Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.

Working Together to Manage Diabetes A Toolkit for Pharmacy Podiatry Optometry and Dentistry

I am Pam Allweiss,an endocrinologist with the CDC Division ofDiabetes Translation. I would like to welcomeyou to this webinar. Today PPOD is not a vegetable;it's a wonderful team of passionate providers whohave come together to develop materials and a webinar toillustrate how team care for people with diabetescan become a reality. They energize all of us, and weare trying to walk the walk when

it comes to team care. You can see all oftheir bios on the screen. PPOD providers may bethe first person who sees somebody with diabetes. Our goal is to have teamcare on your radar screen. We are not trying to makeoptometrists into podiatrists. Some general points:The materials arethe public domain; no copyright.

Please copy as you wish;download themyour office. There are materials forproviders and for patients, which have been pilot tested inmany of our provider's offices. For instance, we have apatient checklist that has been developed and evaluatedby our PPOD providers, as well as by primarycare providers such as family practice docs,nurse practitioners, etc. Everything will be availableon the Web site, including

the slides and therecording of this webinar. At the end, we will answergeneral questions and, eventually, all questionsthat you submit to us will be answered. I have two requests: Pleasestay connected at the end and fill out the quick surveyabout today's webinar, and then please, please fillout the survey that will arriveyour boxa fewweeks to evaluate if there has

been any changehowyou practice team care. We really need theinformation to help us evaluate what we aredoing and to improve. Now, I would like to turn itover to Dennis Frisch. Thank you, Dennis. Frisch: Thank you,and thank you, everybody, for taking some time out of yourday to learn about team care. In this section, we are going tolearn about the NDEP, which is

the National DiabetesEduion Program, the scope of diabetesthe U.S., andthe PPOD team care approach: what it is andwhy it's important. So, what is the NDEP? The NDEP was established1997as an initiative of the U.S. Department of Healthand Human Services. It was established to promoteearly diagnosis of diabetes, improve the management of thedisease and its outcomes, and