Hi, Because of the economy and limited resource$, i have had to go back to work part time. The job was more physical than I could handle. For the last week of post work, I have had little or now feeling in my hands, and or wake up all hours of the morning with my arms/hands tingling, numb and in down right pain. Takes all morning long to get function back! Is this a direct result of my Tx or a combination of past IV use and alcohol & Tx? I am @ week 31/48, clean and sober now for 2 years. I know I will have to re-think my work expectations/limitations. Input ?
Let your doctor know, and perhaps, keep up your B complex - B12, B6 in particular.
I've had similar sx's from 4 weeks post of a 6 month tx (i was okay during tx). My hands were numb and arms very painful when I woke, and pain continued throughout the day (but worse at night and morning). I figured that maybe my muscles had wasted a bit and I was exercising the 'typing' muscles only without the others getting enough exercise. So I upped my other exercises (especially RSI exercises), and did some extra walking to get more oxygen flow (and made myself puffed) - shaking my hands and doing 'arm cartwheels' while walking. I stretch before bed and on waking, and reach for a door and twist until things click!! I even splinted my hands some nights as the tendons felt like they were shrinking. I've had Korean back, shoulder and arm massages for the last 6 weeks and bought a combo of B6, magnesium and zinc to help the joints, upped my water, omega and flaxoil (plus Vitamin C & B12 daily).... This is my own recipe from googling tendonitis etc and experimenting so please research in case I'm putting you wrong; I have a feeling that interferon may have something to do with it all.
My doctor said my neck and shoulder muscles were very tense and suggested massage and acupunture - he also mentioned carpal tunnel syndrome. My specialist said "there is no doubt that interferon has many sx's, but the further away you are from when you took the meds, the more things should settle down", and didn't specifically link the pain with the meds. I am much much better than I was, and looking for (and demanding of myself) further improvement. But if you're still on the interferon, I would definitely let your specialist know, to see if he can pinpoint anything or suggest anything to help. Good luck - it's a very frightening symptom and I was thinking I'd have to resign from work; I hope you have some success.
"Systemic diseases — disorders that affect the entire body —often cause peripheral neuropathy. These disorders may include: Metabolic and endocrine disorders. Nerve tissues are highly vulnerable to damage from diseases that impair the body's ability to transform nutrients into energy, process waste products, or manufacture the substances that make up living tissue. Diabetes mellitus, characterized by chronically high blood glucose levels, is a leading cause of peripheral neuropathy in the United States. About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage.
Kidney disorders can lead to abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. A majority of patients who require dialysis because of kidney failure develop polyneuropathy. Some liver diseases also lead to neuropathies as a result of chemical imbalances.
Hormonal imbalances can disturb normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones 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 characterized by the abnormal enlargement of many parts of the skeleton, including the joints. Nerves running through these affected joints often become entrapped.
Vitamin deficiencies and alcoholism can cause widespread damage to nerve tissue. Vitamins E, B1, B6, B12, and niacin are essential to healthy nerve function. Thiamine deficiency, in particular, is common among people with alcoholism because they often also have poor dietary habits. Thiamine deficiency can cause a painful neuropathy of the extremities. Some researchers believe that excessive alcohol consumption may, in itself, contribute directly to nerve damage, a condition referred to as alcoholic neuropathy.
Vascular damage and blood diseases can decrease oxygen supply to the peripheral nerves and quickly lead to serious damage to or death of nerve tissues, much as a sudden lack of oxygen to the brain can cause a stroke. Diabetes frequently leads to blood vessel constriction. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. This category of nerve damage, in which isolated nerves in different areas are damaged, is called mononeuropathy multiplex or multifocal mononeuropathy.
Connective tissue disorders and chronic inflammation can cause direct and indirect nerve damage. When the multiple layers of protective tissue surrounding nerves become inflamed, the inflammation can spread directly into nerve fibers. Chronic inflammation also leads to the progressive destruction of connective tissue, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and entrap nerves, causing pain.
widespread nerve damage...
Toxins can also cause peripheral nerve damage. People who are exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins frequently develop neuropathy. Certain anticancer drugs, anticonvulsants, antiviral agents, and antibiotics have side effects that can include peripheral nerve damage, thus limiting their long-term use.
Infections and autoimmune disorders can cause peripheral neuropathy. Viruses and bacteria that can attack nerve tissues include herpes varicella-zoster (shingles), Epstein-Barr virus, cytomegalovirus, and herpes simplex-members of the large family of human herpes viruses. These viruses severely damage sensory nerves, causing attacks of sharp, lightning-like pain. Postherpetic neuralgia often occurs after an attack of shingles and can be particularly painful.
Some neuropathies are caused by inflammation resulting from immune system activities rather than from direct damage by infectious organisms. Inflammatory neuropathies can develop quickly or slowly, and chronic forms can exhibit a pattern of alternating remission and relapse. Acute inflammatory demyelinating neuropathy, better known as Guillain-Barré syndrome, can damage motor, sensory, and autonomic nerve fibers. Most people recover from this syndrome although severe cases can be life threatening. Chronic inflammatory demyelinating polyneuropathy (CIDP), generally less dangerous, usually damages sensory and motor nerves, leaving autonomic nerves intact. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively; it may be chronic or acute.
When I first started tx, I noticed that my hands would become numb when I lay on my back in bed. I expected the tx meds were causing this and it would clear up post tx, but no such luck. I have been undergoing tests to figure this out. X-rays, MRI and EMG testing have shown tearing in the tendons of my right shoulder, and a pinched nerve in my right elbow. Nothing to do with the tx drugs at all, it was just a coincidence that I noticed it during tx. I think we tend to blame all our aches and pains on the meds, but for me it turned out to be unrelated.
I've had some neuropathy issues and was fortunate enough to meet with an expert neurologist. I think the treatment can bring on neuropathies, not because of the drugs themselves, but because of weight loss and loss of muscle tone. That might explain for example, why one gets pinched nerves lying in bed or sitting in a chair.
But the point about neurological damage is that once it occurs, it might heal very slowly over time, or it might not heal at all. The nerves are the least repairable cells in the body. Generally the neuropathies don't get worse and people learn to live with them.
Thanks, I did not think in terms of weight loss and muscle tone. That makes sense.
I have some neuropathy in my feet from taking 5 FU, oxiliplatin and xeloda a few years ago, and unfortunately it is permanent damage. That got a little worse during tx, but it is back to pre-tx levels now. That is just an annoyance, but this hand thing is really scary. I hope I can reverse some of the damage as my muscle tone improves.
Oh well, I'm off to the gym to see what I can do to help things along.
I didn't mean to be too pessimistic. Hopefully if you do have a pinched nerve in your elbow and you fix it you'll get relief.
My neurologist put it just the way you did: these are annoyances. You don't die from them.
Some docs do think that exercise can help with nerve issues although they can't establish it definitively. I know that it was my nerve issues that sent me running to the gym. Over time things have improved although they haven't entirely gone away. Stands to reason that when you're nerves are surrounded by healthy strong muscle they are less vulnerable to pinches and injuries.
A Painful Connection: HCV, Cryo, and Neuropathy
By: Roger Smith
People with Hepatitis C who suffer numbness or tingling in their extremities know from experience there is an association between HCV and neuropathy. Increasingly, their claims are finding support: according to medical researchers and clinical physicians, there is a "very strong association" between hepatitis C virus and a blood condition called essential mixed cryoglobulinemia (EMC). Among other symptoms, EMC can cause nervous system abnormalities. Researchers have not yet explained the precise connection between HCV, EMC, and neuropathy, nor have they found significantly effective treatments, but knowledge is sure to increase as more people are diagnosed with HCV and its symptoms increasingly studied.
Neuropathy refers to any disease of the nervous system resulting from localized inflammation of the nerves. If symptoms appear in the body's extremities, the condition is called "peripheral neuropathy," and most HCV-related neuropathies are of this sort. Patients complain of numbness, tingling, and muscle weakness. A physical examination may also reveal decreased deep tendon reflexes. Occasionally, arm and back pain occurs. One patient has even blamed the nerve inflammation for lost teeth.
If symptoms derive from brain malfunction, the condition is an encephalopathy, or central nervous system disease, and the symptoms are more sinister than those of peripheral neuropathy. A team led by George W. Petty reported two cases of encephalopathy in HCV-infected patients in the July 1996 issue of the Mayo Clinic Proceedings. In both cases small vessels in the brain became inflamed, impairing blood flow. One patient had numbness in the right lip, hand, and leg, weakness in the right hand and arm, and word-finding difficulty. The other patient had headaches and seizures, although the latter may have come in part from medication for the headaches.
In both peripheral neuropathy and encephalopathy the key physiologic change is the inflammation of blood vessels (vasculitis). The hepatitis C virus probably does not inflame the blood vessels directly. Instead, the vessels are responding to immune system products floating through the blood stream.
When the body senses an invasion by foreign organisms, such as HCV, chemical responses are triggered. Among those responses are various kinds of immunoglobulin, proteins that help kill the foreigners or regulate the immune response. For some reason * biologists are not sure why * these immunoglobulins can "glob" together and lodge on the walls of medium and small blood vessels.
The immunoglobulins that are involved are called cryoglobulins because they turn into a gel at cool temperatures (cryo comes from the Greek word for cold). Since cold temperature readily affects the small and middle-sized vessels in the body's extremities, the cryoglobulins are most likely to form in them. It appears that this glob-and-lodge action causes the inflammation of blood vessels. Cryoglobulinemia is the condition of having cryoglobulins in the blood.
Cryoglobulinemia and HCV became linked when researchers found bits of HCV and HCV-specific antibodies trapped in globs of cryoglobulin. They speculated that the cryoglobulinemia was HCV-incited, occurring when cryoglobulins specifically attacked the hepatitis virus. Other organisms can cause cryoglobulinemia * cancerous lymph cells, for instance * but the HCV-related version always involves a particular mixture of two types of immunoglobulins. Hence, the "essential mixed" of EMC.
However, the link between HCV and EMC is not entirely straightforward. The chemical tests used to identify specific immunoglobulins and the blood assays used to spot HCV products are complex. Doctors do not order them routinely. As for neuropathies, unless there is an obvious reason to suppose they result from HCV infection, doctors are likely to assume that another, more common system-disturbing disease is responsible. Diabetes mellitus may cause very similar symptoms, for instance.
Medical journals have described only a few cases of the HCV-EMC-neuropathy connection. Reviews of the published literature found that 36 to 54 percent of HCV-infected subjects also had cryoglobulins. According to one study, 21 percent of those with the cryoglobulins showed symptoms, but the authors did not specifically mention neuropathy.
The article by Petty's research team cited a handful of other reported cases of HCV-associated cerebral ischemia similar to their two but added that no detailed description of the condition is available. All the articles warn that their findings are exploratory, not definitive.
The experience of clinical gastroenterologists agrees with the research estimates. Mark Schiele, M.D., a gastroenterologist for Health First, Inc., in Portland, Oregon, estimates that fewer than one percent of HCV patients develop neuropathy. "In general," he said, "it's thought to be quite an uncommon manifestation of HCV infection." Sandra Wilborn, M.D., also a Health First gastroenterologist, concurs. "It's not something that has been clinically important to my practice," she said. In fact, Dr. Wilborn has seen only four cases of cryoglobulinemia altogether, and she encountered them before research uncovered the HCV-EMC link. She typically cares for 25 new HCV-infected patients a year.
Dr. Wilborn emphasizes that the long-term effects of HCV infection are only slowly becoming clear because HCV is so recent a discovery. First identified in 1989 as a distinct viral type, HCV usually takes years to become symptomatic. Most patients are diagnosed with chronic HCV ten to 13 years following infection. Typically, about 20 years pass before the most common serious result, liver cirrhosis, appears. But, Dr. Wilborn points out, the virus causes a "cascade effect" from the immune system, and the symptoms that might come from the cascade, including neuropathy, are just beginning to surface in sufficient numbers to study.
It is a good thing that EMC-related neuropathy is uncommon, according to Dr. Schiele, because "it can be a very disabling consequence of viral infection."
The standard treatment for HCV with EMC-caused neuropathy is interferon alfa, which is also the standard treatment for uncomplicated chronic HCV. Unfortunately, interferon alfa treatment eases EMC symptoms in only about one half to two-thirds of patients, and the side effects include headaches, cognitive changes, irritability, and depression. Still, current research supports long-term treatment with interferon alfa.
Your comment "The job was more physical than I could handle" made me wonder if you were doing something that possibly could have irritated something in your cervical spine, that caused arm/hand tingling and numbness...... If I sound as if I'm trying to diagnose you, I apologize. However, I had the same symptoms and am now 3 weeks post-surgery to relieve spinal cord compression and am wearing a cervical collar for another 3 weeks.
I became licensed to practice physical therapy in '82. My job has always been very physical, (no pun intended). I use good body mechanics, but wear and tear on the joints and discs between the joint have certainly taken a toll on my back and neck.
I was trying to ignore the "dead arm" symptoms, because I was also having radiating pain in my bottom and leg from a herniated disc in my back. When I went to a neurologist, (for my back) he did upper and lower extremity reflex testing and asked me if I was having neck problems or had in the past. I knew I had herniated discs in my neck from the results of a prior MRI, but I agreed to get a CT myelogram. The myelogram showed spinal cord compression at C-5/6 and C-6/7. He felt the spinal cord compression in my neck was much more significant than the pain from the herniated disc in my back.
I had the discs removed at those levels, cadaver discs put in and hardware to fuse the three vertebra involved. I'm symptom free and am thankful I had a neurosurgeon that was so thorough. I had hesitated to say anything about my arm/hand symptoms, because I had been to several dr's in the past who made me feel like a whiner. When I tried to describe the sypmtoms that bending and straightening my neck produced, they looked at me as if I was crazy. MRI's at that time showed herniated discs, but I chose conservative tx of steroid epidural injections, physical therapy and massage. I decided to ignore my symptoms because they weren't painful.
I wouldn't have had surgery without the physical evidence on the myelogram. I felt the same way as others did "these are annoyances. You don't die from them." When I had an EMG done by another doctor, (not the neurosurgeon) and he explained that a fall or another whiplash could make me a quadriplegic, I decided to relieve the pressure through surgery.
I am post-tx and SVR, but I don't think my problems came from tx. My job and possibly a genetic predisposition to "neck problems" are to blame in my case, I think.
Well, good luck, I'm sure my condition was extreme but I would have never known without the good doctor performing reflex testing and asking more questions than others had in the past. And maybe, my problems had just progressed to the point that they were more visible on the MRI, CT myelogram and EMG.
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