I have been told that the lumbar puncture and nerve biopsy were just an indication and not always conclusive. That even if the results of these tests were negative, he could still have CIDP. So why do the tests if his insurance doesn't require them in order for him to be authorized to have IVIG therapy?

I can't say for sure, but, to substantiate continued IVIG, you may need baseline and then tests to show it helps. The other issue is they may want to find out what else is going on with your husband. Since he is 77, some of these tests may be hard on him. I don't know how healthy he is.

I can't say why they want those tests. I did have a lumbar puncture, and a skin biopsy for nerve density, not a sural nerve biopsy, tho, because my neuropathy was suspected to be small fiber. Sural nerve biopsy IS quite invasive, and in fact, is not done much anymore. What kind of biopsy are they talking about, skin biopsy for nerve fiber density, or actually taking a piece of nerve from the sural nerve?? Sural nerve biopsies are falling out of favor, because they do damage the nerve...so, yes, question that.

IVIG is a not a very threatening treatment. IVIG is a blood product. It is antibodies from many people, pooled, and subjected to a 'wash' to make it as safe as possible. I hate to say it is rationed, but, let's just say, it is hard for the docs to make a case to give it and they have to be on the ball to get you to keep it. IVIG, does carry a very minute risk of bloodborne infection.

If I were to go on let's say, Rituxan, then I would be more nervous. That has the capacity to really seriously depress the immune system for months if not years. It can activate the JC virus in very rare cases, and cause PML, a fatal brain condition.

Everything has its downside, but IVIG has the potential to help the Alzheimers for your husband. I don't know how advanced that is, but, gosh, if it would help, that would give him a better quality of life.

Given he has Alzheimers, I would give the IVIG a shot. It isn't approved for that, and the CIDP may in a way, be a blessing, if he can get IVIG...and it helps the Alzheimers, or both.

If you read the side effects of many meds it is scary.

I have had IVIG at home and at the infusion center. I currently have to travel an hour one way to get it, since they won't let me have it at home anymore. My husband has to lose a day of work a month to take me in to the city. He uses vacation time since he saves his sick time for retirement insurance...his job does that. However, he loses 12 vacation days per year for my medical care, and that is tough on him. He will be 60 this year.

Since your husband would likely get a loading dose, which is usually 4 to 5 infusions over a period of time...usually daily to every other day, until the loading doses are given, that is the most likely time he could be sick. Loading doses are not fun. I did get a bad headache and threw up. Once I had a low glomerular filtration rate, but it has been normal lately.

The loading dosees, you may want done in an infusion center if you are nervous about it. Then again, your husband could have to endure the ride home, sick. That is why they opt to give it in home for some people.

Make sure that they infuse slowly, take his BP, pulse and temp during the infusion, and adjust the IV accordingly. Most nurses are knowledgeable about IVIG...(some aren't). Ask the home care provider for a nurse who has given it before. Infusion centers are very experienced with IVIG...so are home infusion services (in general, but always ask.)

As far as getting IVIG for Alzheimers, I am wondering if insurance will cover it despite a positive clinical study? The demand would be so high and IVIG is in limited supply. It makes sense to me since Alzheimer's care is so expensive in the long run, but insurance companies don't usually care about that, because they don't pay for long term care, patients generally do. Most of them exhaust all their assets doing that. You may be lucky on this one, and get the benefit of IVIG for the Alzheimers.

If your husband starts to have any reactions, they will stop the infusion.

Most people that get IVIG, don't have any problems with it.

Oh if a home care nurse does it...make sure the IVIG is room temperature. During one loading dose, they ran it in cold....that made me puke...all over my couch. I felt miserable and got a horrible headache then.

That was my only real bad reaction and I think most of it was do to infusing cold stuff, too fast.

BTW, I do think there has been preliminary evidence that IVIG mitigated Alzheimers.

I would say my headache was migraine like. They can give an IV infusion for hydration and opiates to help the headache. Of course, it does mean a trip to the ER.

I do get really bad headaches occassionally and end up in the ER, but, I assume it was the infusion due to the onset during infusion and the immediate nausea.

This meningitis is not infectious but inflammatory. I imagine it could be a problem, but mine did pass.

Most docs avoid prescribing IVIG because it is usually such a fight to get it....no kickbacks. Most docs look for ways to get you off of IVIG...if there is any other option they try that.

There is absolutely no motivation other than patient care to precribe it. Now if it was one of the antidepressants or antipsychotic, well, then I would say be skeptical about kickbacks.

Oh, one more thing, they premedicate some people, usually with benadryl and tylenol. I can't use benadryl, so I just do Tylenol. Some people require hydrocortisone.

I am sitting here right now with immensely large nodes, (unshelled walnut size in my neck) which I have not ever had before...wondering if it is due to my last infusion several weeks ago, or due to not being suppressed, or what. Of course, I have a bad case of Sjogren's and other issues, so who knows??? One more thing to add to my alphabet soup of conditions. One side went down over night, but the other side is still big. Ugh. I look like a chipmunk.

Also, it is really HARD to catch neuropathy in its early stages. One doesn't know what is wrong with one. It isn't like it comes on all at once for most people....we grow into it and it seems normal until it gets bad.

Back from the doctor. Feeling confused. My husband and I went back to his neurologist we had seen for several years but not in the last year. He said:
(not in this particular order)

regarding the test results and the findings of the new nuro
1. not enough blood work had been done to decide if it is CIDP

2. he was not going to request a lumbar puncture

3. was not happy that my husband's feet were not warmed prior to the nerve conduction test. - gives a more accurate reading.

4. Even if my husband did have CIDP he would never reccommend IVIG at this stage. He said, yes he has painful neuropathy, that he would like to relieve with medications, and he want him to start on cymbaltan.

5. He said my husband's legs are very, very, strong, except that his left foot is about 20% weak. If that causes him to trip, that we can try a brace or some type of support (forgot his exact words)

6. He said that when he prescribes IVIG, he only does it (for instance when some one's legs are so weak that they can't walk)

7. He said IVIG is a very serious medication that he would not prescibe for my husband's situation.

8. He said that it has serious risks and he is aware of two people that had renal failure and died.

9. He said that I should be aware that when a doctor prescribes IVIG they recieive between $1000 to $1500 depending upon the manufacturer, from the manufacturer for each and every infusion.

10. When I mentioned that if it didn't help the CIDP that it just might help Alzheimer's. After looking at the paper work I supplied about the trial, he said: Phase II of this trial showed improvement which consisted of 16 people, Phase III consists of several hundred people and until those results come out showing that hundreds of people showed cognitive improvement he would never recommend it for Alzheimers's. I told him by the time the trial completed and the FDA approves it for Alzheimer's it could be too late for my husband to benefit from it.

11. He said he hopes that is not the case, but he still does not recommend IVIG for my husband. He kept saying that it's not an aspirin, and it carries risks.

So we left with a prescription for Cymbalta and an order to have some additional blood work done. I know this doctor is on the conservative side, and is on the neurology board at a world renowned hospital and teaches there one day a week at the university's medical school. So now I have two opposing opinions, one neuro saying very little risk the possible benefits totally out weight the very small risk, and the other neuro saying don't do it. I am so emotionally exhausted from this whole situation. I really can't think clearly at the moment, so I'm not going to think about it tonight. I am wondering if you know anything about cymbalta? I looked it up and it seems to an anti depressant? I wonder if it is similar to effexor, because my husband took that last year and after the fifth day he had to stop because it really, really confused him and totally affected his memory terribly. I probably should post this question about cymbalta on the nuropathy board to get feedback. Anyway thanks for listening and by the way at what stage were you prescribed IVIG, when you had neropathy pain only or when you had much muscle weakness too? thanks for your response.

What a trial for you! Sometimes waiting a week or so to let the information settle helps with making a decision like this.

I have no experience with IVIG, but I can comment on Cymbalta.
This drug is very similar to Effexor for pain. It also carries some risk to the liver, so tests should be done periodically while people use it, and alcohol is absolutely contraindicated for it.

The bottom line in any decision like this is :
benefit vs risk.

You might investigate supplements to try and determine if something is missing in your husband's diet and life that is contributing to the neuropathy.
B12 levels? (often become very low in the elderly)
Vit D levels? also critical and when low more pain is the result

Other things that may help are:
acetyl carnitine (for toxin or drug induced PN)
r-lipoic acid
CoQ-10

There is a supplement now for aging and neuro deterioration due to failure of mitochondria in the cells (these are the energy cells). The product is a combo of carnitine/lipoic acid
and their website has some good info on it.
http://juvenon.com/index.html?campai...FQUMDQod3Skt3Q

If you decide not to do the IVIG or even if you do, while you are debating you can read Dr. Ames' site, which is very interesting and helpful.
You don't have to buy his product, and you can choose your own sources for the nutrients. (Juvenon can be more expensive).

Many people feel better on a supplement which can help restore some lost functions. So do consider something along this line. Most doctors will not offer anything beyond the standard RX drug therapies, which today don't do much.

Joanne such is the state of diagnosis today for PN for many patients. There is a lot of trial and error and educated guessing. Im surprised the doctor wouldnt want to do a lumbar puncture to help maybe nail down or eliminate possible causes. It can show presence of markers for autoimmune antibodies, lyme, meningitus, bacterial infections, white cells, and more. I had it done and it really is not as big of a deal or as arduous as it is made out to be. A nerve biopsy on the other hand is invasive and usually leaves permanent numbness and or pain in the area cut.

A third opinion might not be a bad idea either. sometimes you have to get a few, research yourself and then decide. When my wife broke her leg and it wouldnt heal after 2 years, she had to go to many different orthopedists and get opinions on what to do which often contradicted each other. They ranged from continuing to wait to heal, to external fixators, to plates, to rods to amputation. Medicine to a large degree is still an art rather than just a science.