Archive for December, 2009

What You Needs to Know About Diabetic Foots Amputations

Yesterday James came into my office because he just found out that he had just been diagnosed with diabetes. His doctor said that he needed to get a diabetic foot check. First thing I asked James was if he’d ever known anybody who have a diabetic foot amputation. He said that yes he did have a cousin who had lost his lead to diabetes. He also said that his cousin had died shortly after the operation. When asked what happened he didn’t seem to recall any of the specifics surrounding the event. Asked if he knew how diabetes can cause an amputation. He said he had no idea.
Shouldn’t every diabetic know the details so that amputations could be prevented?
There are basically two groups of patients when it comes to understanding of diabetic foot problems. One group are ready fully understands all of the risks to their feet related to diabetes, but this is very rare. The much larger group of people have no clue how all of this happens. With every one of these folks I feel that the one goal is to get them to understand that diabetic foot problems are optional.
Diabetes can be a very difficult disease to learn to live with. Next thing you know, your doctor is telling you that you have to start exercising, he’s telling you what you can and cannot eat, and he is also telling you to have a heart attack. Then you are at home learning about blood sugar monitoring, taking medicine, pricking your finger every day. People will say, “Now I gotta think about my feet too? Seems like such a hassle.

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And it is.
But the good news in all of this is that everything bad that can happen to you because of diabetes is preventable. Everything. All it takes is a little learning, a little lifestyle change, and little daily effort. The goal is to get you to understand the basics of how diabetes can affect your feet. . . So you can take action and do something about it.
When you have diabetes you have three main problems, all working together and conspiring against you, that can lead to a diabetic foot amputation. It involves your nerves, blood flow and immune system.
When your blood sugar is high, there is a chemical reaction that directly damages the ends of the longest nerves in your body. The longest ones start in your back (where they exit the spine) and head all the way down to the toes in one long piece. Because the ends get damaged first, any nerve damage starts in the toes and gradually creeps up the foot toward the ankles.
It is always damaged at the same level in both feet. For example, if you have nerve damage (neuropathy) at the ball of the foot, the nerve damage is only in the toes. In this case the part of the foot around healed ankle and arch might be just fine.
Diabetic nerve damage makes it very difficult for someone to tell if they’re starting to develop a blister, cut, or even an infection. This can put them in a very high risk for developing serious problems. It is deceptive because you might be able to feel other things like the position of your feet, shoes and socks squeezing, but not a blister, cut or sore.
The second problem is the circulation or blood flow in the feet and legs. The arteries get clogged faster when you have diabetes. If you take two people who are identical, except one is diabetic, the one who is diabetic is four times more likely to have a heart attack. That is because of the increased rate of clogging up those arteries through the process called atherosclerosis. But this process happens everywhere, not just the heart. The blood vessels to the legs get plugged up too. Then, when you get a sore it takes longer to heal. It is also harder for your infection fighting white blood cells to get down there.
The last problem is your immune system. When your blood sugar is high, the white blood cells (called macrophages) have a hard to time fighting off those nasty bacteria. The white macrophages find bacteria through a process called chemotaxis. It is like following a trail of chemicals to its source. This is not very effective when the blood sugar is elevated. In effect, the macrophages are lost in the dark, simply bumping around, hoping stumble into some bacteria to kill. Very inefficient and not very effective.
Even if the white blood cells to find bacteria, they still have a problem. The high blood sugar prevents them from eating the bacteria. The process where the white blood cells engulf the bacteria (called phagocytosis) is essentially disabled. So they bump up against they bacteria, but can’t do anything. Imagine a great white shark with his mouth wired shut trying to eat a smaller fish for dinner. Because of all of this, the immune system is ineffective, the bacteria continue to grow and the infection quickly gets out of hand.
So a diabetic amputation goes something like this. If you start a walking program to help control your diabetes, but you have a little nerve damage, he may not be able to field blister starting to develop. If you keep walking the blister conversed. Just like that, you have an open sore. Your blood flow is a little sluggish and it takes a long time to heal. Then it gets infected while it is trying to heal. If your blood sugar is high, all of those sharks are wandering around in the dark, mouths wired shut, and the infection spreads.
If it spreads enough, one of the foot bones gets infected. And a bone infection is the kiss of death for the diabetic foot. The most consistently effective method of treatment for a diabetic bone infection (called oseomyelits) is to take out the infected bone. And that is where the amputation begins.
The moral of the story is watch your blood sugar, and your nerve damage will never get any worse. If you walk 30 minutes a day, fives days a week, your blood flow will never get any worse. If you develop any diabetic peripheral neuropathy, it is important that you are closely monitored and evaluated by someone who is an expert in the treatment of diabetic foot problems. If you ever get any open sore, blister or ingrown toenail it is an emergency. . . no joke. Get that foot checked out or it might get chopped off!

Pain Banishment, Not Pain Management: Get Your Life Back with Non-Invasive Treatment for RSD/CRPS Peripheral Neuropathy, Migraines, Arthritis, Fibromyalgia, . . . Chronic Pain – Even When Nothing Else Works

Product DescriptionA must-have item for anyone in chronic pain, PAIN BANISHMENT, NOT PAIN MANAGEMENT describes a unique therapy. It is drugless and non-invasive and relieves pain in patients for whom nothing else has worked. PAIN BANISHMENT contains three parts. First is Dr. Donald Rhodes’ fascinating journey from his first RSD patient through the development of his unique treatment, to which more than 90% of patients respond. The majority of them eventually become pain free. Next, several patients tell their own stories. If you suffer from chronic pain, you will recognize yourself in their accounts and will be encouraged by their praises of Dr. Rhodes, their Miracle Man. Finally, you will read a technical explanation of the basic causes of chronic pain. This book exists because Dr. Rhodes’ patients kept begging him to write a book so others could learn about this fantastic doctor and his treatments.

Pain Banishment, Not Pain Management: Get Your Life Back with Non-Invasive Treatment for RSD/CRPS Peripheral Neuropathy, Migraines, Arthritis, Fibromyalgia, . . . Chronic Pain – Even When Nothing Else Works

Diabetic Foot Care and Treatment

Understanding the effect of diabetes on your foot is important. Most diabetics suffer from some form of foot ailment or infection. Due to unique complications associated with increased blood sugar, these foot problems can take a serious form. In extreme cases, amputation of the limbs might be the only choice available.

With proper precautions and regular diabetic foot care most of the diabetes related foot problems can be avoided or contained.

How does diabetes affect your feet?

One of the problems due to diabetes is nerve damage also known as diabetic neuropathy. Diabetic neuropathy affects the peripheral nerves. These include the nerves for pain, motor neurons which control muscles and autonomous neurons which send signals to the organs. This can lead to numbness and loss of feeling in the feet. It can also lead to muscular weakness. Glucose is a reactive compound and excess levels of glucose can cause adverse reactions leading to the above negative effects.

The numbness in the feet makes it difficult to identify any infection or injury and it is essential that the feet are checked regularly. Also a regular visit to a foot specialist known as a podiatrist will help identify potential problems before they blow up. Then appropriate remedial measures and precautions can be implemented and the situation brought under control.

Another important problem is the reduction in blood circulation. This can make the treatment of any infection difficult as the antibiotics or any medication cannot reach the infected site and act effectively.

Some Important Precautions to take

Role of the foot doctor

The foot doctor is a person specialized only in the treatment of foot and foot related ailments. The podiatrist will do a complete foot check including the blood flow and assess the nerve damage. The podiatrist will then recommend the appropriate diabetic foot treatment based on the severity a non surgical or surgical treatment option. They will also provide advice in minor foot problems which can be serious for a diabetic such as corns, calluses, minor injuries and various infections.

Have A Diabetic Cat? You Must Know These Four Dangerous Complications Of Feline Diabetes

Let’s face it; when you have a diabetic cat, you must pay more attention to your feline friend’s health. Although cat diabetes doesn’t lead to blindness or circulatory problems like it does in humans, there are certain problems that go with this disease that you must be aware of. Here are some complications that a kitty with feline diabetes may face. Feline KetoacidosisYour kitty’s body normally breaks down glucose for energy. However, if your kitty is an untreated feline diabetic, glucose is not available for fuel, so his body will try to break down fat instead. When this happens, ketones are produced as a waste product. These ketones will build up in his body, leading to some very serious problems.

Tarsal Tunnel Syndrome: Carpal Tunnel Syndrome of the Foot?

Tarsal tunnel syndrome is condition where the posterior tibial nerve in the ankle is compressed. In many ways, this condition is analogous to carpal tunnel syndrome in the hand where the median nerve is compressed.
With tarsal tunnel syndrome, compression of the tibial nerve occurs within a tunnel created by a floor consisting of the calcaneus (heel bone) and bounded by the medial malleolus- the bump on the inside part of the ankle- and the far corner of the heel bone. The roof of the tarsal tunnel is formed by a retinaculum- a tough piece of fibrous tissue.
Within the tarsal tunnel run a number of tendons (posterior tibial tendon flexor digitorum tendon, and flexor hallucis tendon) as well as the posterior tibial nerve, and the posterior tibial artery.
Many people with tarsal tunnel syndrome may have compression of nerves elsewhere. An example would be a patient who has a pinched nerve in the low back along with tarsal tunnel syndrome. This condition, where there is compression at least two locations, is termed “double-crush” syndrome.
Another problem is that many people who have tarsal tunnel syndrome may have peripheral neuropathy. This is a condition where there is damage to the small nerves in the feet. Numbness and tingling are common symptoms. Among the diseases associated with peripheral neuropathy are diabetes and hypothyroidism.
Medications can also cause a peripheral neuropathy. These include colchicine given for gout, nitrous oxide (an anesthetic), metronidazole (Flagyl- an antibiotic), phenytoin (Dilantin- an anti-seizure medicine), lithium (given for manic depression), disulfiram (Antabuse- given for alcohol addiction), cimetidine (Tagamet- given for peptic ulcer disease), hydroxychloroquine (Plaquenil- given for autoimmune disorders), amitriptyline (Elavil- an antidepressant), and various chemotherapy agents given for cancer.
Excessive alcohol and tobacco use as well as nutritional deficiencies can cause peripheral neuropathy as can exposure to heavy metals. Infectious diseases such as Lyme disease, leprosy, and HIV infection can also lead to peripheral neuropathy.
The most common symptom of tarsal tunnel syndrome is foot pain, which can also be accompanied by numbness and tingling.
Tapping on the tibial nerve at the tarsal tunnel may cause pain and tingling to occur. This is called a positive Tinel’s sign and is clinical evidence of tarsal tunnel syndrome.
The clinical impression can be confirmed with electrical testing (electromyography and nerve conduction). Electrical testing is important to evaluate the patient for other nerve entrapment problems such as a pinched nerve in the back. Peripheral neuropathy can also be diagnosed.
The posterior tibial nerve divides into three branches that include the calcaneal, medial plantar, and lateral plantar nerve branches, all of which innervate different parts of the foot and ankle.
Magnetic resonance imaging (MRI) and ultrasonography may be useful in evaluating a patient for underlying reasons for tarsal tunnel syndrome.
Medical therapy for tarsal tunnel syndrome may start with local injection of steroids into the tarsal tunnel. Physical therapy may be of some value in reducing soft-tissue edema which can ease pressure on the compartment.
Splints and braces may be helpful for patients who have anatomic abnormalities in the hindfoot and ankle.
When conservative therapy fails to help the patient’s symptoms, surgical intervention may be warranted.
More recently, the use of a percutaneous ultrasound guided needle release technique has been found to be effective. With this procedure, which is done using local anesthetic, the retinaculum is pierced several times with a small needle while injecting small amounts of fluid at the same time. In essence, the retinaculum is shredded to relieve pressure in the tarsal tunnel. Recovery time is limited to about one day compared with the weeks to months that can accompany open surgery.
When a patient doesn’t improve and has persistent pain, associated plantar fasciitis may be a cause of persistent pain in the medial heel region after surgery or percutaneous needle release.
Complete relief of symptoms may not be possible because tarsal tunnel syndrome has many causes and because the likelihood of irreversible nerve damage exists. An increase in pain after decompression either by needle release or by open surgery is extremely rare.

I Am Look For Effective Treatment For Periphreal Neuropathy?

Pain and numbness in the feet.

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Peripheral Neuropathy in Childhood

Product DescriptionPeripheral neuropathies are diseases that affect the neuromuscular apparatus between the muscles or sensory receptors and connections in the spinal cord and the brain. They affect approximately 20-30% of children attending neuromuscular clinics. Uniquely, this text deals exclusively with such disorders in children and draws together the rapidly expanding but widely scattered knowledge in the field. It is a highly practical text, written by clinical neurologists with long experience in physiology, histopathology, and management of neuropathy. This new edition retains the basic structure of its successful predecessor and continues to offer many illustrations and real case histories. An extensive revision of the text has enabled it to encompass the major developments over the past seven years, including particularly recent advances in molecular biology and therapy of metabolic and inflammatory neuropathies.

Peripheral Neuropathy in Childhood

Chemotherapy For Breast Cancer And Neuropathy: What You Can Do

Neuropathy is the medical term for nerve damage, usually to the peripheral nerves in the hands, feet, arms, and legs. Chemotherapy drugs commonly use in breast cancer treatment are toxic to healthy nerve cells as well as to cancer cells. When those nerves begin to stop working, the result is tingling, numbness, weakness, pain, and even an impaired sense of touch.

Loss of feeling in the hands and feet can make it hard to pick up small objects and cause clumsiness and difficulty walking. Some people with nerve damage first notice a “pins and needles” feeling, not unlike when an arm or leg falls asleep. This same nerve damage can also cause constipation and bladder problems.

Common chemotherapy drugs used to treat breast cancer such as paclitaxel (Taxol), vinorelbine (Navelbine), capecitabine (Xeloda) and others can strip the coatings from the nerves, particularly those in the hands, feet, arms, and legs. The higher or more frequent the dose of the chemotherapy drug, the greater chance it will cause neuropathy.

Radiation treatment can also lead to neuropathy, and conditions such as diabetes, kidney problems, and malnutrition can cause nerve damage too. In some people, the cancer itself may be the cause of neuropathy.

Doctors can’t do much to prevent neuropathy from developing, but one medication, amifostine (Ethyol), has been shown to protect nerves and tissues from damage when given to patients before chemotherapy begins. If possible, before beginning chemotherapy, talk to the doctor about which chemotherapy agent she plans to use and, if it’s one that’s likely to cause neuropathy, request amifostine, as well.

A few small recent studies have shown that the minerals calcium and magnesium, given intravenously as part of hydration during chemotherapy, can help prevent neuropathy. This is also worth discussing with the doctor ahead of time.

If you — or the person you’re caring for — experience numbness or tingling, tell the doctor, who will administer tests to evaluate the strength of sensation in your hands, feet, arms, and legs. The doctor may also test your reflexes to see whether muscles are affected.

It’s important to recognize neuropathy as soon as possible because the loss of feeling can make it difficult to do certain tasks, such as buttoning clothes, holding onto pots and pans, and driving. It can be frightening and dangerous to spill a pot of hot water or to stumble and fall.

If someone you’re caring for begins losing feeling in her hands and feet as a result of nerve damage, she’s going to be prone to small injuries and infections that could go unnoticed. She should avoid using knives, scissors, and other sharp objects as much as possible. Make sure, too, that her fingernails and toenails are trimmed regularly, because with the loss of sensation, it’s easy to scratch or hurt herself.

If it’s your mother you’re caring for, take her for a manicure and pedicure, but tell the manicurist not to cut her cuticles to avoid infection.

At home, keep an eye on the thermostat, as extremes of hot and cold can cause increased pain for some people with neuropathy.

When talking to the doctor, describe symptoms of nerve damage as accurately as possible. Fortunately, the doctor has a long list of medicines she can try, so if one doesn’t work, don’t hesitate to ask for another.

In addition, a topical cream made from chili pepper extract (capsaicin) works well to relieve pain in the hands and feet. Some patients don’t like it because it causes a burning sensation on the skin, but this feeling will go away if it’s used regularly.

Chemotherapy can deplete the body of B vitamins and magnesium, and these deficiencies can cause neuropathy. Some breast cancer patients find that it helps to take a combination B vitamin with plenty of folic acid and a magnesium supplement. Some cancer patients find that high doses of powdered glutamine also help.

Neuropathy can also be treated with medications. The doctor may start by prescribing a tricyclic antidepressant or anticonvulsant, depending on the symptoms. Tingling and numbness usually respond well to antidepressants, while sharp stabbing pains respond best to anticonvulsants.

Although neuropathy causes many breast cancer patients to feel less mobile, exercise is one of the best ways to prevent and treat neuropathy because it gets the blood flowing to the extremities. The most effective exercises for people with nerve damage are walking and swimming. When walking, though, be sure to choose comfortable, sturdy walking shoes that fit well.

Neuropathy can cause a great deal of pain. If you or the person you’re caring for experiences pain, ask the doctor about prescription opioid pain medications, which can make day-to-day activities much easier to bear. Opioids can be given in combination with tricyclic antidepressants or anticonvulsants. Numbing lidocaine patches reduce pain in specific areas.

Many cancer patients have found acupuncture to be an effective means of controlling the pain of neuropathy. Doctors vary in their attitude toward such alternative therapies, but there’s growing acceptance of acupuncture for pain relief at many major cancer centers. As long as the doctor doesn’t actively oppose the use of acupuncture, it’s worth a try.

In most cases, neuropathy triggered by chemotherapy goes away over time. However, long-term nerve damage sometimes results. If mobility is a problem, ask the doctor what services are available. Physical therapy can help many patients regain strength and flexibility, while occupational therapy can help patients learn strategies for daily tasks such as getting dressed and preparing meals.

Treating Painful Diabetic Peripheral Neuropathy

The toes burn and tingle and sharp pains shoot into your legs. The bed sheets feel uncomfortable on the feet as you toss and turn, trying to get some rest. Your feet felt numb throughout the day, but now feel like they are on fire. Nothing seems to help as you watch the hours on the clock pass by, hoping to fall asleep.

Burning, numbness, tingling, hot and cold sensations, shooting and electrical pain are common sensations felt at rest in painful peripheral neuropathy. Neuropathy is an abnormality of the nervous system. There are many different types of neuropathy, but the most common neuropathy effecting diabetics is peripheral neuropathy.

Diabetic neuropathy is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs, and in severe case into the hands. It is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling on a stocking.

Sixty percent of diabetics have some type of neuropathy in their feet. Five percent of diabetics will experience painful diabetic neuropathy and the incidence increases with age. Over 45% of individuals who have had diabetes for over 25 years will experience some symptoms of painful diabetic neuropathy.

The cause of diabetic neuropathy is not clearly understood. Many believe that the damage to the small vessels surrounding the nerves, from the diabetes, causes damage to the nerves. Others believe the increase in blood sugar causes damage to the nerves. Despite the different theories, studies have shown better blood sugar control helps prevent progression of the neuropathy.

There are currently no treatments to help reverse diabetic neuropathy. There are no treatments which help reduce the numbness. But, there are many treatments to help decrease the pain associated with the neuropathy.

Your doctor may prescribe medications to help with the pain. There are many options, but until recently none were FDA approved for the treatment of painful neuropathy. Cymbalta