Neuropathy ?linked to poor circulation
 

I have idiopathic peripheral neuropathy in my hands, lower legs and feet. Biopsy confirmed c-fiber neuropathy. My feet are always very very cold. My neurologist says she can feel the pulses in my feet so doesn't think that my pain is related. I have an infrared sauna, and even after I've been in there for 45 minutes, my feet still feel cold and I am unable to sweat. I'm getting pretty worried about this. I also have white patches on my arms which my doctor describes as "poor capillary filling". Also have fibromyalgia and have read about "neurogenic inflammation".

Any thoughts?

Well, certainly--
 

--some neuropathies are linked to poor microcirculation; there are vascultic neuropathies associated with ANA autoimmunities in which this is a factor, and the mechanism of diabetic/impaired glucose tolerance neuropathy is at least in part microcirculatory.

Many of the tests designed to find gross circulatory damage, such as those for peripheral artery disease, may be "normal" and miss damage on the level of the smaller vessels (though without lifestyle intervention or other steps, small level damage has a tendency to get to larger levels in time).

It does sound as if you might have some small-fiber autonomic involvement with your report of the anhydrosis--there are certainly tests that can be done to confirm that, such as sudomotor axon reflex testing. Some level of autonomic involvement, typically disturbances in regulating blood pressure and in sweating, is not uncommon with small-fiber neuropathies.

Have you seroconverted to a positive ANA? What is your CRP and sed rate? If you are negative now, it is worth having this monitored. I believe they can also biopsy blood vessels for inflammation...am I correct Glenn?

My thoughts are the same as Glenn's....a vasculitic neuropathy due to inflammatory disease.

I have the same symptoms as you do, but have seroconverted (finally) indicating autoimmune processes. I have global anhidrosis to heat. I do sweat, if nervous, but not if heated. The sweat glands work, but the nerves that sense heat are kaput.

My feet are always freezing. I have weird vasospasm making my BP very high at times, then vasodilation making it very low at times. All over the map.

It took a long time to show a + ANA for me. Sjogren's is a big culprit for vasculitic neuropathy as well as other autoimmune disease such as Lupus, scleroderma, etc. And there is just plain old vascultic neuropathy as well.



I hope you find answers. You should probably stay out of the sauna, lest you overheat.

Have you soaked your feet in epsom salts?

Magnesium is the mineral that dilates blood vessels.

I had a patient with black hands from severe scleroderma. She had tried every drug out there to dilate her vessels with no results. She responded within a week to daily soaks with magnesium in tepid water. So I decided she needed oral, and added 800 IU of natural Vit E. And her fingers stopped being black, and the doctor stopped the warning about amputation etc.

There is another way to dilate blood vessels. I am using it now, myself, because my feet get really cold in the winter.
You can read about it here: Do not do this if you are taking drugs now for blood pressure, without supervision by your doctor. Do not use these supplements if you use nitroglycerine or other nitrates.
http://www.drignarro.com/

I think if both of these interventions fail, then you can decide about PN affecting the circulation.

I am going to try the epsom salts! I have several bags here at home. Now if only it worked on my nose.:hug:

For feet you can do a pan to soak in or you can do the bathtub.

If you immerse your body in a big soak, you will be very surprised how wonderful they are. About 6-8 oz in a big bathtub, or 2-3 oz in a foot pan. Don't use HOT water. And if you immerse yourself, be aware that it gets SLIPPERY getting out of the tub...you need to be careful to avoid falls.
The magnesium also hydrates the skin, and makes it very nice and soft, which is an added bonus.

What I think happens is a vicious cycle. One is low in magnesium like most people, and this affects the small arteries and arterioles and makes the circulation to the hands and feet inadequate, which then delivers LESS nutrients, and fails in removing things that need to be excreted, and then the damage cycles worse and worse. If one responds to the soaks, you can continue them with no problem, but I think that response means that you need oral help, to get a full benefit.

the plot thickens
 

Wow, Great answers, albeit scary. I haven't had an ANA for awhile. Interesting that in 8% of those with vasculitic neuropathy, there is involvement of the cranial nerve VII, which I have. My neurologist doesn't think there is a connection, but when my PN is bad, I also have right-sided facial pain and tinnitus. I also have fibromyalgia with which there can also be autonomic dysfunction as described by Dr Wallace in All About Fibromyalgia, 2000, including: neurally mediated hypotension, neurogenic inflammation, migraine headaches, numbness, tingling, burning, livedo reticularis, etc. all of which I have.

I've worked in health care my entire life, but can't seem to find a doctor who can sort this out. I've just resigned because my pain, with resultant sleep deprivation, side effects from meds, etc. were interfering with my ability to think and cope in my high-tech work. It was a very hard decision. I'm very good at my work and it's a big loss to the department, and to me. I did have a toxic exposure in the workplace, and although the literature describes nerve damage from benzene, none of my doctors want to consider it. Right now the cause doesn't matter so much, unless it helps with my diagnosis and treatment.

cyclelops: With vasculitic neuropathy would a skin biopsy show C fiber neuropathy, as mine did?

My skin fiber biopsy is + for small fiber. (C fiber) I have profound autonomic neuropathy and also sensory. IMO, autonomic neuropathy is underappreciated.

My neuropathy is likely vasculitc, given the very high ANA, >1:1,280.

I have Sjogren's and probably Lupus overlap.

You may want to consider an ANA.

cyclelops, what a pickle you are in! Those are complex conditions. What kind of doctor do you have treating you--rheumatologist? I presume what you are saying is that although small-fiber neuropathy may be limited to hands and feet--inability to sweat, BP anomalies, migraines, cold extremities, etc. reflect a more systemic dysfunction? Occasionally at night I'll have a sweat so I know I am capable.

BTW, I tried soaking my feet in epsom salts, and it may have been a coincidence, but, I was up until 0400 with worse pain. It felt good at the time though and I will try it again. I take magnesium supplements regularly.