makes up the Peripheral Nervous System (PNS)?
A: Before we answer that, let us note that the Central Nervous System (CNS) is made up of the brain and spinal cord. Thus the PNS is made up of the nerves and ganglia situated OUTSIDE of the brain and spinal cord. This includes:
1) Cranial Nerves - as stated before, most have extensions beyond the brain and spinal cord affect within the periphery. They are responsible for taste, smell, sight, hearing, etc.
2) Spinal Nerves - connects are CNS with the outside world; they carry sensory and motor information to and from the CNS
3) Autonomic Nervous System - consists of 2 divisions Sympathetic and Parasympathetic and is responsible for blood pressure, heart rate, respiration rate, digestion, etc.
13. How important are my blood tests?
A: We use these a great deal in our office to determine the different causes of Neuropathy and the different organs it may be affecting. When reviewing blood tests the KEY things we look for are A1C levels, anemia, heavy metals, statins, chemical exposure, food sensitivities, diabetes (what type), cholesterol levels, thyroid function, and markers of inflammation. These are but a few of the different things we look for in a blood test.
14. What's the difference between our treatment and the treatment done by your medical doctors?
A: The basic difference as we see it, the medical profession is only working to manage the symptoms of Neuropathy - not with what caused their Neuropathy in the first place. At our office we devise a unique treatment plan based on the patients specific symptoms to treat the root cause - not just the symptoms.
To follow up on this questions, the medications traditionally prescribed are only trying to control the pain symptoms but allow the numbness and tingling to worsen because the disease continues to progress. They do nothing to correct the root cause. At our office we are not trying to control the symptoms; we are trying to correct the cause of your Neuropathy!
15. Could a herniated disc be the cause of my Neuropathy?
A: The short answer is YES! However, we are doctors that love to explain and educate.
How a herniated disc could be the cause of your Neuropathy is the same way it can cause foot drop or sciatica or bowel/bladder dysfunction.... It's the nervous system and is a neurological problem by the disc putting pressure on the affected nerves and can manifest as pain in the back and legs/feet.
These types of cases are solved with 2 types of treatment:
1) Our DRS protocol for herniated discs
2) Our Neuropathy protocol
Please refer back to question 3 and keep in mind that the reasons for Neuropathy are diverse and complicated. The good news to you is we can help!!
16. Could I have a combination of different types of Neuropathy?
A: Almost every person we treat has a combination of different Neuropathies or the same type of Neuropathy but with different nerves involved - either motor, sensory or autonomic. However, we do see patients that have just one cause such as Diabetic, Ischemic or Compression Neuropathy.
To be quite frank, it's usually a combination the patient will present with. It is our job to determine what kind, what nerve and what treatment is needed. This is the reason why we tell patients that they are all different and will be treated as such.
17. What is the A1C test and what is it used for?
A: The A1C test is a common blood test used to diagnose Type 1 and Type 2 Diabetes and then to gauge how well you're managing your Diabetes. The A1C test goes by other names such as Glycated Hemoglobin, Glycosylated Hemoglobin. Hemoglobin A1C and HbA1C.
The A1C test reflects your average blood sugar level for the past 2-3 months. Specifically, the A1C test measures what percentage of your hemoglobin - the protein in red blood cells that carries oxygen - is coated with sugar (glycated). The higher your A1C level the poorer your blood sugar control is and the higher your risk of Diabetes complications.
18. What is a Toronto Test?
A: The Toronto Test is used a lot with patients who have numbness and tingling and loss of sensation in their feet. It's a way of grading how much or how little of Neuropathy the patient has. It is also used in future testing to show improvements the patient may have made with treatment.
The symptoms you are checking for are pain, numbness, tingling, weakness, ataxia, knee and ankle reflexes, pin prick sensation, temperature, light touch sensation, vibration sensation and joint position (proprioception). After the test is completed, it is scored to see if you have Neuropathy and to what degree you have it.
In our office we use this test for every patient suspected of having any form of neuropathy.
19. What does the EMG and NCV show the doctor?
A: An electromyography (EMG) tests the electrical activity of the muscles to evaluate the electrical impulses from the nerves. Dorland's Medical Dictionary defines it as an electro-diagnostic technique for recording the extra cellular activity (action potentials and evolved potentials) of skeletal muscles during voluntary contraction and during electrical stimulation. It is performed using any variety surface electrodes, needle electrodes and devices for amplifying, transmitting and recording the signals.
Nerve Conduction Velocity (NCV) is a test to see how fast electrical signals, or nerve impulses, move along a nerve (nerve damage results in reduced conduction).
Any Peripheral Neuropathy can cause abnormal results. Damage to the spinal cord and disc herniation with nerve root compression can cause abnormal results. It is also important to note that an NCV test shows the condition of the best surviving nerve fibers - meaning this test could be normal and you could still have an underlying problem!
20. What is the Semmes-Weinstein Monofilament Examination (SWME)?
A: The SWME is a non-invasive, low cost, rapid and easy-to-apply test to identify patients at high risk for ulceration or amputation. The monofilaments are applied to test sites on each foot perpendicularly until they bend for about one second. If patient fails to sense monofilament after it bends, the test site is considered to be insensate. The general consensus regarding the definition of loss of protective sensation involves the inability to sense the 5.07/10g Semmes-Weinstein Monoifilament.
The buckling force of this monoifilament, or force felt by the patient when the monofilament bends, is 10 grams. The logarithm of this force in milligrams is the gauge, which is 5.07 for this monofilament. The methods for performing the SWME vary greatly - with differences in the site number of sites and threshold for defining the loss of sensation. Recent meta-analysis of our group has established that a 3-site SWME test involving the plantar aspects of the Great Toe, 3rd Metatarsal and 5th Mettarsal maximizes the sensitivity and specificity of the test in diagnosing Diabetic Peripheral Neuropathy.
21. What is a Pedal Pulse?
A: The Pedal Pulse is an arterial pulse which can be felt on top of the foot and in front of the ankle. It is created by a shockwave that travels along the arterial walls as the heart contracts. The Pedal Pulse is often part of a trauma patient assessment.
In our office, we use it to see if there is blood flowing to the foot. Neuropathy patients have either not enough blood flow or they don't have enough nerves flowing through the feet.
22. What is the primary cause of diabetic foot problems and ulcers?
A: According to Dorland's Medical Dictionary:
Ulcer - A local defect or excavation of the surface of an organ or tissue, which is powered by the sloughing of inflammatory necrotic tissue.
In 41 years of clinical practice, the only time we see these on patients is when they have diabetes - and thankfully we have always been able to heal up the sore(s). What it looks like is an open sore about the size of a quarter that usually starts with a callus. The way we treat these now is with nutrition from the inside out and we also use light therapy as well.
In addition to ulcers, patients may also get neuromas, bunions, and calluses due to the numbness and tingling. Thus, the foot rubbing on the shoe or sock can cause these issues. Most, if not all, of these conditions and symptoms are a result of neuropathy and the fact the patient has very little feeling in the foot. In the U.S., Diabetic Neuropathy is the primary cause of diabetic foot problems and ulcers
Neuroma - a trauma growing from a nerve or made up largely of nerve cells or fibers.
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