I just went to my foot doctor because I had a very bad achilles problem and severe leg and foot cramping which i think was brought on by taking budesonide and a ciprofloxin eye ointment. I stopped both those medications and my other dr then put me on apriso for microscopic collitis. started that this last monday and on the same day while at the foot dr we also discussed the numbness in the balls of my feet. I had been there before for that problem. he thinks it is neuropathy even tho i had a nerve test for that. he said it is missed because it is not advanced enough. the foot dr gave me naprosyn. Anyway after 4 days of apriso and naprosyn my feet are burning, numb, painful, hard to walk. called the gastor dr this am but they are closed until monday. I think i should quit the apriso, does anyone know if that causes neuropathy to get worse? and continue the naprosyn. also, i think the neuropathy was actually better with the budesonide. what do you think? my foot dr gave me a list of supplements for neuropathy..vit c 1000mg, alpha-lipoid acid 100mg, n-acetyl-cystine 600mg, l-caritine 500mg, selinium 200mg, b-complex 100mg, b-12.

Apriso depletes folic acid. It would help to take activated folic acid called methylfolate. This bypasses conversion in the body, which is broken in 10-30% of people.

The ALA...is it r-lipoic stabilized? If not 100mg is not enough.
Switch to R-lipoic stabilized (the new active soluble form) and 100mg a day is enough. If you use the old mixture ALA you would need at least 600mg a day or more. It must be taken on an empty stomach too.

The B12 should be methylcobalamin, the active form. Same reason as the methylfolate. Ideally it is best to have testing before starting to see if you are really low. This information is useful before beginning. This has to be taken on an empty stomach too.

New research suggests that selenium doses should be lower. 100mcg a day is typically the new suggestion.

Steroids like budesonide deplete many nutrients. So it is a good idea to do the B complex. But perhaps 50mg a day is enough.
This steroid also depletes potassium, zinc and magnesium.
Potassium you can get by choosing foods high in this mineral.
Same with magnesium. But some people soak in epsom salts, to enable magnesium better. If you choose a supplement, AVOID OXIDE form, and go for a chelate or SlowMag, at 1/2 the RDA daily... which is 350mg elemental a day.
This is my magnesium thread:
http://neurotalk.psychcentral.com/thread1138.html
You'll see it is a huge topic.

I think people with a mild colitis should try going sugar and fructose free. Fructose causes inflammation of the bowel, in 1/3 of adults in the US. Also carrageenan a common additive in many foods including dairy products is thought to irritate the bowel.

People taking steroids can also get elevated blood sugars. This can lead to PN and should be tested out. Steroids because of this blood sugar effect can flare Candida yeast in the GI tract and on the skin.

To Debter:

Also (as mrsD mentioned earlier) you should get methylcobalamin. If you get B12 you should buy it separately rather than get it in a B-Formula. This is because most B12 is of the (Cyanocobalamin) and NOT "methylcobalamin" which is the better form of B12 as its absorbed by the body better.

But getting methylcobalamin might be hard to get from a local store. You may have to order it from the internet. Regular B 12 Cyanocobalamin isn't bad to start with. (I've been on it for months) If you do get it, I suggest getting the sublingual tablets (the ones that melt under your tongue).
although unproved, the sublingual pills are allegedly more easily absorbed as well.

Also if you are taking any type of Ciprofloxacin, or any other Flouriquinolone drug -I feel you should stop taking it immediately and ask your doctor for something else.

You should never take any NSAIDS with it -that includes Aspirin, Alieve, and Naproxen because this enhances the side effects of these drugs.

...I hope you feel better soon.

This is a paper on colitis and PN occurring together:
http://www.ncbi.nlm.nih.gov/pubmed/17715640
Now, I'd like to ask if you if only used one tube or so of the ciprofloxacin opth ointment?
This ointment has 3 milligrams of ciprofloxacin in a gram of base. The average tube is 3.5 grams.
In comparison, the smallest oral dose is 250mg twice a day.
This is a bit of reality check...and continues below.

This link gives blood levels measured in patients using the ophthalmic ointment:
http://www.alcon.ca/pdf/Product_phar...iloxan_eng.pdf

Typical absorption into the blood stream was 1.5 to 2.5 NANOgrams per ml of blood measured.
The typical blood level of Cipro 250mg is 1200 NANOgrams per ml.

What is a nanogram?
A nanogram (ng) is, therefore, 10-9g or one billionth of a gram. This can be written as a unit in the 9th decimal place: 0.000000001g.

It is unlikely therefore, that an ophthalmic ointment would deliver much Cipro to your body, or enough to create a systemic neuropathy. It is significant for allergic reactions however.
If a neuropathy were to begin I would expect it in or around the eye first.

But also I'd like to know how much or often you used that ointment. Most people only use a product like this for temporary infections, or surgery around the eye.

I have a thread here on drugs known to cause PN...
http://neurotalk.psychcentral.com/thread122889.html

The PN could be related to your colitis. Crohn's patients sometimes get an inflammatory arthritis with their pathology.
It is a similar autoimmune effect.

The link I gave you first on this post has treatment options for colitis that has other manifestations....and that is to use other immune suppressing drugs.

Some people just cannot tolerate mesalamine products. So yes, to ask your doctor and explain your potential side effects.

...My ongoing debate about neuropathy and PN is with a new friend I met on the net recently. He's another person other than me, that has PN from antibiotic use although it's not the same antibiotic - I feel that there is a great similarity in treating it. I could be wrong.

Here is our argument. I feel that drinking beer or any alcohol is not a good idea for anyone with PN. In a nutshell, if you can't stop drinking entirely, you should limit your alchol use and when you do, make sure to lessen the load some by drinking a small amount of beer over a long amount of time...meaning stretch out your beer by drinking slow so that you do not drink more than you should.

I feel this buffers your body from too much alcohol while your body processes the drinks. Also drinking a lot of water, as well as eating a decent meal afterwards seem to help me.

After my PN I never drank enough beer to get a hangover and I never was a heavy drinker to begin with so I "Buzz" pretty fast anyway.

But, like me, sometimes it is difficult not to drink a few cans of beer (about 4 light Beers) every other weekend or so, especially during holidays and social events (the only time I drink.)

I only drink light beer which has a fairly low alcohol content in it. I don't drink more than a six pack (most times about 3/4 beers max) and if I do drink that week it's only for that one day of the week.

My friend believes that since his PN is not from alcoholic roots that he can drink more than that. I'm not saying this guy drinks a lot. He does not, and in fact, probably drinks not much more than me, about two days out of the week and around a six pack - still that is at least double the amount that I drink. I also avoid all hard liquor. While this guy will drink a shot of Vodka from time to time.

He says that for alcohol to affect nerves, even damaged nerves, you have to drink hard liquor, or an amount of beer much larger than a 6 pack - or drink a few every other day to affect your nerves.

I'm no expert, but I disagree with this. I think alchol can start irritating your nerves after just a few beers for most people. I often feel quite well with no flare-ups for days or weeks even after I drink 5 beers, but I rarely drink that much. Truthfully I simply don't know the answers to our debate.

As he says, peoples' tolerances for alcohol are all different and points out a diabetic friend of ours with PN that drinks over a 6-pack nearly every Saturday.

I often feel some peer-pressure to drink, mainly from depression when I'm at a social event -I want to feel that happy little buzz and join the party - but I'm very wary of how much and what I drink.

Personally, I feel anyone with PN shouldn't be drinking alchol at all, but I know this could be difficult for some, including me.

Does anybody here have similar feelings on these ideas? I hope I get some replies on this as I think this is one issue that many people often think about.

...

Here is a graphic showing equivalence of various alcoholic drinks:

http://rethinkingdrinking.niaaa.nih....ndarddrink.asp

Hence 4 whiskeys (6oz) = 4 -- twelve oz beers.

The body does not separate out what form the alcohol is in.
A breath test by a police officer will register intake independently from the type of alcohol consumed.

Remember CONGENERS in various drinks may affect nerves, as well as gluten (beers) and yeasts.(in wines and beers).
This is what a congener is:
http://en.wikipedia.org/wiki/Congener
Congeners are thought to create hangovers. Hence the quality charcoal filtered vodkas, which have them removed.

People with gluten intolerance will have significant reactions to beers independently from the alcohol content. There are gluten free beers with alcohol in them.

It is highly idiosyncratic how people with PN will respond to various alcoholic beverages, therefore.

% alcohol content of beers:
http://www.alcoholcontents.com/beer/

If you are still taking that clonazepam, you should avoid alcohol consumption, but you probably know that already.

--Thank you, mrsD: this is very helpful. I'm actually surprised at how many people ask me about drinking beer and nonalcoholic neuropathy. ...Especially at this time of the year.

For me, I don't feel any flare-up from drinking a few beers on the weekend, but then again, I'm very cautious about it and limit my drinking to low alcoholic beer and just a few over a few hours. Now that I think of it -about 4 beers in 4 hours. I "Buzz" quickly so I never drink more than a 6-pack on a drinking day.

I skip a week a lot, too, sometimes not drinking a beer for over 2 weeks or so. But honestly with the holiday parties coming up, it seems harder to dodge the urge to sip a few.

I do not mix Clonazepam with alcohol or - leastwise I don't think I do. There's at least 8 hours to a full day between me drinking a few beers and taking a clonazepam.

But this was not always the case - months ago, I would take the 0.5 pill about 3 hours or so after a few beers. The only thing I noticed then was an increased drowsiness. Still, I do my best to avoid it and certainly never mix them outright.

---To mrsD: I tried to get off of clonazepam cold-turkey with bad results - meaning that my PN flare-ups got worse just 3 days after ditching my usual twice-a-day 0.5 pills. Then I tried to do so using low dose Melatonin 1 as a substitute, but that didn't work out too well. (I was afraid of the possible side effects of melatonin so I gave up that attempt very quickly).

I was once on 2mg of Clonazepam per day for about 2 years in the past (before that just 1mg) and now, 0.5 - so far the dose reduction has gone well over the last 5 months. But there will be a time soon enough where I will try to get off of it again.

My goal is to give up ALL medication and just rely on vitamins for my health conditions. I hope that sounds realistic and not silly. As it is, clonazepam is the only drug I take other than my staple of vitamins.

My problem is actually my PN - my doctor wants the severity of my PN to go down before attempting to wean me off of the pills. Indeed, for long periods at a time, my PN does seem to fade away quite a bit - but I'm afraid that attempting to wean off of it at those times would cause me to relapse.

...also about the previous issue of alcohol, how long am I supposed to be off of Clonazepam before I have a drink? --Is my current 8-hours difference alright?

I hadn't noticed a thing concerning this other than being tired more. I hope it doesn't instigate PN flare-ups...though that never happened to me.

Truthfully, I was absolutely furious with my doctor when he told me a full year after taking clonazepam, that I might be addicted to it. He told me that small dosages don't addict patients -and I fell for it.

So, the guy actually got me addicted to a drug without letting me know it was highly addictive! ...oooooh, that freakin' quack!

Anyway, I don't want to be addicted to any drug ever -and to be honest, I don't even know if I AM addicted to it -I just assumed I was because I've been using it for so long. (5 years now -but no more than 2 mg per day in the past) Don't know if that makes a difference.

Yes, it is difficult to totally wean off clonazepam. I mentioned that to you before.

Of all the benzos it binds very tightly to receptors. Some people take 6months or more to get off it completely. The serum half life for clonazepam is 18 to 50 HOURS. That means only 1/2 of the drug is gone within that time frame. So waiting 8hrs to drink is not wise, as you are getting a synergistic effect. This is why getting off this drug is very problematic. Also your age factors into this. Older people, have slower renal clearance of benzos, and for this reason the 1/2 life would be much longer. So the drug can build up in the body in elderly patients.

You need a careful SLOW taper. Klonopin makes wafers you can split to get to lower doses more easily.
http://www.drugs.com/imprints/1-8-1521.html
This photo is of the .125mg wafer.

I believe the clonazepam is masking your PN, and once off of it you will have much more pain for a while. Over time tolerance to this drug leads to higher doses to get relief...and becomes a vicious cycle.

There are websites devoted to benzodiazepine withdrawal, and all of them suggest very slow tapers (most doctors go too fast).

Melatonin is not going to work as it does not sit on GABA receptors.
Melatonin is only for sleep. It is not a tranquilizer. The inhibitory receptors benzos sit on, prevent excess firing and are rather unique.
You may find some suggestions for this on the benzo withdrawal sites.

I want to thank you for the uplifting post on toxic PN. I didn't take Cipro, but took Flagyl and had an EXTREME reaction.

I've gotten extremely painful PN. Everywhere in my body. This all started in March this year (2013.). I also have very bad headaches/head pressure. It's made me very depressed and hopeless as it seems to get worse, but I agree it is much worse with depression, anxiety, and stress.

I hope there is some recovery for this. I am a young mother of two babies and and struggling to take care of them over pain.