It’s Not Your Hands and Feet; It’s Your Brain.

Here I sit feeling so incredibly pleased that I don’t have pancreatic cancer anymore. Yet, at the same time, I’m so very displeased with the neuropathy that has me using a cane and causing my fingers to hit between the keys on the keyboard instead of on them. I’ve already mentioned in a previous blog that this is a brain connection problem. Today, I’d like to explore that more.

Let’s start with something simple before we wade into what I suspect is going to be complex. Lexico’s English Dictionary at https://www.lexico.com/en/definition/neuropathy tells us neuropathy is,

“Disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness.”

I get the numbness or weakness, but what are peripheral nerves? I went to WebMD at https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#1 for help.

“The name of the condition tells you a bit about what it is:

Peripheral: Beyond (in this case, beyond the brain and the spinal cord.)
Neuro-: Related to the nerves
-pathy: Disease

Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased.

The peripheral nerves make up an intricate network that connects the brain and spinal cord to the muscles, skin, and internal organs. Peripheral nerves come out of the spinal cord and are arranged along lines in the body called dermatomes. Typically, damage to a nerve will affect one or more dermatomes, which can be tracked to specific areas of the body. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain.”

Let’s see if we can find out what these nerves are. The Cleveland Clinic at https://my.clevelandclinic.org/health/diseases/14737-neuropathy has an easily understood answer for us,

“The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.

  • Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.
  • Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.
  • Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body’s temperature from rising too high.

The type of symptoms you feel depend on the type of nerve that is damaged.”

Now the biggie: What causes neuropathy? MedicineNet at https://www.medicinenet.com/peripheral_neuropathy/article.htm was right there with an answer.

  1. Diabetes mellitus
  2. Shingles (post herpetic neuralgia)
  3. Vitamin deficiency, particularly B12 and folate
  4. Alcohol
  5. Autoimmune diseases, including lupusrheumatoid arthritis or Guillain-Barre syndrome
  6. AIDS, whether from the disease or its treatment, syphilis, and kidney failure
  7. Inherited disorders, such as amyloid polyneuropathy or Charcot-Marie-Tooth disease
  8. Exposure to toxins, such as heavy metals, gold compounds, lead, arsenic, mercury, and organophosphate pesticides
  9. Cancer therapy drugs such as vincristine (Oncovin and Vincasar) and other medications, such as antibiotics including metronidazole (Flagyl) and isoniazid
  10. Rarely, diseases such as neurofibromatosis can lead to peripheral neuropathy. Other rare congenital neuropathies include Fabry disease, Tangier disease, hereditary sensory autonomic neuropathy, and hereditary amyloidosis.
  11. Statin medications have been linked to peripheral neuropathy, although neuropathy caused by statins only rarely causes symptoms.

While diabetes and postherpetic neuralgia are the most common causes of peripheral neuropathy, oftentimes no cause is found. In these situations, it is referred to as idiopathic peripheral neuropathy.”

Uh-oh, diabetes, Vitamin B12 deficiency, cancer therapy drugs, antibiotics, and statins. Any of these could have caused my neuropathy. Since many Chronic Kidney Disease patients develop diabetes (which is also the foremost cause of CKD), you need to keep your eyes open for the symptoms.

Of course, knowing the symptoms would be helpful. The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 explains:

“Signs and symptoms of peripheral neuropathy might include:

  • Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
  • Sharp, jabbing, throbbing or burning pain
  • Extreme sensitivity to touch
  • Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
  • Lack of coordination and falling
  • Muscle weakness
  • Feeling as if you’re wearing gloves or socks when you’re not
  • Paralysis if motor nerves are affected

If autonomic nerves are affected, signs and symptoms might include:

  • Heat intolerance
  • Excessive sweating or not being able to sweat
  • Bowel, bladder or digestive problems
  • Changes in blood pressure, causing dizziness or lightheadedness”

Treatment may be any number of things. Medical News Today at https://www.medicalnewstoday.com/articles/147963#treatment elucidates for us:

“Treatment either targets the underlying cause, or it aims to provide symptomatic pain relief and prevent further damage.

In the case of diabetic neuropathy, addressing high blood sugars can prevent further nerve damage.

For toxic causes, removing the exposure to a suspected toxin, or stopping a drug, can halt further nerve damage.

Medications can relieve pain and reduce burning, numbness, and tingling.

Drug treatment for neuropathic pain

Medications that may help include:

  • drugs normally used for epilepsy, such as carbamazepine
  • antidepressants, such as venlafaxine
  • opioid painkillers, for example, oxycodone or tramadol

Opioid painkillers come with warnings about safety risks.

Duloxetine may help people with chemotherapy-induced neuropathy.

Doctors can also prescribe skin patches, such as Lidoderm, for temporary, localized pain relief. This contains the local anesthetic lidocaine. The patches are like bandages, and they can be cut to size.

The choice of drug should take into account medications for other conditions, to avoid unwanted interactions.”

Before I close, do you remember my writing about Flavis’s low protein products? We combined their penne with Bear’s signature ground turkey spaghetti sauce and it was exquisite. I’m not one for heavy pasta, so I really liked how light and delicate it tasted.

Until next week,

Keep living your life!

Neurology –> Neuropathy –> New To Me

With all the medical messes at my house lately, I hadn’t expected yet another one.  You’ve been reading about the established ones and how they affect Chronic Kidney Disease.  Here’s the new one: neuropathy.

I can’t tell you how long it took for me to simply pronounce the word correctly. I knew neuro comes from the Latin for nerve and pathy, also from Latin, is a “word-forming element meaning feeling, suffering, emotion, disorder, disease.” (Thanks for the help on pathy goes to The Online Etymology Dictionary at: http://www.etymonline.com/index.php?term=-pathy&allowed_in_frame=0.) There was no connect in my brain until my family doctor sent me to a neurologist.

Why you ask?  I wondered aloud in her office why I was feeling such tingling in both of my hands and, sometimes, my feet.  I found no discernible pattern to the tingling, although I could tell it was stronger in the hands than the feet.sad

Next thing I knew, I had an appointment with Dr. Maninder S. Kahlon at his Arizona Neurological Institute, better known as ANI, all the way out in Sun City.  That’s a bit away, but I agreed to the drive because Dr. Zhao recommended him so highly.  That’s also why I agreed to a male doctor when I usually prefer females.

This turned out to be a good move.  Dr. Kahlon is not only a good neurologist, but charming.  Now while that’s not usually my criteria for choosing a doctor, it was very necessary in this case since it was deemed necessary to have EMGs on both my upper and lower extremities.

EMG means Electromyography. Big help, huh? Back to basics (Yes, I do know how often I use that phrase, but let’s face it: you can’t build a house without a foundation.). According to eMedicineHealth at http://www.emedicinehealth.com/electromyography_emg/article_em.htm, “… electromyography involves testing the electrical activity of muscles. “

Next question: why in heaven’s name would anyone want to do that? I suspected it might have to do with a trapped nerve since I’d had carpal tunnel surgery 27 years ago and remembered a little bit of the process for diagnosing it.carpal tunnel

MedicineNet.com at http://www.medicinenet.com/electromyogram/article.htm answered that one for me: “When muscles are active, they produce an electrical current. This current is usually proportional to the level of the muscle activity.”    

So did that mean I had carpal tunnel again?  Oh, sorry, carpal tunnel is when the median (middle) nerve in your wrist is trapped by the ligament.  Ligament surgery was pretty painful.  I’m hoping things have improved in the last 27 years… just in case, you understand.

Back to why.  I found an answer I could live with on my old friend The Mayo Clinic’s website at http://www.mayoclinic.com/health/emg/MY00107/DSECTION=why-its-done:

“EMG results are often necessary to help diagnose or rule out a number of conditions such as:

  • Muscle disorders, such as muscular dystrophy or polymyositis
  • Diseases affecting the connection between the nerve and the muscle, such as myasthenia gravis
  • Disorders of nerves outside the spinal cord (peripheral nerves), such as carpal tunnel syndrome or peripheral neuropathies
  • Disorders that affect the motor neurons in the brain or spinal cord, such as amyotrophic lateral sclerosis or polio
  • Disorders that affect the nerve root, such as a herniated disk in the spine”

I was floored.  I hadn’t remembered that both my family physician and Dr. Kahlon explained this.  I only concentrated on the possible carpal tunnel.  Come to think of it, it would have had to be something else in my feet.  Lesson learned; you need to keep reminding yourself to listen to your doctors’ explanations even if you think you know the information already.

Scuttlebutt had it that this was a very painful test, but Dr. Kahlon distracted me with a constant stream of chatter about CKD, neurology, families, and even Landmark while he worked on my lower extremities. By the next day, we’re weren’t chattering anymore but having serious discussions.  This distracted me so much that I was barely aware of what he was doing.

Thank you, Dr. Kahlon from a stoic coward, which means I bear with the pain, but I hate the thought of it. This time, pain wasn’t a problem.

Time to tell you what the good doctor actually did to me. I was asked not to use any lotions or creams the days of the tests.  When we were ready to start, Dr. Kahlon asked me to lay down for the lower extremities test and sit up on the examination table for the upper extremities test.

EMG needlesFrom my side, the tests were simple.  First, electrodes were applied to different parts of my legs or arms (depending on which were being tested that day). Once he had recorded the readings from the electrodes, he pierced my skin with needles.  I cannot say any of this hurt, but there was some discomfort.

Bear had the test years ago and had expected me to come home in extreme pain.  Instead, I went to meet a friend for coffee one day and to the Landmark Center the other.  It really didn’t hurt.

Dr. Kahlon gave me the results of both days’ tests as well as those of the blood test he’d ordered for TSH, B12, folate, and vitamin D.  Apparently, a deficit of any of these could cause the tingling I had. None of my readings for these elements were out of range.

What I really got a kick out of was watching him use Dragon Medical to write his notes.  That’s the doctors’ version of the same program I’ve been struggling with since Christmas!

So far, I don’t need anything.  He suggested a follow up visit.  I suggested ten years.  He didn’t laugh.  I suggested a year.  He still didn’t laugh and told me six months would do.  I guess being on the borderline of having carpal tunnel is more serious than I thought.

How does this impact CKD?  There is medication that can help, but I didn’t want to discuss it yet since it is eliminated via the kidneys. I’ve become pretty good at doing without medication these days.  More on that should it come to a point when it’s a necessity.

Book news!  I have just paid off the cost for printing the book.  I’m going to keep this little game up, though.  Now I want to recoup the cost for converting the book to digital form.  You know I’m still going to keep donating, no matter how much I recoup or not.  I am thankful to have the money to be able to do this.Book Cover

Until next week,

Keep living your life!