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More hand neuropathy questions
I posted here last week (http://www.medhelp.org/posts/Neurology/2-nerves-in-hand-inexplicably-dead/show/1667988#post_7606225) about a friend of mine who is having a mysterious loss of sensation/function in her left hand. A couple of people recommended the possibility of a herniated spinal disc or something like that; I suggested she inquire about it, but when she came back from more EMGs at the neuro today, she said that the doc had confirmed that she has diabetic neuropathy in her feet but that it's unrelated to what's happened to her hand, and that she'd ruled out something cervical "because there is no blockage. The entire nerve tests the same. If there was something cervical, one area would test much lower than the other. It tests the same all the way up the arm."
Evidently the neuro is basically baffled and has told her to come back in six months, or call if it seems to be getting worse. Frankly this doesn't make sense to me...I would have thought loss of feeling all the way up would *more* indicate something spinal than not. (Of course, what do I know about it?)
Anyway, I'm curious what other people here think. Should she just wait out the six months and see what happens? Is a second opinion a good idea here? Does what the neuro said about cervical herniation make sense? Are there any other likely causes of something like this about?
Evidently the neuro is basically baffled and has told her to come back in six months, or call if it seems to be getting worse. Frankly this doesn't make sense to me...I would have thought loss of feeling all the way up would *more* indicate something spinal than not. (Of course, what do I know about it?)
Anyway, I'm curious what other people here think. Should she just wait out the six months and see what happens? Is a second opinion a good idea here? Does what the neuro said about cervical herniation make sense? Are there any other likely causes of something like this about?
Wow, thanks for the very detailed answer. :) Much appreciated.
My friend has actually been doing some serious work over the last six months at dieting and getting her blood sugar under control; she's actually quite proud that she has been losing weight pretty much the whole time, and has not had to take insulin for the last couple months, too. My understanding, actually, is that diabetic neuropathy can flare up further in the period just following a sugar level stabilization, and then settle back down, so I'm wondering if maybe that's what this is?
Given that she's been keeping such a close eye on it, I'm wondering if the endocrinologist would really tell her anything she doesn't already know (and unfortunately money is a factor here so I know she doesn't want to see anybody she doesn't have to).
As near as I can tell, having talked a bit further to her, it sounds like the neuro has ID'd it as idiopathic neuropathy and has assigned her to do some hand exercises in the meantime. I guess this is something...personally I'm still wondering why a back or shoulder compression is still out of the question.
Anyway, I have still encouraged her to see about getting a second opinion and getting some further tests done...she seemed to have mixed feelings about it, since I don't think she is fully satisfied with the opinion she got but also doesn't want to spend more time and money on the issue...at any rate, I'll have to see how it goes, but I've definitely suggested she look into it further. And I'll see if I can find a specifically hand doctor type thing in our area.
I'm sorry to hear you've had to deal with both chemo and this sort of nerve problem...sounds like a terrible combination, and I'm glad to hear it's doing better. :) Thanks again for the time you spent in responding.
My friend has actually been doing some serious work over the last six months at dieting and getting her blood sugar under control; she's actually quite proud that she has been losing weight pretty much the whole time, and has not had to take insulin for the last couple months, too. My understanding, actually, is that diabetic neuropathy can flare up further in the period just following a sugar level stabilization, and then settle back down, so I'm wondering if maybe that's what this is?
Given that she's been keeping such a close eye on it, I'm wondering if the endocrinologist would really tell her anything she doesn't already know (and unfortunately money is a factor here so I know she doesn't want to see anybody she doesn't have to).
As near as I can tell, having talked a bit further to her, it sounds like the neuro has ID'd it as idiopathic neuropathy and has assigned her to do some hand exercises in the meantime. I guess this is something...personally I'm still wondering why a back or shoulder compression is still out of the question.
Anyway, I have still encouraged her to see about getting a second opinion and getting some further tests done...she seemed to have mixed feelings about it, since I don't think she is fully satisfied with the opinion she got but also doesn't want to spend more time and money on the issue...at any rate, I'll have to see how it goes, but I've definitely suggested she look into it further. And I'll see if I can find a specifically hand doctor type thing in our area.
I'm sorry to hear you've had to deal with both chemo and this sort of nerve problem...sounds like a terrible combination, and I'm glad to hear it's doing better. :) Thanks again for the time you spent in responding.
And thanks for coming back to us and filling us in on your friend's situation! I still think this hand thing is related to her diabetes. I DO think it's okay that she chooses not visit a doc if she cannot afford it, but if her hand gets rather worse, then it should be an endocrinologist she should see first (unless she has a regular doc helping her with insulin and so forth). I mean, if your friend's cervical spine or neck is actually bothering her, perhaps that might be a cause, but since her health issue is diabetes, an endo is the next step IF things get all out of hand at some point.
Yeah, she's not specifically feeling trouble in the spine and neck, so maybe you're right.
I get the impression that (mostly for reasons of cost) she's just going to let it be for now, exercise the hand as best she can, and see if it gets worse, so it's good to hear you feel that's a reasonable approach. But I will definitely suggest to her that an endocrinologist might have some extra insight on the subject.
I don't know if she talks to someone specifically like that right now; I think she just talks to an internist for her primary care appointments for the most part, including discussing the diabetes. It never occurred to me that an endocrinologist might work directly with the neurological symptoms of diabetes; I guess I pictured them working solely with the endocrine system itself, hormone levels and so forth. Guess this is why I come to boards like this. :)
Anyway, everything you've said has made much sense and been helpful, and I feel a lot better than I did when she first mentioned what was happening. (As I mentioned in my first thread, my initial Google searches were causing me to freak out a bit.) So thanks again for all your help, and I will definitely continue to post here if/as things develop.
I get the impression that (mostly for reasons of cost) she's just going to let it be for now, exercise the hand as best she can, and see if it gets worse, so it's good to hear you feel that's a reasonable approach. But I will definitely suggest to her that an endocrinologist might have some extra insight on the subject.
I don't know if she talks to someone specifically like that right now; I think she just talks to an internist for her primary care appointments for the most part, including discussing the diabetes. It never occurred to me that an endocrinologist might work directly with the neurological symptoms of diabetes; I guess I pictured them working solely with the endocrine system itself, hormone levels and so forth. Guess this is why I come to boards like this. :)
Anyway, everything you've said has made much sense and been helpful, and I feel a lot better than I did when she first mentioned what was happening. (As I mentioned in my first thread, my initial Google searches were causing me to freak out a bit.) So thanks again for all your help, and I will definitely continue to post here if/as things develop.
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Now, this can happen not only because someone has had diabetes all their life, but also as a result of not keeping those blood sugars as close to the target range all the time, as humanly possible. In other words, the effects of diabetes have a chance to wreck nerves and all the other things diabetes can do, simply by sugars getting out of control a little here and there, either too long-term or too often short-term. She may watch her sugars very well, but could be this can be improved, OR could be because if she's always had diabetes, this sort of nerve damage can be an expected problem way down the road.
My suggestion is she go to her endocrinologist (diabetics normally have one of those docs, and if she doesn't, she should make an appointment to see one forthwith, which her family doc can refer her or any county clinic), and that doctor can perhaps update her with newer and more effective ways of testing her sugar numbers, and also that doctor can look into her new development of peripheral neuropathy in her hand, and in general see where she's at with this diabetes she has. An endo doc will know what I have explained about how her hand problems can come from diabetes.
This is not to say the neurologist is not helpful. Diabetics usually have a neurologist, since diabetes can affect the nerves. But he cannot know for sure what all the ins and outs are of diabetes and the relationship to peripheral neuropathy; he is more concentrated on precisely neurological matters and just isn't as on top of diabetic issues as an endocrinologist, who is an expert in a number of hormonal type things, including diabetes, and how it can affect NUMEROUS parts of the body and their functions. I know the neuro realizes diabetes and neuropathy can go hand in hand, but perhaps not all the details right off the top of his head. The neuro can also treat neuropathy.
Now, this EMG test he did, this does not change the FACT that your friend has a hand issue! And since I have chemotherapy-induced neuropathy in my own hands (which is improving greatly, by the way), I know exactly how troublesome this is to your friend and you, too. Oh, my fingertips became so sensitive that I could not open up soda bottles, rip open an adult-proof bag of cookies, and my hands were so weak I'd drop things and break them, and in general they were swollen and hurt. I was given drugs whilst in this predicament, and so, too, can your friend be treated for this, to at least make her more comfortable, but I'm not as sure about any real improvement in what losses she has right now, other than perhaps a brace, but the endo doc will know, as will a neurologist...once he gets word from the endo what's going on, I presume. If this neuro refuses to deal with this on account of HIS findings then, obviously your friend can see a different neurologist.
So, I hope your friend will go see her endocrinologist. Surely he will realize what is going on here. They can scan her hand, perhaps, and there are "hand doctors" in various cities all across the country, so once the endocrinologist has diagnosed the situation and has done what he can, she COULD eventually visit one of those hand doc groups, they could perhaps provide extra assistance on what is essentially a disability now in her hand. I sure feel for her!
By the by, when you want to come back and talk to us some more, which I certainly hope you will, all you have to do is look for this very post you have made, and then after our bunch of comments, you can type in your NEW news right in the "Post a Comment" square, and it'll bring the whole previous post and your new comments right to the top of the neurology posts, and that way everyone here will know the background on this. And I always look for my name in the first few pages of the neurology posts for any updates or new info from a particular person, which in this case is YOU! And the way to find your own post is to go to the dark blue bar that goes all the way across the top of the page, and click on "My Med Help" at the end. When your Profile Page comes up, there will be a list of all your posts, with the most recent one at the top. GG