Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interestingcondition 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 nerveconduction study. So what I tell patients and actually residents or students who trainunder us is that a normal nerve conduction study does not exclude a neuropathy. And wewill confirm this by doing additional testing, specifically the nervous the the examinationat the bedside asking patients about their symptoms, for example, loss of sensation tocool or or hot temperatures, loss of pain sensation and also doing skin biopsies wherewe look at nerve densities in the skin both
from the calf and the thigh as well as doinga special test that looks at sweat function both in your foot in in the legs as well asthe feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typicallywill progress unless the underlying cause is identified and reversed. Diabetes of coursebeing the most common cause is always screened for. But once the more common causes are excludedand the focus becomes on excluding any underlying secondary disease process but also controllingpain because if patients' symptoms of pain are generally controlled they tend to do prettywell and really have no other major functional deficits. I've really become interested overthe years is how interconnected neurology
and rheumatology are and one thing I oftendo on patients who have unexplained small fiber even autonomic neuropathy is have themsee rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren's orsarcoid and sometimes even if we are not directly involved in treating the patients, this canbe the first sign of an underlying connective tissue disorder that can then be brought tothe attention of rheumatology and addressed from their standpoint.
PreDiabetic Peripheral Neuropathy Randall Gates Power Health Talk
Hello, I am Randall Gates. I am a chiropractor,as well as being a board certified chiropractic neurologist. We work with patients who have have peripheralneuropathy on a very common basis. It's actually the majority of our case load. What we areseeing is that, in our al practice certain neuropathy patients can be helped. So lets pause there. You are watching thisbecause you likely know something about prediabetes and peripheral neuropathy. You may know morethan what your s know about this condition. I'm not saying that in a denigration fashion.It's just that this is a relatively new finding
and we will get to that. So what is peripheral neuropathy? Peripheralneuropathy is basically where patients commonly have numbness, tingling and or burning intheir feet, maybe spreading up to their knees and maybe involving their hands. Yes, thereare many other kinds of peripheral neuropathy but they're not what we are commonly talkingabout here. So for those with blood sugar disorders, we'veknown for a long period of time that diabetes causes peripheral neuropathy. The currentstatistics estimate that for those withperipheral neuropathy, diabetes counts for half of that.In our al experience many types of patients
with peripheral neuropathy are told it's yourdiabetes half the time or we don't know the cause the other half of the time. We can runlots of lab tests but we are not going to figure it out. You just have to go home andlive with it because there is really nothing we can do for you anyway. Those are commonly the accounts patients getfrom their medical peripheral neuropathy or their medical general practitioner. Whilethat may have been true some time ago, a new research is coming out that patients withperipheral neuropathy can be helped. So I'm just going to stop there.
So now lets go into prediabetes. The literaturestarted coming out late 1990s early 2000s. This prediabetic peripheral neuropathy hasreally been discovered by two gentlemen out of the Universtiy of Utah, Gordon Smithand Robinson Singleton. These are two neurologists from the University of Utah,which is a specialty center, where they started showing that prediabetes can cause peripheral neuropathy. We thought diabetes counts for half of peripheralneuropathy patients in America. They are now showing that prediabetes can account fora significant percentage. This statistic varies from 10% but I've seen it as high as 30%,which I think is a little too high. Prediabetes
can account for a significant percentage ofthose cases of idopathic peripheral neuropathy or cryptogenic peripheral neuropathies, whichbasically means we don't know the cause of it. So we are now seeing that prediabetescan cause peripheral neuropathy. How does it do that? Well, when someone hasprediabetes, in essence what happens is that they have periods where their blood sugargoes too high. It is not too high all the time as is commonly the case in an unmanagedcase of diabetes. So let's say you go have your feast of pasta and bread, you go to anice Italian dinner, and if you are moving into a prediabetic state there is a possibilitythat you just cant make enough insulin to
get that sugar into yourself. So insulin takessugar from our blood stream and puts it into our muscle cells or our fat cells. So in essence, in prediabetes you eat thathigh carbohydrate meal and sugar goes a little too high. When that sugar goes a little toohigh, there are three tissues in the body that can't get sugar out of them. The retina,the kidney and peripheral nerves and nerve tissue basically. If you can't get sugar out,the problem is that sugar gets converted into a substance that attracts water. So now thosewith prediabetes, we are seeing that they can pull water into the nerves. That can causethe nerves to start to dysfunction.