Let’s Get to the Bottom of This

You may have heard the expression, “It’s all in your head.” Today, we’re going there and in the other direction: your feet. More specifically, today’s blog is about your feet, neuropathy, and podiatry. You all know I had pancreatic cancer and chemotherapy helped me survive. Here’s a shocker: chemotherapy is poison. As such, it does damage to different parts of your body in addition to reducing or killing your tumor. But I had just a bit of neuropathy before the chemo. Today, we learn how that happened.

Let’s go back to the very beginning of this topic and define neuropathy. The National Kidney Federation, a UK group, helps out here:

“ Kidney disease is a lifelong condition which may cause foot problems. Some of these problems can occur because the nerves and blood vessels, including those supplying your legs and feet, are damaged.

This can affect:

–    the circulation in your feet (ischaemia); and

–    the feeling in your feet (peripheral neuropathy).

These changes can be very gradual and you may not notice them. This is why we recommend that you have your feet screened and assessed by a podiatrist every one to two months. You can then agree [stet] a treatment plan to suit your needs.”

I don’t know about you, but I was looking for something a little more exact. And I found it at our old friend, the Mayo Clinic’s, website:

“Peripheral neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged. This condition often causes weakness, numbness and pain, usually in the hands and feet. It also can affect other areas and body functions including digestion and urination.

The peripheral nervous system sends information from the brain and spinal cord, also called the central nervous system, to the rest of the body through motor nerves. The peripheral nerves also send sensory information to the central nervous system through sensory nerves.”

I think most of us know the symptoms, but let’s take a look at them for those who read the blog for their friends, loved ones, and the medical students who are just starting their schooling. Another old friend, The Cleveland Clinic, explains the sensory symptoms for us. There are also automatic symptoms, but they don’t affect the feet:

• “Tingling. This happens when there’s a problem with nerves that carry signals to your brain. This is like radio static you hear when you’re too far from the broadcasting station.
• Numbness. This happens when nerves can’t send or relay sensory signals, causing the loss of specific types of sensations. An example of this would be picking up a cold pop can, but not feeling the smoothness or coldness of the can, or not being able to feel the texture of carpet or the temperature of the floor through your feet.
• Imbalance and clumsiness. Nerves also carry sensations that your brain uses to keep track of the location of your hands and feet. You’re not consciously aware of these sensations, but they’re critical for balance and coordination. Without these sensations, you can experience a loss of balance, especially in the dark, and clumsiness with your hands.
• Pain. Nerve damage from peripheral neuropathy can cause malfunctions in how and when nerves send pain signals, making pain signals more intense (hyperalgesia) or happen too easily (allodynia). It can even cause nerves to generate pain signals spontaneously. This is known as ‘neuropathic’ pain, and it’s the most noticeable and disruptive symptom of peripheral neuropathy.”

Aha! Now I understand my occasional clumsiness. As a former dancer, it made no sense to me before reading this. [Cute anecdote: when speaking with the surgeon who would perform my hip replacement, my daughter – the true dancer in the family – asked him if I’d be able to dance again after the surgery. How endearing!]

Okay, back to serious work now. I am very interested in if there is a treatment for neuropathy. So, in the words of Mr. Rogers, “Let’s find out.”

I turned to a third old friend, Johns Hopkins, to find our answer:

“Usually a peripheral neuropathy can’t be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.

In some cases, over-the-counter pain relievers can help. Other times, prescription medicines are needed. Some of these medicines include mexiletine, a medicine developed to correct irregular heart rhythms; antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.

Lidocaine injections and patches may help with pain in other instances. And in extreme cases, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.”

Wait a minute. This is all very interesting, but what does it have to do with your podiatrist? According to the American Podiatric Medical Association:

“The podiatrist may prescribe oral medication to help with symptoms. He or she will also perform a thorough foot check to look for any injuries or infections and will teach you how to do the same. Your podiatrist will also show you how to take care of your feet at home. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year.” 

I’m lucky in a way in that I’m old enough for Medicare. Why? Because Medicare pays for a podiatrist visit every nine weeks. If you’re over 65 and have neuropathy, I’d suggest you make an appointment with your podiatrist. If you don’t have one, you can always ask your primary care physician for a referral.

Until next week,

Keep living your life!