By NILAYA BHAWSAR
For Montclair Local
Editor’s note: This series will be written by practitioners in Summit Medical Group on health-related topics. This one is by neurologist Nilaya Bhawsar, DO, who practices in Montclair and Livingston. He specializes in peripheral neurology and neuromuscular disorders. Dr. Bhawsar enjoys running and playing tennis.
Do you have numbness or tingling? It could be neuropathy.
In an average week, I see a number of patients with symptoms of neuropathy or nerve damage. Numbness, tingling, pain, weakness, and erectile dysfunction are common complaints.
I like to think of the approximately 100 billion nerves in our body as wires that carry messages. Without these nerves we would not be able to see, feel pain, pick up a pen, or do pretty much anything. Imagine it is time to go for your daily walk. The brain sends motor impulses to the spinal cord, which relays the signal to peripheral nerves in your leg telling your muscles to move. Sensory impulses run in the reverse direction, from the periphery to the brain. Like a car engine that won’t start because of a battery shortage, nerve damage impedes effective communication.
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An estimated 20 million Americans suffer from peripheral neuropathy. Numbness or tingling often first develops in the toes or feet. In some people, sensory symptoms may rise in the legs and affect the hands. It is important to address these symptoms right away, because in some people the underlying problem is treatable. Delays in identification and treatment may lead to symptom progression and irreversible damage. When a 65-year-old man comes into my office after experiencing numbness in both feet for three weeks, we can identify the problem in the early stages. If that same patient waits several months or years, the tingling that was once a nuisance may progress to weakness in the hands and difficulty walking or driving a car. Erectile dysfunction can also be a sign of late-stage neuropathy in male patients.
Beyond blood tests, your doctor may recommend a nerve conduction study, and sometimes a nerve or skin biopsy. Unfortunately, for nearly 1 in 4 patients, reason for their neuropathy is indiscoverable —a condition we call idiopathic neuropathy.
Over the age of 50, the culprit is often diabetes. In fact, an estimated 60 to 70 percent of individuals with diabetes develop nervous system damage at some point. Less common causes of neuropathy include Lyme disease, nutritional deficiency (e.g. B12 deficiency), autoimmune disease, and medication toxicity (e.g. chemotherapy). A small minority of patients present with rapidly developing symptoms of neuropathy, caused by an autoimmune condition known as Guillain-Barre syndrome. In most patients, medications can help manage symptoms and improve quality of life, but for some, treatment can prevent further nerve damage and permit recovery.
It would be easy to blame diabetes when a man presents with numbness in both feet. However, after further investigation, we may find he suffers from Guillain-Barré syndrome. As a result, his treatment and prognosis would be entirely different.
Remember, numbness and tingling sensations of any kind are not normal. If you feel something, say something. It can make all the difference.