An Algorithm for the Evaluation of PN (Neuropathies)
 

This was published in '98, but take a look and tell me what you think:
http://www.aafp.org/afp/980215ap/poncelet.html

Nothing's perfect, but that is one of the good ones some of us having been passing around for years.

Good on ya for posting it again!!

rose

I've seen it
 

Bob,
I think this is one that GlennT posted in the "stickies". I agree with Rose that it is one of the better ones.

Billye

Bob:

I went to the algorithm information.

It said this,"Nerves are composed of different types of axons. Large, myelinated axons include motor axons and the sensory axons responsible for vibration sense, proprioception and light touch. Small myelinated axons are composed of autonomic fibers and sensory axons and are responsible for light touch, pain and temperature. Small, unmyelinated axons are also sensory and subserve pain and temperature. Neuropathies involving primarily the latter two fiber types are called small-fiber neuropathies."

If you think I can understand most of that, forget it. So here's my question. I have diabetes and most recently, I burn, and then I freeze (only my feet). I don't have pins and needles. I only had the pins and needles (and burning) on the day the podiatrist used that vibrating tool on me. Never got the pins and needles again. I have burning and freezing of the feet),I can feel everything that touches any part of my feet (except for the tips of my toes, at least that's what my doctor at Cornell told me). I don't have any problem with sheets being on my feet, or socks or anything like that. I don't have any stabbing, or electric shocks. And the B-12 methyl seems to make the burning much less problematic.
So what do I have?? Small fiber, large fiber, axonal, large mylinating, demylinating, sensory, WHAT???? Your best guess!!!!!

Thanks, Melody

BOb
 

I can across that one some years back just crusing the net - and even gave a copy to one of my docs - who thought it was really good... I tried to see the author as a patient - but she's 400 miles north of me - so found help locally...

but yes, its a good article......

Predominately small fiber neuropathy with the unmyelinated axons being damaged to the greatest degree.

"Predominately small fiber neuropathy with the unmyelinated axons being damaged to the greatest degree."

Now break this down in words that a two year old can understand (aw, you know what I mean).

So far as I can understand it, I have small fiber neuropathy. That's about all I could understand. Oh, just so you know, the weather greatly affects the freezing. If the weather changes, (goes from nice warm day to a little bit brisk, my feet freeze). If it's a gorgeous warm day, so far I'm fine. I will never undersand why the weather outside affects me inside the house.

Thanks,
Melody

Melody, Joe is just saying that you display mainly small nerve damage because of your reaction to the heat and cold, the small nerves job is to interput the right temperature and send those signals to your brain, they can't when there damaged.
Myelinated nerve fibre wraps around the axon and becomes damaged and cannot send the proper signals to your brain, then its unmyelinated.
An axon is just the portion of a nerve cell that carries nerve impulses away from the cell body. A neuron typically has one axon that connects it with other neurons or with muscle or gland cells. Some axons can be real long, sometimes from the spinal cord down to a toe. Most axons of vertebrates are enclosed in a myelin sheath, which increases the speed of impulse transmission.
i hope this helps.
Brian :)

Okay, let's see if I have this correctly (or as far as my little own brain can understand)

I HAD myelinated nerves (that became damaged due to my diabetes). So my melinated nerves then became unmyelinated nerves.....and these unmyelinated nerves are wrapped around an axon and because they are damaged, everytime the weather changes, my brain is getting a wrong signal and freezes or burns (depending on whether it decides to freeze or burn).

Now I've been taking the methyl b-12 since the burning started. Probably a good week up to this morning. I notice the burning is much less severe.

So I gather it's a good thing I'm doing the methyl b-12. Can't be bad thing, right?

So if I keep my blood sugar around 100 to 112 (which ain't easy but I'm trying the best I can), then by keeping my blood sugar under good control, I have a better chance at not experiencing the freezing and the burning.

And by taking the Methyl b-12, well, over a period of time, I just might turn these unmyelinated nerve things into myelinated nerve things. So when they wrap around the axon, they might not send such mixed signals.


Did I get this right? and if not, correct whatever I said that was incorrect, okay?

And thanks much.


Jeez, I wish this was french class, it would have been SO MUCH EASIER than axons and myelination

Sounds like you are spot on to me, & yep your doing all the right things to heal those damaged small fibres, perhaps do a "Google image" search may explain it more so in a diagram of " unmyelinated nerves "
Brian :)

Mel,
Here's my 'take' on your question.

The body has myelinated (with a sheath) and unmyleinated
(with no protective sheath/coating) nerves, naturally.

Myelinated nerves can have the sheath affected and become exposed
due to outside reasons/causes.
Result- neuropathy.

Unmyelinated nerves can be disturbed more easily than myelinated.
(less protection because they naturally never had a sheath)
Disruption of the sheath doesn't necessarily cause the entire nerve to become unmyelinated - just a portion, but that's all that is necessary to cause a neuropathy
These nerves can be affected by weather change due to barometric pressure on our bodies.
Its not the weather itself, but the change of pressure in the atmosphere,
whether you're in the house or out- doesn't matter, the barometer is
the same, unlike the temperature - which can be different than the
outside weather.
The atmospheric pressure is what bothers the neuropathy-
pressure on the nerves that give signals to the brain that are
mixed and 'corrupt'.
The brain interprets theses signals as pain, or other Sx of our PN.

I am sorry its my mistake, Bob's right we have them both unmyelinated & myelinated naturaly, jeez its 2.am :eek: in the morning here, time to hit the sack.
good night, morning whatever :D

It's even more complicated than that.
 

There are actually numerous types of sensory nerves, generally labelled with both Roman and Greek letters.

Take a look at this:

http://www.neuro.wustl.edu/neuromusc...other/axon.htm

While this gets complicated, the nerves can be basically divided into those that naturally have myelin coverings--all motor nerves fall into this group, as do many larger sensory nerves that sense vibration, position, mechanical touch--and those that do not (the so-called "free nerve endings"); these are either sensory or autonomic, and the sensory ones are responsible for temperature and pain sensation.

Once can have a neuropathy that damages the myelin coverings of larger nerves, OR one that damages the axons (fibers) in these nerves from the inside out. AND, one could have a neuropathy that preferentially damages the free nerve endings--the "small fibers". Such a neuropathy is by definition axonal. Some people have mixtures of all these types.

For diabetics, the most common presentation is that of a length-dependent small-fiber neuropathy, with symptoms of burning, stabbing pain and/or numbness. (These different symptoms may represent different stages of damage--though the pain of damaged nerves, which are sending erroneous signals to the brain that are being interpreted as pain, can be extreme, most neuros will say that means at least those nerves are still alive. Numb areas represent the death of fibers in that area. One can have both symptoms in the same area--some fibers damaged, some gone.)

A lot has been made in the media of diabetics with numbness, but many researchers, especially those who are working in the area of pre-diabetic, or impaired glucose tolerance, neuropathy, think that more people have pain symptoms first.

Thanks
 

I have read both before,didn't hurt to read them again. I'm a diabectic,,
i have feet,calves,hands to elbow,across the back you can feel that
through the brest bone. Bob's article talks about Hysterical symptoms.
I think that what you get when you find out you have polyneuropathys.

I am having a good day so please feel free to ignore this,except i'm
really having a pain free day. wow :D Sue

Hey, I'm not burning today, nor am I freezing. I'm just fine and that's JUST FINE BY ME.

I shall contine to do my Methyl B-12 thing.

Thanks for all the information. I feel very blessed for knowing all of you.

Melody

I did answer your question further yesterday but apparantly it didnt post. Bob and Glenn have covered it well.

Bob a question for you please
 

Hi Bob, i found your post most interesting regarding Barometric pressure, i knew nothing of this affecting our nerve fibre's until i read your reply, so if you don't mind could you possibly elaborate a bit more to explain were the Barometric pressure is present at whatever certain heights in our atmosphere.
eg- As far as i know the earth's atmosphere is divided into several altitude regions, Troposphere-surface to 5 miles , Stratosphere-Tropopause to 31 miles, Mesosphere-Stratopause to 53 miles, Thermosphere -Mesopause to 420 miles, Exosphere- Thermopause to 6200 miles.

What i am trying to find out is, say a person was in extreme discomfort with terrible small nerve damage, if they were to board a plane and they turned up the inside tempature of the plane up to say 110 degrease F, but they were in flight and were above the Barometric pressure region would their PN symptoms dissapear all together ?

Something else i am confused with now, i can't work out is that when our nerve's are on fire and really hurting, applying cool temperatures to the affected area normally responds well or at least helps most times, but if its not the normal temperature but the barometric pressure that really affects our small nerves, then why do Pner's find relief by cooling down the area ?
With all that the scientific world can do these days, then wouldn't it be great for Pner's if they could come up with an apparatus that creates the opposite to what the Barometric pressure does, what a relief it would be for so many sufferers of this awfull disease.
appreciate any info on this,
thanks
Brian :)

I think they did come up with an apparatus. It's called a Hyperbaric Chamber.

But who can afford one??


Am I right? anyone?????


And if a person has small fiber neuropathy and is affected by temperature, change in temperature, like it gets worse before a thunderstorm, and then after the storm, you go AHHHH!!!! Where is the best place in the USA to live????

I think it's Arizona, or New Mexico

Any thoughts.


P.S. I'v saving up.

Melody

A nurse on the old board, years ago, was passionate about the hyperbaric chambers, wrote about sessions with it and brought other to using it.

I don't know enough to say one way or another.

rose

Brian,
I don't know enough, either - Im no scientist, but I'm an old salt.
Sailed for years. Sailed sloops and yawls. From 25 to 50 feet. Marconi rig, Fractured rig, single & double headsail, aft cockpits, center cockpits. Sailed the Irish Sea, sailed the Atlantic coast, sailed the Chesapeake Bay (my home waters) -but I don't sail anymore. Afraid I'd fall overboard cause my balance is all screwed up. Miss it, terribly.
But I do know that as a sailor, I'd watch the barometer for changing weather. Drops in millibars always made my feet hurt. Drops in millibars means there's a change coming, a front is moving in..... I'd watch out for changing weather- anything from a summer thunderstorm to something BIG! (Big drop-FAST!)
My feet stared telling me of barometer changes almost before the
barometer did. I'd check the barometer if my feet started aching in a special way.
Sometimes it meant nothing (PN is screwy that way), but it was
an even 50/50 shot that there was a change on the way.
That's all I can say.
Barometer rising, means fair weather (It says so, right on the instrument. Gives you a section for ....fair, change, & foul weather.........right on the dial.)
I was used to an almost unconscious habit of checking the chrono,
the barometer, and my compass headings- all the time - a habit.
I've made an analogy, for me. I'm just passing it along.
I don't need to check the barometer anymore, my feet tell me
if there's gonna be a change in the weather.
Get yourself an inexpensive (not cheap) wall barometer (not a digital) for your house, and see if it affects you the same way.......... It might.

(BTW - Travel by airplane doesn't seem to help my feet,
it makes them worse!)

Call me cynical, but since hyperbaric chambers are being purchased by doctors for their offices, for example for autism to name but one, i think we would be hearing more about people being offered these treatments if it worked for many peoples PN. Once a doctor makes an investment in equipment, they want to use it as much as possible to make their money back. It may work for some, either because of their cause or makeup, or at the point they caught it, but i doubt it works for many. I wish it did.

I could see a hyperbaric chamber working for PN MORE THAN I COULD SEE IT WORKING FOR AUTISM!!!!

How on earth could it do anything for autism???? Doesn't it bring oxygen to the blood vessels, or something like that?

What would doctor do?? Put an autistic child in a hyperbaric chamber, and after a few treatments, he wouldn't be autistic anymore??

Is there an autistic child who would sit still in a hyperbaric chamber???

And since more kids (1 in 150) are being diagnosed with an autism spectrum disorder, our Presiden better wise up and put more money into research on what causes autism, AND LESS MONEY IN THE WAR.

Just my two cents. Sorry to vent!!!

Melody

I have no idea if it helps or not, but i do know that they are using hyperbaric chambers for autism and allergies.

On myelin
 

A myelinated nerve has a myelin sheath. It is made that way. An unmyelinated nerve is a small fiber nerve. Multiple Sclerosis, for example is a disease where the myelin sheath deteriorates. For a myelinated nerve to function properly, it needs the myelin sheath, that is what helps conduct electricity. Once demyelinated, they seldom ever myelinate again, I won't say never. Some small nerve fibers are myelinated, but most are not....they are simply unmyelinated fibers...never had myelin, never will.


Small fiber nerves innervate absolutely every millimeter of your body. Your autonomic nervous system is predominantly small fiber nerves, and your sensory nervous system is a lot of small fibers too.

When sensory nerves are damaged, they send inappropriate signals to the brain to interpret. They are broken and therefore send the wrong message...such as, pain, when you are not hurt, or numbness or nothing when you are badly hurt, or tingling just for the hell of it.

They also may make your blood vessels contract or dilate inappropriately to heat or cold. They may make you not sense heat or cold properly.

The other thing about small fibers is they control heart rate. If you need to have more blood to the brain they are supposed to increase your pulse. If they are damaged, they don't do this properly. The small fibers also control blood vessels as I said, and generally this works in tandem with your heart rate....special receptors sense your position or exertion level, or heart rate and increase or decrease your pulse accordingly. For example, fluid drops to your feet when you stand and in a properly functioning human, your veins construct and employ strategies to return blood up against gravity. For some one who has small fibers that do not function properly, they can have lethal arrhythmias, or fatal drops in blood pressure. Management of blood pressure and heart rate become very serious issues for people afflicted with this kind of neuropathy. Some people get high blood pressure when they lay down and when they get up, it drops precipitously and they feel like passing out. It has to be managed with medications and fluids. Often times, these individuals get excruciating headaches, as they do not get enough blood to the head and neck. Often times they feel like they will pass out. It feels like the gravity on Jupiter would feel.

They almost always have sensory neuropathy as well.

Often times, these people have no or little innervation of sweat glands, or they don't feel heat and henceforth do not sweat or their blood vessels do not dilate to disappate heat.

Small fibers innervate your stomach. Damaged fibers-no stomach movement, food sits in there for hours---also transit time in your intestine is delayed. The result can be horrible constipation and vomitting, and of course the ever present sensation that one is going to puke. Some people can only eat frequent, small liquid meals. Because their stomach feels full, they don't like to drink enough, and they can overheat, or get hypovolemia.

As of yet, small fibers have not been known to regenerate. I think, and this is my personal opinion, that exercising them helps get blood flow to them, however, this is not going to stop the process of degeneration as far as I know. Some people do not know why they have this condition despite all testing. Good nutrition is probably helpful too. It probably is good to remove any offending possibility if you can. If I had any inkling of what causes my PN, I would control it. I don't know, so I can't do much to stop it. So I do what doctors advise healthy people to do, exercise and eat right.

It is theorized that barometric pressure can cause pain, but they don't know why. People with pain problems do best in climates with fewer weather fronts and dryer, sunnier weather.

That's it then, I'm moving to Tahiti!!!!

Get my sarong ready!!!!

Melody

Bob, we have got one of those long wall clocks that has a Barometer underneath the clock itself, iv'e never really payed much attention to it, but i can see now how usefull this instrument would be to a person that travels the seas.
I won't be able to do any tests with the barometer, because i don't get any PN symptoms anymore, only once in a blue moon i might get a very, very slight burn, thats all, thank god.
I am intrigued with earth's natural forces as i am with how magnetic fields can reduce severe pain [when used properly] i really do think the scientist's haven't even touched first base yet on a lot of this type of stuff yet.
I hope one day you will be able to sail again.
all the best
Brian

Small nerve fibers can regenerate--
 

--if the cause of their degeneration is removed or at least mitigated. The rate is very slow, though--most sources list a rate of axonal re-growth at approximately 1mm/day under optimal conditions (meaning it might take years for some axons that start near the lower spine and extend to the toes). The growth cone fibers have to fight around and through other tissue to "hit" their targets, and there's no guarantee they will hit the original targets or wind up in the same place as before; genreally the patten of regeneration will not resemble the original enervation pattern. And, as this process occurs, one can have all sorts of bizarre sensations that may lead one to think one's neuropathy is getting worse, not better--the difference is usually apparent only in long-term retrospect.

I am an example of axonal regeneration; my acute onset full-body burning neuropathy--still officially "idiopathic", but with high suspicion of an autoimmune molecular-mimicry process--began on April 12, 2003. A skin biopsy on Jul 24, 2003 confirmed major destruction to the smaller nerve fibers, though my larger, myelinated ones, as measured by nerve conduction studies/EMG's, seemed intact. At the time, I had been reduced to 2% of normal intraepidermal fiber density. My neuropathic process seems to have been monophasic, though--a subsequent skin biopsy in November 2005 showed I had recovered to 11% of normal nerve fiber density (and my nerves were in much better shape, with much less swelling and excessive branching, both characteristic of small-fiber neuropathies). As a subject being followed by the Cornell-Weill Center for Peripheral Neuropathy, I will probably get another skin biopsy in about a year to see where the numbers then lie.

I have, overall, experienced fewer symptoms as time has gone by, though I am still prone to sudden "flares" of neural pain, and I am far more prone to compressive nerve effects than most "normal" people. I am currently dealing with a C5/C6 right radiculopathy that may be related to my tendency to compressive forces.

I am fortunate that I have evidence of nerve regeneration, and that a reduction in burning pain symptoms has come with it. Nevertheless, I am not asymptomatic, and cannot expect full nerve regeneration to average levels, according to most of the literature, which tends to rather hazily proclaim "slow, partial recovery". Part of the reason I am being followed is that researchers at Cornell-Weill are interested to see just how much regeneration I get over time. I have indicated that my supplement regimen probably deserves some credit for optimizing the conditions for such regeneration.

You are more of a comfort and inspiration to many than you realize.

Oh yeah, absolutely with no doubt at all, the small nerves can & do regenerate & my neuro said the larger nerves do regenerate as well, once they are in the right environment, but it all takes time.

Lots of time.
Sometimes we don't have that much time left on this earth.
My son, who experienced a spinal cord injury - fractured neck
at C-5 (Behind your "Adam's Apple"), 7 months ago-
is now a quadriplegic. (Chris Reeve was a C-2/C-3)
His therapy is designed to help regenerate nerves and re-connect pathways......so he can use his normal skills again. His meds and supplements are to give those nerves an optimum environment.
He's 33 and may live to see stem-cell, nerve implant surgical help.
I'm 63 and doubt I'll live to see him have that, and get restoration of his functions. I also doubt that I have the time for my nerves to re-grow to any significant degree, no matter what my health and regimen may be.

Hi Bob:

Don't count your chickens out just yet. I'm on the methyl b-12 and my feet do NOT burn like they did before I started to take it. Some people might take longer but what the hell. If you find something that helps rebuild, re-grow, re-heal....WHATEVER it does to the nerves, well, I just hope you are on the methyl b-12 and whatever else it takes.

The day they vote out the guy in the white house who is opposed to stem cell research (to it's fullest potential), well that will be the day that everybody with Parkinson, PN, MS, damaged nerves, WHATEVER!!! that will be the day, we will all celebrate.

Until then, we pray and hope our bodies heal. That's what I do every day.

I do believe one thing however. That stress plays a big part in when our PN flares up.

For example. I've been on the methyl B-12 for almost 2 weeks now. I take 5000 a day. I have noticed a significant improvement in the burning and the freezing. So that's a good thing. HOWEVER, last night, my son (who has aspergers disorder, phoned me up and went into his spiel about how he hates humanity, and humanity is against him, and he's going to be a millionaire by the time he's 40, and he knows everything, blah blah, blah). Now I've been hearing this BS for almost 6 years now. It doesn't get any easier believe me but I've gone to a place in my head where I have the ability to tune him out and I don't get stressed.

But he pushed my buttons last night. We ended on a good note BUT, when I hung up I said to my husband "I wish Frank would not call me, because it sets me up in my head and puts me in a place where I don't want to be".

And sure enought, a few moments later, my feet started to burn. I had to put the Freeze it on it and I was fine after that and I went to bed.

But Alan and I had a long talk about our son and how his behavior has definitely impacted our health. I wish I could just have him NOT CALL US ANYMORE but he's our son and of course the guilt would eat me up alive. But obviously I am in a better place mentally, and feet wise, when I do not hear from him, when I don't have to hear on the phone that "life sucks, why should I work, why can't I gamble, after all it makes me feel good".

My goodness, I mean, how plain can it be. I was fine before I spoke to him and then BOOM, the burning.

So I truly believe that stress (as far as it applies to me), definitely impacts my PN. All I want to do is heal my nerves. My son never asks about our health, anything to do with US. It's all about him. It's gets repetitive and tiring to hear the same garbage from a 25 year old man who never worked a day in his life. I wish I could say to myself "Oh, he has aspergers, he's ill, he's not responsible". But from speaking to professionals, and other people with aspergers, it's not so clear cut.

Ever see Boston Legal?? They have guy named HANDS and he has Aspergers. He hops up and down and makes noises with his mouth AND HE'S AN ATTORNEY!!!. I've met many people with Aspergers since I've made it my business to get to know this disorder. My son exhibits none of that bizarre behavior. He has OCD and is quirky. But he knows exactly what he is doing and has said so more often than not.

I am heading toward the day when I will probably have to completely distance myself totally from his behavior. I believe that is the only way I will live (to my full potential). To do otherwise will be a death sentence for me emotionally and physically.

It's very hard, believe me.

Sorry to go on and on.

Hope you feel better.

Melody

stem cell research
 

Who really knows for certain how long it will be before they will be able to do miracles for those that did no have much hope beforehand.
My personal opinion about stem cell research is that they already know a LOT MORE than they are telling us, they have had this knowledge for a while now and no one could convince me that all governments world wide are just sitting on life saving technology, just doesn't make sense for any country not to go ahead with what they are telling us is only research, yeah right. ha! ha!
As Aussie posted not long ago that our Victorian Goverment has given the go ahead for stem cell research, its more like you can publish more of your findings now, that sounds more right to me, anyway.
Brian

Brian:

I wholeheartedly agree with you that our government knows WAY TOO MUCH THAN THEY SHARE WITH US!!!

I mean, really, do you think there is no cure for the common cold???

Give me a break!!!

Melody

Whoever has the cure for the common cold, will
win the Nobel Prize!! Just let the stem cell research be
able to help my crippled son, someday - please !

Amen Bob; Hopefully the Christopher Reeve foundation will have a big impact in finding answers to problems like your son's.

We absolutely need more stem cell therapy research if we are ever going to find cures for ANYTHING.

Let's hope the politicians in Congress wise up.

If I've said it once, I'll say it again. What we need in the White House, is a President who knows what it is like to have a family member who has been through Cancer, a President who knows what it's like to have a child with an autism spectrum disorder, and a President who has had a family member impacted by a spinal injury. Only then, will he have a lightbulb moment and sign all the bills that need to be signed.

Just my humble opinion. It will never hit home unless THEY GO THROUGH IT!!!

Melody