Saturday, February 20, 2016

Estrogen Levels Drop Leads to Peripheral Neuropathy in Post-Menopausal Women

We often talk about neuropathy as a problem for people with type 2 diabetics. However, there are over two dozen other causes for neuropathy, and one of them may sound quite surprising to you: it is Menopause.  Or, more specifically, it can be attributed to a sudden drop in estrogen levels, whether caused by menopause, or by stopping estrogen therapy. Researchers believe that blood flow decreases when estrogen ceases to be produced. This affects your nerves, muscles, joints, hair and can cause symptoms similar to peripheral neuropathy. These symptoms often manifest well before you actually reach menopause.

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What is peripheral neuropathy (PN)?

Neuropathy means “disease of the nerves.” The brain and the spinal cord make up the central nervous system. The peripheral nerves are those that branch out from the spinal cord into the trunk and the extremities (arms and legs).

“The peripheral nervous system is like the body’s electrical wiring,” says Tina Tockarshewsky, executive director of the Neuropathy Association, a New York–based national voluntary organization, serving patients with neuropathy resulting from cancer treatment or other causes. “When the peripheral nerves are damaged, the electrical system goes haywire. Sometimes there are sparks, and sometimes the lights go out.”

Pain and numbness, particularly in the hands and feet, are hallmark symptoms of PN. The condition can also cause a wide variety of other symptoms, depending on which nerves are damaged.

These symptoms may begin during or after cancer treatment. They tend to worsen over time, and they may persist for a year or more after treatment is completed. For many patients, damaged nerves do eventually heal and symptoms clear up. For others, however, the nerve damage—and the symptoms—may be permanent.

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Symptoms of PN

Symptoms vary depending on type of nerves affected - and may include:
* Gradual onset of numbness and tingling in feet or hands - may spread upward into your legs and arms;
* Burning/Searing pain – especially at night, when it can seriously disrupt ability to sleep;
* Sharp, jabbing or electric-like pain;
* Extreme sensitivity to touch - even light touch;
* Lack of coordination;

More severe cases experience:
* Muscle weakness/wasting or paralysis - if motor nerves are affected;
* Autonomic nerve dysfunction (Organ/gland dysfunction) – inability to:
1. Swallow/digest food properly/control bowel function - lack of esophageal or intestinal muscle control (possibly manifesting as diarrhea or constipation)
2. Maintain healthy blood pressure - lack of arterial muscle control for contraction/dilation – experienced as dizziness, lightheadedness, or even fainting when a person moves suddenly from a seated to a standing position;
3. Control bladder function - lack of bladder muscle control can cause incontinence or lead to infection.
4. Sweat normally
5. Have normal sexual function
  
Causes of nerve damage/inflammation

Numerous factors can cause neuropathies - which affect at least 20 million people in the USA. All forms of neuropathy involve inflammation as a result of damage from:

* Autoimmune diseases – E.g. Lupus, rheumatoid arthritis and Guillain-Barre syndrome. Some neuropathies are caused by inflammation resulting from immune system activities, and can develop quickly or slowly.

* Diabetes (Diabetic peripheral neuropathy) – more than 50% of diabetics develop some type of neuropathy to several nerves; nerve endings slowly die leading to loss of sensation in the feet, legs and hands which at times can be painful and can lead to weakness and difficulty walking. Nerve damage may result from impaired ability to utilize glucose for energy.

* Toxin exposure – can cause peripheral nerve damage:
Heavy metals – E.g. arsenic, lead, mercury, thallium; Magnesium deficiency allows heavy metal deposition in the brain.
Certain medications - certain anti-cancer drugs (especially chemotherapy),  anticonvulsants, antiviral agents, and antibiotics.
Environmental toxins

* Infections – the table below lists some viral or bacterial infections that can cause peripheral neuropathy by directly attacking and damaging sensory nerves, often producing sharp pain. Viral and bacterial infections can also cause indirect nerve damage by provoking autoimmune disorders. In this case, I.S. components attack the neural myelin sheath or axon.

* Inherited disorders – E.g. Charcot-Marie-Tooth disease, amyloid polyneuropathy;

* Traumatic injury - can sever/crush/compress/stretch peripheral nerves.
Motor vehicle accidents
Falls
Sports injuries

* Pressure on the nerve – can compress nerve fibers:
Slipped disks between vertebrae
Broken/dislocated bones
Using a cast or crutches / Spending a long time in an unnatural position
Repetitive Stress /Repeating a motion many times (E.g. typing) - repetitive flexing of any group of joints for prolonged periods often leads to entrapment neuropathies, by causing ligaments, tendons, and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass. E.g. Carpal tunnel syndrome
A pinched nerve in the back
Tumors - Growths can form directly on the nerves themselves, or tumors (malignant and benign) can exert pressure on surrounding nerves contributing to PN;

* Acute and chronic inflammation of connective tissue – acute inflammation of protective tissue surrounding nerves can spread directly into nerve fibers. Progressive destruction of connective tissue from low level chronic inflammation renders nerve fibers more vulnerable to compression injuries and infections. Inflamed, swollen joints can entrap nerves, with ensuing pain.

* Vitamin deficiencies /Alcoholism - Vitamins B1 (thiamine), B3 (niacin), B6, B12, E are particularly important to nerve health and whose deficiency is a factor in PN.
B1 deficiency is typically seen in alcoholics
There are several causes of B12 deficiency:
A strict vegetarian diet - since animal-based foods such as red meat, dairy products, fish, poultry and eggs are the only recognized source of dietary B12.
Inability of stomach acids to aid in B12 absorption – as such, drugs taken to reduce stomach acid should be taken with B12 supplements.
Other conditions/procedures associated with a reduced ability to absorb B12 - include autoimmune diseases, pernicious anemia, pancreatic diseases, ileal resection, Crohn's disease, HIV infection, gastritis, gastric or small intestine surgeries, malabsorption syndromes, M.S.

* Kidney disease, liver disease - by allowing abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. Most patients on dialysis because of kidney failure develop polyneuropathy.

* Reduced oxygen supply to peripheral nerves – hypoxia caused by vascular damage or diseases of the blood can seriously damage or kill nerve tissue. Blood flow is impeded as blood vessels become inflamed, which reduces lumen size as vessel walls harden, thicken, and develop scar tissue. Blood vessel constriction is often present with diabetes.

* Hormonal imbalances - can disturb normal metabolic processes and cause neuropathies.
Underproduction of thyroid hormones (Hypothyroidism)- slows metabolism, leading to fluid retention and swollen tissues that can exert pressure on peripheral nerves.
Overproduction of growth hormone -  can lead to acromegaly, a condition where many parts of the skeleton become abnormally enlarged. Nerves running through enlarged joints can become entrapped.
Estrogen neuropathy  – in women, neuropathy can start within a decade of approaching menopause.

* Gluten sensitivity – PN may respond to a strict gluten-free diet

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Self-Care & Coping Skills

Self-Care

The following suggestions can help you manage peripheral neuropathy:
* Take care of your feet. Tight shoes and socks can worsen pain and tingling and may lead to sores that won't heal. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet.
* Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems.
* Eat healthy meals. If you're at high risk of neuropathy or have a chronic medical condition, healthy eating is especially important. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Drink alcohol in moderation.
* Massage your hands and feet, or have someone massage them for you. Massage helps improve circulation, stimulates nerves and may temporarily relieve pain.
* Avoid prolonged pressure. Don't keep your knees crossed or lean on your elbows for long periods of time. Doing so may cause new nerve damage.

Coping Skills

Living with chronic pain or disability presents daily challenges. Some of these suggestions may make it easier for you to cope:
* Set priorities. Decide which tasks you need to do on a given day, such as paying bills or shopping for groceries, and which can wait until another time. Stay active, but don't overdo.
* Get out of the house. When you have severe pain, it's natural to want to be alone. But this only makes it easier to focus on your pain. Instead, visit a friend, go to a movie or take a walk.
* Seek and accept support. It isn't a sign of weakness to ask for or accept help when you need it. In addition to support from family and friends, consider joining a chronic pain support group. Although support groups aren't for everyone, they can be good places to hear about coping techniques or treatments that have worked for others. You'll also meet people who understand what you're going through. To find a support group in your community, check with your doctor, a nurse or the county health department.
* Prepare for challenging situations. If something especially stressful is coming up in your life, such as a move or a new job, knowing what you have to do ahead of time can help you cope.
* Talk to a counselor or therapist. Insomnia, depression and impotence are possible complications of peripheral neuropathy. If you experience any of these, you may find it helpful to talk to a counselor or therapist in addition to your primary care doctor. There are treatments that can help.

Peripheral Neuropathy and Sleep

Sleep is an essential part of living—sleep helps us avoid major health problems and it is essential to our mental and physical performance.  It affects our mood and stress and anxiety levels. Unfortunately, sleep disturbance or insomnia is often a side effect of the pain. It is a common complaint among people with living with chronic pain.

It’s no surprise that about 70 percent of pain patients, including those suffering from PN, back pain, headaches, arthritis and fibromyalgia, report they have trouble sleeping according to the Journal of Pain Medicine.

Pain can interfere with sleep due to a combination of issues. The list includes discomfort, reduced activity levels, anxiety, worry, depression and use of medications such as codeine that relieve pain but disturb sleep.

Most experts recommend a range of seven to nine hours of sleep per night for adults, regardless of age or gender. This may seem impossible to people with chronic pain, but there are steps you can take to improve your sleep, which may lead to less pain and lower levels of depression and anxiety. First, talk with your doctor to see if there are medications that may lessen your sleep disturbance. You should also check with your doctor to make sure your current medications aren't causing some of your sleep disturbance.

Beyond medication, there are several things you can do yourself to improve your sleep. Here are some methods to try and help you fall asleep more quickly, help you sleep more deeply, help you stay asleep, and ultimately help keep you healthy.

Following are tips for improving your sleep:
* Reduce your caffeine intake, especially in the afternoons
* Quit smoking
* Limit and/or omit alcohol consumption
* Limit naps to less than one hour, preferably less
* Don’t stay in bed too long—spending time in bed without sleeping leads to more shallow sleep
* Adhere to a regular daily schedule including going to bed and getting up at the same time
* Maintain a regular exercise program. Be sure to complete exercise several hours before bedtime
* Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support
* Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.
* Turn off your TV and Computer, many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it.
* Don't watch the clock – turn your alarm clock around so that it is not facing you
* Keep a notepad and pencil by your bed to write down any thoughts that may wake you up at night so you can put them to rest
* Refrain from taking a hot bath or shower right before bed; the body needs to cool a degree before getting into deep sleep
* Try listening to relaxing soft music or audio books instead, or practicing relaxation exercises.
* Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

It may take three to four weeks of trying these techniques before you begin to see an improvement in your sleep. During the first two weeks, your sleep may actually worsen before it improves, but improved sleep may lead to less pain intensity and improved mood.

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