The Many Ills of Peripheral Nerve Damage

This article is from the New York Times science section (see link below)and it gives a very good overview of neuropathy as a disease. There may be something here that you don't already know.

PERSONAL HEALTH; The Many Ills of Peripheral Nerve Damage
By JANE E. BRODY
Published: October 20, 2009

If you have ever slept on an arm and awakened with a ''dead'' hand, or sat too long with your legs crossed and had your foot fall asleep, you have some inkling of what many people with peripheral neuropathy experience day in and day out, often with no relief in sight.

And numbness and tingling are hardly the worst symptoms of this highly variable condition, which involves damage to one or more of the myriad nerves outside the brain and spinal cord. Effects may include disabling pain, stinging, swelling, burning, itching, muscle weakness, twitching, loss of sensation, hypersensitivity to touch, lack of coordination, difficulty breathing, digestive disorders, dizziness, impotence, incontinence, and even paralysis and death.

I realize now that I had a mild, reversible bout of peripheral neuropathy several decades ago when a misplaced shot of morphine damaged a sensory nerve in my thigh. It took three years for the nerve to recover, and for much of that time I could not tolerate anything brushing against my leg.

One of my sons, too, was afflicted when a nerve behind his knee was injured during a basketball game. He had no feeling or mobility in his foot for nine months, but after several years the nerve healed and he regained full use of his foot.

And a good friend was nearly paralyzed, also temporarily, following a flu shot, by a far more serious form of peripheral neuropathy -- an autoimmune affliction called Guillain-Barré syndrome, in which one's own antibodies attack the myelin sheath that protects nerves throughout the body.

There are hundreds of forms of peripheral neuropathy. A medical guide describing them, compiled by a team of neurologists at the behest of the Neuropathy Association, fills a booklet the size of a two-year wall calendar.

The association, which sponsors research and provides education and support for patients and families dealing with peripheral neuropathy, estimates that the disorder afflicts more than 20 million Americans at any given time. If the cause can be corrected, peripheral nerves can regenerate slowly and patients can recover, although not always completely.

But many people never recover. They must learn to live with the disorder, with the help of treatments and devices that can ease their discomfort and disability. With such a wide array of symptoms and causes, getting a correct diagnosis is often a challenge. Worse, frustrated patients are sometimes told, ''It's all in your head.''

Causes Behind an Ailment

There are three types of peripheral nerves: sensory nerves, which transmit sensations like pain, touch, heat and cold; motor nerves, which control the action of muscles throughout the body; and autonomic nerves, which regulate functions that are not under conscious control, like blood pressure, digestion and heart rate. Symptoms of neuropathy depend on what nerves are involved.

Someone with damaged sensory nerves might not feel heat, for example, and could be scalded by an overly hot bath. Neuropathy of the motor nerves can result in weakness, lack of coordination or paralysis; neuropathy of the autonomic nerves can lead to high blood pressure, irregular heart rate, diarrhea or constipation, impotence and incontinence.

The list of possible causes of neuropathy is far too long for this column. They include inherited conditions like Charcot-Marie-Tooth disease; infections or inflammatory disorders like hepatitis, Lyme disease, AIDS, rheumatoid arthritis and lupus; organ diseases like diabetes, hypothyroidism and kidney disease; exposure to toxic substances like industrial solvents, heavy metals, sniffed glue and some cancer drugs; trauma to or pressure on a nerve from an injury, cast, crutches, abnormal body position, repetitive motion (as in carpal tunnel syndrome), tumor or abnormal bone growth; alcoholism; and deficiency of vitamin B12.

The most common cause, accounting for nearly a third of neuropathy cases, is diabetes, especially among those whose blood sugar levels are poorly controlled. Half of all people with diabetes eventually begin to lose sensation and develop pain and sometimes weakness in their feet and hands. In people with diabetes, even minor injuries to the feet, if not quickly and properly treated, can result in gangrene and amputations.

In nearly a third of cases, no cause is ever found, leaving patients with no other recourse than treatment of their symptoms.

Suspected cases are best referred to a neurologist, who should begin by taking a complete personal and family medical history and performing a physical and neurological examination, checking on reflexes, muscle strength and tone, sensations, balance and coordination.

A complete workup is likely to include blood tests, urinalysis, a nerve conduction study and electronic measurements of muscle activity. Imaging studies, like a CT scan or an M.R.I., may reveal a tumor, vertebral damage or abnormal bone growth. In some cases, a nerve or muscle biopsy may be done.

Relief and Restoration

If the underlying cause cannot be corrected, the goals of treatment are relief of symptoms and restoration of lost functions. Pain control is paramount. Effective relief may come from over-the-counter remedies or a lidocaine patch but sometimes requires prescribed opiates.

Many with neuropathic pain have benefited from drugs licensed for other uses, including antiseizure medications like gabapentin, topiramate (Topamax) and pregabalin (Lyrica) and antidepressants like the tricyclic amitriptyline and the selective serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta).Vitamin B12 deficiency can be treated with supplements and fortified cereals or by judicious consumption of meats, poultry, fish, eggs and dairy products.

And since alcohol and tobacco are particularly risky for people with neuropathy, or a health problem that predisposes them to it, they have every reason to quit smoking and to drink only in moderation.

Many patients are helped by physical therapy, occupational therapy and devices like braces, splints and wheelchairs. Railings on stairways and in the bathroom, elimination of tripping hazards like scatter rugs, and improved lighting (including night-lights) can reduce the risk of falls. For those insensitive to heat, a thermometer should be used to test water in a tub, shower or sink. Orthopedic shoes are invaluable to patients with lost sensitivity in their feet or impaired balance.

A variety of mechanical aids can make it easier to live with peripheral neuropathy, among them kitchen tools made by Oxo. Those with digestive problems might try eating small frequent meals and sleeping with their heads elevated.

http://query.nytimes.com/gst/fullpage.html?res=9404E4D6123DF933A15753C1A96F9C8B63&pagewanted=all

How Vitamin B12 Helps To Reduce Or Prevent Nerve Pain

Today's interesting post from liveitholistic.com (see link below) looks in detail at vitamin B12 and the role it plays in helping with and preventing neuropathy. Many people take vitamin B12 supplements for nerve pain because they've heard or read that it helps but few know why they do. Most neurologists will agree that a vitamin B (and B12 in particular) deficiency can cause nerve damage but it's rare that you see a breakdown of how vitamin B actually works in the body. This is such an article and therefore an important one for neuropathy patients. Well worth a read.

The Importance of B12 and its role in Neuropathy and Anemia. 
Marc Capistrano June 19, 2016
 
The stars have aligned on this post. The topic of B12 keeps coming up lately, and it was a sign that I had to put something up on the blog. The thing about writing is that it’s almost like a personal journal (…here’s what’s on my mind at this point in time and how I feel about it.)

In this case, Vitamin B12 is on my mind!

It’s involved in every metabolic cellular process in our body, DNA production and nerve function to name a few.

A good balance of all b-vitamins is important but B12 tends to get most of the attention because it is not absorbed into the blood stream the same way the other b’s are. B12 is usually more deficient than the other b-vitamins due to a deficiency in Intrinsic Factor. It also binds with “intrinsic factor” (It’s a specialized type of protein produced in the stomach). B12 must be bound to Intrinsic Factor. Then it is absorbed in to the small intestine (There are receptor sites for B12). You need to produce HCL in order to produce intrinsic factor. You also need to produce enough HCL to produce pepsin. Intrinsic (IF) is internally produced. On the other hand, B12 is the extrinsic (outside) factor produced.

Ok Marc. Tell me why B12 vitamins are important.

1. It prevents Peripheral Neuropathy: The myelin sheath acts as an insulating cover over a nerve fiber. It’s through this nerve fiber that conduction impulses are produced and electrical signals are sent and received. Think of it this way, you touch something hot, once the sensation is felt, your nerves send a signal to your brain. This signal works on these conduction impulses. If you don’t know, now you know ***Biggie Voice***.

Well B12 prevents the breakdown of the myelin sheath that covers our nerve fibers (also known as “demyelination”). When we hear myelin sheath, we usually associate this with the brain (MS). But, the myelin is also very important for your spinal cord’s nerve fibers. This damage leads to a condition known as peripheral neuropathy, in which symptoms include loss of coordination, sensory touch and eventual decreased muscle mass.

It’s shown that B12 intake from food and supplementation can improve neuropathy conditions. With issues like tingling, muscular dysfunction and especially neuropathy, it’s best to have a specialist (Chiropractor, Physiotherapist) look at you and make a proper diagnosis. As a nutritional practitioner, my job is to support the physical intervention through nutrition once a person is diagnosed.

2. The effects of B12 deficiency can cause irreversible symptoms: This is seen in Multiple Sclerosis (a degenerative disease of the nervous system). As with any tissue in the body, once it’s damaged, scar tissue forms (also known as Sclerosis).

3. A lack of B12 can lead to Pernicious Anemia: This is a form of anemia caused by a lack of absorption of B12 due to a deficiency in Intrinsic Factor. B12 binds with “intrinsic factor” as I had mentioned earlier. Without B12 and Intrinsic factor, the membranes of immature red blood cells rupture, disintegration of the stomach lining can occur which can lead to autoimmune diseases such as Crohn’s disease.

4. It makes us happy: B12 plays an important role in supporting and assisting with the formation of neurotransmitters such as serotonin and dopamine production. And this, make us happy…

5. B12 helps us recycle Homocysteine: Anyone out there with a history of cardiovascular disease will have some knowledge of homocysteine levels. If you don’t, then just know that homocysteine is created as a by-product of our body’s metabolism of methionine and cysteine.

Homocysteine isn’t all bad, it still gives us things like Cysteine, which is a precursor to glutathione (an amino acid known for its detoxification capabilities) and is important to the synthesis of Neurotransmitters. The only problem is that high levels of homocysteine are indicative of cardiovascular and neurodegenerative diseases. B12 is important in taking homocysteine and converting it back to methionine.

Ok…What do I do?

Before we get into the details of B12 intake, it’s important to note that all b vitamins including B12 are depleted in the body by things like stress, birth control pills and high intake of sugars.

1. Some people can’t produce Intrinsic Factor. If this is the case, B12 shots are available. You’ll want to buy Methylcobalamin (the active form), not Cyanocobalamin.

2. HCL (stomach acid) is required in order to take B12 from its protein carrier Intrinsic Factor. Refrain from antacids and supplement with Hydrochloric acid with betaine to improve stomach pH.

3. If you’re simply deficient and looking for the next best thing to a shot, then a sublingual (under the tongue) is another alternative option. This skips the digestion process and gets right into the bloodstream. People looking to simply optimize or increase B12 intake can take a Vitamin B complex with a higher B12 content.

4. B12 food sources: Liver, Meat Protein, Dairy, and Seafood (particularly shellfish).

5. The liver has to activate B-vitamins. If you have an under functioning liver, then B-vitamins are not being absorbed. Support the liver, and the b-vitamins will follow!

6. Supplements and B12 aside, it’s important to look at the root cause of demyelination (breakdown of the nerve fiber). In some cases, autoimmune conditions cause the self-destruction of the myelin sheath. Eliminating triggers that cause chronic inflammation (high sugar, poor diet etc.…) can prove to be your best prevention and early treatment. The entry of pathogens through the blood brain barrier affects the CNS, which in turn affects the peripheral system. Boosting your immune system can also be a great way to properly limit the amount of sclerotic tissue that forms.

http://www.liveitholistic.com/blog/2016/6/19/the-importance-of-vitamin-b12-and-its-role-in-neuropathy

How Nerve Cells Map Themselves

Today's post from sciencedaily.com (see link below) is a fascinating look at how nerve cells map their own position and either block or allow other embryonic nerve cells from moving into their right position in the nervous system. Apparently the axons have a lot to do with this (the axons are the 'wires' you see connecting one nerve to another in images of nerve cells) and act as corridors for both information and nerve development. If the axons are disrupted, it can lead to all sorts of conditions, due to nerve signals being diverted, or prevented from reaching their destination. It just shows how complex and amazing the nervous system is and highlights how little we appreciate how things get done in our bodies. The question is: although scientists can deliberately interfere with axons to prove a point, can they effectively repair them in the future so that normals nerve signals are restored to their normal function?

Nerve cells use each other as maps
Date:May 19, 2015 Source: Umeå universitet 

Summary:

When nerve cells form in an embryo they don't start off in the right place but have to be guided to their final position by navigating a kind of molecular and cellular "map" in order to function properly. In a recent research study published in Nature Communications neurobiologist Sara Wilson, Umeå University, found that during embryonic development different parts of the nerve cell are important for guiding other nerve cells into their physical positions.

"We found nerve cells do this in two ways, either acting as barriers preventing cell bodies to move further than they need to, or by acting as guides opening a corridor that the cell bodies can travel along," she says.

The nervous system is analogous to a biological "computer" with different nerve cells forming connections that continuously send neural information around the spinal cord, brain and body and back again. Each nerve cell has a kind of "GPS coordinate" and exactly where nerve cells are physically located is very important so they can connect correctly with other nerve cells.

When nerve cells are in the wrong place neural information is not transmitted properly and it results in dysfunction and neurodevelopmental disorders such as lissencephaly, Kallmann syndrome and periventricular heterotopia. These misplacements can also happen in very common developmental disorders such as dyslexia and autistic spectrum disorders but it is not fully clear what role such misplacements play in these cases.

"Because nerve cell position is so important in normal nervous system function and dysfunction we wanted to find out how nerve cells position themselves in the first place. This study uncovered an exciting new mechanism for how this happens" Sara Wilson says.

Two of the main parts of a nerve cell are the central part (called the cell body) and a very long part like a "wire" (called the axon) that connects with and sends information to other nerve cells. It is important for both of these parts to be in the right place to get the nervous system to work properly.

The axons usually group together and form structures similar to corridors heading in a certain direction. Using genetic changes in mouse embryos to disrupt these axonal corridors (make them head in a different direction), her research group at Umeå Centre of Molecular Medicine, now at the Department of Molecular Biology, Umeå University, found that cell bodies from nerve cells also end up in the wrong place.

"This means the axons from some nerve cells are influencing the position of the cell bodies of other nerve cells meaning that the nerve cells are creating a "map" for other nerve cells to find their way" Sara Wilson says.

"This is the first time that axons have been shown to act as barriers and it could have important implications for understanding how the nervous system forms in all animals, including humans" Sara Wilson concludes.

Overall, this work and other work from the group focuses on understanding the mechanisms (genetic, cellular and molecular) of how the precise "anatomy" of the nervous system first forms and how that influences neuronal function and dysfunction. This basic science research has important medical implications for understanding the cause of some neurodevelopmental disorders: For example do the genes that are associated with such disorders generally control cell body guidance and is that what leads to dysfunction?

"It can also give clues as to how to grow axons during regeneration following damage or disease of the nervous system. Can we "force" regenerating neurons to connect properly? In the future, we plan to continue this basic research and find medical research teams to collaborate with to see if our findings are beneficial in these medical contexts" Sara Wilson says.

Story Source:

The above story is based on materials provided by Umeå universitet. Note: Materials may be edited for content and length.

Journal Reference:
Christophe Laumonnerie, Yong Guang Tong, Helena Alstermark, Sara I. Wilson. Commissural axonal corridors instruct neuronal migration in the mouse spinal cord. Nature Communications, 2015; 6: 7028 DOI: 10.1038/ncomms8028
 
http://www.sciencedaily.com/releases/2015/05/150519084229.htm

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How Alpha Lipoic Acid Can Restore Nerve Health

Today's post from prohealth.com (see link below) is another article examining the benefits of the anti-oxidant and co-enzyme, alpha lipoic acid to the nervous system and especially to the protective lining of nerves - mitochondria. There are other articles on this blog about lipoic acid to be found by checking the alphabetical list to the right of the blog. Many people living with neuropathy have benefited by supplementing with alpha lipoic acid and Acetyl L-carnitine but it has to be stressed that for some, it makes no difference whatsoever. Whether you believe all the claims or not, it's certainly worth talking over with your doctor or neurologist, as a possible non-drug option in your treatment regime. In order to follow all the reference links via the numbers, you will need to visit the original page.
  

Lipoic Acid Reverses Mitochondrial Decay
By Michael Anderson • www.ProHealth.com • October 28, 2014

It is estimated that 85% of the oxygen contained in every breath you take is consumed by the mitochondria within each cell of your body.1

The decay of these energy-producing powerhouses in turn lies at the core of most age-related pathologies.

In experimental models examining the mitochondrial theory of aging, it has been shown that cells microinjected with mitochondria isolated from old animals degenerate far more rapidly than those microinjected with mitochondria from young animals.2

The good news is that when supplied with a nutrient regimen that includes lipoic acid, a profound regeneration is observed in similar animal models,3 including improved metabolic function and a marked decline in oxidative stress.

In this article, the recent data on lipoic acid’s multimodal power to combat a host of age-related diseases is detailed. You will learn how it may help prevent cardiovascular disease, obesity, diabetes, neurodegenerative disorders, and cancer. You will also learn of drug company efforts to produce high-cost, synthetic forms of lipoic acid to capitalize on its unique health-promoting properties at your expense.

Mitochondrial Decay and Aging

The mitochondrial theory of aging has long held a prominent place in scientists’ understanding of the processes that impact aging. First proposed by Denman Harman in 1972, this theory posits that accumulated DNA damage to mitochondria, the cells’ energy generators, leads to increased free radical stress and decreased cellular energy production.4 In the past 30 years, a wealth of evidence supporting the mitochondrial theory of aging has led prominent researchers such as Bruce Ames to consider it a major contributor to aging.5

Experimental models support this theory and demonstrate the importance of youthful mitochondria function in maintaining cellular health. For example, cells microinjected with mitochondria from aged animals display greater cellular degeneration, compared with cells microinjected with mitochondria from youthful animals.2 The mitochondrial theory of aging has analyzed the components of young and old cells. Youthful organisms contain abundant numbers of smaller, bioenergetically efficient mitochondria, while older organisms contain larger, inefficient mitochondria that decrease energy supply in the cells.6,7

Delaying mitochondrial aging through the use of nutrients such as lipoic acid and acetyl-L-carnitine has been proposed as a top-line strategy for preventing aging-related diseases.8

How Lipoic Acid Combats Cellular Degeneration

Lipoic acid is a vital “co-factor” for enzymatic reactions within the mitochondria, helping to optimize energy conversion.9,10 It possesses unique properties that specifically slow mitochondrial aging by preventing release of mutagenic oxidants.11 Recent research further reveals lipoic acid’s ability to alleviate mitochondrial dysfunction in aging cells (thus improving mitochondrial function).12,13

Researchers have further discovered that lipoic acid enhances the effects of insulin, benefitting glucose metabolism and lowering blood sugar levels.10

This in turn mitigates the pathologic cross-linking of glucose and protein that result in advanced glycation end products (AGEs).14

These advanced glycation end products have been shown to accelerate the onset of cardiovascular disease, brain degeneration, ocular disorders, and cancer.14-17

Lipoic acid also suppresses production of inflammatory cell-signaling molecules, while increasing production of molecules involved in vascular tone, such as endothelial nitric oxide synthase (eNOS).18,19

Owing to its pronounced power to combat mitochondrial aging, behemoth pharmaceutical companies are now attempting to manipulate its molecular structure and render it patentable.20 Such drugs include more complex molecules in which lipoic acid is “conjugated,” or chemically joined, to form hybrid compounds with additional biological characteristics.

This would allow drug manufacturers to make absurd claims of superior benefit for their artificial, synthetic lipoic acid products. The result would be needless additional cost for what is already a proven multi-modal nutrient.

Lipoic acid in the biologically active “R” form (see below) is readily available without a prescription and affordable.

Use the “Right” form of Lipoic Acid

Lipoic acid comes in two “mirror image” forms labeled “R” and “S.” Only the R form is produced and used by life processes. Inexpensive chemical manufacturing produces equal quantities of R and S lipoic acid, often labeled “R/S Lipoic Acid” or simply “alpha lipoic acid” (ALA).

Newer precision techniques allow production of a pure R-lipoic acid, which has a much higher potency. A dose of pure R-lipoic acid provides twice the active ingredient as a typical R/S-alpha lipoic acid supplement, simply because the whole dose consists of the active “R” molecule. Look for the “R” label to assure you are getting the most potent form of this valuable nutrient.21,22

Cardiovascular Defense

Lipoic acid’s powerful antioxidant, anti-inflammatory, and lipid-lowering capabilities make it an ideal, multi-targeted nutrient for reducing cardiovascular risk.23,24 Lipoic acid helps protect the endothelium, the delicate, one-cell-thick lining of blood vessels. Additionally, lipoic acid improves blood vessels’ ability to relax, helping to lower blood pressure, improve blood flow, and reduce risk for cardiovascular events such as heart attack and stroke.25-28 Better blood flow in legs can also mean reduced pain with prolonged walking or other exercise.29

Cardiac surgeons are now beginning to recommend lipoic acid, along with other antioxidants such as CoQ10, prior to surgery in order to protect delicate blood vessels during surgery. Improved physical and mental quality of life in such patients has been reported to last for more than a month after the surgery.30

You can use lipoic acid to help lower your risk for cardiovascular disease long before you need cardiac surgery, though. Lipoic acid lowers total cholesterol and low-density lipoprotein (LDL) levels and reduces the size and number of atherosclerotic plaques, the dangerous points of arterial narrowing that produce heart attacks and strokes.23,24,28,31 In addition, lipoic acid may also lower levels of certain cellular toxins that contribute to cardiovascular diseases, especially those related to diabetes.32,33

Even people with pre-existing heart disease can benefit from lipoic acid. Cardiac stents, intended to improve blood flow following a heart attack, can become blocked by formation of unwanted new tissue, an effect that is prevented by lipoic acid supplementation.34 And, lipoic acid prevents death of heart cells exposed to high blood sugar levels, a contributor to diabetic heart disease.35

Targeting Obesity

Lipoic acid has beneficial effects on the forces that cause us to gain weight and store excess fat. It works on brain areas to reduce appetite, food intake, and body weight.36-39 Lipoic acid also stimulates increased energy expenditure, burning excess calories by activating cellular energy signaling complexes.13,36

Overweight and obese people lose their normal sensitivity to insulin, resulting in ever-higher levels of blood sugar and advanced glycation end product–induced tissue damage. Lipoic acid improves insulin sensitivity and stimulates sugar uptake from the blood to help normalize sugar levels.40-43 In the liver, lipoic acid decreases fat production and accumulation, helping to prevent development of dangerous non-alcoholic fatty liver disease (NAFLD).44,45

Lipoic acid has been successfully used in patients taking medications that stimulate weight gain, such as antipsychotic drugs.46 Even in people who are only overweight (not yet obese), lipoic acid reduced body weight by 8% while shrinking waist size by more than 2 inches.47 In patients who are already obese, there was a 9% loss of weight and a decrease in waist size of more than 3 inches.47

What You Need to Know: Lipoic Acid Reverses Mitochondrial Aging

Cells with mitochondria isolated from old animals degenerate far more rapidly than those with mitochondria from young animals.
When supplied with a nutrient regimen that includes lipoic acid, a profound regenerative effect is observed.
Experimental models show that lipoic acid optimizes function of the mitochondria in aging cells and reverses cell aging.
Recent data reveal that lipoic acid specifically targets factors that contribute to mitochondrial aging, dysfunction, and cell death.
Lipoic acid can help to prevent cardiovascular disease, obesity, insulin resistance, and diabetic complications.
Lipoic acid protects against nerve and brain cell damage induced by aging and trauma.
New evidence suggests that lipoic acid may also have important cancer-preventive effects, even against some of the most difficult-to-treat malignancies.

An Anti-Diabetic

Lipoic acid has an important role in managing diabetes, particularly the massive oxidative and inflammatory changes the disease produces.48,49 The benefits of lipoic acid include promoting insulin sensitivity and glucose uptake.50-52 Diabetics are at increased risk for the kinds of cardiovascular problems that lipoic acid can prevent, including accumulation of cellular toxins.32,53 By protecting against endothelial damage, lipoic acid reduces the threat of diabetic vascular and kidney complications.26,54

Lipoic acid is proving to be especially effective at preventing the painful and debilitating condition known as diabetic neuropathy, an almost inevitable complication in people with poor blood sugar control.55 Diabetic neuropathy begins with pain, burning, and/or stabbing sensations in the extremities.56 In more advanced stages of this condition, the pain disappears as severe damage is done to microscopic blood vessels. Ultimately the loss of nerve function can lead to open sores, infections, and even amputations. Despite considerable knowledge about how diabetic neuropathy arises, no drug treatment has yet proved effective in preventing or reversing the condition.56

Lipoic acid’s powerful antioxidant actions limit damage to the lining and blood supply of nerves, helping to reduce both symptoms and nerve dysfunction.57 Clinical studies have uniformly demonstrated improvements in pain, numbness, and stinging, while also improving nerve conduction velocity, a measure of how efficiently nerves transmit electrical impulses.58-61 Studies have shown that lipoic acid produces significant improvements when administered for 3 weeks, and longer studies have shown sustained effects.62,63 Lipoic acid also has beneficial effects on circulation in patients with diabetic neuropathy, improving blood flow and the amount of blood reserve available during high demand.64

It’s essential to start early with optimal levels of lipoic acid to prevent diabetic neuropathy. People with good blood sugar control and younger patients do better, as do women, and thinner patients in general.58 While doses of up to 1,800 mg/day are well-tolerated, 600 mg/day of alpha-lipoic acid seems to produce the best results in those with diabetes.59 This translates into a 300 mg dose of R-lipoic acid to obtain the same biological activity.21,22

Protection from Brain Cell Degeneration

Lipoic acid protects brain tissue from the long-term effects of advanced glycation end products and the resulting inflammation and oxidative damage, conditions that lead to neurodegenerative diseases like Alzheimer’s disease.9,65,66 A hallmark of Alzheimer’s disease is the formation of an abnormal protein called amyloid-beta, the result of chronic inflammation and a producer of increased oxidative stress. Lipoic acid reduces amyloid-beta-induced inflammation and improves brain cells’ production of the chemical signaling molecules called neurotransmitters.67,68 Mitochondrial function is significantly impaired in the brains of Alzheimer’s and Parkinson’s disease patients and lipoic acid decreases mitochondrial oxidant stress in those cells.69,70

These effects work together with other nutrients like acetyl-L-carnitine, docosahexaenoic acid (DHA), phosphatidylserine (PS), and glyceryl-phosphoryl-choline (GPC) to improve cognitive performance.71 Research has shown that lipoic acid prevents cell death in the brain regions most affected in Parkinson’s disease.72 These findings are both good news and important reminders of the need to incorporate lipoic acid early, before symptoms progress in these chronic, debilitating diseases. Lipoic acid may also have an important role in preventing the immune over-response that causes multiple sclerosis, another chronic, progressive brain disease.73-81

By increasing antioxidant capacity, scavenging free radicals, reducing lipid peroxidation, and enhancing energy utilization, lipoic acid may also minimize the damage produced by brain trauma.82 Lipoic acid has shown benefit in preventing trauma-related injuries to the brain, spinal cord, and even peripheral nerves, all of which are vulnerable following a major accident.83-85

Anti-Cancer Mechanisms

Cancer scientists are growing increasingly interested in lipoic acid because cancer cells offer many targets for its anti-inflammatory attributes.86 These attributes allow lipoic acid to intervene at multiple points in the chain of carcinogenesis.86,87 In experimental studies, lipoic acid shows promise against cancers of the blood (leukemia), lung, breast, and liver.88-93 Preliminary research indicates that lipoic acid acts to halt the cell reproductive cycle of cancer cells, slowing or stopping tumor growth.88,89 Lipoic acid may also help induce apoptosis, the programmed cell death that is the body’s natural control mechanism for weeding out nascent cancers.88-93 Lipoic acid also protects against chemical-induced DNA damage that can lead to cancerous transformation.94 Lipoic acid may help prevent metastatic cancer spread by reducing activity of enzymes that tumors use to invade tissues.93 Finally, in those unfortunate enough to require chemotherapy to treat an existing cancer, lipoic acid can afford powerful protection against some of the side effects, such as diarrhea, intestinal cramping, and ulcers, thanks to its antioxidant capabilities.87

Lipoic Acid: Research Update

An abundance of recently published studies reveals a wide range of new findings about lipoic acid:

Weight loss support. Overweight or obese individuals who received 1,800 mg of alpha lipoic acid daily for 20 weeks lost more weight compared with subjects who did not receive lipoic acid.95 This translates into 900 mg of the biologically active R-lipoic acid.

Migraine prevention. Individuals with frequent or poorly controlled migraine attacks who consumed lipoic acid each day displayed a trend toward fewer migraines.96 These findings build on earlier research suggesting a role for lipoic acid in migraine prevention.97

Improving endothelial function. Impaired glucose tolerance contributes to endothelial function, an underlying cause of cardiovascular disease. When lipoic acid was administered to individuals with newly diagnosed impaired fasting glucose, endothelial function improved, as did a marker of oxidative stress.98

Benefits for polycystic ovary syndrome. Polycystic ovary syndrome (PC OS) is characterized by hormone imbalances, irregular or absent menstrual periods, and blood sugar and lipid abnormalities. Lean, non-diabetic women with PC OS who consumed 600 mg of alpha lipoic acid daily demonstrated improved insulin sensitivity, decreased triglycerides, and beneficial changes in low-density lipoprotein (LDL), and some experienced more regular menstrual periods.99

Relieving back pain. Individuals undergoing rehabilitation therapy for back pain caused by disc compression of nerves who consumed 600 mg of alpha lipoic acid and 360 mg of gamma-linolenic acid (GLA) daily experienced greater improvements in nerve pain, compared with patients undergoing rehabilitation alone.100

Preventing steroid-induced osteonecrosis. Corticosteroids such as prednisone threaten bone health and increase fracture risk by impairing blood flow to bone.101

 In an animal model, lipoic acid helped prevent steroid-induced osteonecrosis (bone death that increases fracture risk), possibly by reducing oxidative stress and/or by improving endothelial function.102

Decreasing leptin levels. Elevated levels of the fat-secreted hormone leptin are involved in the development of metabolic syndrome and diabetes. Lipoic acid administration to animals decreased circulating leptin and leptin expression in fat tissue.103 

Summary

Cells with mitochondria isolated from old animals degenerate far more rapidly than those with mitochondria from young animals, revealing the importance of healthy mitochondria to delay the aging process. When supplied with a nutrient regimen that includes lipoic acid, a profound regenerative effect is observed, including improved metabolic function and significant declines in oxidative stress.

Recent data reveal that lipoic acid specifically targets factors that contribute to mitochondrial aging, dysfunction, and cell death. Lipoic acid can prevent and even mitigate cardiovascular diseases, obesity, insulin resistance, and complications of diabetes. Lipoic acid protects against nerve and brain cell damage induced by aging and trauma.

New evidence suggests that lipoic acid may also have important cancer-preventive effects, even against some of the most difficult-to-treat malignancies.

http://www.prohealth.com/library/showarticle.cfm?libid=19361

New Ways To Repair Nerve Pathways

Today's post from (see link below) looks at new discoveries about dendrites, which are a component of nerve cells which receive information from the brain. It explains that these dendrites are capable of rapid re-growth after injury. before it was thought that axons (part of the cell which sends information to other cells) were the only cell components capable of regeneration. Discovering that dendrites can do it even more quickly and independently of axons may lead to treatments which can promote this activity and thus repair nerve damage more effectively. Sure, all this investigation has been done via fruit flies but the science always has to be established first before it can be applied to human injury - fascinating.

New Pathway for Neuron Repair Discovered  
Jan. 9, 2014 Story Source: The above story is based on materials provided by Penn State.

— Penn State University molecular biologists have discovered a brand-new pathway for repairing nerve cells that could have implications for faster and improved healing. The researchers describe their findings in a paper titled "Dendrite injury triggers DLK-independent regeneration," which will be published in the 30 January 2014 issue of the journal Cell Reports. These findings demonstrate that dendrites, the component of nerve cells that receive information from the brain, have the capacity to regrow after an injury.

Previous studies using many models have shown that when nerve cells, or neurons, are injured they repair the damage through regrowth of axons, the component of a neuron that sends information to other cells, explained co-author Melissa Rolls, associate professor of biochemistry and molecular biology at Penn State. "For example, if you break your arm and the bone slices some axons, you may lose feeling or movement in part of your hand. Over time you get this feeling back as the axon regenerates."

Using the fruit fly (Drosophila) as a model system, the researchers took what Rolls calls a "radical approach," cutting off all of the dendrites in neuron cells. "We wanted to really push the cells to the furthest limit," she said. "By cutting off all the dendrites, the cells would no longer be able to receive information, and we expected they might die. We were amazed to find that the cells don't die. Instead, they regrow the dendrites completely and much more quickly than they regrow axons. Within a few hours they'll start regrowing dendrites, and after a couple of days they have almost their entire arbor. It's very exciting -- these cells are extremely robust."

Moreover, it appears that dendrite regeneration happens independently of axon regeneration. When Rolls and her colleagues blocked the key signaling molecules that are required for axon regeneration in all animals, they found that dendrites were unaffected and continued to regrow. "This means that, not only do these neurons have an incredible ability to generate, they have two different regeneration pathways: one for axons and one for dendrites," she said. "Because it has not even been clear that dendrites can regenerate, it's a complete open question about what might be involved in that process. The next step will be to look for markers for dendrite regrowth -- proteins that are required or genes that are turned on in the process -- so we can learn more about what's going on during dendrite repair. We don't even know in what scenarios dendrite regeneration might happen in people yet because no one has known that it exists."

The implications for human health -- although a long way down the road -- are important, Rolls said. For example, in the case of stroke, when a region of the brain suffers blood loss, dendrites on brain cells are damaged and can be repaired only if blood loss is very brief. Otherwise, it is thought those brain cells die. But if those cells are able to regenerate dendrites, and if scientists learn how dendrite regrowth happens, researchers may be able to promote this process.

"We've provided some cause for hope when it comes to neuron damage," Rolls said. "This is optimistic work we are doing. It's just great to know there is this whole other pathway for survival that no one has even looked into before."

 http://www.sciencedaily.com/releases/2014/01/140109132422.htm

New Drugs To Be Targeted At Pain Receptors Deep In The Nerve Cell

Today's post from sciencedaily.com (see link below) may at first sight seem a little difficult to understand but basically, when the body experiences pain, there are pain receptors on the surface of nerve cells that identify it and transmit the information further and let you feel that pain. If the pain is extreme, sometimes these pain receptors retreat to the nucleus of the cell, as if it's 'safer' there. Pain relieving drugs are designed to block the pain signals in the receptors at the surface of the cell but if the receptors have migrated to the nucleus then the drugs don't have any effect. This knowledge enables researchers to design pain-relieving drugs that can penetrate the nerve cell to the nucleus and thus block the signals from reaching the receptors. They can then 'safely' return to the surface of the cell. At least that's the theory and although it may seem like double-dutch to most of us, sometimes it's interesting to know in which direction the scientists are going.
 

Location may be key to effectively controlling pain
Date:February 3, 2016 Source:McGill University
 
In real estate, location is key. It now seems the same concept holds true when it comes to stopping pain. New research published in Nature Communications indicates that the location of receptors that transmit pain signals is important in how big or small a pain signal will be -- and therefore how effectively drugs can block those signals.

Blocking pain receptors in the nucleus of spinal nerve cells could more effectively control pain than interfering with the same type of receptors located on cell surfaces. The scientists also found that when spinal nerve cells encounter a painful stimulus, some of the receptors will migrate from the cell surface into the nucleus.

A team of researchers led by McGill University's Director of Anesthesia Research Terence Coderre and Karen O'Malley at Washington University in St. Louis, found that rats treated with investigational drugs to block the activity of the receptors in the nucleus soon began behaving in ways that led them to believe the animals had gotten relief from neuropathic pain. According to Prof. Coderre, "drugs that penetrate the spinal nerve cells to block receptors at the nucleus were effective at relieving pain, while those that don't penetrate the nerve cells were not. Rats with nerve injuries had less spontaneous pain and less pain hypersensitivity after blocking receptors at the nucleus, while the pain sensitivity of normal rats was not affected."

Location is key
Scientists have been studying glutamate receptors in the pain pathway for decades. What's new, Coderre explained, is that these most recent experiments -- in cell cultures and rats -- demonstrate that the location of the receptor in the cell has a major effect on the cell's ability to transmit pain signals.

The researchers focused mainly on nerve cells in the spinal cord, an important area for transmitting pain signals coming from all parts of the body.

"We'll now focus our research at determining what events cause the glutamate receptors to migrate to the nucleus, and how to produce drugs that more specifically block glutamate receptors only at the nucleus," added Coderre.

Story Source:

The above post is reprinted from materials provided by McGill University. The original item was written by Cynthia Lee. Note: Materials may be edited for content and length.

Journal Reference:
Kathleen Vincent, Virginia M. Cornea, Yuh-Jiin I. Jong, André Laferrière, Naresh Kumar, Aiste Mickeviciute, Jollee S. T. Fung, Pouya Bandegi, Alfredo Ribeiro-da-Silva, Karen L. O’Malley, Terence J. Coderre. Intracellular mGluR5 plays a critical role in neuropathic pain. Nature Communications, 2016; 7: 10604 DOI: 10.1038/NCOMMS10604

http://www.sciencedaily.com/releases/2016/02/160203111018.htm

Archive Treatment for the sciatic nerve

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Prion Proteins The Sci Fi Villains Behind Mad Cow Disease And Human Chronic Nerve Problems

Today's post from media.uzh.ch (see link below) may seem light years away from the sorts of neuropathy we experience every day but in fact is much closer than you think. With all these things, you have to continually remind yourself exactly what neuropathy is:- damage to the nerves. There are dozens of causes and dozens of types but nerve damage leads to the symptoms we most frequently feel. This fascinating article brings images from the 90's of cows struggling to stay on their feet under the same general umbrella description as the tingling and burning we suffer from when we report our symptoms to our doctors. Scientists are seemingly just beginning to scratch the surface of the knowledge that concludes that certain proteins can be responsible for all this strange behaviour in our nervous systems. It's fascinating and frightening at the same time but you do get the feeling that we're on the point of huge scientific discoveries regarding neuropathy and that can only be a good thing as we struggle with drug treatments that clearly only work to a limited extent. Worth a read - fascinating stuff!

Impact of prion proteins on the nerves revealed for the first time
News release, 8 August 2016 
 
When prion proteins mutate, they trigger mad cow and Creutzfeldt-Jakob disease. Although they are found in virtually every organism, the function of these proteins remained unclear. Researchers from the University of Zurich and the University Hospital Zurich now demonstrate that prion proteins, coupled with a particular receptor, are responsible for nerve health. The discovery could yield novel treatments for chronic nerve diseases.


Without the prion proteins, the so-called Schwann cells around the sensitive nerve fibers no longer form an insulating layer to protect the nerves. (Image: NatureReview / Neuroscience)

Ever since the prion gene was discovered in 1985, its role and biological impact on the neurons has remained a mystery. “Finally, we can ascribe a clear-cut function to prion proteins and reveal that, combined with particular receptor, they are responsible for the long-term integrity of the nerves,” says Professor Adriano Aguzzi from the Neuropathological Institute at the University of Zurich and University Hospital Zurich. The present study therefore clears up a question that researchers have been puzzling over for 30 years, but ultimately went unanswered.

Prions are dangerous pathogens that trigger fatal brain degeneration in humans and animals. In the 1990s, they were responsible for the BSE epidemic more commonly known as mad cow disease. In humans, they cause Creutzfeldt-Jakob disease and other neurological disorders that are fatal and untreatable. Meanwhile, we know that infectious prions consist of a defectively folded form of a normal prion protein called PrPC located in the neuron membrane. The infectious prions multiply by kidnapping PrPC and converting it into other infectious prions. 

Absent prion proteins cause nerve diseases

For a long time, it remained unclear why we humans – like most other organisms – have a protein in our neurons that does not perform any obvious function, yet can be extremely dangerous. Aguzzi has spent decades researching this issue and examining the theory that animals without the PrPC gene are resistant to prion diseases. But what are the repercussions for the organism if the prion protein is deactivated?

A few years ago, Aguzzi and his team discovered that mice without the PrPC gene suffer from a chronic disease of the peripheral nervous system. The reason: The so-called Schwann cells around the sensitive nerve fibers no longer form an insulating layer to protect the nerves. Due to this insulating myelin deficit, the peripheral nerves become diseased, potentially resulting in motoric disorders in the motion tract and paralysis.

The researchers have now gone one step further in the lab: In a new study, Alexander Küffer and Asvin Lakkaraju clarify exactly why the peripheral nerves become damaged in the absence of the prion protein PrPC. They discovered how the PrPC produced by the neurons docks onto the Schwann cells: namely via a receptor called Gpr126. If the prion protein and the receptor work together, a particular messenger substance (cAMP) which regulates the chemical interaction in the cells and is essential for the integrity of the nerve’s protective sheath increases. Gpr126 belongs to the large family of “G-protein-coupled receptors”, which are involved in many physiological processes and diseases.

30-year-old research question finally answered

This discovery solves a key question that has long puzzled neuroscientists and points towards future applications in hospitals. “If you want to deactivate the prion protein PrPC fully for potential Creutzfeld-Jakob disease treatments, you need to know the potential side effects on the nerves in the future,” explains Aguzzi. Moreover, the present results on the effect of PrPC at molecular level could yield a new approach for peripheral neuropathy. Currently, there are only extremely limited therapeutic options for these chronic debilitating diseases of the nervous system.
Literature:

Alexander Küffer, Asvin K. K. Lakkaraju, Amit Mogha, Sarah C. Petersen, Kristina Airich, Cédric Doucerain, Rajlakshmi Marpakwar, Pamela Bakirci, Assunta Senatore, Arnaud Monnard, Carmen Schiavi, Mario Nuvolone, Bianka Grosshans, Simone Hornemann, Frederic Bassilana, Kelly R. Monk & Adriano Aguzzi. The prion protein is an agonistic ligand of the G-protein-coupled receptor Gpr1/Adgrg6. Nature, 8 August 2016. doi:10.1038/nature19312

http://www.media.uzh.ch/en/Press-Releases/2016/Prion-Proteine.html

Can You Laugh At Your Nerve Pain

Today's post from scopeblog.stanford.edu (see link below) has no direct link to neuropathy but does have a link with living with chronic pain and if you have nerve damage, you know you belong in that family. it's basically an account of how someone compensates their chronic pain with humour and laughter. you need to read the article to see how this works for her but the point on this blog is that we (neuropathy patients) could seriously do with a good laugh now and then, so if you have any funny jokes related to pain, or neuropathy, or any funny stories from the same source, please send them in and share them with the rest of us. Googling 'neuropathy jokes' is a bit like looking for an oasis in the desert but there must be related humour out there somewhere!! Otherwise, this article may just stimulate your laughter buds into action - it's the best form of pain distraction you know.

Laughing through the pain: A comedy writer’s experience with chronic illness
Inspire Contributor on October 13, 2015

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, on a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from a Los Angeles woman with Ehlers-Danlos Syndrome.

When you fall down at least once a week, you learn to laugh it off. No matter how much it hurts, you laugh because you know it makes other people more comfortable with what’s going on. If they believe you’re all right, your story is a comedy rather than a tragedy. I’m quite sure that this lesson I learned as a child (and have called on hundreds of times since) had a big part in my decision to become a comedy writer and performer, a career I began a decade before I was finally diagnosed with Ehlers-Danlos Syndrome.

Everyone with my rare connective tissue disorder knows the routine of explaining our condition to others. I like to gauge at what point a healthy person’s eyes glaze over and they check out completely; it’s usually around when I get to my issues that are caused by EDS, like arthritis and gastroparesis. After my first few monotonous rundowns of what ails me failed to enthrall anyone, I began weaving elements of humor into my explanations: “I have hip dysplasia, so I can’t be in the Westminster dog show… My joints hyperextend, which is great for sex but terrible for JV soccer… I tore my hamstring in Greece, but it’s not like that’s the worst thing that ever happened there.” Once engaged, people are much more likely to find some aspect of my condition that interests them and ask about that. This type of light interaction is far more comfortable than feeling like I’m teaching an NIH seminar on some disease nobody cares about.

In my experience, the people who really appreciate someone with a sense of humor are those I rely on most: Doctors and nurses. Just after my diagnosis, I was so confused and in so much pain that I was relatively curt with medical professionals. I also thought that if I even smiled, they would think I was faking my illness. But once my symptoms started to improve a bit and I understood more about what was happening, I tried being open and jovial with those who were treating me. The result was great; it should not have come as a surprise that a doctor who likes his patient is more likely to pay attention to her. Regardless of how badly I feel or how much I think something devastating may be happening to my body, I now try my hardest to make whatever dumb jokes I can manage in the hospital or at the doctor’s office. The staff members, many of whom somehow make it through day after day of maudlin events and miserable people, respond quite positively to my Tommy Boy quotes and ridiculous metaphors about how the exam room smells like a robot dog’s pee. (In fact, I would like to think I get better treatment because of David Spade.)

The need to laugh off my issues has become so innate that it is now my first response when I go into shock. My old roommate loves to tell the story of when I stepped onto our back porch and it looked like a sniper hit me: I was down in an instant. She ran out to see what was wrong and found me laughing hysterically, screaming, “I’m fine! Everything’s fine!” When I saw her worried, maternal expression, it made me even more afraid; I knew I had to alleviate her concern for both of our sakes, so I kept up my laughing and made jokes even as the unbelievable pain set in. As it turns out, I had ruptured my Achilles tendon and torn my calf muscle so badly that the orthopedic surgeon said it looked “like pulled pork; like a zipper went down the whole thing from top to bottom.” Looking back, I laughed and joked to make my roommate think everything was fine – the way you would treat a toddler who fell down and looks to you to gauge the severity of his injuries – but really I was the toddler, and making myself laugh got me through it.

I do not know where my life would be without my love of comedy, nor how I would have made it through the ups and downs of Ehlers-Danlos Syndrome. When it comes to relating to people, passing time in the hospital, or just convincing ourselves that there’s a lighter side to almost every situation, the most important part of the human body is the funny bone.

Paula Dixon is a comedy writer and photographer based in Los Angeles. She is a graduate of the USC School of Cinematic Arts and the Spéos Institute of Photography in Paris. She will be returning soon with her humorous podcast The Chronic Life, which covers chronic illness as well as pop culture and personal revelations.

http://scopeblog.stanford.edu/2015/10/13/laughing-through-the-pain-a-comedy-writers-experience-with-chronic-illness/

Sciatica Sciatica Nerve Pain

                                    
Sciatica commonly describes the signs and symptoms of pain and possibly numbness or weakness that radiate across the sciatic nerve and are generally felt in the rear, along the back of the leg and maybe to the foot. Sciatica is probably the most common forms of pain brought on by compression of the spinal nerves within the lower back, and the leg pain is normally much worse as opposed to back pain.
The sciatic nerve could be the largest single nerve within the human body; it runs from them of the lower spine through deep inside the rear and back from the thigh and all just how down to the foot, connecting the spinal-cord with the leg and foot muscles.
The word sciatica describes the signs of leg pain and perhaps tingling, numbness or weakness that comes from the lower back and travels from the buttock and on the large sciatic nerve at the back of the leg.
Sciatica is often a symptom of an underlying problem - it is not a medical diagnosis by itself.


Sciatica Nerve Pain
Sciatica can often be characterized by one or more with the following symptoms:
• Constant pain within one side of the buttock or leg (rarely may appear in both legs)
• Pain which is worse when sitting
• Burning or tingling around the leg (vs. a monotonous ache)
• Weakness, numbness or difficulty moving the tibia bone or foot
• A constant pain somewhere of the rear
• A sharp pain which could make it difficult to fully stand up or to walk
For a lot of people, sciatica pain can be severe and debilitating. For others, thesciatica symptoms may be infrequent and irritating, but have the possibility to get worse.
Usually, sciatica only affects either side of the lower body along with the pain often radiates from your lower back all the way through the rear of the thigh and down with the leg.
Low back pain might be present along with the leg pain, but most of the leg pain is markedly much more serious than the low back pain.


Common Sciatica Symptoms
• Lower lumbar pain, if experienced in any respect, is not as severe as leg pain
• Constant pain within one side of the buttock or leg, but rarely the right and left sides
• Pain that comes from the low back or buttock and continues across the path of the sciatic nerve - around the back of the thigh and in to the lower leg and foot
• Pain that feels better when patients lay down or are walking, but worsens when sitting or standing
• Sciatic pain that is typically called sharp or searing, instead of dull
• Some experience a “pins-and-needles” sensation, numbness or weakness, or even a prickling sensation around the leg
• Weakness or numbness when moving the shin bone or foot
• Severe or shooting pain in a leg that may ensure it is difficult to stand up or walk
• Depending on in which the sciatic nerve is affected, the pain sensation and other sciatica symptoms could also include foot pain or pain within the toes.

Sciatica Symptoms for each Sciatic Nerve Root
There's two sciatic nerve roots that exit the lumbar spine (L4 and L5) and three that exit the sacral segment (S1, S2 and S3). All five nerves bundle together to create the sciatic nerve, then branch out again from the leg to deliver motor and sensory functions to a particular destinations in the leg and foot.
Sciatica symptoms vary depending on where the compressed nerve root is situated. For example:
• L4 nerve root sciatica symptoms usually modify the thigh. Patients may suffer weakness in straightening the tibia bone, and may have a diminished knee-jerk reflex.
• L5 nerve root sciatica symptoms may extend for the big toe and ankle (called foot drop). Patients may go through pain or numbness in addition to the foot, particularly around the “web” of skin involving the big toe and second toe.
• S1 nerve root sciatica affects the outer section of the foot, which may radiate on the little toe or toes. Patients can experience weakness when raising the heal off the floor or trying to climb onto tiptoes. The ankle-jerk reflex are often reduced.

Since many nerve root could possibly be compressed, patients may go through a combination of the above symptoms.
Sciatica Symptoms that need Immediate Attention
Rarely, sciatica symptoms that worsen quickly might require immediate surgery. The following symptoms indicate a necessity for immediate medical care:
• Sciatica symptoms that carry on and get worse rather than improve, which can indicate possible nerve damage, specifically progressive symptoms are neurological (including weakness)
• Symptoms that appear in both legs (called bilateral sciatica) and cause either bladder or bowel incontinence or dysfunction, that might indicate cauda equina syndrome. Cauda equina syndrome can be an acute compression of a single or several nerve roots that develops relatively rarely, e.g. in 2% of herniated lumbar disc cases.

Reasons for Sciatica
When discussing sciatica you should understand the underlying medical reason behind the sciatica symptoms. You'll find 6 lower back problems that include the most common causes of sciatica:
Lumbar herniated disc.
A herniated disc takes place when the soft inner core from the disc (nucleus pulposus) leaks out, or herniates, with the fibrous outer core (annulus) in the disc and irritates the contiguous nerve root mainly because it exits the spine. Normally, it is thought that a rapid twisting motion or injury can bring about an eventual disc herniation and sciatica. However, most discs weaken with time due to repetitive stress, eventually producing herniation. A herniated disc may also be referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or possibly a pinched nerve, and sciatica is among the most common symptom of a lumbar herniated disc.
Lumbar spinal stenosis
This problem commonly causes sciatica because of a narrowing of the spinal canal. Spinal stenosis. Lumbar spinal stenosis relates to natural aging within the spine and is relatively common in older adults over age 60. The situation typically results from a mixture of one or more of the following: enlarged facet joints, overgrowth of soppy tissue, and a bulging disc placing pressure about the nerve roots since they exit the spine, causing sciatic nerve pain.
Degenerative disc disease
While disc degeneration can be a natural process that occurs with aging, for many people one or more degenerated discs within the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed every time a weakened disc leads to excessive micro-motion at that spinal level, and inflammatory proteins within your disc become exposed and irritate the region (including the nerve roots). That is truly not a disease despite its name, it really is part of the natural process of getting older.
Isthmic spondylolisthesis
This condition occurs when a tiny stress fracture allows one vertebral body to slide forward on another vertebral body (e.g. the L5 vertebra slips on the S1 vertebra). With a combination of disc space collapse, the fracture, as well as the vertebral body slipping forward, the nerve will get pinched as it exits the spine and cause sciatica.

Piriformis syndrome
The sciatic nerve will also gain irritated as it runs beneath the piriformis muscle in the rear. If your piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, you can get sciatica-type pain. This is not an authentic radiculopathy (the clinical concept of sciatica), but the leg pain can seem to be the same as sciatica the result of a nerve irritation.
Sacroiliac joint dysfunction
Irritation with the sacroiliac joint - located at the end of the spine - could also irritate the L5 nerve, which depends on top of the sacroiliac joint, causing sciatica-type pain. The shin bone pain can feel exactly like sciatica caused by a nerve irritation.
More Reasons behind Sciatica
• Pregnancy. The changes that this body goes through during pregnancy, including fat gain, a shift on one's center of gravity, and hormonal changes, could cause sciatica during pregnancy.
• Scar tissue. If keloid compresses the nerve root, it may cause sciatica.
• Muscle strain. In most cases, inflammation related to a muscle strain can put pressure with a nerve root and cause sciatica.
• Spinal tumor. In rare cases, a spinal tumor can impinge with a nerve root inside lower back and cause sciatica symptoms.
• Infection. While rare, disease that occurs in the mid back can affect the nerve root and cause sciatica.
It is very important know the underlying clinical carried out the cause of sciatica, as treatments will most likely differ depending on the cause. For example, specific sciatica exercises, which can be almost always a part of a sciatica treatment program, will change depending on the underlying source of the sciatica symptoms.

Autonomic Neuropathy The Nerve Damage You Have No Control Over

Today's post from dressamed.com (see link below) talks about autonomic neuropathy, which may be a new term to many people. Basically, it's a form of neuropathy that affects the involuntary functions of the body, breathing, digestion, excretion, sweating, sexual function, etc. You have no control over these functions and when they go wrong thanks to nerve damage, the consequences can make life pretty miserable. Most people begin their neuropathy lives with the well-known symptoms of numbness, tingling, burning etc in the feet and/or hands and for some it stays that way but for others, the damage spreads to the autonomic functions and you begin to notice things going wrong. Your doctor will inevitably try to rule out all other other possible reasons why this is happening and it may be years before you get a proper diagnosis of autonomic neuropathy. The treatment for your pain will remain the same but you may find your medicine chest being expanded to include treatments for dysfunctions elsewhere in your body. I'm sorry, there's no sugar-coated pill to this story: if you have autonomic neuropathy it sucks but there are always ways to improve your situation but you need to take time to research and explore your options. Working with your doctor and not waiting for him or her to provide answers, is the key.

When Autonomic Neuropathy Affects Bodily Functions 
Posted on May 11, 2016 Posted in Staff Pick by Staff Pick

Do any of these symptoms sound familiar? 
 
Dizziness and fainting when you stand up
Difficulty digesting food and feeling really full when you’ve barely eaten anything
Abnormal perspiration – either sweating excessively or barely at all
Intolerance for exercise – no, not that you just hate it but your heart rate doesn’t adjust as it should
Slow pupil reaction so that your eyes don’t adjust quickly to changes in light
Urinary problems like difficulty starting or inability to completely empty your bladder

If they do, you could have autonomic neuropathy. Especially if you have diabetes, your immune system is compromised by chemotherapy, HIV/AIDS, Parkinson’s disease, lupus, Guillian-Barre or any other chronic medical condition.

You need to see a doctor immediately. A good place to start would be a physician well versed in diagnosing and treating nerve disease and damage, like your local clinician who specializes in our treatment protocol.
What Is Autonomic Neuropathy?

Autonomic neuropathy in itself is not a disease. It’s a type of peripheral neuropathy that affects the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration. The nerves are damaged and don’t function properly leading to a break down of the signals between the brain and the parts of the body affected by the autonomic nervous system like the heart, blood vessels, digestive system and sweat glands.

That can lead to your body being unable to regulate your heart rate or your blood pressure, an inability to properly digest your food, urinary problems, even being unable to sweat in order to cool your body down when you exercise.

Often, autonomic neuropathy is caused by other diseases or medical conditions so if you suffer from: 

Diabetes
Alcoholism
Cancer
Systemic lupus
Parkinson’s disease
HIV/AIDS

Or any number of other chronic illnesses, you stand a much higher risk of developing autonomic neuropathy. Your best course of action is not to wait until you develop symptoms. Begin a course of preventative treatment and monitoring with a clinician to lessen your chances of developing autonomic neuropathy.

How Will The Clinician Diagnose My Autonomic Neuropathy?

If you have diabetes, cancer, HIV/AIDs or any of the other diseases or chronic conditions that can cause autonomic neuropathy, it’s much easier to diagnose autonomic neuropathy. After all, as a specialist in nerve damage and treatment, your clinician is very familiar with your symptoms and the best course of treatment.

If you have symptoms of autonomic neuropathy and don’t have any of the underlying conditions, your diagnosis will be a little tougher but not impossible.

Either way, your clinician will take a very thorough history and physical. Make sure you have a list of all your symptoms, when they began, how severe they are, what helps your symptoms or makes them worse, and any and all medications your currently take (including over the counter medications, herbal supplements or vitamins).

Be honest with your clinician about your diet, alcohol intake, frequency of exercise, history of drug use and smoking. If you don’t tell the truth, you’re not giving your clinician a clear picture of your physical condition. That’s like asking him to drive you from Montreal to Mexico City without a map or a GPS. You may eventually get to where you want to be, but it’s highly unlikely.

Once your history and physical are completed, your clinician will order some tests. Depending upon your actual symptoms and which systems seem to be affected, these tests might include:
Ultrasound
Urinalysis and bladder function tests
Thermoregulatory and/or QSART sweat tests
Gastrointestinal tests
Breathing tests
Tilt-table tests (to test your heart rate and blood pressure regulation). Once your tests are completed and your clinician determines you have autonomic neuropathy, it’s time for treatment. 

Treatment and Prognosis

Our clinicians are well versed in treating all types of peripheral neuropathy, including autonomic neuropathy. They adhere to a very specialized treatment protocol that was developed specifically for patients suffering from neuropathy. That’s why their treatments have been so successful – neuropathy in all its forms is what they do.

Autonomic neuropathy is a chronic condition but it can be treated and you can do things to help relieve your symptoms.

Your clinician will work with you and your other physicians to treat your neuropathy and manage your underlying condition. They do this through:

Diet Planning and Nutritional Support
You need to give your body the nutrition it needs to heal.

If you have gastrointestinal issues caused by autonomic neuropathy, you need to make sure you’re getting enough fiber and fluids to help your body function properly.

If you have diabetes, you need to follow a diet specifically designed for diabetics and to control your blood sugar.
If your autonomic neuropathy affects your urinary system, you need to retrain your bladder. You can do this by following a schedule of when to drink and when to empty your bladder to slowly increase your bladder’s capacity.

Individually Designed Exercise Programs
If you experience exercise intolerance or blood pressure problems resulting from autonomic neuropathy, you have to be every careful with your exercise program. Make sure that you don’t overexert yourself, take it slowly. Your clinician can design an exercise program specifically for you that will allow you to exercise but won’t push you beyond what your body is capable of. And, even more importantly, they will continually monitor your progress and adjust your program as needed.

Lifestyle Modifications
If your autonomic neuropathy causes dizziness when you stand up, then do it slowly and in stages. Flex your feet or grip your hands several times before you attempt to stand to increase the flow of blood to your hands and feet. Try just sitting on the side of your bed in the morning for a few minutes before you try to stand.
Change the amount and frequency of your meals if you have digestive problems.

Don’t try to do everything all at once. Decide what really needs to be done each day and do what you can. Autonomic neuropathy is a chronic disorder and living with any chronic condition requires adaptations. Your clinician knows this all too well and will work with you to manage your level of stress and change your daily routines to help you manage your condition and your life.

All of these changes in conjunction with medications, where needed, will make it easier to live with autonomic neuropathy and lessen the chances of serious complications. Early intervention with a NeuropathyDR® clinician is still the best policy if you have any of the underlying conditions that can cause autonomic neuropathy. But if you already have symptoms, start treatment immediately.

About The Author

Dr. John Hayes, Jr. is an Evvy Award Nominee and author of “Living and Practicing by Design” and “Beating Neuropathy-Taking Misery to Miracles in Just 5 Weeks!”. His work on peripheral neuropathy has expanded the specialty of effective neuropathy treatments to physicians, physical therapists and nurses. A free Ebook, CD and information packet on his unique services and trainings can be obtained by registering your information at neuropathydr.com. To book interviews and speaking engagements call 781-754-0599.

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https://www.dressamed.com/root/autonomic-neuropathy/

Ten More Things To Consider If You Have Nerve Pain

Today's post from dailyhealthrecords.com (see link below) is yet another list of learning experiences from someone living with chronic pain. People love making lists and judging by their popularity on the internet, people love reading them too. There's nothing wrong with that and nothing wrong with sharing tips based on your own experiences, so long as you don't descend into cliché and so long as you keep it practical and realistic. Having said all that, with it's implied criticism of new age wisdoms, if you skim through the 10 headings and don't want to read it after that, then this article is not for you. Personally, I agree with everything she says!

10 Things I’ve Learned About Living With Chronic Pain
December 26, 2015 lussy

I was first diagnosed with chronic pain when I was 7 years old. I just turned 21. For the past 14 years, I have told as few people as possible about my illness. I have my reasons for this. It’s not a very glamorous topic, and I would like for most people to assume I’m a normal 21 year old.

Recently, my condition seems to be changing, deteriorating more rapidly than doctors can, or want to, deal with. These past few months have been full of exercises in looking for silver linings, but there are times I’ve had to be honest with myself about my disease and my pain. Learning how to cope with pain is a process, and I had to start writing down things I needed to remind myself: don’t take your pain out on other people, try to remember that people won’t understand when or how much pain you’re in, don’t defend yourself for making your health a priority. They were hard truths to deal with, but they have helped me.

I wake up in pain, and I go to sleep in pain. I can not explain the kind of toll this takes on you mentally, physically, and emotionally. These coping mechanisms worked for me, and I can only reference my own pain, hence the following truths are my stories, but I do believe that other pain patients experience many of the same frustrations I do. I can’t talk about what living in pain is like for everyone. What I can do is talk about my pain, something I largely avoid for several reasons — the chronically ill and in pain are meant to be brave and handle their suffering in inspiring ways, talking about it with the wrong people can make it worse, and trying to keep up a positive front all being important ones.

These are some things I’ve learned about how to be chronically ill, and how to manage living with chronic pain, and still try to remain as sane as possible. I hope that should other chronic pain patients read this, that they will find some comfort in knowing they are not alone in their pain.

1. People can’t understand.

Unless you live in chronic pain, or with a chronic illness, you cannot possibly imagine it. For months, my health has been rapidly deteriorating, and I realized quickly most people either don’t understand, or don’t care.

The hardest part of dealing with chronic illness/pain for me has been cutting people out of my life who make it harder to deal with. This wasn’t a choice, but a necessity. I couldn’t take any extra negativity, I couldn’t handle defending my situation time and time again to people who were supposed to be my friends. I guess I understand, it’s hard for them to deal with, maybe. Unlike me, they don’t have to deal with it. It is also important to remember that when people can’t see your suffering, when they can’t see outwardly that you are in pain, they can’t be expected to understand.

The reason for the archaic pain scale with the faces slowly becoming more warped in pain with a scale of 1-10 is because there is no test for pain, no base line, there is just pain. I’m lucky to have a few friends who — while they don’t pretend to understand — still put up with me and do their best to help me be comfortable and get out of the house. Find your people and keep them by your side, you’re going to need them. Get anyone out of your life who is making your journey more difficult, you don’t need that kind of negativity.

2. Some medical professionals suck at their job.

First, all hail good nurses. Good nurses have done more for me than any doctor I’ve seen so far. That said, for every one good nurse there seem to be two bad ones. The ratio changes for doctors. By my experience, almost all doctors suck at managing chronic illness and pain. They want you in and out of their office, and they don’t want to deal with you on a weekly, or even more frequent basis. Yes, most people I have gone to asking for help — be it an ER doctor, an internist, or one of the dozens of specialists I’ve seen — have shrugged, decided they don’t want to deal with this and washed their hands of me. Not all doctors are created equal. I have had exactly one good doctor so far, and I’ve seen dozens.

I’m not saying good doctors don’t exist, I’m saying that, as in any profession, some people excel far above others. Keep searching for the right doctor for you, it’s going to be miserable and time consuming and frustrating, but despite all the bad doctors I’ve met, I believe there is one out there that can help me. I’ve just got to find them.

3. You get to feel however you want.

People won’t understand what it’s like to try to get through a day, and you don’t have to explain why you feel how you do today. I found myself frustrated whenever someone asked “How are you feeling?” If my answer was “good,” then I found they were less likely to be understanding if I needed a break, or if I couldn’t keep up with the group. Wasn’t I feeling good today? It’s all relative.

For me, a good day is one where I do not reach a 9 on that pain scale. If I told someone I was feeling bad, or having a bad pain day, I would quickly be reminded there are worse conditions than mine, that I could be dead already, that there are people starving all over the world. These are all true things, but do not negate my right to have a bad day.

Staying positive is an important part of managing life with chronic pain, but bad days still happen. To lie and say that even when you’re in pain every day has to be bright and sunshine-y is not mental health, it’s crap. You get to feel however you want and you don’t have to explain why you are having a bad day. You also don’t have to defend why your health takes priority over everything else. If people around you don’t understand that, you might want to re-consider who you are keeping in your inner circle. While you have the right to feel however you want, be careful not to let your pain cause you to lash out at people. It is hard to be patient when you are hurting, but you can’t get let your frustrations out on people. You have the right to be in pain, but pain does not give you a free pass to become cruel.

I have also noticed that people seem to think that chronic illness somehow instills some sort of super human strength inside the person suffering. As if all sick people experience pain but survive solely by persevering with integrity and grace. I have to side with Julius Caesar who said, “It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.” Make no mistake, I do not wish for my life to end. But there are days where the pain has been so great that I would have been very happy to die. That’s the side of chronic pain the universe doesn’t see — how much you keep wrapped up to try to put on a façade of a “normal” person.

I’ve had many days where I found myself losing track of the conversations happening around me, enveloped in pain and trying to hold back tears or outward manifestations of the pain. I know many other chronic pain patients who try to stay quiet about their illness, and it is brave and wonderful and inspiring and all those words often used to describe those of us living in the genre of sick personhood. You still are allowed to have bad days, even if the world could be a worse place, and you don’t always have to pretend the bad days aren’t bad days.

4. Be honest.
 
I’ve learned you must be honest with people when you are sick, and when you need them to understand. My teachers, coaches, and friends I’ve trusted with the details of my illness/treatment are all people I need to be up front with when I need extra time for an assignment, or I can’t go to practice, or I’m not feeling up to going out. However, it’s also very important to state that you don’t have to disclose any of your medical history to people you are not comfortable discussing it with. It’s your choice to decide how, when, and in what detail you would like to discuss your illness with someone, so never feel bad about keeping details to yourself if you are uncomfortable discussing them. Your body, your rules.

Also, be honest with your doctors. This can be difficult because I feel that, culturally, I have been raised to think that doctors had the answer and that I didn’t need a second opinion. If you don’t think they’re listening, if you don’t think the current treatment is working, if you think more tests need to be run — demand it. I’ve learned that playing nice while trying to get treatment just doesn’t work. I don’t seem to get any attention until I start advocating for myself. I’ve also learned to be honest when evaluating doctors. Before I tried to always be kind. Maybe that doctor had a bad day, maybe their head is somewhere else, perhaps they’re exhausted. These are all things that are understandable- but if you are not receiving the care you deserve it’s time to start making calls. I’ve realized that the only way to get better treatment is to make them give it to you. You deserve the best quality of life possible.

5. Listen to your body.

When you’re a professional sick person, you have to learn to listen to your body. Stay in if you need to stay in. I was a 20 year old student-athlete who was active on my university’s campus when my illness quickly took a turn for the worse. Giving up my sport was heart breaking, but physically I couldn’t do it anymore. I pushed myself long and hard before I listened to what my body was telling me: slow down, you can’t do this. I needed to take a step back from all the things I was participating in and try to get my health back. I still find myself frustrated when I have to cancel plans with friends, I even had to cancel my 21st birthday celebrations because I just wasn’t feeling up to it. I could have pushed it, but I knew how I felt, and I knew that if I went out and forced myself to stay out all night that I would pay for it later. It is hard to give up things you want to do just because your organs suck at being organs, and it is disappointing to be stuck in a body you particularly care for. I do believe that I have more good days when I slow down, and don’t push myself harder than my body can handle. Learn to listen to your body’s limits, and it can help increase your overall wellness.

6. Go out when you feel up to it.

When you’re in constant pain, or you just don’t ever seem to feel good, it can be easy to become a homebody. Maintaining your quality of life as much as possible is essential to coping with chronic illness. I know — I just said you should stay in if you need to, but if you are feeling up to going out by all means do so! Staying in sick all day every day can quickly lead to depression and anxiety. Even small things like going out to a movie seem to do wonders to cheer me up if I’ve been stuck home sick for a few days. If I find myself having a good day and I didn’t have plans, I try to take advantage of healthy moments, even if that just means a walk around the block with a friend. It can be tricky to find where the line between going out and having fun and going out and wearing yourself out so that you’re even sicker after is, but searching for that area is well worth the effort it requires.

7. Accept your body, even when you hate it.

Having my body shut down on me so painfully and rapidly was hard for me to accept, I was so active before and my illness was very manageable. While I have every intention to stay involved with my case, to find relief and answers, I had to accept that — for right now — this is the one body and one life I have. I’ve had to sit back and watch my athleticism slowly disappear, the dark circles develop under my eyes from sickness and exhaustion, and watched the color drain from my lips. It is beyond frustrating to watch my body waste away and have no say in it, no way to stop it. I am not particularly fond of my current situation. But when I accepted it, when I stopped trying to act as if I wasn’t sick, and started to listen to my body I found myself having more less bad days, which for chronic pain patients are synonymous with good days.

8. Seek out anything that will keep you smiling.

Every chronic pain patient I have met has also struggled with depression, some mild some as debilitating as the pain that caused it. Find anything you can to keep your spirits up: good books, movies, a special tea to drink, a place in the park that you like to visit — do whatever you can to keep smiling. It sucks to be sick and in pain, and unfortunately for chronic pain patients the elimination of pain is a fantasy. So we must deal with the pain while trying not to let it change who you are. Pain can change you, quickly. It makes you angry, depressed, frustrated, exhausted, scared, and other unpleasant adjectives. If you can find one song, one poem, one comedy sketch that can get you to smile hold onto it, and refer back to them often. Try to find whatever you can to get you through the next second, hour, or day.

9. You are allowed to ignore people who think they know what’s best.

For some reason if you are chronically ill, people in your life from family members to random hospital personnel will start to fancy themselves physicians. They might recommend a new diet, snorting some homeopathic remedy, covering yourself in some sort of home made salve, or some other ridiculous thing they once read on the internet. These people mean well. They hope that their insight will bring you relief. You are allowed to ignored these good intentioned people, specifically the ones who have no knowledge of your illness or medicine. I’ve taken to smiling, saying “I’ll look into that,” and then politely excusing myself from the conversation.

10. Advocate for yourself.
This is the single most important thing I’ve learned as a professional sick person: you must advocate for your own health. Doctors see many patients every day, nurses are busy, and none of them know what it’s like to live in your body. Take action, get involved in your case, start doing research. Go into appointments with documentation, ideas, second opinions, anything you can get to push your treatment forward. Medical professionals may not understand the urgency of your case, or the severity of your pain, so make it clear. Write down everything you need to talk about before your visit, and make sure you get every question you have answered. If your doctor can’t answer them, get a referral or find another opinion. Nothing is more important than your health and trying to maintain the best quality of life possible.

http://dailyhealthrecords.com/10-things-ive-learned-about-living-with-chronic-pain-2/