Lung Cancer Patients Who Also Have Neuropathy

Today's post from cancergrace.org (see link below) is very useful if you have lung cancer or lung problems in general and have contracted neuropathy as a result of the cancer drugs you're taking. It explains the issue simply and highlights the chemotherapy drugs most likely to cause neuropathic symptoms. Whatever your medical history, there is always a possibility that  you may end up with a form of cancer and neuropathy is a fairly common side effects of cancer treatment drugs. It's important that you discuss the options with your doctor or specialist.
 

What about treating patients who have medical problems? Treating lung cancer in patients with kidney issues or neuropathy.
Published March 2, 2014 | By Dr West 
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One of the challenges of cancer care is that we guide our treatments by what clinical trial evidence tells us is best for particular patient populations. However, trials exclude patients who have significant medical issues other than cancer. So what do you do for patients who have lung cancer but also have common medical problems like compromised kidney function or pre-existing numbness and tingling (neuropathy) from diabetes or vascular disease? A purist in evidence-based medicine would say that patients who don’t have good kidney function or who have other medical problems that would exclude them from the trials of our standard treatments can’t get treated, but fortunately most oncologists are more flexible than that. What’s the right way to proceed? The answer is that it falls to best medical judgment. But can we be more specific than that?

In the setting of renal insufficiency, which is common as patients get older, as well as being a result of years of high blood pressure or diabetes, we need to substitute out the treatments that are most threatening to kidney function worsening. Specifically, this means avoiding the particularly kidney-threatening cisplatin, considering avoiding carboplatin (or perhaps giving it and carefully monitoring kidney function and dropping if it kidney function worsens, and then substituting non-kidney damaging agents instead). If kidney function is only minimally impaired, it may be very acceptable to give carboplatin plus a taxane: Taxol (paclitaxel), Abraxane (nab-paclitaxel), or Taxotere (docetaxel)), Gemzar (gemcitabine), Navelbine (vinorelbine), or Alimta (pemetrexed). An alternative, and the leading one if kidney function is quite compromised or gets worse on carboplatin-based chemo, is to give a nonplatinum doublet, which basically means pairing two drugs for lung cancer that are more commonly partners for cisplatin or carboplatin. Common nonplatinum doublets include Gemzar/Navelbine or Gemzar with one of the taxanes. About 15 years ago, there was a significant hope that these agents might turn out to be an improvement from platinum-based doublets, with comparable or slightly superior efficacy and improved tolerability. That didn’t turn out to be the case: the nonplatinum doublets were typically of the same or very slightly lower efficacy, and the same or slightly better tolerability. Overall, they were a lateral move and never took hold as a leading choice, but they are certainly a fine choice and arguably the ideal one for people with limited kidney function.

Then there’s the case of patients with peripheral neuropathy. The taxanes and especially Taxol are the worst offenders here, as is cisplatin, and Navelbine can also worsen neuropathy. Here, we commonly favor carboplatin with a less neuropathy-inducing partner drug, so Gemzar is often a leading choice, or Alimta for a non-squamous lung cancer.

It’s also reasonable to consider single agent chemotherapy, though several recent trials have shown that carboplatin doublet chemotherapy is associated with better outcomes as first line treatment than single agent chemo, even in patients with a marginal performance status. But it’s certainly reasonable to consider single agent chemo in individual patients with significant organ compromise, or simply in patients who are particularly wary about significant side effects.

Though there are certainly other problems that merit individual treatment recommendations, these are among the most common ones. In the end, it still comes down to individualized judgments and considerations of the circumstances of the particular patient.

http://cancergrace.org/lung/2014/03/02/treating-patients-with-other-med-problems/#more-14241

Do You Have Neuropathy In Your Feet

Because neuropathy is generally not well known as a disease, most people really aren't sure what's happening to them in the beginning. Today's useful, basic article from articlesnatch.com (see link below) helps explain whether what you're feeling is neuropathy or not. Even after reading this, you should get confirmation from a doctor, or better still a neurologist. There are many forms of neuropathy and also many causes. It's important to get an accurate diagnosis on both counts. Finally, the remedies mentioned here are just a few of the many possibilities available and again, doctor's advice is very important.

Do I Have Neuropathy In My Feet?
By: Brandt R Gibson DPM - a foot and ankle specialist with special interest in neuropathy and the new treatments.

Often, I see patients in our office concerned about strange feelings to their feet. Many are found to have neuropathy (or peripheral neuropathy). Neuropathy is the poor functioning of nerves and can lead to significant abnormalities in the feet and legs. Do you have neuropathy? Some simple questions are:

- Are your feet numb or do your feet feel dead? - When you injure your feet, do you feel pain? - When walking on your feet, do you have difficulty feeling the feet or do you trip regularly because you can't feel your feet? - Can you feel heat or cold in my feet or hands? - Do your feet tingle? - Do you have regular "pins and needles" sensation to your feet? - Do you have burning, stabbing, shooting or electrical shock pains in your feet? - Are your feet overly sensitive to touch, including pain from bed sheets or other items that shouldn't hurt? - Do you feel like there is cotton, leather, or sock on your foot, even when there isn't? - Do your feet hurt significantly at night and keep you awake?

An abnormal answer to any of these questions usually indicates neuropathy. Neuropathy can be a complex problem with multiple possible causes including diabetes, AIDS or HIV, toxins and metallic poisons, certain chemicals, alcoholism, vitamin deficiencies or nutritional imbalances, it may also occur from systemic diseases (kidney failure, liver disease, rheumatoid arthritis, abnormal blood proteins, cancer especially with chemotherapy, leukemia and shingles). Entrapment may also lead to the symptoms of neuropathy. Diabetes is the most common, however in the United States.

There are multiple theories on the cause of neuropathy, but the most common theories included blood flow interruption to the nerves or nerve fiber damage (or a combination of these). Therefore, for many years it was thought nothing could be done to improve neuropathy. You may have been told this about your discomfort. That is no longer the case. Many new treatments are coming that may help neuropathy.

The most common natural substances to improve neuropathy are B complex vitamins: B1 (thiamine), B6, B12 and folic acid. Many of the over-the-counter vitamins that contain these products, however, are in a form that are not as easily absorbed or utilized by the body. In our research, we have found two products that provide the vitamins in a form that are beneficial and easily utilized by the body.

1. Metanx - A prescription item that contains L-methoylfolate, Pyridoxal 5'-phosphate and Methylcobalamin (all natural forms of folic acid, B6 and B12 respectively). These products work together to produce increased blood flow to the nerves and assist in nerve repair. Many people are encountering improved feeling in their feet and decrease of their symptoms. It usually will require treatment for at least 4-6 months to insure it has sufficient time to help repair nerves.

2. Neuremedy - A over-the-counter item that contains a form of B1 (benfotiamine) that is absorbed and modified by the body to the active form of B1 (thiamine). Most forms of this vitamin fail to be absorbed in the body, but the benfotiamine of Neuremedy is easily absorbed and utilized by the body. It has been shown to nourish dysfunctional nerves and allow them to conduct impulses more normally. It has been utilized since the early 1960s in Europe and Asia on thousands of patients.

So, neuropathy although a common problem doesn't need to continue to cause problems in your life. It can be treated often very effectively through the use of one of these two options. Many other options are also in the works.

Copyright (c) 2009 Mountain West Foot & Ankle Institute

http://www.articlesnatch.com/Article/Do-I-Have-Neuropathy-In-My-Feet-/774206

How To Help Problems With Standing If You Have Neuropathy

Today's short post from paincommunity.org (see link below) gives some practical tips for people who find standing for long periods of time both uncomfortable and painful (almost all neuropathy sufferers). In this case the advice applies to the kitchen. Worth a quick read.

TPC Comfort Cookin’ – Stand Your Ground: Comfortably
Posted by Janice Reynolds | February 11, 2014

Do you find that standing for any length of time can be difficult? Does that keep you from spending time in the kitchen cooking your favorite meals? I find that when your feet or hands hurt, your overall pain may worsen.

Tip #1: Look at what is under your feet.
One thing that can help is strategically placing a thick area rug in the kitchen. I highly recommend that it has a no skid backing and that the edges that do not roll up (which I have in my work area) or better yet–a gel mat. These can be found in stores or online by names such as “comfort “mat, “anti-fatigue” mat and “wellness” mats. They are widely available, in a variety of sizes as well as price ranges from low-cost to expensive. User reviews indicate that they have been helpful for back pain, a variety of foot problems, joint problems, and fatigue. I know when my rug has been taken up for cleaning that I notice the difference immediately.
Tip #2: Look at what is under your bum.
For those longer periods of time (like doing prep work) when it is really difficult to stand, a bar chair/stool (preferably with a study back) is wonderful. Just be sure, for you, it is easy to sit on, easy to get up on or down from and if it swivels that it does not move too freely that you miss your mark and down on the floor you go

http://paincommunity.org/tpc-comfort-cookin-stand-ground-comfortably/

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What Have Sodium Channels To Do With Neuropathy

Today's post from neurologyadvisor.com (see link below) talks about something you may well have heard of during your journey with neuropathy treatments. Many of the pain-killing treatments for neuropathy, work by influencing 'sodium channels' which normally control, or fail to control, the 'excitability' of nerve signals, leading to the symptoms we're all aware of. Certain drugs can block these channels and that reduces the feeling of chaos in our nervous system that characterises neuropathy. It's finding the right drugs to block sodium channel signals in the right way, that is the key to solving neuropathic problems. It's a technical topic and not easy to follow but worth reading about because it increases our understanding of what's happening to us and what certain drugs can do to influence that.

The Role of Sodium Channels in Painful Neuropathies Chris Illiades, MD October 29, 2014 

The peripheral nervous system is a vast network of nerves carrying messages between the brain and spinal cord and every part of the body. Peripheral nerves are highly specialized and can cause a wide range of sensory, motor, and autonomic symptoms, making peripheral neuropathies hard to diagnose and hard to treat.1

There are more than 100 known types of peripheral neuropathy. Common acquired causes include diabetes, injury, autoimmune disease, and nutritional deficiency. However, peripheral neuropathies can also be inherited or caused by genetic mutations.1 Some genetic neuropathies cause pain due to hyperexcitability of pain-sensing nociceptors. Research into these conditions teaches us a lot about the pathophysiology of neurogenic pain.2
Sodium Channels and Painful Neuropathies

It has been known for a long time that voltage-gated sodium channels (VGSCs) control the flow of sodium ions that can trigger excitability of pain-sensing nociceptors in the peripheral nervous system. In humans, nine VGSCs have now been identified, and some have been linked to genes that alter their function.2,3

“We know that sodium channels play an important role in painful neuropathy. Genetic mutations that cause extreme pain have been linked to several disorders, and we may find that genetic polymorphisms play a role in more common peripheral neuropathies as well,” said Christina Ulane, MD, PhD, assistant professor of neurology at Columbia University Medical Center in New York City.

Gene mutations have now been linked to sodium channels Nav1.7, Nav1.8, and Nav1.9. Gain of function mutation in the gene SCN9A has been linked to Nav1.7 and a disorder called inherited erythromelalgia (IEM).2 IEM is also called “Man on Fire Syndrome,” because it causes excruciating burning pain in response to mild warmth.4

The gene SCN10A has been linked to Nav1.8 and small fiber neuropathy, a condition that causes severe pain attacks in the hands or feet..2. It may also cause autonomic pain symptoms such as palpitations, bowel problems, and abnormal sweating.2,5

Genetic mutations can also cause less excitability by reducing sodium flow through a VGSC. The gene SCN11A causes hyperpolarization of Nav1.9, which may cause loss of pain sensation.2 Nav1.9 has also been linked to mutation that causes painful neuropathy.3
Nav1.7 and Diabetes

A 2014 article published in the journal Trends in Molecular Medicine suggests that as we learn more about VGSCs and the genes that affect them, we could find that they play a much larger role in acquired peripheral neuropathy—and maybe even in some common diseases. The article notes that painful diabetic peripheral neuropathy (DPN) occurs in up to 25% of people with diabetes.

It has traditionally been believed that painful DPN is a direct result of hyperglycemia. Painful DPN may actually occur very early in diabetes and some people with long-standing diabetes never get DPN, the study authors noted. They proposed that painful DPN is not a complication of diabetes but rather the result of mutations at Nav1.7 that have been found in nerve cells and in pancreatic beta cells. Could these mutations increase both the risk for diabetes and painful DPN?6

“It may be that the diabetic pain we associated with metabolic changes may also be linked to genetic susceptibility. The pain medications we use for diabetic neuropathy now are mostly pregabalin (Lyrica, Pfizer) and duloxetine (Cymbalta, Lilly). Neither one is a sodium channel blocker, and they are only about 50% effective,” said Ulane. 

Could Sodium Channels Offer Better Treatments for Neuropathic Pain?

“We already have sodium channel blockers, but they are not very effective and are limited by side effects. If we can find more targeted sodium channel blockers, we might be able to improve treatment of neuropathic pain,” Ulane said.

The problem with the sodium channel blockers now available is that they block all sodium channels. This includes VGSCs like Nav1.3 in the central nervous system and Nav1.5 in skeletal muscle. It also means these drugs can cause lots of unwanted adverse effects.7 For example, those associated with the sodium channel blocker lamotrigine include dizziness, joint pain, blurred vision, and uncontrollable shaking.8

This emphasizes the importance of the research on Nav1.7, Nav1.8, and most recently Nav1.9. These channels seem to be the ones that are specific to nerve pain. Pharmaceutical companies are actively working on drugs for Nav1.7 and Nav1.8 and will probably begin to include Nav1.9, now that it has also been linked to human pain. Finding drugs that selectively block just these channels could be the holy grail of neuropathic pain treatment.3,7

Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.

This article was medically reviewed by Pat F. Bass III, MD, MPH

References
National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy Fact Sheet.http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Updated September 26, 2014. Accessed October 28, 2014.
Brouwer BA, Merkies ISJ, Gerrits MM, Waxman SG, Hoeijmakers JGJ, Faber CG. Painful neuropathies: the emerging role of sodium channelopathies. J Peripher Nerv Syst. 2014;19(2)53-65.
Sutherland S. Third sodium channel implicated in painful small-fiber neuropathy. Pain Research Forum.http://www.painresearchforum.org/news/40751-third-sodium-channel-implicated-painful-small-fiber-neuropathy. Accessed October 28, 2014.
Boyle AM. Sodium channels offer path to personalized pain management, U.S. Medicine Web site.http://www.usmedicine.com/agencies/department-of-veterans-affairs/sodium-channels-offer-path-to-personalized-pain-management/. Accessed October 28, 2014.
Genetics Home Reference. Small Fiber Neuropathy. http://ghr.nlm.nih.gov/condition/small-fiber-neuropathy. Reviewed November 2012. Accessed October 28, 2014.
Hoeijmakers JG, Faber CG, Merkies IS, Waxman SG. Channelopathies, painful neuropathy, and diabetes: which way does the causal arrow point? Trends Mol Med. 2014;20(10):544-550.
Theile JW, Cummins TR. Recent developments regarding voltage-gated sodium blockers for the treatment of inherited and acquired neuropathic pain syndromes. Front Pharmacol. 2011;2:54.
Lamotrigine. MedlinePlus Website.http://www.nlm.nih.gov/medlineplus/druginfo/meds/a695007.html. Accessed October 28, 2014.

http://www.neurologyadvisor.com/targeting-sodium-channels-for-neuropathic-pain-treatment/article/380020/

How Do You Know If You Have Neuropathy

Today's post from neuropathytreatment.co (see link below) is another one providing basic information for people experiencing nerve problems for the first time. It's short and to the point but sums up the symptoms and problems very well. Useful also for friends or relatives who may not understand what's happening to you.

Tingling, Burning, Numbness in Your Feet, Could It Be Peripheral Neuropathy?
MAY 1, 2013 BY WESLEY MILNE

Recognizing your symptoms

For those who are undergoing the perpetual trauma of feeling tingling, burning, and numbness in the feet must realize that this condition is not a disease but the symptoms of a very vexing and prevalent condition known as peripheral neuropathy. Peripheral neuropathy is usually diagnosed at an advanced stage or after a subsequent period. Majority of peripheral neuropathy sufferers spend years searching for the most superlative treatment plan and seeking the best diagnostics. But most of the doctors order a list of tests with various treatment plans only to have their patient seek elsewhere for better pain relief methods. Peripheral neuropathy is not just a disease. It is a chronic nerve disorder which is extremely challenging to combat and to live life with. The feeling of pins and needles while walking and the creepy numbness that seems to crawl up your limbs and render your legs devoid of sensations is an unpleasant reality. Even the most advanced techniques and treatment plans are accepting defeat to this notorious monster.

What exactly is peripheral neuropathy?

Our body’s mechanism relies on two main important systems: the central nervous system and the peripheral nervous system. The central nervous system houses the brain and the spinal cord, and the peripheral nervous system consists of the peripheral nerves interlining the entire body. The peripheral nervous system again branches into two main functional classifications: somatic nervous system and autonomic nervous system. The somatic nervous system consists of the sensory nerves which send signals to the brain and the spinal cord and the motor nerves which send signals to the muscle nerve fibers. The autonomic nervous system is taxed with the function of sending signals to the muscles of the organs and glands, and controlling our involuntary but most prominent body functions such as digestion, breathing, circulation, excretion, sexual function, etc.

Individuals who are at risk of peripheral neuropathy are:

Cancer patients and those who are undergoing chemotherapy
People who are exposed to toxins and metals like lead, mercury, and arsenic
People who are suffering from malnutrition or nutritional disorders
HIV/AIDS, Hepatitis B and C sufferers
Diabetics
Alcoholics
Autoimmune disease patients
People with inherited neuropathy like Charcot-Marie tooth disease
People who have had shingles
Patients with tumors are also likely to suffer from peripheral neuropathy

What are the main symptoms of peripheral neuropathy?

Apart from burning, tingling, and numbness in the feet and hands, peripheral neuropathy adversely affects other functions too. Mild to moderate and excruciating pain is experienced in the hands and feet depending on the amount of nerve damage. Some people even suffer from sharp pins and needles like sensations which can make walking impossible.

Loss of sensitivity is also quite common in peripheral neuropathy. Increased sensitivity is also a highlighting symptom that can cause discomfort and irritation from someone’s touch, sharp objects, and even the clothes on the body can feel like parched paper. Uneasiness can cause sleeplessness at night and increased fatigue and depression.

If the autonomic nerves have received damage, the patient will feel a general anxiety and serious symptoms will follow such as constipation, diarrhea, urinary incontinence, sexual disorders, high blood pressure, extreme panting even with light exercise, high blood pressure even while at rest, etc.

If the motor nerves are the ones that have received injury, then the patient will be suffering from muscle cramps and weakness, have trouble keeping a firm grasp on things, and have decreased flexibility and coordination.

How do the peripheral nerves receive damage or injury?

Growing scientific research has shed some light in to the growing concern of nerve damage. One contemplated research brought forth the theory of anoxia. Anoxia means oxygen deprivation. When the nerve cells are deprived of their required levels of oxygen, they contract in order to consume less oxygen. This increases the gap between the cells (the cells are naturally a little distance apart from each other) and when nerve impulses or signals are passing through, they cannot cross the bigger void and the nerve messages are lost. This causes nerve malfunction and ultimately leads to peripheral neuropathy.

During an infection, disease or over exposure to dangerous chemicals, the body is consumed with free radicals. These free radicals tend to take up all the oxygen, thus depriving the nerve cells of their nutrition.

Why is peripheral neuropathy pain untreatable?

Peripheral neuropathy can be considerably treated with over the counter and prescription medications, but the pain cannot be treated permanently. The nature of the neuropathy pain renders it as an untreatable disease. There has not been ample research guided in this field which despairs the sufferers of neuropathy. Though the pain can be relieved temporarily with lidocaine patch and opioids, much advancement needs to be made to conquer the peripheral neuropathy pain and restore life and happiness back in to the lives of the neuropathy sufferers.

http://neuropathytreatment.co/tingling-burning-numbness-in-your-feet-could-it-be-peripheral-neuropathy/

Do You Have Neuropathy Quiz

Dr. Marc Spitz produces a wealth of useful information for people living with neuropathy on his sites and today's post from drmarcspitz.com (see link below) adds a little more to the whole picture. This is a quiz for people who are not sure if what they're feeling is the result of neuropathy or not. It may seem to be a little simplistic but it may also give you enough information to go to your doctor and discuss it further. One thing is sure, the quicker you get your problem identified, the more likely you can be helped.

Take the Pop Quiz - Do You Have Neuropathy?

Neuropathy Pain Quiz

This entry was posted on Sunday, September 9th, 2012

 

 

Please answer Yes or No to each Question

Can your pain be described as;

Hot, as in feels like the area is “burning” Yes ? No ?

Cold, as in feels like the area is “freezing” Yes ? No ?

Sharp, as in feels like a “knife wound” Yes ? No ?

Shooting, as in feels like an “electric shock” Yes ? No ?

Prickling, as if on “pins and needles” Yes ? No ?
 

Do you experience any other sensations in the same area as the pain, such as:

Tingling, as if “ants are crawling over your skin” Yes ? No ?
 

Itchiness, like a “mosquito bite” Yes ? No ?
 

Numbness, as in “lack of sensation” Yes ? No ?
 

Is the pain sometimes worse from light to touch such as clothing? Yes ? No ?
 

Do you have muscle weakness, “heaviness”, cramping, or temperature variation in the same area as the pain. Yes ? No ?
 

Yes= 1 Point, No= 0 Points

Total out of a possible 10 points:

If total is equal or greater than 4, it is very likely that you have neuropathic pain

http://drmarcspitz.com/blog/2012/09/09/take-the-pop-quix-do-you-have-neuropathy/