Hey guys, welcome back, kevin here. we’re going to do an educational segment today on peripheral neuropathy, so those of you that suffer with this can really understand the basically the life cycle, the continuum of neuropathy. First of all a couple of definitions; neuropathy means death or damage to any of the millions of nerves of our body. Continuum progressively getting worse. Our nervous system consists of two parts the central nervous system, brain spinal cord, it’s like the trunk of the tree. The brain is protected.
By the bones of the skull, the spinal cord is protected by the twenty four bones of the back. Between every two bones there is a pair of nerves that come out on both sides called the peripheral nerve, or ‘totheside nerve’, these nerves are large, maybe half as big around as this pen, going all the way down to spiderweb size; but all of them are wrapped in a fatty protective coating called myelin, it’s like the bark on the branch of a tree. Trunk of the tree, branches, nerves that go to every organ, every tissue, every cell of.
The entire body, controlling and coordinately all aspects of human life by the electrical messages from the brain. At the end of the branches, there are small three nerve endings, microscopic in size, living in all the layers of the skin, from the top of your head to the tips of your toes, but far in a way most densely packed in your feet, your hands and your face. These nerves have the density of approximately one hundred and fifty thousand free nerve endings for every one inch of skin on your feet hands and face. Because they.
Live in the layers of the skin, and the skin is always coming off, there’s a certain amount of these nerves that die normally every day. There’s also a certain amount that are regenerated or born every day, as long as the birth and death rate are the same there is no problem, when there’s more death than birth, that’s small fiber peripheral neuropathy, basically knocking out these little leaves. What are the main causes? Diabetes, by far in a way the most common cause of small fiber peripheral neuropathy. Chemotherapy survivors; people.
That have been through chemotherapy and survived. certain medications such as statin drugs, or cholesterol lowering medications, antifungal oral medications, immunosuppressive disease medications (such as AIDs medications). People that were exposed to things like Agent Orange in the military. Those are your top causes of peripheral neuropathy and not also to be excluded is spinal considerations; damage to the trunk of the tree. Disc bulge, herniation, stenosis, arthritis; those account for approximately fifty percent of the thirty million sufferers.
Of neuropathy. what about the other fifty percent? the other fifty percent is called idiopathic unknown cause. The continuum of neuropathy consists of numbness, which then translates into lack of sense of balance. Last year two thousand and fifteen, fifty thousand falls had caused fatality in America in the ages sixtyfive and over. Loss of temperature control you can’t tell cold from hot or hot from cold, it’s a bit of a rheostat problem. Loss of movement in the toes or ankles and commonly but not always worse at night. Inability.
To have a full night’s sleep because of the burning, tingling, numbness, pins and needles in the feet. This is considered the mild side of neuropathy. Doesn’t sound mild, but it is. That’s the mild side, it gets much worse. This goes to fifty percent loss. Once you’ve lost over fifty percent of the one hundred fifty thousand nerve endings, now you accentuate, you go over to the moderate side of neuropathy. Here’s where the phantom pains of neuropathy really start to accentuate. Now we start to experience burning pain, but the foot’s not.
Hot to touch. or freezing pain, and it might be hot; i had one patient that put their foot on the glass of their fireplace and gave themselves second and third degree burns and didn’t even feel it. The numbness could be so complete; I had another patient step right through a framing nail, a three inch framing nail, went right through their foot, they walked off of it, didn’t even feel it, walked around the house on the white carpet, bled everywhere of course his wife was quite upset about that! Pins and needles that you can’t stomp.
Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interesting condition because it consists typically of just burning, numbness, pain of the feet, sometimes the hands later on without necessarily having any abnormalities on your EMG or nerve conduction study. So what I tell patients and actually residents or students who train under us is that a normal nerve conduction study does not exclude a neuropathy. And we will confirm this by doing additional testing, specifically the nervous the the examination at the bedside asking patients about their.
Symptoms, for example, loss of sensation to cool or or hot temperatures, loss of pain sensation and also doing skin biopsies where we look at nerve densities in the skin both from the calf and the thigh as well as doing a special test that looks at sweat function both in your foot in in the legs as well as the feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typically will progress unless the underlying cause is identified and reversed. Diabetes of course being the most common cause is always screened.
For. but once the more common causes are excluded and the focus becomes on excluding any underlying secondary disease process but also controlling pain because if patients’ symptoms of pain are generally controlled they tend to do pretty well and really have no other major functional deficits. I’ve really become interested over the years is how interconnected neurology and rheumatology are and one thing I often do on patients who have unexplained small fiber even autonomic neuropathy is have them see rheumatology or get evaluated for connective.