Peripheral Neuropathy & on

Dear Doctor,

How do I ask my Neuro to be tested for Autonomic Neuropathy and what do I expect in that test? It can be hard to get some tests done.

Have had uncontrolled diabetes for some time, now coming under control with new treatments. Have had neuropathic pain episodes for a long time, mainly numbness and some heat; but now I am having completely disabling attacks leaving me unable to walk. I have had burning pain inside my gut for a number of years, thought I might have an ulcer but had no other symptoms so I didn't pursue it. However now I still get burning pain but, where it used to travel tot my lower abdomen it now stops well above my half belly button, about maybe 2 inches.

Concurrently I have become incontinent of bowel, my colon not working at all, but my small bowel continually active (unitl I was put on imodium (immodium) which slowed it down but causes pain and bloating in the upper abdomen). The anal sphincter does not even respond so I don't know that I need to go to the loo, so theres a party in my pants. :((

Blessings,
Rhian

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Neuropathy comes in two major forms – small fiber and large fiber. Autonomic testing would be to evaluate the small fibers. The testing typically includes QSART (which looks at how much sweat the skin makes), tilt table (to evaluate the heart), and possibilly skin biopsy. EMG/NCS will not show abnormality in small fiber neuropathies, but will in large fiber. Given your disability, I would assume you have (either alone or in combination) a large fiber neuropathy. Have you had an EMG/NCS?

There are multiple causes of neuropathy – including vitamin deficiencies, rheumatological, etc. I would suggest that you follow up with your PCP to discuss. You should also discuss your symptoms with your neurologist. If not already performed, an EMG/NCS would be beneficial.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.