Fluoroquinolones and Peripheral Neuropathy
Peripheral neuropathy, this is an often devastatingcondition in which people develop pain and numbness in their hands and feet. Basicallythey're told on the evening news that they should be taking this or that medication 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 that in America,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 dramatically increases yourrisk for having peripheral neuropathy and
in fact being devastated by it. This is adisease that effects 1 in 15 Americans. Let's take a look. So again this is 1 in 15 Americansâ€”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, in 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 used in walk in s. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study published in September2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodand in this 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 fluoroquinolones in the United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these drugs 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 review journals is nowtelling us that the use of these medicationsâ€”these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep that in mind 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.
Leg Ulcers 7 Facts About Leg Ulcers You Must Know
Leg ulcers are common approximately 2%of adults will have a leg ulcer at some stage in their lives. Literally thousands of peopledevelop a leg ulcer each year in the United Kingdom and many of those get more leg ulcersas the years go by. Despite the misery they cause, leg ulcers remain a neglected problem.I am going to tell you the 7 essential facts should you know about leg ulcers. Number 1 What is an ulcer? The medical definition of an ulcer is a break in the epithelium ofa body surface or lining. Many of us will be familiar with a mouth ulcer. This is abreak in the cell lining the mouth. It can be caused by an injury such as biting theinside of the mouth by accident. Well if the
skin breaks down anywhere on the body it iscalled an ulcer. If the ulcer is on the leg and has been present for more than 6 weeksit is called a chronic leg ulcer. Number 2 What causes a leg ulcer? Four out of 5 ulcers that's 80% are caused by a problem with the leg vein pump and they are called venousulcers. The leg vein pump is the mechanism by which blood flows out of the leg back tothe heart. So problems with the deep veins such as obstruction from a deep vein thrombosis,superficial vein reflux or perforator vein problems can cause venous leg ulcers. Theleg vein pump depends mainly on good ankle movement, good calf muscles and healthy legveins. A minority of leg ulcers about 15%
are caused by problems in the arteries thatcarry blood into the leg. About 95% of venous leg ulcers can be correctly identified bytheir appearance, by checking for pulses in the feet and by checking sensation. As mostleg ulcers are venous that's what I am going to concentrate on. Number 3 Whereon the leg do you get venous ulcers? Well venous leg ulcers appear on the lower partof the leg usually just about the ankle. Often, there are varicose veins or thread veins aroundthe ulcer and the leg is usually swollen. The skin is often thickened and discolouredby varicose eczema which many actually develop many months or years before the ulcer as awarning sign that the vein circulation is
not normal. Number 4 Who gets a venousulcer? Well these ulcers affect people who have deep vein problems, usually from a pastdeep vein thrombosis (DVT), people who have superficial venous disease or those with anklemobility problems. Leg ulcers are more common as we get older. Number 5 How do you treatvenous ulcers? The aim of treatment is to get the ulcer healed as quickly as possible.This usually means graduated compression either with bandages or compression stockings. Inmost cases, antibiotics, creams and ointments are not necessary. Once the ulcer is healedit is very important to identify any problems with the superficial veins or perforator veinsand that these are treated to reduce the risk
of another ulcer. This means getting a fullassessment with a duplex ultrasound scan. Number 6 Can you cure a leg ulcer? Well thisis controversial. Some would say that if the problem is only in the superficial veins,the veins under the skin, or in the perforator veins that connect these superficial veinsto the deep veins, then the ulcer can be cured. While there is good evidence that such treatmentwill greatly reduce the risks of getting another leg ulcer, if the skin has been very damagedand the ulcer has healed with a lot of scarring, this area of the leg may remain vulnerableand a trivial knock or injury might cause another skin breakdown even though the veinabnormality has been completely eradicated.
Number 7 How can we avoid leg ulcers? Wellthere are 3 things I would suggest. Firstly, if you are unfortunate enough to suffer adeep vein thrombosis (DVT), it should be treated promptly to limit the damage to the deep veins.Unfortunately, damage to the deep veins cannot be reliably reversed by surgery. So, prompttreatment with anticoagulants blood thinning medication reduces the extent of the clotand the damage to the deep veins. Secondly, if you have had a DVT, you should considerwearing good quality medical grade compression socks some studies suggest that doing somay reduce the risk of leg ulcers after a big DVT. Thirdly, if you have superficialvein reflux have it treated early to reduce
Knee pain neuropathic knee pain
Hot off the press news about knee arthritisfrom Madridâ€¦ not all knee pain comes from the knee Neuropathic pain features common in knee OA Lucy Piper writing in Medwire News reportedenough patients with knee osteoarthritis (OA) experience pain with neuropathic characteristicsto warrant attempts to diagnose and classify these features, say researchers.They found that among 2176 patients with OA, a third scored positively for neuropathicpain on the Douler Neuropathique (DN4) questionnaire, after patients with reasons other than OAfor such pain had been excluded.
Analysis showed that three of these potentialconfounders â€“ conditions other than OA that cause changes in cutaneous sensory perceptionson the knee, or cause abnormal sensations over the area of the knee, and referred backor hip pain â€“ were highly specific for neuropathic pain, but less sensitive than the DN4.â€œWhen these factors are absent, the presence of neuropathic pain is unlikely, yet the DN4can sense additional neuropathic features in some patients,â€� explain the researchers,led by Ã�ngel OteoÃ�lvaro ( General Universitario Gregorio MaraÃ±Ã³n, Madrid,Spain). Further confirmation and classification ofthese additional features could reveal links
between neuropathophysiology and signs andsymptoms of the condition, they note. Comment: Neuropathic pain may require differenttreatment than pain coming from other sources.