Hello, and welcome to our introduction, assessment and diagnosis of peripheral neuropathy. Now when a key thing is and asked me out there podiatrist who's actually familiar with peripheral neuropathy, and also the assessment and diagnosis, but this is mainly to introduce other health care professionals who may well be wanting to treat peripheral neuropathy with acupuncture, but not be familiar with the assessment. So it's just going to give you a basic understanding of the assessment diagnosis of peripheral obviously it's the main aim of today's presentation is to introduce you to the surveillance type. Cause of peripheral neuropathy. By the end of the presentation you have an understanding or a basic understanding of the main cause of peripheral neuropathy and also the symptoms of peripheral neuropathy. So regard to the tablet for peripheral neuropathy, there is at least 100 different causes.

These causes may well affect different nerves, whether it's sensory motor or the autonomic nervous system. Now, if you're looking at something like diabetic peripheral neuropathy, now that is going to affect all three. So that is mainly classified as poly neuropathy. Now the pro valence in itself is going to vary, but generally you're going to find most of these presenting is to say that the oldest individual, particularly over the age of 55, the greater the susceptibility to having painful peripheral neuropathy. Now, of course don't necessarily Really include subjects who's actually had injuries through trauma or anything else such as that this is primarily subjects who may well have diabetic or chemo induced peripheral neuropathy. Now with regard to the main cause, as we saying his trauma can be a main cause, this can be brought about through road traffic accidents, or maybe injury from falling for scaffolding that severed spinal nerves or anything such as that.

But that can be when a key cause is going to be trauma, or it could be even from surgical intervention. chemo induced, that's when a common causes where it's from toxicity of the medication in which the individual is actually taken. diabeetus is one of the main cause, if not the most prevalent cause of painful peripheral neuropathy, HIV that can be coming about again through the auto immune system. Primarily attacking the body's own nervous system. Now, what I do tend to see quite frequently within my clinical setting is subjects who's actually come in and presented with pain in the lower limb, and is showing symptoms similar to peripheral neuropathy. And that's mainly brought about through a reduction or lacking in vitamin B 12.

So normally, a quick blood tests will actually indicate that these individuals will actually report having difficulty walking just in pain and discomfort walking to the bottom of the garden, or something along that line. So again, you know, I've treated them, assess them for performance. They're not quite presenting with peripheral neuropathy, but however, in a lot of cases, it's been through a reduction in B 12. If it's not been reduction in B 12, it can be status. So again, both of those will give similarly Symptoms is where the taking status and presenting with pain and discomfort within the feet or the lower limb, mainly when walking. And there are two key things.

So I normally center for a book test and if they're on status, I get the GP to reduce the status to see if that has any impact on the pain and discomfort in the lower limb. So their main things, particularly if any of you out there or physios or physical therapists and getting patients presenting that is making sure that you do a differential diagnosis to make sure it isn't peripheral neuropathy that you're actually treating. So I do have quite a few patients presenting with that. And again, they can present with falls and weakness within a lower limb with those particular medication or vitamin 12 deficiency. Now, the other interesting group is a reason why I say interesting because I have had a number of patients that's actually come in and presented through neuropathy that is brought about for alcoholism. Now, many of these patients don't want their GP to know about this.

I mean, one patient in particular, that came into my practice pain within his feet, mainly in his right foot as opposed to his left. And when he actually presented I remember looking at his work boots, he was a builder, we looked into his work boots, and notice you can see all the metal plates because he was still toe cap boots, metal plate in the bottom of the boat, no inlay in this particular boat. So I made an automatically assumption is that this individual is getting most painted discomfort due to inadequate cushioning within the footwear. So it wasn't until I went to put an insole into the boot. And while I was actually doing that, because I'd already done a full assessment and it wasn't anything, you know, red flags that was actually flagging up at the time, and I couldn't really reproduce any discomfort as such.

But however, when I went to put the interview So into the shoe, I didn't notice. The existing insole was still in there. It was all wrapped up into the toe box. I thought, well, that's unusual. Surely he must have felt that. And when I proceed to explain that to him, he just looked at me and said, Oh, I wondered where that had gone.

So that automatically start to ring alarm bells, to say, well, surely you must have noticed that in there so I'll find it down to the next room. Got my equipment to assess for neuropathy, such as one or filaments and undertook a what I'd normally do on a diabetic is a neurological assessment of the feet. And tuning fork, no reaction whatsoever. light touch, sharp, pricking, no reaction whatsoever. So I did explain to say, Look, I'm gonna have to write back to GP. The interesting story he did give me After that was the fact that he'd walked two miles the weekend before, enter town with his wife for a meal.

It wasn't until they were actually sitting at the table. And he went on to say that it felt something while he was walking in his shoe, but it wasn't sure what it was he felt he was a little stone or something like that. And it turned out that it was his lighter, that he dropped into a shoe and it worked from home two miles into the restaurant and didn't feel the lighter in his shoe. So as I said, I did write to his GP explained he's gonna have to pay a visit to his GP, what he wasn't keen on doing because he know that his GP was going to ask him to cut back on the alcohol. So there are key things that will lead to peripheral neuropathy. So there are key things that you do need to check on.

I have had a number of patients that come in, and once you look at their alcohol level, once you start to look at the medical history, many firms only put down I have a bottle. Now this was another interesting case. Had where which his answer was and only have a bottle. And I was, in my naivety thinking that is a bottle of beer, in which case, it wasn't a bottle of wine, it was a bottle of spinach per day. So again, large quantities, they're not always the one who are consuming quite a bit is not necessarily telling you what they're actually consuming. And again, what is one unit in a pool is going to be approximately two units if you're drinking at home.

So there are key things to bear in mind as well is if they put down one unit, then expect it to be to have to put down for you next and expect it to be closer to eight units. So there are key things to bear in mind. Smoking is going to cause key problem atherosclerosis, narrowing of the arteries, so they can lead to peripheral neuropathy as it starts to effect the macro circulation to the nerves and autoimmune with Barry disease. Those kind of conditions can also lead to peripheral neuropathy. So as we've already mentioned, medication, particularly chemo, those kind of medication is going to cause neuro toxicity to the actual nerves itself. So if we start to look at diabetic induced peripheral neuropathy, now as I've seen beforehand is going to be the main cause of painful peripheral neuropathy.

50% Of diabetics will develop peripheral neuropathy. Now, with regards to that 50% of those who do develop peripheral neuropathy will be asymptomatic enough words, not all of them will lead to painful peripheral neuropathy. They may will have numbness but they will not have pain. Same again, the longer they have and what it's basically showing you is a type two over who's had type two diabetes over a period of eight years is more susceptible to painful peripheral neuropathy. If we start to look at chemo, again, not as prevalent as diabetic, but however 60% of those patients treated with chemotherapy is susceptible to peripheral neuropathy mainly seen in patients treated with the neurotoxic chemotherapy agents. So again, they're more susceptible to developing peripheral neuropathy.

HIV I was saying beforehand is susceptible to that which where it can cause damage to the central as well as the peripheral nervous system. 30% will develop peripheral neuropathy but however, only 20% will develop painful peripheral neuropathy. Symptoms is going to vary from individual to individual. If you're looking at somebody on chemo, it's going to depend to some extent as to the amount of drugs and the extent of drugs in which they're actually taken will determine The severity common symptoms is going to involve numbness, tingling, prickling of the hands and feet or, as better known is the socket and glove. So normally you're going to have it's milled the hands and feet up to the ankle or just above where to gradually start to get more of the peripheral neuropathy, sharp stabbing, burning type sensation dependent nerves in which it's actually affecting. Now quite a few patients will present with sensitivity.

So where is the middle touch things or you may will touch them in certain areas, and they're going to find that can be very sensitive, very painful, whereas normal people won't have that kind of sensitivity, even to the extent where they may will report at night when they're in bed just bedclothes going on to it can make it very, very sensitive. So again, they may will have nocturnal discomfort, that's gonna start to affect the sleep and if it's not sleeping properly, that's going to start to affect the patient. Make it that much worse the day after. Or the key thing to bear in mind is if it's affecting the motor nerve, then you're going to start to get muscle weakness and muscle weakness is going to start to present itself. So therefore, that leaves that person more susceptible to falls and sustained injury. So it is going to be important that you do assess muscle strength to determine the strength of the muscles within the feet.

If that is weak, then obviously strengthening exercises was going to have to be prescribed. And again, as I was saying, if the motor nerve is affected, then paralysis may will start to actually develop. So with regards to the assessment, I do understand those podiatrists out there obviously not teaching you to suck eggs hopefully but it goes to the assessment in itself. I'm sure you're familiar, podiatry wise, where you monitor filaments you like to watch you gentle touch you sharp pricking, which is generally carried out in your neuropathic assessment. But their key tools to determine the level of neuropathy also the utilization of a tuning fork. In addition to that, you do need to check the reflex the ankle reflex and if it's the hand that's been affected, then you will need to check the reflex in the elbow and also the reflex within the wrist itself as well.

Pulses quite important so you can also check the pulse of the wrist, pulse width in the hand also in around the elbow, but also within the feet which is more commonly affected is going to be a dorsalis pedis and he posterior tibialis palsy we can't palpate those, then you're going to need to use Doppler. As we mentioned beforehand, muscle strength It is important you do a manual assessment of muscle strength to determine as to if there's any weakness. As several research has demonstrated. Click On the elderly, which has shown that if there's any weakness within the feet, they are more susceptible to falls, where they've actually undertaken strength exercises, those strengthen exercises have been demonstrated to reduce the amount of falls off those particular individuals. footwear, quite important footwear. So the broader the base Cushing base is going to be more comfortable to the individual.

And same again, that's going to start to reduce false. So make sure there's no weakness in the feet and make sure that you're wearing suitable footwear, in addition is to get them to check the footwear on a regular basis, make sure they've not got anything in there. So that's going to be quite important. Therefore it's going to prevent anything sharp or anything stabbing into the feet. Now one of the gold standard is going to be your conductivity test. Now that's going to determine as to whether the accidental or whether it's the deamination of the actual nerve that may will be affected, and also the conduction of the impulse along the nerve is also going to be determined.

Now, these are quite good, particularly if you're going to undertake acupuncture because these are key areas where acupuncture has been shown to have its effect, particularly in enhancing nerve conductivity and also improving my own ation of the actual nerves itself. So again, once you start to understand these, then you can start to target your acupuncture addressing these particular problems, as opposed to just purely getting acupuncture to purely address the pay. So that's going to be quite important to understand but next presentations will actually lead on to the past or physiology of diabetic or chemo induced peripheral neuropathy. Well, thank you for listening. If you do have any questions and by all means pose a question within the discussions of the presentation. So you can go to discussion.

Normally it's located top right, put your question into there, other colleagues may will answer the question. Otherwise, I'll come back and answer the question, and therefore at least everybody who may will have the same questions. If it's in the discussion, at least, they won't need to be asking the question themselves, you'll be there for them and answer their question that they may will have. Alternatively, you can email me directly on info at Steve Bailey acupuncture.com. Look forward to seeing you in the next presentation.