Peripheral Neuropathy A Johns Hopkins Press Health Book Per ipher a l Neu r op at hy What It Is and What You Can Do to Feel Better JJAaNnIiCcEe FF.. WWIiEeSsMmAaNn,, MMDD TJohhen Jso Hhnosp Hkionps kUinnsiv Uenrsiviteyr Psirteys Psress Baltimore Note to the reader: This book is not meant to substitute for medical care of people with neuropathy, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. Our book has been written to help with that dialogue. Drug dosage: The author and publisher have made reasonable efforts to determine that the selection of drugs discussed in this text conform to the practices of the general medical community. The medications described do not necessar- ily have specific approval by the U.S. Food and Drug Administration for use in the diseases for which they are recommended. In view of ongoing research, changes in governmental regulation, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert of each drug for any change in indications and dosage and for warnings and precautions. This is particularly important when the recommended agent is a new and/or infre- quently used drug. © 2016 Johns Hopkins University Press All rights reserved. Published 2016 Printed in the United States of America on acid-free paper 9 8 7 6 5 4 3 2 1 Johns Hopkins University Press 2715 North Charles Street Baltimore, Maryland 21218-4363 www.press.jhu.edu Library of Congress Cataloging-in-Publication Data Names: Wiesman, Janice F., 1958– author. Title: Peripheral neuropathy : what it is and what you can do to feel better / Janice F. Wiesman, MD. Description: Baltimore : Johns Hopkins University Press, [2016] | Series: A Johns Hopkins Press health book | Includes bibliographical references and index. Identifiers: LCCN 2016002110| ISBN 9781421420844 (hardcover : alk. paper) | ISBN 1421420848 (hardcover : alk. paper) | ISBN 9781421420851 (paperback : alk. paper) | ISBN 1421420856 (paperback : alk. paper) | ISBN 9781421420868 (electronic) | ISBN 1421420864 (electronic) Subjects: LCSH: Nerves, Peripheral. | Nerves, Peripheral—Diseases. | Health—Popular works. Classification: LCC QP365.5 .W54 2016 | DDC 612.8/2—dc23 LC record available at http://lccn.loc.gov/2016002110 A catalog record for this book is available from the British Library. Special discounts are available for bulk purchases of this book. For more information, please contact Special Sales at 410-516-6936 or [email protected]. Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible. Contents Preface vii 1 What Is a Nerve? 1 2 What Is Neuropathy? 8 3 Symptoms of Neuropathy 15 4 Causes of Neuropathy 24 5 How Is Neuropathy Diagnosed? 38 6 Tests 46 7 Treatment of Neuropathy 64 8 Clinical Trials 86 9 Other Conditions That Feel Like Neuropathy 90 10 Living with Neuropathy 95 Acknowledgments 103 Glossary 105 References 109 Resources 111 Index 113 This page intentionally left blank Preface Approximately 20 million people in the United States have neu- ropathy. That is about 1 in every 15 persons. You may have neuropathy, and there is a good chance that you know other people who have neu- ropathy as well. This book is intended for you, and for them—and for your family members and professional caregivers. It explains nerves and neuropathy and describes what causes neuropathy as well as the symptoms. It walks the reader through the diagnosis and treatment of neuropathy and describes lifestyle changes that can help keep nerves healthy. I first heard the word “neuropathy” from my husband, who looked up my symptoms on the Internet. He said it meant nerve damage. He read to me all the symptoms and causes, and it seemed overwhelming. My primary doctor sent me to see a neurologist, who examined me, did some tests, and told me that I did have neuropathy. The tests showed that I also had early diabetes. The doctor said that high blood sugar, over a long time, can hurt the nerves, and that nerve injury causes the nerves to be activated when they shouldn’t be. That is what was causing the tingling and pain. I was started on medicine and lost some weight, and my blood sugar went back to normal. After a few months, the tingling almost completely went away. I was on medicine to help with the pain, but I don’t need that anymore. This book is designed to take the reader through the same jour- ney toward healing and symptom relief that my patients travel when I see them in the office. Over the past twenty years, I have gone through an abbreviated form of this book with patients individually and in small groups. When I speak at support group meetings for people who have neuropathy, inevitably someone approaches me and asks me to make my talk available. After pursuing this inefficient method of distribution for many years, I decided to listen to my patients and write this book. They have asked me for it. This book is meant to be read in order from first chapter to last, and then to be used as a reference to look up specific topics. Basic definitions and concepts are discussed in the first few chapters; under- standing these definitions and concepts is necessary for understand- ing the rest of the book. When appropriate, I refer the reader back to earlier chapters for a quick refresher and review. A glossary at the end of the book defines terms that may be unfamiliar to readers, and the resources section lists reliable websites and sources of additional in- formation. viii PREFACE Peripheral Neuropathy