Hi there:
I posted this question yesterday to the "old" braintalk community but realize most are posting here. Here's my letter. Hope someone can give me some insight regarding my instep pain.
Hi all:
I'm new to the forum and really pleased to have a place to ask questions. A bit about my history. I had a multitude of symptoms during 2005 including fatigue that actually hurt, dizziness, diffuse pins and needles (facial, legs, hips, legs, etc.), severe anxiety, some mild depression, heart palpitations from time to time and eventual numbness in both feet and hands. My feet were numb at the bottom and my hands became numb when I was falling asleep or using the phone, typing, etc. Eventually, I had pain in the instep when I walked which has been debilitating.

After seeing an internist, my endocrinologist (I have previously diagnosed Graves disease), a neurologist, an infectious disease specialist, a podiatrist, a cardiologist and a rheumatolgist--FINALLY a second neurologist diagnosed severe B12 and B6 deficiencies. I began supplementation in early August 2006 and last blood test results the end of October 2006 show both vitamin levels are in the normal range.
Most of my symptoms are showing improvement. My anxiety has decreased, my energy levels are improved, no more dizziness and my hands no longer wake me up at night but still go numb from time to time. The bottoms of my feet are still numb, however, and they are quite painful in the instep when I walk (primarily the left one). I also still have periods of time when my heart races a bit. Has anyone ever experienced instep pain as a part of peripheral neuropathy or in general? Also, can my heart racing be a part of neuropathy too? Thanks for the opportunity to talk to fellow travelers!
Sincerely...
Sara

post later, but, I can say, from experience that you need, but absolutely Have to learn about the different 'B's and b-deficiencies. Most 'B's are necessary, and shortcomings are under/non-diagnosed and thus wreak more messes in life than we all need. There are a couple of 'B's mostly B-6 which you CAN get too much of [I forget the other bad B], the rest tho, are like vitamin C where if you take in too much, it, well just goes thru you. How much of what you need depends on the quality of the B intakes AND if there are any asorbtion issues [damage done by anti-b's, or off center body processes]. Read up about B-12 on, I believe, a supplement site further up on the menu. Also, check into the Gluten File, again, above...to see if that could be the culprit, or contribute to things going WRONG?

IN the meantime, don't overlook the old remedies of magnesium in a footbath or a bananna for potassium.

Hope this helps for starters? Pain free moments for all! - j

Ontheroadback--

It is good you are getting some forward progress.

I would seriously have you consider some magnesium supplementation.
I have a thread on it here, at the vitamin forum.

1) a simple way to feel better is to soak the feet in epsom salt baths.
In a foot bath you need about 2 ounces of epsom salts and soak at least a
1/2 hour or more if you can.
If you see some improvement with this, then

2) start some magnesium in the diet (see that thread), or take a good supplement like SlowMag (twice a day). This often stops crampy pain in its
tracks.

Also to consider is thiamine for PN. Doctors do not test for this, and you can
add that in very inexpensively now, with no side effects. At least 200mg a day up to 500mg a day in divided doses. Thiamine has a long history of being useful for PN, but with Neurontin and its aggressive salesmen, was totally forgotten by doctors. Thiamine can be really effective for some people!
Some people inherit errors of metabolism concerning thiamine...so if you are one you may not even know it!

Good luck!

http://www.emedicine.com/NEURO/topic278.htm


This link has some informaton regarding vitamin deficiencies. Small fibre neuropathies can also present with some autonomic instability such as racing heart,blood pressure irregularities & anxiety states, due to the the same nerves also controling and regulating some of the internal functions.

You could also possibly be getting very worried and anxious in your own right, due to the PN, and unintentionally also be causing some of the symptoms.

There is alot of stress involved.

I know you have been to neuro, but have you had any small fibre testing done?

MrsD:
Thanks for all the suggestions. I picked up some epson salts on the way home and look forward to trying them. I was tested for thiamine (b1) and it was within normal range, so I guess I'm ok there. I've wondered about the magnesium connection and will look into a supplement. Thanks again!

I'm learning all about the B vitamins. I was totally shocked when the neurologist found the deficiencies. Amazing (sigh). Thanks for the info!

Hi Aussie:
My neuro has diagnosed me with small fiber PN. He did a nerve conduction test/EMG and based on the results made the diagnosis. He didnt feel the need to do the skin test, apparently. I didn't know that racing heart, anxiety and BP issues were related to small fiber PN. It's interesting sice my entire episode began with the fatigue and then a period of weeks where my heart raced before all the neuro stuff started. And the anxiety has been horrific. Its improved significantly sice my B12 and B6 levels were restored. I couldn't even sit for a haircut without severe panic symptoms.
Thanks for calling my attention to the autonomic connections with small fiber. I'll call my neuro tomorrow.

Sara,

Have they checked your foot for a heel spur. The pain you describe sounds so familiar.

Hugs.

Barb

Hi Barb:
No, they haven't checked for a heel spur. My heels don'tt hurt. My pain is located on the top of the foot, the instep. Its crampy pain and makes walking very paiful. I used to walk an hour a day and miss it terribly.
I hope someday I can walk for exercise--even 20 minutes would be a dream come true.
Thanks again for your response!

some people have a genetic error in thiamine metabolism. This leads to
what is called a dependency state (not a deficiency). This means that
normal levels do NOT work for them, and they need more.

So normal serum levels, mean nothing for those people.

A biochemist from OBT found this information, that it is linked to familial
alcoholism genes. These may not express in alcoholism for that patient, but
they do interfere with thiamine metabolism. So extra thiamine works for these
folks. Some drugs deplete thiamine also... diuretics like furosemide, and others, antibiotics, and sulfa drugs.

Because thiamine is so cheap and easy to use, it is worth a try. It works extremely well for me, in the 200mg/day range. (My paternal grandfather was an alcoholic-- that is the closest family member with that problem to me).

here is a good reference:
http://www.springboard4health.com/notebook/v_b1.html