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Suggest Treatment For Peripheral Neuropathy When Diagnosed With Nerve Compression
Question: Okay...i am not prepared at this moment to give you all the details of my MRI, that has affected my Cerivical spine nerve C4-7, with compression, degeneration, etc...which i can provide results of. But i just want to know briefly...i am and have had problems associated with this type problem...the tingling and numb left hand and arm, neck pain, spasticmodity (sp), fatigue and some breathing problems with light exercise and motion...and a few i cant think of right now....but, this one that has occurred recently is associated with heat. And i have suffered very much from this...when the temperature rises above a certain degree (which it has started doing here because of summer weather), when it rises above this temperature...i begin to retain heat without cooling down, and the worst part of it has been this very severe (for me) burning pain in my back and neck areas..even my arms at times. The burning pain stays in place, and the heat retention moves around as i apply any cool or cold packs, etc...to those areas. It instantly moves to another area. Anyway...i did wind up in the ER about 2 weeks ago...and no help there. Umm...i recently had an epidural injection in the cervical area affected...and that did help to alleiviate the burning pain, which i am soooo grateful for. But, I still retain the heat in this weather above that temperature point, to the point that i'm just unable to focus or do much, due to my uncomfortable status. At any rate... i am planning on visiting my primary care, who I know will begin the referral process to a neurologist, which is going to take some time to happen. I have researched briefly and am convinced this is peripheral neurology association, affecting...what?..nerve compression with sensory glands, something like that...i need to read more...but i guess i'm asking if you have some knowledge about this. i can supply more info on what i was reading...which i read briefly, so i'm not well versed here. But, can you talk with me a bit on this? okay..thanks
Brief Answer:
Peripheral neuropathy with autonomic nerves involvement.
Detailed Answer:
Hello and thanks for using HCM.
I have read your question and understand your concerns.
Regarding to your symptoms especially heat intolerance, most probable diagnosis is peripheral neuropathy wich has affected autonomic nerves too.
Fatigue and breathing problems could be related to nerves disfunction that causes inappropriate work by musculature.
Peripheral neuropathy is related to several other causees besides nerves compression, such diabetes, vitamin B group deficiency, prolonged alcohol use, some drugs side effects etc.
So, there is need for the MRI results first, for me to judge about correlation between MRI findings and your symptoms.
Another test needed to evaluate better your condition is EMG, but this needs to be discussed with your primary care Doctor to get it done.
About your symptoms, Gabapentin is a good choice, other possible drugs to use are Pregabalin ( Lyrica ), Amytriptiline, Duloxetine ( Cymbalta ), local use of capsaicin cream.
Since epidural injection helped a lot, this can be use two other times more with one month distance between procedures.
Hope you found the answer helpful. I remain at your disposal for further questions and clarifications.
Take care.
Peripheral neuropathy with autonomic nerves involvement.
Detailed Answer:
Hello and thanks for using HCM.
I have read your question and understand your concerns.
Regarding to your symptoms especially heat intolerance, most probable diagnosis is peripheral neuropathy wich has affected autonomic nerves too.
Fatigue and breathing problems could be related to nerves disfunction that causes inappropriate work by musculature.
Peripheral neuropathy is related to several other causees besides nerves compression, such diabetes, vitamin B group deficiency, prolonged alcohol use, some drugs side effects etc.
So, there is need for the MRI results first, for me to judge about correlation between MRI findings and your symptoms.
Another test needed to evaluate better your condition is EMG, but this needs to be discussed with your primary care Doctor to get it done.
About your symptoms, Gabapentin is a good choice, other possible drugs to use are Pregabalin ( Lyrica ), Amytriptiline, Duloxetine ( Cymbalta ), local use of capsaicin cream.
Since epidural injection helped a lot, this can be use two other times more with one month distance between procedures.
Hope you found the answer helpful. I remain at your disposal for further questions and clarifications.
Take care.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hello Dr. Spaho...Thank you for your reply. I've have not been well the last 2 days due to this 'heat intolerance', or whatever it is...and it renders me unfocused and unable to do ordinary things as quickly as normal. I wanted to write you back. I would try to send you the whole MRI results by a normal method, but i'm not sure how right now..and my time for writing you back is about up, so i will just write you on about the Bones, Cervical Disc Levels, and Conclusion.
Exam Date: 11/20/14
The note on Bones: Mild reversed cervical lordosis centered at C-4. Trace C4-5 and C5-6 retrolisthesis. Trace C3-4 anterolisthesis.
Cervical Disc Levels:
C2-3: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
C3-4 : Mild disc degeneration. Minor broad-based dorsal disc bulge. Facets intact.
C4-5:Mild disc desiccation. Mild broad-based dorsal disc bulge contours the ventral thecal sac. Facets intact. No stenosis or neural compression. (hmmm?..i'm wondering about neural compression now).
C5-6: Disc compression and desiccation. 3 mm deep broad-based dorsal disc spur comple,,,, Central dimensions adeuate. Facets intact. Bilateral foraminal stenosis right greater than left related to uncovertebral osteophytes. Correlate for C6 radiculopathy.
C6-7: Mild disc desiccation with 2 mm central discprotusion. Facets intact. No stenosis.
C7-T1: No significant disc/facet abnordmality, spinal stenosis, or foraminal stenosis.
Conclusion:
1. Chronic disc degenration C3-4 through C6-7. Changes most pronounced at C5-6.
2. Bilateral right greater than left foraminal stenosis C5-6 related to uncovertebral osteoophytes. Correlate for C6 radisulopathy.
3. Otherwise no significant posterior disc herniation facet arthrosis or stenosis.
4. No fracture or bony destructive change.
So, that is that. I'm not sure how much change there has been since then, but some of the symptoms i have now were not present then. And some of the symtoms that i began with, are not as intense as they were at the beginning. I started out with having problems with fatigue and also with breathing, which seemed to occur most at first when i would bend over..but grew worse with simple ekxercise and chores. This in fact i went to the ER back in October'14 , when it scared me badly. I had done a little research by the time of my appt. with Primary Care doc, and i was on the path of radiculopathy, and he thought also. So, i had Xrays and then MRI. That was the beginning of my testing with this condition. So, he sent me for the Epidural injection stuff, and it took forever with getting that set up, and by then, i was having more symptoms...spasmodic behavior, increased pain it seemed. i was paranoid about getting epidurals at first as i had been reading about some of the risk factors, so i put it off even longer, and was opting for just having those 'trigger point' injections. So then..the spasmodity had increased a lot, and then this heat intolerance began starting in early XXXXXXX i guess. But, i had noticed back in the Winter months, when here in San XXXXXXX county we have a weather condition called XXXXXXX XXXXXXX and it can get very hot, even in winter months...and i then did notice i was having these strange heat reactions then. So, what scared me the most about this...was this horrific burning feeling in my back and neck...something i would think a burn victim might feel, that bad, and this along with the heat retention...my body just would not cool down. Being in direct sunlight was/is not an option. I have bought a special umbrella with UV protection, and it shields you pretty well from that intenseness. It also is that i'm not sweating in this intense heat. I'm not sweating much at all now...which surprises me, because it use to not take much for me to attain 'BO' at the armpits. and now...it does not seem to occur. so that is strange also.
So, i had the epidural about 2 weeks ago, and that did help with the intensive burning pain, which i was very grateful for. And also, the spams have slacked off. The numbness, tingling in my left hand is still there...the neck pain still there, and i also have back pain, which i've had a long time as well...chronic somewhat due to broken back in early 2000s.
okay wow...lot of stuff. but something tonite that has thrown me off. well, i just have acquired a little a.c. for where i live...and i am so happy about that. But this late afternoon and on...i noticed even after being so cool for a while....that i still felt all this body heat with me...back, neck, face, arms, front waist to neck also. and it keeps moving around. That is the way it has been...but usually if i'm in a.c. for the amount of time i have been today/tonite...my body would cool off faster. So, now...oh gosh. i dont know. i just have this body heat that wont go away! and it seems really hot. well doctor, i'm sorry...this is so long. gosh, but i thank you for reading. i'm sending this off, before the time runs out. thank you...
Exam Date: 11/20/14
The note on Bones: Mild reversed cervical lordosis centered at C-4. Trace C4-5 and C5-6 retrolisthesis. Trace C3-4 anterolisthesis.
Cervical Disc Levels:
C2-3: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
C3-4 : Mild disc degeneration. Minor broad-based dorsal disc bulge. Facets intact.
C4-5:Mild disc desiccation. Mild broad-based dorsal disc bulge contours the ventral thecal sac. Facets intact. No stenosis or neural compression. (hmmm?..i'm wondering about neural compression now).
C5-6: Disc compression and desiccation. 3 mm deep broad-based dorsal disc spur comple,,,, Central dimensions adeuate. Facets intact. Bilateral foraminal stenosis right greater than left related to uncovertebral osteophytes. Correlate for C6 radiculopathy.
C6-7: Mild disc desiccation with 2 mm central discprotusion. Facets intact. No stenosis.
C7-T1: No significant disc/facet abnordmality, spinal stenosis, or foraminal stenosis.
Conclusion:
1. Chronic disc degenration C3-4 through C6-7. Changes most pronounced at C5-6.
2. Bilateral right greater than left foraminal stenosis C5-6 related to uncovertebral osteoophytes. Correlate for C6 radisulopathy.
3. Otherwise no significant posterior disc herniation facet arthrosis or stenosis.
4. No fracture or bony destructive change.
So, that is that. I'm not sure how much change there has been since then, but some of the symptoms i have now were not present then. And some of the symtoms that i began with, are not as intense as they were at the beginning. I started out with having problems with fatigue and also with breathing, which seemed to occur most at first when i would bend over..but grew worse with simple ekxercise and chores. This in fact i went to the ER back in October'14 , when it scared me badly. I had done a little research by the time of my appt. with Primary Care doc, and i was on the path of radiculopathy, and he thought also. So, i had Xrays and then MRI. That was the beginning of my testing with this condition. So, he sent me for the Epidural injection stuff, and it took forever with getting that set up, and by then, i was having more symptoms...spasmodic behavior, increased pain it seemed. i was paranoid about getting epidurals at first as i had been reading about some of the risk factors, so i put it off even longer, and was opting for just having those 'trigger point' injections. So then..the spasmodity had increased a lot, and then this heat intolerance began starting in early XXXXXXX i guess. But, i had noticed back in the Winter months, when here in San XXXXXXX county we have a weather condition called XXXXXXX XXXXXXX and it can get very hot, even in winter months...and i then did notice i was having these strange heat reactions then. So, what scared me the most about this...was this horrific burning feeling in my back and neck...something i would think a burn victim might feel, that bad, and this along with the heat retention...my body just would not cool down. Being in direct sunlight was/is not an option. I have bought a special umbrella with UV protection, and it shields you pretty well from that intenseness. It also is that i'm not sweating in this intense heat. I'm not sweating much at all now...which surprises me, because it use to not take much for me to attain 'BO' at the armpits. and now...it does not seem to occur. so that is strange also.
So, i had the epidural about 2 weeks ago, and that did help with the intensive burning pain, which i was very grateful for. And also, the spams have slacked off. The numbness, tingling in my left hand is still there...the neck pain still there, and i also have back pain, which i've had a long time as well...chronic somewhat due to broken back in early 2000s.
okay wow...lot of stuff. but something tonite that has thrown me off. well, i just have acquired a little a.c. for where i live...and i am so happy about that. But this late afternoon and on...i noticed even after being so cool for a while....that i still felt all this body heat with me...back, neck, face, arms, front waist to neck also. and it keeps moving around. That is the way it has been...but usually if i'm in a.c. for the amount of time i have been today/tonite...my body would cool off faster. So, now...oh gosh. i dont know. i just have this body heat that wont go away! and it seems really hot. well doctor, i'm sorry...this is so long. gosh, but i thank you for reading. i'm sending this off, before the time runs out. thank you...
I have also had this symptom which has been really strange for me. Out of the blue (no pills taken or anything)...but just out of the blue...i will start feeling like 'i'm drunk', or something like that. i even start slurring my words, and i start talking and feeling like i'm drunk or i call 'loopy'. i guess most people would think i have taken something...but this would happen to me without taking anything, and it seemed like just out of the blue it would happen. I started calling it my 'loopy nerve.' and i became convinced that this had to be neurology associated.
Now, since the epidural...i have not had this symptom.
Now, since the epidural...i have not had this symptom.
Brief Answer:
New examinations needed.
Detailed Answer:
Welcome back and thanks for the clarifications.
It is obvious according to MRI findings that you are suffering from degenative spine disease.
Foraminal nerve compression could explain a part of symptoms such pain distribution in a certain fashion, tingling, numbness, but doesn't explain heat intolerance.
I still think you need to be examined about peripheral neuropathy, as discussed in our previous conversation.
MRI is too old, and since there are new symptoms after this MRI, a new one is needed to follow up disease progression.
Epidural or periradicular injections are a good solution to control symptoms in cases like yours.
About your problems with feeling drunk and slurring words this could be blood pressure related or could be related to transient ischemic attack.
If it happens again, neurologic evaluation and brain MRI are needed.
Hope I helped you.
Best regards.
New examinations needed.
Detailed Answer:
Welcome back and thanks for the clarifications.
It is obvious according to MRI findings that you are suffering from degenative spine disease.
Foraminal nerve compression could explain a part of symptoms such pain distribution in a certain fashion, tingling, numbness, but doesn't explain heat intolerance.
I still think you need to be examined about peripheral neuropathy, as discussed in our previous conversation.
MRI is too old, and since there are new symptoms after this MRI, a new one is needed to follow up disease progression.
Epidural or periradicular injections are a good solution to control symptoms in cases like yours.
About your problems with feeling drunk and slurring words this could be blood pressure related or could be related to transient ischemic attack.
If it happens again, neurologic evaluation and brain MRI are needed.
Hope I helped you.
Best regards.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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