appropriate type of specialist for PN?
 

Hello, I'm new to the forum and in the process of being dx'd with PN due to burning on the soles of my feet. My PCP ruled out diabetes & deficiencies of vitamin B12 or D, then referred me to a podiatrist. By the time I saw the podiatrist I noticed that I had bald spots on various areas of my legs. She ordered more blood work (B1, B6, ANA, CRP, RF, and "ESP" (I think the nurse may have meant ESR). She plans a NCV test if nothing obvious results from the blood work. She thinks this will be idiopathic but says it's important to try to get info so as to treat it best. This podiatrist seems caring and fairly knowledgeable but I find no reference to her having special expertise or experience with PN and can't help thinking that I should be seeing a neurologist. I don't know whether I should stick with her for a while, since she seems to be doing the right things so far, or make a request to be sent to a neurologist. Any advice will be appreciated. Thanks.

IMO, it's up to you.
 

If your symptoms aren't worsening at an alarming rate, I don't see the harm in sticking it out with the podiatrist at least until current business (tests, medication trials, etc.) is concluded.

My first choice would be a neurologist whose practice is devoted solely to PN, but I don't see any reason why a podiatrist (or podiatry practice) couldn't do the same. I think what matters is the results & doctor/patient relationship.

Ask her; it's a reasonable question, and of a neurologist as well (if/when you decide to see one).

The door is/will always be open to either switching to a neurologist, or adding one to your team.

Doc

PS FWIW, I wound up consulting both specialties, and still came out idiopathic. Like a lot of folks here, I wound up having to be my own detective (which I'd done before with other issues).

Just a reminder...you need to get the B12 actual results. Doctors
still follow the outdated lab ranges, which go down to really low values, and they still call these "normal". Many doctors still call levels of 200pg/ml "normal".

You should be at least at 400pg/ml if you are in the US.
Other countries use different concentrations like pmol/L.

This is our B12 thread:
http://neurotalk.psychcentral.com/thread85103.html

Testing is only one half of the investigative tools. Getting the results interpreted correctly is the OTHER HALF.

Good food for thought, Doc. It had occurred to me that I could end up with someone else who doesn't take it as seriously as she seems to be. But it did bother me that she formed an opinion on my first visit that it will be idiopathic. Maybe because I have no other obvious symptoms. You're right though, I can always see someone else in the future if necessary. Thanks.

This is my thread listing and discussing DRUGS that may cause PN in some people. Most doctors will not go to this subject, because of liability and fear they will be blamed. Some idiopathic PNs are results of RX drug use in the past.

http://neurotalk.psychcentral.com/thread122889.html

The biggest offenders are the fluoroquinolone antibiotics, Flagyl, and statins for cholesterol.

Burning only on the bottoms of the feet is odd. Usually a larger area is involved. I'd try dusting your feet with a good antifungal powder, double rinse all socks so there is no soap residue in your clothing. Sometimes fungal infections lie dormant below the skin esp if you have had athlete's foot in the past. Then you can get burning, but no lesions when it activates a bit.

Burning really responds to Biofreeze. This cools off the nerves and blocks the burning sensations:

http://www.amazon.com/BIOFREEZE-Pain...ords=Biofreeze

Amazon has free shipping on this, and Biofreeze is not commonly in stores. If you do find it locally it can be as much as $15.00.
You can also apply to the top of the foot..as many nerves go thru there too.

Some foods will also cause burning. The biggest offenders are nightshade veggies. If you avoid all tomato, potatos, peppers, hot sauce (jalopenjoes) for 2 weeks, you can see if your burning reduces in intensity.

Histamine in foods can also cause burning and tingling:
http://neurotalk.psychcentral.com/sh...ight=histamine

MSG often found in processed chips, sauces, and Chinese food is also hard on nerves. Monosodium glutamate will trigger the NMDA pain receptors.

you can check out lizajane.org to see what testing you should be having. keep a copy of all of your tests. when the podiatrist has gone as far as she can go and if you are still having the burning, take them to a neurologist and see what they have to say. podiatrists often come into contact with people who have diabetes and pn.

B vitamins
 

My B12 was 792 pg/ml. Folate was >19.9ng/ml. I began a supplement with a lot of B vitamins, for hair loss on my scalp (hormonal) about 5 weeks before the foot burning became a daily occurrence. The podiatrist thinks the high folate may be aggravating my symptoms. However, the burning, in a more sporadic form, pre-dates the supplement usage by over a year. I initially suffered with severe nightly burning of my soles 8 years ago concurrently with a diagnosis of plantar fasciitis, which gradually responded to use of an orthotic for a few years.

Thanks for the suggestions, echoes. It's reassuring to have a kind of roadmap in mind as I begin this process with so many unknowns at this point.

The odds were with her.
 

Quote:

idiopathic (not comparable) 1.(pathology) Of, relating to, or designating a disease or condition having no known cause.

When you walked into her office, neither of you knew the cause, therefore, it was "idiopathic". If, after testing, she can't find any obvious cause/reason, it'll still be "idiopathic". The doesn't mean that there isn't a cause or reason, or that one cannot/willnot be found; it just hasn't been found as of a point in time.

A recent (2009) Neuropathy Association poll asked 1,000 patients to identify their specific type of neuropathy. While there are over 100 known types of peripheral neuropathy, 52% of the patients responded their neuropathy was “idiopathic,” meaning of no known cause. So the chances were in her favor.

First-Time National Poll Confirms Neuropathy Hits Millions In Their Prime

There are some other interesting facts/stats in the article/poll. :cool:

Well, that's not the only thing about me that's been called "odd". :rolleyes: :Head-Spin: :Grin-Nod:

Doc

clues emerging
 

Thanks Doc for the interesting information (and a chuckle). I had previously read somewhere that about 30% of PN cases were idiopathic.

I got some lab results yesterday including positive ANA and DNA antibodies. From what I read, this is not conclusive of, but is consistent with, lupus. My podiatrist who ordered the tests is on vacation this week, so tomorrow I meet with my PCP to discuss the results, and find out where the investigation goes from here.