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Taking on Challenging Cases

Peripheral Neuropathy

Neuropathy has been one of the lesser understood conditions in the general public for generations now. What is it? Why do I have it? How do I get rid of it? A few of these questions, with the help of experts and a great deal of research, can finally be answered.

Neuropathy is a vague term that breaks down into “Neuro” (involving a nerve) and “pathy”, which is short for pathology or a dis-eased state. This spectrum is far too broad to cover in this article. What we are primarily focused on, both in this article and in our offices, is peripheral neuropathy (also abbreviated as PN)

PN has a spectrum of symptoms and presentations. Most of the cases we see are losing feeling in the feet and are often seeing their sense of balance deteriorating. The other common presentation is burning, aching, and tingling. As odd as it sounds, both numbness and pain can be present at the same time.

An important distinction that we must assess in the office is to rule out the possibility of a different condition called “Radiculopathy”. A radiculopathy is a pinched nerve, commonly coming from the back/neck or a joint space where nerves could potentially get squeezed. We are still very capable of treating these cases, but careful diligence is necessary to determine which problem our patients are suffering from.

Peripheral neuropathy affects approximately 8% of the population over the age of 55 (NIH.gov). The most common cause is credited to Diabetes Mellitus. I would like to take this opportunity to say that diabetes is not the only cause. The latest research has been compiling a list of over 140 known contributing factors leading to the development of PN.

Outside of Diabetes, some of the more common causes of peripheral neuropathy we have seen in the offices are chemotherapy, agent orange exposure, agricultural and industrial chemical exposure, properly prescribed medications like frequent antibiotics (ciprofloxacin) and long-term use of statins, and occasionally surgeries.

The process, involving most neuropathy cases, is similar in nature. Something causing high levels of inflammation circulates into the micro-capillaries of the extremities (usually lower extremities). Think of micro-capillaries as the smallest level of the circulatory system. An analogy of the circulatory system would be like pulling a large weed out of the ground. There is a main trunk, larger branches, and tiny little hair-like roots where most of the water and nutrients are absorbed. In the body, those micro-capillaries are analogous to those hair-like roots. Our cellular oxygen and nutrient exchange take place largely at this level. The inflammation causes these small blood vessels to constrict and close off. This causes damage to the nerve, in time leading to a condition called demyelination. Demyelination is where the vital coatings of the nerve start breaking down. Once we get to this stage, symptoms are very progressive

In cases where the nerve is cut or damaged by trauma or surgery, nerves may repair on their own in 12-18 months. If the nerve symptoms don’t resolve on their own after 18 months. Aggressive treatment may be indicated. Positive outcomes are still observed in most cases with treatment.

Now that we understand how most neuropathies occur, we can discuss treatment options. The traditional management for neuropathy is pharmaceutical. Most patients will be prescribed Gabapentin or Neurontin. These are anti-seizure medications, but they have shown to de-sensitize many nerve problems. Lyrica and Cymbalta are also commonly prescribed. The problem with this type of symptom management is it does not address any of the underlying problems. As such, the disease will continue to progress until the patient is often told that nothing can be done, and they should learn to live with it. Worth noting, thousands of amputations are taking place every year due to diabetic neuropathy.

Treatment for peripheral neuropathy is MOST effective when all three root components are addressed. We target inflammation, vascular compromise, and the nerve damage with a combination of therapies which take place at home and in-office. We use FDA-cleared durable medical equipment which will go home with the patient, as well as natural products to support vascular and nerve function. Our in-office treatments help speed recovery. Correcting neuropathy takes time but we carefully set expectations for each patient and accomplish our goals in excess of 90% of cases.

If you or a loved one is suffering from peripheral neuropathy, know there IS help. Carolina West Clinic may be the most important phone call you can make. Please don’t hesitate to schedule a consultation with one of our doctors. We have convenient locations in Lexington and Newberry.

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