Can Fish Oil With Omega 3 Help With Neuropathy

Today's post from newswise.com (see link below) looks at the potential benefits of fish oil containing omega 3 fatty acids for people suffering from nerve damage. It has been found that the omega 3 fatty acids improved nerve health in terms of density and sensory signal transmission in rats. Now if these results can be successfully applied to humans then we have a cheap and relatively harmless, easily produced supplement which could really help neuropathy patients restore some normality to their nerve reactions. It's all still at the research stage but the science and potential seem solid. In the meantime, supplementing your diet with fish oil (plus omega 3) is not bad advice anyway unless your diet is already enriched with fish products.

Fish Oil May Help with Diabetic Neuropathy Released: 6-May-2015 4:05 PM EDT
Source Newsroom: American Physiological Society (APS)

Newswise — Bethesda, Md. (May 6, 2015)—Approximately 50 percent of patients with diabetes suffer from nerve damage, or neuropathy. No cure exists, and the most effective treatment, keeping blood sugar in control, only slows neuropathy. A new study in the Journal of Neurophysiology, however, introduces a new alternative, omega-3 fatty acids found in fish oil. The study shows that fish oil supplements can restore the condition of nerves damaged from diabetes in mice.

“Diabetic neuropathy is a very costly and debilitating complication of diabetes. It is the leading cause of foot ulcers and nontrauma-related amputations, and the impact of diabetic neuropathy on the patient and family are unmeasurable,” said Mark Yorek of the VA Medical Center in Iowa City, the study’s lead investigator. Fish oil is an attractive treatment approach because “supplements are considered very safe and could be easily translated into everyday care. Fish oil would be easy to take, like a vitamin, and should have few side effects when combined with other medications,” explained Yorek.

Previous studies of obesity and diabetes have reported better blood sugar handling, liver function and reduced inflammation with omega-3 fatty acids treatment. The health benefits were attributed to protective molecules produced from omega-3 fatty acids, including one type called resolvins. The research group had previously observed that diets enriched with omega-3 fatty acids from fish oil improved diabetic neuropathy in rats with Type 1 and Type 2 diabetes, and in this new study they examined why.

Researchers used a mouse model of diabetes to study the effect of fish oil. Diabetic mice were fed a high-fat diet and treated with daily injections of resolvin or given a high-fat diet in which half the fat came from fish oil. The results were compared to healthy, non-diabetic mice.

The researchers found that untreated diabetic mice had diminished sense of touch in their paws that corresponded to fewer nerves in the paw’s skin and slower transmission of signals along the nerves. The eyes of untreated diabetic mice also had fewer nerves. Though dietary fish oil and resolvin did not lower glucose levels closer to healthy range, they improved nerve health in terms of density and sensory signal transmission. The researchers also observed that resolvin stimulated nerve cells to grow.

“Even though a lot more work needs to be done, including clinical trials with human subjects, our animal studies suggest that fish oil can reverse some of the harmful effects of diabetes on the nerves. Our intent is to do more animal studies to demonstrate that fish oil treatment can reverse the harmful effects of diabetes on nerves even after a long period of poorly controlled diabetes. After completion of this work, we hope to begin studies with diabetic patients with neuropathy,” Yorek said.

The article “Effect of enriching the diet with menhaden oil or daily treatment with resolvin D1 on neuropathy in a mouse model of Type 2 diabetes” is published ahead-of-print in the Journal of Neurophysiology.

NOTE TO JOURNALISTS: To schedule an interview with a member of the research team, please contact Maggie Kuo at mkuo@the-aps.org or 301-634-7253.

About the American Physiological Society (APS)
Physiology is the study of how molecules, cells, tissues and organs function in health and disease. Established in 1887, the American Physiological Society (APS) was the first U.S. society in the biomedical sciences field. The Society represents more than 11,000 members and publishes 14 peer-reviewed journals with a worldwide readership.

http://www.newswise.com/articles/view/633928/

The Placebo Effect With Pain

Today's post from updates.paintopics.org (see link below) is an interesting look at the history of and the ways a placebo can work. Many people feel slightly ashamed and even angry if they discover that what they've been taking is a placebo but there's no reason to be. a) It is the only way that many drugs can be tested for efficiency and b) if it works, why knock it? The brain is a highly complex organ and may react to a placebo by repressing the pain signals anyway. You've not been deceived; it's just that the brain can react positively to the power of suggestion. This subject especially applies in our case, to supplements and alternative treatments which may work irrespective of their content (homeopathy has built a whole industry around that concept). The point is that a neuropathy patient generally desperately needs relief from the symptoms and whatever helps you is of value. It may cloud the picture in neuropathy statistics because of the huge variation of reactions that patients have to particular treatments - placebos or otherwise. It's possible that your improvement may be due to a placebo effect; the trick is not to fight it but be grateful for small mercies!

Unconscious Mind Guides Placebo Response to Pain

Friday, September 28, 2012

 

Concepts of placebo, dating back to medieval times, are becoming increasingly important today for understanding the efficacy and limitations of pain management therapies. For example, we most recently discussed in Pain-Topics UPDATES major influences of placebo effects in acupuncture [here] and transcutaneous electrical nerve stimulation (TENS) [here] as therapies for pain. With the newly reported discovery that the unconscious mind may play a key role in placebo effects, researchers have proposed a novel mechanism that helps to further explain the power of placebos and their sinister sister, nocebo.

Writing online in the Proceedings of the National Academy of Sciences (PNAS), Karin Jensen, PhD — of Massachusetts General Hospital and the Program in Placebo Studies at Beth Israel Deaconess Medical Center/Harvard Medical School — and colleagues report a novel study that demonstrated how placebo and nocebo (negative placebo) effects may rely on brain mechanisms that are not dependent on conscious awareness [Jensen et al. 2012]. They enrolled a total of 40 healthy volunteers (24 female, 16 male; median age 23) in 2 experiments:
 

1. In the first experiment, researchers administered a heat stimulus to participants' arms while simultaneously showing them images of male human faces on a computer screen. The first face was associated with low pain stimulation and the second image with high pain. Subjects were then shown the faces again, along with a heat stimulus, and asked to rate their pain on a 0-to-100 scale; however, unknown to the subjects, all heat stimulations had the same moderate intensity. As predicted from classical conditioning theory, the pain ratings correlated with the previously learned associations, with an average pain rating of only 19 when subjects viewed the low-pain face and a mean rating of 53 (nocebo effect) associated with the high-pain face.
2. In the second experiment, a different group of participants were first administered the same high and low levels of thermal heat stimulation in association with different faces. Following that, the facial images were again projected on the computer screen, along with the moderate-intensity stimulus; however, this time the images were flashed by so quickly that subjects could not consciously recognize them. Despite this lack of visually recognizable cues, when participants were asked to rate their pain they still reported a mean pain rating of only 25 associated with the low-pain face (placebo effect) and a mean pain rating of 44 in response to the high pain face (nocebo effect).

The researchers believe these new findings demonstrate that a patient may have a favorable (placebo) or a negative (nocebo) response to a therapy even if he/she is not consciously unaware of any suggestion of therapeutic benefit or anticipation of getting worse. This process, operating below the level of cognition, may be automatic, rapid, and powerful, and does not rely on conscious deliberation or judgment. It adds a new level of complexity to understandings of placebo and nocebo effects in research and medicine in general.

 

COMMENTARY: This unique study by Jensen et al., suggesting an influence of non-conscious conditioned stimuli on placebo/nocebo effects could be of significant consequence, since the results challenge the exclusive role of awareness and conscious cognition in placebo responses. At the same time, however, this was a small laboratory experiment in a select group of subjects and needs further verification.

 

Traditional thought has contended that placebo responses are related to conscious beliefs or thoughts and, when given an inert pill or therapy, patients may improve because they have the expectation that they will get better. Or, in the case of nocebo, patients get worse because of anticipation some harm, such as due to knowledge of possible adverse effects. This new research proposes that patients may learn to expect or anticipate either benefit or harm quickly and automatically, without needing to consciously register the idea in their brains.

 

The implication is that a host of factors beneath conscious awareness, operating “under the radar” so to speak, may influence patient responses. Among other things, it highlights the absolute necessity of blinding in clinical trials — whereby neither practitioners nor patients know whether the actual intervention of interest is being administered — to avoid biased outcomes. Yet, this is often problematic or impossible to achieve, and placebo or nocebo effects will continue to be a difficult to control confounder in research.

 

In an interesting review of the biological, clinical, and ethical aspects of placebos, Finniss et al. [2010] observed that placebos in medical research and practice have been defined by their inert content. However, “recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings.” They further noted that placebo effects can exist, even if no placebo is given, which appears to portend these latest findings by Jensen and colleagues of a subconscious context.

Finniss and colleagues [2010] also offer some fascinating and important commentary regarding the origins of placebos, which is abstracted here for interested readers:

The notion of a “placebo” started with St Jerome's mistranslation of the 9th line of Psalm 116; instead of translating the Hebrew as “I will walk before the Lord,” St. Jerome wrote, “Placebo Domino in regione vivorum” (“I will please the Lord in the land of the living”). By the 13th century, Finniss et al. continue, when hired mourners awaited Vespers for the Dead to begin, they often chanted that mistranslated 9th line, and so were called “placebos” to describe their faked behavior. Later, in The Canterbury Tales, Chaucer named his sycophantic, or falsely flattering, courtier “Placebo.”

The idea of placebo controls were introduced in the 16th century, when progressive Catholics administered fake procedures to separate the effects of imagination from reality. To discredit the validity of exorcisms, individuals “possessed” by the devil were given false holy objects and if they reacted with violent contortions — as if those were genuine religious relics — it was concluded that their possession was in their imagination. This concept of a placebo control was later applied to medical experiments, beginning with the Franklin commission's debunking of the psychic force of mesmerism or animal magnetism in 1784.

Finniss and colleagues further note that use of the word placebo in a medical context to describe innocuous treatments to make a patient comfortable dates from at least the end of the 18th century. The earlier, unsavory connections likely led to the tainted reputation of placebos and placebo effects as being undesirable, which persisted until relatively recently.

Mainstream interest in placebo effects only began with the widespread adoption of the randomized controlled trial (RCT) after World War II. It was then noticed that people improved — sometimes dramatically — in placebo-control groups. Soon after, in his legendary work during the 1950s, Henry Beecher claimed that about 30% to 35% of pain patients responded positively to placebo treatment [previously discussed in an UPDATE here].

Beecher, however, encouraged an inflated notion of the “powerful placebo” because he failed to distinguish the placebo response from other confounding factors, Finniss et al. contend. Since that time, there has been increasing interest in investigating placebo effects by rigorous research methods, especially during the past decade or so, and this has included recognition of the importance of nocebo effects.
 

 http://updates.pain-topics.org/2012/09/unconscious-mind-guides-placebo.html

Can Yoga Help With Nerve Pain

Today's post from livestrong.com (see link below) looks at the potential benefits of yoga for people living with neuropathy. To my mind, this may be literally 'stretching' a point when it comes to the relief of nerve pain (especially in the feet and legs). If you've ever tried yoga, you'll know that it requires a level of fitness that tests even the healthiest bodies and while its benefits are sworn by, neuropathy patients may not be prepared to go through yet more pain to achieve a non-guaranteed end-result. Where it may well help is with people who are at the beginning stages of peripheral neuropathy and who can do the exercises (however gentle) without too much physical strain but I do wonder how many long-term neuropathy patients will be willing to take the risk. It may also help with neuropathy conditions such as sciatica, where entrapment is probably involved. However, we all know that exercise is good (and even necessary) for neuropathy patients but subscribing to the theory of 'no pain, no gain' may just be a stretch too far. I'm very willing to be proved wrong here and success stories will be published.
 

Yoga for Peripheral Neuropathy
by ANDREA CESPEDES Last Updated: Dec 24, 2010

Tingling, numbness, sensitivity to touch and lack of coordination are all telltale signs that you may have damage to your peripheral nervous system, a condition known as peripheral neuropathy. Yoga is one of many therapies that may help strengthen the communication pathways between your nerves and your brain, alleviating symptoms and discouraging progression. 

A Peripheral Neuropathy Primer

Your peripheral nervous system consists of the sensors that transmit information between your brain and spinal cord and the rest of your body, including your skin, digits, arms and legs. Muscle weakness, abnormal sensitivity to temperature changes and, over time, paralysis, impaired digestion and disrupted endocrine function can develop.

Causes of peripheral neuropathy are varied. You might experience it as a result of a traumatic accident, such as a fall or car accident; repetitive stress, as is the case in carpal tunnel syndrome; or from metabolic and endocrine disorders, which includes diabetes. Cancer, certain infections, autoimmune disorders, nueromas and small vessel disorders may also be to blame.

Regardless of the cause of your nervous system compromise, you want to increase the communication between your spine, brain and nerves throughout your body. While your doctor must help you treat the underlying condition, yoga can assist in symptom management. 

Yoga's Potential

Research has revealed potential for treatment of neuropathy with yoga practice. A 2002 issue of the Indian Journal of Physiology and Pharmacology reported a study showing that, among 20 people with type 2 diabetes, yoga performed 30 to 40 minutes daily for 40 days improved nerve function and glycemic control (high glycemic levels aggravate neuropathy.)

A 2012 review of the research of the effects of yoga on nervous system disorders published in Annals of Indian Academy of Neurology confirmed yoga as a valid integrative and complementary therapy for conditions such as peripheral neuropathy. Remember that yoga ought to be combined with other treatments; it shouldn't be your only line of attack. Lifestyle modifications, medical interventions and electrical nerve stimulation are also important strategies.
 
Poses to Practice

The severity of your condition determines the type and intensity of yoga you'll practice to address peripheral neuropathy. Less-advanced cases may do well with a Hatha-style class that involves seated and standing postures, including Triangle pose, Camel and Bow pose.


More advanced neuropathy may require a gentler practice, but you can still benefit from meditation, gentle twists and supported backbends. Use a bolster or block for support in Bridge pose or reclining Hero, for example.

All of these poses are particularly beneficial in opening the front side of your body, increasing oxygenation of tissues and improving blood circulation to nerves.
The Benefits of Relaxation

A regular yoga practice teaches you to handle the stress of living with peripheral neuropathy. Meditation and deep breathing helps you learn how to live through distraction, even painful physical ones as can happen with nerve disorders. When you learn how to breathe and be present on the mat, you can more easily shift into a pattern of acceptance off the mat. Peripheral neuropathy can't be cured, only contained, so acceptance is essential.

The body-mind connection acquired through yoga also helps benefit you when trying to manage the symptoms of peripheral neuropathy. You'll have a better sense of how you react to specific poses and which ones are helpful and which are aggravating. This translates off the mat, so you have an idea of what activities you can push through, what may set off an episode and how you can manage symptoms of neuropathy when it occurs.

Read More: How to Relax the Nervous System Naturally

http://www.livestrong.com/article/342259-yoga-for-peripheral-neuropathy/

The Absolute Bottom Line With Neuropathy Vid

Today's post from themighty.com (see link below) may seem like a 'post-to-slit-your-wrists-by' but it truthfully reflects the sad reality of living day to day with severe neuropathy. We can read all the self-help articles we like but sometimes we just have to admit...sometimes...it's just too much! Unfortunately, this relentless suffering can occasionally lead to suicidal thoughts and this article offers support links but her main message (after all the depression), is that we shouldn't worry so much about days like this. Let them happen and wallow for a while because they give your brain and body a brief pause to regenerate. Yes you feel like there's no tomorrow but there is and even if that's not a prospect to cheer you up, your body will get you through another day and another and another, until you feel a bit better and less distraught. You may never get back to the old you but you can still get pleasure out of life and the pleasure moments can make the bad moments feel so much less important. Other people's stories can work both ways - you can take comfort in the fact that you don't feel as bad as they do and you can take comfort in the fact that you're not alone in feeling the way you do. Well worth a read.
 

5 Things I Don’t Admit on My Bad Pain Days 
By Sharilynn Battaglia Contributor I write about Chronic Pain

Have you ever had a day when you just stared off into space? Not staring and thinking deep thoughts about your future. Just empty, with random thoughts floating around occasionally. But nothing coherent. And definitely nothing cheerful. This is the place I am in right now.

My brain has just shut down. The disease has become too much to handle any more and my brain went bye-bye. So, I thought I’d let you into the taboo side of chronic illness and pain. The stuff we really don’t want to admit. The thoughts we may have when our brain and body are at their lowest.

1. I am tired. 
That’s why my brain shut down. Fighting pain is hard. And those of us in daily pain don’t ever get to rest. The constant struggle of trying to stay physically in control of pain is draining. Add to that the daily demands of running a home and raising kids and you have the perfect storm for extreme fatigue. And extreme frustration. And we crack. Because being nice and patient and understanding is also hard work. And when our brains get tired of fighting our disease, we may not care about the niceties anymore. My brain already fled so only fight is left. And it doesn’t matter who gets in the way (sorry)!

2. I am sad. 
It’s emotionally drained. It’s extremely hard to deal with an illness every day and then still be able to deal with what comes in every normal relationship I know of. Disagreements. My husband and I are no different. We argue. It’s not always roses and chocolate. And to be honest, I don’t always have the fortitude to deal with any discord, whether it’s about a burnt dinner or the several hundred bucks he just lost at the casino. I’ll end up in a puddle of tears. (And if it’s about the kids, fuhgetaboutit!) Pain makes everything personal and much more intense. So the small stuff becomes huge and nastiness becomes much more easy.

3. I am depressed. 
It’s hard to stay positive and accepting of a disease that causes so much pain, weakness, degeneration, loss, forgetfulness, uncertainty… I could go on, but you get the point. Obviously, I have accepted my illness. I’ve had to. I would never have gotten out of bed otherwise. But these diseases are progressive and constantly change over time. So we have to constantly readjust our mindset. And let’s be honest, it has to become part of who we are. We can’t exist by putting on rose-colored glasses and ignoring it. So the feelings have to be accepted and allowed to come out, too. But that can cause intense fear that can leave us overwhelmed to the point of motionlessness.

4. I am confused. 
 And confusion is very frustrating. And time-consuming. You see, my body remembers everything it used to be able to do. From dancing to walking miles to rearranging furniture all by myself carrying pieces up and down stairs. So sometimes, I still think I am capable and try to do those things expecting that I will be able to. And when I can’t, I either end up hurting myself or I have to find someone else to help me.

5. I want to give up.
 I know the facts about my disease. I know what my back injuries mean. I know what the future probabilities are for disease progression and pain management. And I worry about where I will end up when I can’t care for myself and who will care for me. I worry about that when I’m tired, hurting, or alone. And I’m alone a lot. And I’m scared. I think about giving up a lot, too. I don’t talk about it, but I think about it. And honestly, in some ways, giving up feels equivalent to being pain-free again and on days like this, that’s all I really want.

When my brain gets like this, what I really need is some sort of regeneration. I’ll watch a movie, find funny shows on TV, watch kittens on YouTube, or bundle up and sleep! These “lost brain” days don’t last forever. And they’re not as common as they may seem, though they do tend to come in clusters. But after 20 years of this, the silver lining seems to be the fact that by letting these days happen, you allow for a mental reset. The negativity gets acknowledged, then let go – and that’s exactly what needs to happen.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

https://themighty.com/2017/02/bad-pain-day-struggles/

Spiritual Ways Of Coping With Pain

Today's post comes from beliefnet.com (see link below) and offers ten tips for coping with your pain. You may not agree with all of them but there is little doubt that there is a great deal of common sense in these help tips. Even if just one or two can be achieved, you may find your pain lessened and that's the whole point.

10 Spiritual Tools for Coping with Chronic Pain

By Maureen Pratt

Chronic pain can make us feel isolated and helpless, especially if its cause is an illness or physical condition for which there's no cure or effective medical treatment. At times of deepest despair, finding ways to nurture our spirits can help us not only cope with the pain, but also discover nuggets of grace, comfort, and productivity that can move us through and beyond the helplessness and hopelessness we feel. Here are ten spiritual tools that can help you get started toward peace in spite of and in the midst of pain.

Find quiet

When we are in great pain, finding true peace and comfort is not easy. But it is possible, if we first try to still our worries and fears, both external and internal. Finding a place where there are no noisy distractions is a great start. Enjoying the outward quiet, we can then calm our inner selves and nurture peace within.

Just breathe

The act of breathing is not only a physical process, but it can also be a tool to move our pain, negative thoughts, and worry out of our bodies and hearts, replacing these with a better sense of self. In a quiet place, breathe in slowly and deeply, then let the breath out, expelling stress and pain with it. Feel the sharpness of pain subside as relaxation and calm take its place.

Listen to music

A beautiful piece of music can inspire our spirits and soothe our pain like no other sound. It can also help us get in touch with the absolute joy of living, even if we live with severe pain. Put on your favorite piece of music - instrumental or vocal - sit back, and close your eyes. Let the music carry you away from your immediate pain to a place of calm.

Lose Yourself in Prayer

So often when we pray, we ask for relief from our pain and leave it at that. Perhaps more effective when pain is oppressive is lifting up our pain and then resting quietly with the comfort that our concerns are being tended to by One greater that ourselves - and we do not have to take them back again.

Reflect in Nature

Pain can isolate us and make us feel very much alone. But in reality, we are part of an amazing world. A walk in the outdoors, a glance outside at a garden, a quiet moment with a beloved pet - each of these things can renew our sense of belonging to the world, help us to feel less alone in our pain, and make us grateful for our lives among such wonder.

Laugh More

Pain itself is no laughing matter, but the act of laughing can be physically and spiritually healing. It helps us breathe deeply, cleanses tense pain from our bodies, gives key muscles beneficial exercise, and lets us travel to an uplifting place of joy. Whether it's a joke, a cartoon, or the antics of a pet, find laughter and enjoy it often!

Reach Out to Others

When we are in pain, it can be easy to feel as if no one cares. But there are many in the world who feel the same thing - and we can make a difference in our lives and in others' lives by reaching out in comfort and care. A phone call to a hurting friend, a visit to someone in need, even an email to an online support group - all of these can help us become less isolated, and help others in the process.

Live in the Light

It's easy for our souls to be flooded with darkness when pain is sharp and overwhelming. We can combat this darkness by bringing on light. The flicker of a candle, the warm glow of one small lamp illuminating a dark room - light can help focus thoughts and bring comfort. Even in the darkness, be conscious of the light all around, and let it guide you to greater calm.

Take Care of Yourself

Often, there is no cure for what causes our pain. This can make us feel as if our lives are out of control. But the better we take care of ourselves, the more we will feel at least a little control over our circumstances - and our attitude toward pain. Taking time to follow a healthful regimen reflects on our spiritual health, too, and gives us a chance to rise above our pain and feel better - inside and out.

Never Lose Hope

Each day, there are new developments in medicine and in therapies to ease pain, inside and out. Hope is not just a feeling that things will be better - it is a tangible tool to motivate and guide us through the frustrations that accompany pain into positive actions that can make our lives better now and in the future. Without hope, our spirits wither. With hope, as with the Creator, all things are possible!

http://www.beliefnet.com/Health/Physical-Health/10-Spiritual-Tools-for-Coping-with-Chronic-Pain.aspx

Patience Is Needed When Living With Neuropathy

Today's post from neuropathy.org (see link below) is a personal story illustrating the importance of having patience when faced with the strange twists and turns of neuropathy. It can take a very long time before doctors and specialists a) identify your symptoms as being of neuropathic origin and b) take you through a number of steps in treating it. It's important not to panic but at the same time it can be a very frustrating process. Learning to take each day and each step as it comes, is pretty much forced upon you but it will help if you can try to go with the flow, rather than fighting it.

Finding Answers Takes Time, Patience, and Action!
By Mike Smith

As a professional writer, I spend much of my day at work and at home typing away on my computer. Working within a deadline-oriented industry as well as on a number of personal creative projects, I find myself typing vigorously -- often for hours at a time and with few breaks in between. So, in 2011, when I developed tingling and numbness in my wrists and hands, I -- like most people with neuropathy --initially ignored these slightly bothersome symptoms.

Could I Have Carpal Tunnel Syndrome?

Over time, the numbness and tingling sensations were progressing slowly, lasting for days and then for weeks. It wasn’t painful per se, but it certainly was distracting: I found I needed to take breaks from my writing to give my fingers and wrists a rest. The tingling (for lack of a better word) was continuous -- all the time, day and night.

Fearing I might have carpal tunnel syndrome, I decided to visit an orthopedic surgeon. He was certainly helpful -- and agreed that the tingling in my wrists could signify a classic case of carpal tunnel syndrome, given the amount of time I spend on a computer.

The orthopedic surgeon gave me a cortisone shot and we hoped for the best. Unfortunately, the shot was no help. In my mind though, it had to be carpal tunnel syndrome -- I mean, what else could it possibly be? So for six months, I used wrist splints every day at work and even while I slept to see if the symptoms would subside. But unfortunately, they didn’t…

Getting A Neurology Consult

After six months of waiting and watching, I went back to my orthopedic surgeon in the spring of 2012. By then, the numbness and tingling that I initially felt in my wrists had spread to both my feet and ankles.

The orthopedic surgeon referred me to a neurologist, believing that the spreading of the symptoms might represent something beyond carpal tunnel syndrome.
 
The neurologist definitely appeared concerned, as I was, otherwise, a healthy and active 25-year-old. I went through a series of tests and exams, ranging from MRIs of my spine and brain, to blood tests, and nerve-conduction studies. My doctors were searching for signs of anything from multiple sclerosis to Lyme disease, and celiac disease. Unfortunately, none of these tests helped us determine the root cause of my symptoms, nor did they pick up any nerve damage.

Given the sequence of events surrounding just one test (schedule an appointment, wait, have the test, wait, make a follow-up appointment, wait, go over results, etc.), by the time I had my second MRI, the symptoms had spread even further. What was a constant tingling in my wrists and feet now spread up to my knees and elbows. I also began to notice that there were particular instances when the tingling was most severe. When I took a hot shower, I had to avoid the water hitting me for too long since it aggravated my symptoms. When I stood barefoot on hard surfaces, I would need to sit down after a while to provide (minimal) relief to what felt like standing on hot bricks. It was also beginning to affect my sleep. Trying to sleep every night is a challenge given the constant tingling in an otherwise dark and quiet environment.

Finding The Neuropathy Association

Each time I was referred to a different specialist, or to undergo another test, I’d eagerly await the results, hoping that we would find something … an answer that explains what I have been experiencing for two years. The stories I read about on the Internet have saturated me with a series of worst-case-scenarios. But it was also while searching for answers online that I stumbled upon The Neuropathy Association’s website. The website provided a plethora of resources – online Chat transcripts, updates on medical studies and research, disease-specific information (considering there are over 100 causes of neuropathy), access to health experts... But what most interested me was learning that there were local patient-led neuropathy support group across the country for people living with neuropathy.

I reached out to the leader of the Pittsburgh support group and attended my first neuropathy support group meeting in the summer of 2013. I met over a dozen people, all with a variety of neuropathies, symptoms, and experiences. While everyone I spoke with at the meeting had a unique story, I was amazed by how each of these people continued to overcome their battles in different ways: they shared the common bond of living with neuropathy and wanting to improve their quality of life.

One of the people I met at the support group meeting took several years to discover the cause of her neuropathy and to get a diagnosis. I was able to relate because I am still working on getting my diagnosis. Connecting with her was especially helpful because I learned -- despite the frustration -- that seeking a diagnosis was a process and I would have to work towards it.

Being Able to Relate and Determine A Plan of Action

I know what I am experiencing, and I know it is 24/7/365 … for almost two years now. Why can’t we find out what’s going on? Why does test after test come back inconclusive? Are my doctors doubting my symptoms – or worse, do they think I’m making them up? It is frustrating to have to explain what I am struggling with over and over again. I learned recently through The Neuropathy Association that 30% of people diagnosed with neuropathy have “idiopathic” neuropathy – in other words, the underlying cause is not known. I’m fine with that…I could deal with that. But in order for me to move forward, the tests need to show my doctors what I’ve known all along: that something is wrong, and it’s spreading, and intensifying...

And, so my quest continues with the help of the Association and with the support of my family and my friends. I will continue to pursue all possible avenues to obtain my diagnosis, seek treatments to get well, and offer support to others too. Though I’m sure this means more doctors, more tests, more questions, and more waiting, I’m confident that the time will soon come when I can check off my battle with uncertainty and begin the process of living well with neuropathy, and not some unknown illness.

Amidst everything that’s going on in my life, I am determined to help increase public awareness of neuropathy. I’ve shared my experiences with a few of my family members and friends, and their first question is always “What’s neuropathy?” This needs to change.

I’m Running in the 2014 Pittsburgh Half Marathon for the Neuropathy Community

It’s crazy that a disease that affects over 20 million people in the US alone (whether they realize it or not) is not on the public radar. So I asked myself “what could I do to make a difference?”

I like to run. Running is therapeutic for me: it’s a mental sport, forcing your mind to focus on every aspect of your body movement: breathing, running, pacing, etc. Despite the fact that my neuropathic symptoms are still present, I can concentrate on other parts of my body to lessen their impact.

I frequently run 5Ks and other races with my wife and friends. Earlier this year, I participated in the 2013 Pittsburgh Half Marathon to help raise awareness and much-needed funds for the Animal Rescue League Shelter; Wildlife Center, a local animal shelter where I rescued my cat from in 2010. And, I recently signed up for the 2014 Pittsburgh Half Marathon – this time I’ll be running to support my fight -- our collective fight -- against neuropathy. And I’ll be wearing my “Together, We Can Beat Neuropathy!” t-shirt, awareness bracelets, and ribbons, and I will have my friends, family, and fellow neuropathy patients joining me as well. It is a great way to raise awareness of neuropathy among tens of thousands of runners, walkers, and volunteers involved in the event … as well as thousands of viewers across the U.S.

It is so important that we, as a community, continue to bring awareness -- in our own way and within our own networks -- to the neuropathy epidemic. Running is the best way I know how to achieve this goal.

http://www.neuropathy.org/site/News2?page=NewsArticle;id=8565

COMMON ANTIBIOTICS LINKED WITH HEART DEATH

The antibiotic clarithromycin -- widely used for treating common bacterial infections -- is associated with an increased risk of heart deaths, finds a study published on thebmj.com today.

The authors say their findings require urgent confirmation, given that many millions of people are prescribed the drug each year. But they stress that the absolute risk is small and that prescribing practice should not be changed until results have been confirmed in an independent study.

Clarithromycin belongs to a group of antibiotics known as macrolides. Macrolide antibiotics prolong the duration of electrical activity of the heart muscle (known as the QT interval) and are therefore thought to increase the risk of potentially fatal heart rhythm problems.

Given this background, the cardiac safety profiles of individual macrolides need to be studied in greater detail to help guide clinical treatment decisions.

So a team of Danish researchers decided to assess the risk of cardiac death associated with clarithromycin and another macrolide called roxithromycin, compared with penicillin V, an antibiotic with no known cardiac risk.

Using national databases, they identified over 5 million treatment courses among Danish adults aged 40-74 years from 1997 to 2011 (160,297 with clarithromycin, 588,988 with roxithromycin and 4,355,309 with penicillin V).

Individuals with serious disease, who may be at high baseline risk of death, were excluded from the analysis.

A total of 285 cardiac deaths were observed during ongoing use with the study drugs, 18 of which occurred during use of clarithromycin and 32 during use of roxithromycin.

After adjusting for factors such as age, sex, baseline cardiac risk and use of other medication, ongoing use of clarithromycin was associated with a 76% higher risk of cardiac death compared with use of penicillin V. There was no increased risk of cardiac death with clarithromycin after treatment had ended.

The absolute risk difference was 37 cardiac deaths per 1 million courses with clarithromycin. No increased risk of cardiac death was found with ongoing or past use of roxithromycin.

"Our study expands on the available knowledge of the cardiac safety of macrolides, being the first large scale population based observational study to show significantly increased cardiac risk with clarithromycin and the relative cardiac safety of roxithromycin," write the authors.

The authors emphasise that the absolute increase in risk is small and should have limited, if any, effect on the prescribing practice in individual patients. However, they note, "clarithromycin is one of the more commonly used antibiotics in many countries and many millions of people are prescribed this drug each year; thus, the total number of excess (potentially avoidable) cardiac deaths may not be negligible."

Before these results are used to guide clinical decision making, "confirmation in independent populations is an urgent priority given the widespread use of macrolide antibiotics," they conclude.

Massage Helps People with HIV and Neuropathy

Another interesting article from the Australian, positivelife.org.au (see link below) describes one man's way of giving back to the community. Someone to massage your hurting body for you seems to me a fantastic way to make you feel better. No 'happy endings', or commercial rip-offs, just careful massage carried out by someone who knows what he or she is doing. It's an idea that should be promoted in as many places as possible, though finding the volunteers with the right intentions might be easier said than done. Hats off to Mr Page.

Touching bodies - and souls
by Greg Page - •This article was originally published in the Oct-Nov 2011 edition of Talkabout

Greg Page reflects on what leads him to donate an hour of his time each week to massaging HIV+ clients.

Once a week I do a volunteer massage for HIV+ patients. As a trained massage therapist with over five years of experience, I'm constantly asked the same question by my clients, who are almost invariably middle-aged men: "Are you one of us?" By which they actually mean, "Are you HIV positive too?"

There is always a real sense of relief in their voices when I reassure them that, yes, I understand the nuances of niggling neuropathy, constant painful twinges and strange, doctor-confounding ills that can befall a person who is a long-term sufferer. You see, I'm a massage therapist who has also been HIV+ now for eight years.

I actually began my training about six years ago at a course offered by an instructor who wisely believed it a good idea to give newly-HIV+ men an insight into their bodies, what makes them tick and what makes them tick better. Massage therapy is a skill for life, as well as a skill that can help and heal, for both the giver and the receiver. My massage training took about six months to complete. It included two hours per week of intensive anatomy lessons, with a book to practice with, not a body, in case you're wondering. I had to learn multisyllabic phrases and convoluted names for parts of the body that normally only specialist doctors would know off my heart. In my course, of the 10 HIV+ men who began the training, only six finished. One disappeared never to be seen again, one became a crystal addict, another decided it was all too hard and another took his first three months of training and turned it into a business, touting himself as the "massage therapist who gives happy endings".

96 percent

I finished my training with a 96 percent score, something I was very proud of, although I wasn't top of my class – a hunky Canadian-born guy scored 99 percent (though I did better than him in the practical assessment!)

Over the course of our training, our group constantly practised on each other, but the biggest challenge we faced wasn't concentrating on what we were doing or making sure we were doing it properly. It actually came when we had to massage a group of HIV+ women.

None of us was familiar with women's bodies and it was a truly eye-opening moment. As gay men we are generally so unfamiliar with the curves and nature of a woman that it took some major readjustment for us as massage therapists to accommodate them. It was a good lesson in what was to come as a masseur – everybody is different and some bodies are more different than others.

Although our course had been offered free, the deal we all agreed to was that on successfully completing the course and qualifying, we would have to allocate 60 hours of free massages to community services. Somehow for me that 60 hours has now become six years of offering my services to the HIV+ community.

Troubled bodies and minds

Most of the men I massage are relatively advanced in their HIV+ prognosis. Some have lived with it for over 20 years. One man told me he knows he has been positive since 1980, if not before. He witnessed his entire circle of friends, lovers and ex-lovers die before his very eyes in those early first years of AIDS. He is now somewhat bitter, quietly angry and rather fed up with life. The massage I give him every few weeks helps alleviate the pain not only in his riddled body, but his troubled mind.

The one question I always like to ask my clients is what their job is. Some are still working and on my bench, laid out in front of me, I've had professions as varied as shopkeeper, actor/model, ad agency boss, librarian, historian, labourer, insurance man, personal trainer, healthcare worker, recovering addict and full-time nudist. Some of the men have been on sickness benefits for so long they can't even contemplate the idea that they could once again be valuable members of the workforce. They never thought they would live this long, let alone be healthy enough to return to the jobs they assumed they were leaving to go and die. The meds changed things and kept them alive. Some of my clients are happy about this, yet others feel somehow guilty they survived. Some like to talk about how they feel, with the massage helping to ease their suffering and their inhibitions, while others prefer to just simply enjoy the serenity of being able to have their body caressed and touched like they haven't been touched in a long time.

It's a powerful reminder to me as to how important the sense of touch is. Although we often think seeing is believing, through my work with clients on the massage bench I have come to see that the greatest gift I can give to those who are suffering, or who have suffered hard, is simply that of a compassionate, caring touch.

No words

Sometimes there are almost no words before, during or after our one-hour sessions. Some people choose to lose themselves for the 60 minutes, regaining a connection with their body tissue that years of toxic medication, intensive doctor prodding and a raft of severe illnesses have left tenuous and tense. If I can help ease that tension, then I feel my work has been a success.

Generally my clients leave after the massage feeling the best they've felt in a long time. "I feel like I'm floating" is a piece of feedback I receive constantly. That's when I know that not only have I done a good job, but I made the right choice in volunteering my services, rather than charging a fee and making it my full-time profession.

It's a shame there are not more people from the HIV+ community who get involved in complementary therapies. Not only does it help you give something back, but also gives you a link to the past of the AIDS epidemic. It's a way to help ease those survivors through the new era of manageable chronic illness.

More alive

One week recently I massaged a blind man who brought in his guide dog, which sat quietly as his owner groaned his way through our session. It was as if my client had not felt a human hand near his weakened body in a long time. He shook my hand firmly afterwards and I could tell he felt more alive.

I truly get a strong sense of satisfaction when I finish my volunteer session each week. Not only because I know I'm doing something good for others, but because I'm actually doing something good for myself. You should try it some time – you might find it as soul-enriching as I do.
Greg Page

http://positivelife.org.au/talkabout/2011/oct-nov/touching-bodies-and-souls

Can Progesterone Hormone Help With Neuropathy

I must confess to having no knowledge of hormones at all but today's post from hormonesmatter.com (see link below) provides very interesting reading. It talks about the possibility of hormone therapy (in particular using the hormone progesterone) to relieve neuropathy symptoms. Apparently progesterone is a key element in myelination (myelin is the protective coating around a nerve which, when damaged, is so often the cause of neuropathic pain.) It is essential for myelination to take place therefore it's logical to assume that using progesterone therapy to repair myelin damage is a potentially effective treatment. However, like all these things, assumptions mean nothing and long-term studies are going to be needed to prove the theory. Trials have taken place and are ongoing but finding a specialist doctor willing to take you on may be incredibly difficult. Hopefully, eventually the treatment will be proven and will be available to all patients with neuropathy but (you've heard this before) don't hold your breath!

Progesterone for Peripheral Neuropathy 
Chandler Marrs, PhD Wednesday, February 19th, 2014 / 

Some 20 years ago, during my very first neuro class taught by an accomplished neurologist from a prominent research university, I had a conversation about hormones and the brain. It was a brief conversation during which he admitted not only knowing nothing about how hormones affected the brain or nervous system functioning, but also, how he and others had no interest in considering the question. He believed hormones were too complicated to consider relevant. One didn’t ‘mess with hormones’ as he put it.

Lucky for us, some intrepid neurologists have moved the science of neuroendocrinology past the foibles of ‘don’t mess with hormones’ to hormones might be important therapeutic options. Nowhere is this more evident than in the areas of traumatic brain injury and diseases of demyelination. Here we see advances in hormones used as viable and important treatments where once there were none. Although the research is yet in its infancy and suffers from the typical one-size-fits-all approach, it marks a huge step forward in clinical neuroendocrinology.

What is Neuropathic Pain?

Neuropathic pain, the often chronic and difficult to treat pain that comes from nerve injury and demyelination affects approximately 3% of the population. The number of individuals suffering from neuropathy is likely much higher when one considers diseases such as endometriosis and the ill-understood, under-recognized neuropathy emerging post medication or vaccine adverse reactions. The experience of neuropathic pain in hands, feet, arms and legs is described as burning, freezing, electrical, tingling, prickling and more often than not, severe and unrelenting. As the nerve injury progresses and the pain continues, the rawness and intensity of the pain becomes indescribable to someone who has not experienced nerve pain first hand. 

Hormones and the Nervous System

Since the late eighties, researchers have known that steroid hormones, such as progesterone were not limited to reproductive functions; that many steroids were active in the nervous system. Not only were those steroids synthesized peripherally in ovaries, adrenals or adipose tissue able to cross the blood brain barrier, but all the core substrates for steroid synthesis were available in the brain too, meaning the brain could make its own steroids, de novo, from scratch. Researchers initially deemed steroids made or active in the brain as neurosteroids. Eventually, that nomenclature fell by the wayside as researchers realized there was tremendous crosstalk between peripheral and central hormones, no matter where the hormones were synthesized.

It should be noted, that hormones exert influence all over the body and brain via receptor binding. (A discussion on hormones and receptors can be found here: Promiscuous Hormones and Other Fun Facts. In addition to steroid hormone receptors on (cell membrane) and in (nuclear) hormone-specific cells, like those in ovary, testes, adrenals, uterus, endometrium, hormone receptors are co-located on neurons, glial cells, oligodendrocytes and Schwann cells (myelin producing cells), immune cells, cardiomyocytes (heart), hepatocytes (liver), adipocytes – essentially every cell, organ or tissue in our body is modulated in some way by a hormone. Hormone influence is particularly important in the in the nervous system, where everything from neurotransmitter release and uptake to synaptic connections are modulated. 

Traumatic Brain Injury, Peripheral Neuropathy and Hormones

When we talk about injuries to the nervous system, be it the brain and spinal cord, which is called the central nervous system (CNS), or all of the nerves that control movement and organ function in the body, the peripheral nervous system (PNS), there are two categories of injuries, those that develop acutely, post trauma, or those that develop chronically because of some metabolic dysfunction. In the case of the former, traumatic brain injuries (TBI) or traumatic nerve injuries, the research points to progesterone for repair and regrowth. In the case of the later, where injuries develop as a result of internal and often chronic dysfunction, such as diabetic neuropathy, multiple sclerosis and other diseases affecting nerve fibers and myelin, less is known about progesterone and the thryoid hormone triiodothyronine (T3) is implicated, more strongly. 

What is Myelin and How Does it Impact Neuropathy?

Myelin is the insulation that protects the axons of the neuron (in the brain) or nerve (in the body) to allow rapid conduction or messaging across the brain or through the body. Recall the axon is the part of the neuron/nerve that sends messages to other neurons/nerves, to other tissues, like muscle or to organs like the heart or the liver. The dendrites receive messages and the nucleus processes messages. Myelin is like the plastic coating around the electrical wiring in your house. If the coating is too thick, conduction is blocked. If the coating is frayed or too thin, electrical sparks fly everywhere. Frayed myelin around axons is one of the mechanisms of neuropathic pain. Myelinated axons in the brain look white and therefor are called white matter. Whereas the grey matter, is where the nuclei of the brain reside. White matter in the brain consists of the oligodendrocytes – the type of cell that forms the myelin sheathing around axons. Myelin in the body, around the peripheral nerves, is made from cells called Schwann cells. 

Progesterone, Myelination and the Nervous System

In the 1990s, Etienne-Emil Baulieu and colleagues recognized a role for progesterone (and other hormones) in central nervous system myelination. Over the next two decades, researchers uncovered the possible mechanisms and delineated more clearly for whom and in what types of injury progesterone seems most helpful. From studies of neurons (CNS) nerve cells (PNS), we now know that progesterone is key for myelination and neuron/nerve regrowth, at least in the acute stages. Progesterone stimulates myelination both directly by acting on oligodendrocytes and indirectly via actions on the neurons and the astrocytes that then message the oligodendrocytes to produce more myelin. Similarly in the PNS, progesterone aids in the remyelination and re-growth of nerve fibers, via the Schwann cells and via progesterone receptors located in what are called the dorsal root ganglia (DRG), the sensory neurons that carry information from the periphery to the brain. Whether in the CNS or the PNS, timing and length of progesterone administration are critical. 

Animal Research – Progesterone, Nerve Injury and Neuropathy

The animal research has been mixed, but taken together, the results seem dependent upon the type of injury, the timing of the treatment and the methods of assessment. When treatment is begun early enough and extended long enough (this varies) and when the measure is neuropathic pain versus other potential outcomes (such as morphological changes to the nerve), there seems to be a favorable response. In rodents, single dose treatment does not seem to work, neither does treatment that is initiated too late after the injury or ended prematurely, though these criteria vary from study to study.

For example, using an induced model of diabetic neuropathy, researchers from Italy found that diabetes markedly reduced progesterone concentrations in male rodents (females were not tested) within three months (the only study I could find that measured progesterone concentrations relative to treatment and outcomes). Chronic treatment (one month) with progesterone or one of its derivatives restored nerve function, increased key components of myelin production and reduced pain. Similarly, an induced model of trigeminal pain in male rodents, found when progesterone was initiated early and at a high enough dosage, it tempered the experience of pain while increasing myelin producing proteins. Lower dosages did not work. 

From Animals to Humans: Traumatic Brain Injury and Neuropathy

The research with animals, male rodents specifically, shows that progesterone treatment works best if given early enough, for long enough and at high enough dosages. With acute or induced injuries under experimental conditions, early treatment is much easier than in real life where neuropathic pain develops much more gradually and often goes undiagnosed and untreated for some time. Would progesterone work in humans and would it work for chronic, well established neuropathy? The answers to those questions are not clear because the human research on progesterone and myelin focuses on acute injury, like the traumatic brain injuries. The human research also suffers from short duration dosing, includes mostly males, and without exception fails to address endogenous progesterone concentrations either pre or post treatment. Nevertheless, there are some indications that progesterone therapy may work.
Progesterone and TBI – Human Studies

In a smaller, single center open trial and two larger, double-blind, placebo-controlled, human trials, progesterone therapy was administered to individuals with severe traumatic brain injuries (Glasgow coma scale less than 8).
In each case, the progesterone group did better, showed reduced morbidity rates than the placebo groups.

 In the first study, 26 cases were treated with progesterone and 20 controls with placebo. At both 10 days and three months post injury and treatment, the progesterone treated group improved significantly more than the control group (abstract only).

In a second study, 159 patients, arriving to the treatment facility just eight hours post traumatic brain injury were randomized to receive either intramuscular injections of progesterone (82) or placebo at 1.0 mg/kg via intramuscular injection and then once per 12 hours for 5 consecutive days. Both intake neurological functioning and post treatment functioning were assessed and compared using a number of measures. Followup assessment was conducted at 3 and 6 months post injury/treatment. The results were positive, albeit small. The progesterone treated group improved significantly across all measures showing consistently larger improvements compared to the placebo group. It should be noted that only 44 of the total subject population was female, 24 in the placebo group and 20 in the progesterone group. No analysis by sex was conducted and so it is not clear whether progesterone therapy works equally well in males and females.

In the third study, called ProTECT, a similar double-blind, placebo controlled, randomized methodology was used. Here, however, the randomization was 4:1 and favored progesterone treatment, whereas in the study cited above, the progesterone and placebo randomization was 1:1. Progesterone was given IV for three days. The ProTECT study researchers found that patients in the progesterone had a lower 30-day mortality rate than controls (rate ratio 0.43; 95% confidence interval 0.18 to 0.99). While those who suffered more severe injuries had relatively poor outcomes at the followup tests 30 days post injury, despite the treatment, those who suffered only moderate traumatic brain injury and received progesterone were more likely to have a moderate to good outcome than those randomized to placebo (abstract only).

Two additional trials are on-going, hoping to test progesterone on thousands of patients: the ProTECT-III and SynAPSe studies.
Translating the TBI Research for Use with Neuropathy

What does improvement post TBI tell us about treating neuropathic pain from demyelination disorders? It is not clear, because even though researchers know that progesterone promotes myelination, the human research has focused narrowly on injuries where demyelination occurs but also where other factors are also involved in the outcome. We know from animal and cell culture research that progesterone attenuates the cascade of events that occur post TBI or post nerve injury via multiple mechanisms, inducing myelin regrowth is only one of those mechanisms. Progesterone reduces swelling of both vasogenic and cytotoxic sorts. It has anti-oxidant properties, upregulating enzymes that increase free radical elimination. Progesterone inhibits inflammation, stabilizes mitochondria, reduces neural excitoxicity and can limit apoptosis. Finally, progesterone promotes myelination. All factors that should point to consistent improvement in TBI and neuropathic pain syndromes, but the research is limited and mixed. Why?

The primary reason for mixed results is study design, almost all are short duration. Hormones are long acting molecules and the shorter duration may not be sufficient to generate the response, particularly when the injuries are severe or longstanding. Longer treatment regimes are likely in order.

Another reason for mixed results is the one-size-fits-all approach. None of the human studies and few of the animal studies, investigates why progesterone works in some subjects and not others. Almost all of the studies are predominantly male, rodent and human alike. None have investigated whether being female has anything to do with efficacy. None of the human studies measured circulating concentrations of progesterone, either pre-, during, or post-treatment and so there is no way to tell if those who responded had higher circulating concentrations or if improvement was contingent upon reaching a certain concentration.

Perhaps even more importantly, is the fact that progesterone, like any hormone, works within a vast and compensatory network of other hormones. The reductionist approach that utilizes a single hormone treatment protocol, while ignoring the potential cross-talk with other hormones and other variables is a consistent flaw these and other research protocols. Again, hormone measurement, progesterone and its metabolites, in addition to other key hormones, is imperative if one is to determine therapeutic efficacy.

I Have Peripheral Neuropathy, Can I Try Progesterone?

Progesterone therapy is generally safe, but as with everything there are risks. Women have been using it for generations in its bio-identical form to mitigate menstrual and menopausal symptoms. Since it is fat soluble, transdermal (skin) absorption is possible and progesterone creams have become popular. Some physicians prefer micronized progesterone, a pill form that reduces the molecule so it more easily passes through the liver without degradation. The pill form and to a much lesser degree, transdermal progesterone, cause sedation and should be taken at night. Micronized progesterone has been shown to increase free thyroxine (T4) as well. For some women, and presumably men too, a gain of function mutation on the mineralcorticocoid receptor can evoke very high blood pressure with any increase in progesterone concentrations (luteal phase of the menstrual cycle and during pregnancy especially). Although there are dosing references for progesterone relative to menstrual or menopausal therapy, the dosing is individualized and often includes the replacement of other hormones along with progesterone. Salivary hormone testing is used to monitor and hormone doses are adjusted regularly. Progesterone is also used predominantly for women. No such dosing considerations exist for men that I am aware of. Likewise, for peripheral neuropathy there are no references from which to design a treatment protocol and so it would be prudent to work with a functional medicine specialist, familiar with hormone management, to develop and monitor the course of treatment. 

My Two Cents

I suspect, if progesterone therapy works for peripheral neuropathy, it will require a much longer term treatment period than is currently tested in the human trials. I suspect also, it will be difficult to ascertain whether it is the sole contributor to improvements in neuropathy symptoms, as neuropathy is a multi-factorial process that ought to be treated as such. Nevertheless, if you suffer from neuropathy and can find a physician to work with, familiar with hormones and the research, progesterone therapy might provide a viable option, among other options like stabilizing thyroid hormones and supporting mitochondrial function.

http://www.hormonesmatter.com/progesterone-peripheral-neuropathy/

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CHILI PEPPER MAY COME WITH BLOOD PRESSURE BENEFITS

For those with high blood pressure, chili peppers might be just what the doctor ordered, according to a study reported in the August issue ofCell Metabolism, a Cell Press publication. While the active ingredient that gives the peppers their heat -- a compound known as capsaicin -- might set your mouth on fire, it also leads blood vessels to relax, the research in hypertensive rats shows.

We found that long-term dietary consumption of capsaicin, one of the most abundant components in chili peppers, could reduce blood pressure in genetically hypertensive rats," said Zhiming Zhu of Third Military Medical University in Chongqing, China.

Those effects depend on the chronic activation of something called the transient receptor potential vanilloid 1 (TRPV1) channel found in the lining of blood vessels. Activation of the channel leads to an increase in production of nitric oxide, a gaseous molecule known to protect blood vessels against inflammation and dysfunction, Zhu explained.

The study isn't the first to look for a molecular link between capsaicin and lower blood pressure. However, earlier studies were based on acute or short-term exposure to the chemical, with some conflicting results. Zhu says their study is the first to examine the effects of long-term treatment with capsaicin in rats with high blood pressure.

The findings in rats should be confirmed in humans through epidemiological analysis, the researchers said. In fact, there were already some clues: the prevalence of hypertension is over 20% in Northeastern China compared to 10-14% in Southwestern China, including Sichuan, Guozhuo, Yunnan, Hunan, and Chongqing, where Zhu is from.

"People in these regions like to eat hot and spicy foods with a lot of chili peppers," Zhu says. "For example, a very famous local food in my hometown, Chongqing, is the spicy hot pot."

It isn't yet clear just how many capsaicin-containing chili peppers a day you'd have to eat to "keep the doctor away," although that's a question that should now be examined in greater detail, Zhu says.

For those who can't tolerate spicy foods, there might still be hope. Zhu notes the existence of a mild Japanese pepper, which contains a compound called capsinoid that is closely related to capsaicin.

"Limited studies show that these capsinoids produce effects similar to capsaicin," Zhu says. "I believe that some people can adopt this sweet pepper.

Cardio Vascular Disease Associated With Neuropathy

Today's post from diabetesincontrol.com (see link below) looks at the connection between neuropathy and a higher risk of cardiovascular problems. It appears that people with peripheral neuropathy are more at risk anyway of cardiovascular disease. This may be a slightly slanted view in that diabetes patients are traditionally at risk of such problems and by far the greatest number of people with neuropathy also have diabetes. However, this study is the first to show that neuropathy patients have a greater risk of going on to develop cardiovascular disease and strokes, although if you don't have diabetes Type 2, your risk may be less.

Peripheral Neuropathy Associated with CV Disease and Stroke in Type 2 Diabetes Patients           This article originally posted 15 August, 2014 and appeared in  Cardiovascular, Type 2 Diabetes, Neuropathy, Issue 742

Testing for peripheral neuropathy may provide a way to identify individuals at higher risk of cardiovascular events....

Jack Brownrigg, a PhD student at St George's, University of London, UK, who conducted the research at St George's Vascular Institute, said, "While the risk of cardiovascular disease is known to be higher in patients with diabetes, predicting which patients may be at greatest risk is often difficult. "We looked at data on individuals with no history of cardiovascular disease and found that those with peripheral neuropathy were more likely to develop cardiovascular disease." Robert Hinchliffe, Senior Lecturer and Consultant in Vascular Surgery at St George's who co-led the study with Professor Kausik Ray, said: "While loss of sensation in the feet is known to be a key risk factor for foot ulcers, it may also provide additional useful information to guide patient management. This is the first study to show that it can also indicate an increased risk of cardiovascular problems like heart attacks or strokes. "The good news is that peripheral neuropathy can be easily identified by simple tests carried out in GP surgeries. The results of the study warrant further investigation as to whether even greater control of risk factors including blood pressure and blood sugar can prevent or delay the onset of cardiovascular disease. "There is likely an unmet potential to reduce cardiovascular disease in this group of patients through greater monitoring and simple treatments." The researchers analyzed data from 13,000 patients diagnosed with type 2 diabetes with no history of cardiovascular diseases. They found that individuals with peripheral neuropathy were more likely to develop cardiovascular disease, noticing that patients who experienced loss of sensation in their feet also tended to have heart and circulation problems, and so, they suggested that the presence of peripheral neuropathy could be used as a simple way to indicate which high-risk patients with diabetes are in need of intensive care and monitoring. Practice Pearls: Patients with diabetes are at higher risk of developing cardiovascular disease and strokes. Predicting which patients are at higher risk of developing cardiovascular disease is very difficult. Patients with peripheral neuropathy are at a greater risk of developing heart and circulation problems, and therefore, peripheral neuropathy could be used as a way of identifying patients who are at high risk of cardiovascular disease. Press Release, St. George's, University of London Peripheral neuropathy and the risk of cardiovascular events in type 2 diabetes mellitus. Heart doi:10.1136/heartjnl-2014-305657, http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=16752-peripheral-neuropathy-associated-with-cv-disease-and-stroke-in-type-2-diabetes-patients&catid=1&Itemid=8

PRENATAL EXPOSURE TO COMMON HOUSEHOLD CHEMICALS LINKED WITH SUBSTANTIAL DROP IN CHILD IQ

Children exposed during pregnancy to elevated levels of two common chemicals found in the home--di-n-butyl phthalate (DnBP) and di-isobutyl phthalate (DiBP)--had an IQ score, on average, more than six points lower than children exposed at lower levels, according to researchers at Columbia University's Mailman School of Public Health.

The study is the first to report a link between prenatal exposure to phthalates and IQ in school-age children. Results appear online in the journal PLOS ONE.

DnBP and DiBP are found in a wide variety of consumer products, from dryer sheets to vinyl fabrics to personal care products like lipstick, hairspray, and nail polish, even some soaps. Since 2009, several phthalates have been banned from children's toys and other childcare articles in the United States. However, no steps have been taken to protect the developing fetus by alerting pregnant women to potential exposures. In the U.S., phthalates are rarely listed as ingredients on products in which they are used.

Researchers followed 328 New York City women and their children from low-income communities. They assessed the women's exposure to four phthalates--DnBP, DiBP, di-2-ethylhexyl phthalate, and diethyl phthalate--in the third trimester of pregnancy by measuring levels of the chemicals' metabolites in urine. Children were given IQ tests at age 7.

Children of mothers exposed during pregnancy to the highest 25 percent of concentrations of DnBP and DiBP had IQs 6.6 and 7.6 points lower, respectively, than children of mothers exposed to the lowest 25 percent of concentrations after controlling for factors like maternal IQ, maternal education, and quality of the home environment that are known to influence child IQ scores. The association was also seen for specific aspects of IQ, such as perceptual reasoning, working memory, and processing speed. The researchers found no associations between the other two phthalates and child IQ.

The range of phthalate metabolite exposures measured in the mothers was not unusual: it was within what the Centers for Disease Control and Prevention observed in a national sample.

"Pregnant women across the United States are exposed to phthalates almost daily, many at levels similar to those that we found were associated with substantial reductions in the IQ of children," says lead author Pam Factor-Litvak, PhD, associate professor of Epidemiology at the Mailman School.

"The magnitude of these IQ differences is troubling," says senior author Robin Whyatt, DrPH, Professor of Environmental Health Sciences and deputy director of the Columbia Center for Children's Environmental Health at the Mailman School. "A six- or seven-point decline in IQ may have substantial consequences for academic achievement and occupational potential."

"While there has been some regulation to ban phthalates from toys of young children," adds Dr. Factor-Litvak, "there is no legislation governing exposure during pregnancy, which is likely the most sensitive period for brain development. Indeed, phthalates are not required to be on product labeling."

While avoiding all phthalates in the United States is for now impossible, the researchers recommend that pregnant women take steps to limit exposure by not microwaving food in plastics, avoiding scented products as much as possible, including air fresheners, and dryer sheets, and not using recyclable plastics labeled as 3, 6, or 7.

The findings build on earlier, similar observations by the researchers of associations between prenatal exposure to DnBP and DiBP and children's cognitive and motor development and behavior at age 3. This September, they reported a link between prenatal exposure to phthalates and risk for childhood asthma.

It's not known how phthalates affect child health. However, numerous studies show that they disrupt the actions of hormones, including testosterone and thyroid hormone. Inflammation and oxidative stress may also play a role.