--but there are neurological chiropractors, such as Dr. T. (They even have a professional association.) This may have been just a little professional nitpicking--people in the medical professions are very sensitive about titles, especially in the Internet age when many feel their status as purveyors of specialized, esoteric knowledge is eroding.

Now, as far as Alan goes, of course he's been through this for quite a while now, and of course to this point there's been no definitive "smoking gun"--unfortunately the case for many. The evidence as to the etiology of his neuropathy has been mostly circumstanital/anecdotal, simply because the medical technology/knowledge is as of yet insufficiently advanced in this area.

Still, I suspect there may be multiple factors contributing to his symptoms. He may have some sort of low level autoimmunity going on, that has not been documentable--though I'd love to see the results of one of Cornell Weill's ganglioside agglutinin tests on him (the only test of autoimmunity that ever came up even slightly positive on me--it's a gross test of autoantibody activity). The fact that he has psoraisis certainly leads to the suspicion that autoimmune factors may be a part of this--people seldom have just one autoimmune condition. (And Ashkenazic Jews are rather prone to autoimmune syndromes--just ask them. )

But, there may be other factors going on here that compound the symptoms--including compressive effects, possibly from the spine (MRI's are not always accurate at noticing minor impingment of nerve roots--none of his reports have ever mentioned foraminal narrowing, have they?). Small degenerations of the spine are common is all of us as we age, and are not always heavily symptomatic--hey, I'm full of disc bulges, oesteophytic complexes, etc., that occassionally increase my symptoms, especially in certain positions. Pressure may even be coming from lower down in his legs or feet. The ankle is a common area of nerve entrapement/compression, as is the knee--and this can even be caused by muscular overdevelopment in athletes (so called compartment syndrome). It may be that Dr. T's treaments help to releive such pressure for short periods of time and that's enough to mitigate the symptoms. (You may remember we discussed the double-crush hyporthesis--the idea that two "minor" compromised to a nerve along its length produces a symptomatic effects that is greater than the presumed sum of their parts. people with neuropathies form one cause are far more prone to even small compressive effects on their nerves than normals.)

It also occurred to me that Alan's symptoms may be contributed to by some degree of peripheral artery/capillary compromise (he does have a history of heart/circulation issues) so that his symptoms may fluctuate depending on how well his circulation is working to his legs/feet--and Dr. T's theory of loosening muscles to take some of the pressure off of those vessels could certainly fit in with that idea.

In any case, you can certainly pursue further opinions--and I know you'll always bring Alan's full medical history with you to any of those. It's entirely possible, though, that the "a-ha" moment will never occur. (It hasn't for me, though we have our suspicions.)