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.
Types of pulmonary diseases
Voiceover: So the job of our lungs on a pretty general level is to take blood, that's without oxygen that our bodies have used up. So I'm going to use bluehere to represent that. To take that blood andto put oxygen in it, and it comes out as oxygenated, which is red blood.
I mean blood without oxygengets a little darker, that's why conventionally we think of it as blue versus red. And from there the heart pumps this blood to the rest of the body. So in a nutshell, that'swhat the lungs do. And to do that, they grab oxygen from the atmosphere
and take the carbon dioxide from the blood and blow it out. Co2, carbon dioxide. And this exchange really is a full picture of what you do with every breath. Now in terms of how the lungs do this, let's talk about thestructure first for a bit. I think it looks kind oflike an upside down tree,
just because all thesebranches keep getting smaller and smaller as we reached the terminal branches. I mean there's 20 or 30 levels here, I can't draw them all, but you get the idea,they keep branching off. And at the end, we've reached this units called alveoli.
Let me write that word for you, alveoli. Which is plural for alveolus. And what that is essentially an air sac. Let's blow that up down here. So the alveolus looks kind of like a bulb, is an air sac, it has very thin walls, and laying along the walls, almost, almost in contact but not quite,
is the blood supply. This is how things get from our blood to the lungs and back and forth. So I'm going to draw ablue here to begin with because there's no oxygen to begin with. As it travels and that theair goes back and forth between the blood supply and the alveolus, it becomes red as it leaves,