My Neuropathy Patient Almost Died

Guillain-Barre Syndrome often comes with Autonomic Neuropathy.

One of the rarer acute types of an acute peripheral neuropathy is Guillain-Barre syndrome, sometimes called Landry’s paralysis or Guillain-Barre-Stohl syndrome.

Guillain-Barre turns up most frequently in people who have recently had an infection, like a lung or gastrointestinal sickness. Unfortunately, it can also be a consequence of some immunizations.

Guillian Barre has just been in the news again as a direct complication of the once in the news every day Swine Flu vaccine.

Fortunately, the condition affects only about one or two in every 100,000 patients far fewer than the more common neuropathy types. Most affected by Guillain-Barre syndrome are between age 30 and 50.

Guillain-Barre syndrome is diagnosed through nerve-conduction studies and by studying the cerebrospinal fluid.  History taking is critical! Early medical intervention like plasmapheresis can save the patient years of suffering. But, you the neuropathy treatment professional MUST be alert to its possibility!

Most sufferer’s experience ascending paralysis (loss of strength in the feet and hands that migrates towards their core), along with typical polyneuropathy symptoms such as pain and tingling in their extremities. Typically, the duration of onset is short, and it’s progression rapid. I remember how quickly one of my patient’s condition progressed- a delay in treatment may have killed her! You’ll learn about that story next time!

Perhaps most serious of all, Guillain-Barre syndrome often comes with autonomic neuropathy. These neuropathy patients will then of course then suffer multiple autonomic related issues that will challenge the most seasoned clinicians!

There is still a lot we don’t know about Guillain-Barre syndrome, such as why it attacks some people after an infection and not others, or what actually sets it in motion to attack the nerves. We don’t have a cure for GB yet, either, but there are now treatments available to help manage symptoms and restore quality of life to those suffering from the after effects of the acute illness.

Next time, I’m going to tell you about a very unique post GB neuropathy case, and very fine neuropathy patient I’ve known for 30 years!

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Educating and Treating Herniated Disc and Compressive Neuropathy Patients

As a Private Practice professional specializing in neuropathy, you can offer these patients the best chance possible for avoiding permanent nerve damage.

Let’s say you have a patient who presents with[1]

∙           Severe, sharp, electric shock-like, shooting pain

∙           Deep burning or cold in the feet or legs

∙           Numbness, tingling or weakness in the feet and legs that doesn’t go away

∙           Radiating pain down the legs and into the feet

∙           Muscle spasms and deep muscle pain

∙           Depression

∙           Sleeplessness

∙           Fear and anxiety

∙           Inability to perform normal daily activities

∙           Reduced social interaction with friends and family

∙           Loss of bowel and/or bladder control and sexual dysfunction

That’s quite a laundry list of symptoms.  If the patient doesn’t appear to be really physically active or a manual laborer, your first thought probably isn’t going to be a herniated disc.  You might be considering some type of neuropathy but not likely compressive neuropathy caused by a herniated disc.

Doctor and PatientBut maybe you should move both conditions a little farther up the list of possibilities.

To get started, do a thorough history, physical and a complete battery of tests based on their symptoms.  Once you have your diagnosis, you can begin educating and treating your patient.

Explaining What The Discs Do

A well informed patient is a more compliant patient.  If your patient has a desk job and doesn’t engage in any strenuous physical activity, it will be harder for them to understand how they developed a herniated disc and compressive neuropathy.

First, explain to them exactly what the discs do. The bones in the spine are separated and cushioned by small discs that act as shock absorbers. When they function properly, they allow your spine to remain flexible.  But when they’re damaged, which is much more likely as we age, the discs can bulge or rupture and that is what is known as a herniated disc.[2]

Any number of things can cause a herniated disc – plain old fashioned wear and tear, sitting too much or traumatic injury from lifting too much weight and lifting it improperly.

If your patient sits for long periods of time and frequently experienced minor back pain and chronic back tiredness before they came to see you with more advanced symptoms, they are a great candidate for developing a “wear and tear” herniated disc. Something as simple as bending over to pick up a piece of paper, a minor fall or even a sneeze can be all it takes to cause a disc to rupture.

If their job or lifestyle requires them to do frequent heavy lifting and they lift with their back instead of their legs, they’re a herniated disc waiting to happen.  Educate your patient extensively on the proper way to lift to avoid damaging their back in the future.

So…They Understand Herniated Disc But Where Does Compressive Neuropathy Come In?

Here’s a good analogy to use when explaining why herniated discs can causes compressive neuropathy.

Tell them to think of the spine and the nerves that run along the spine like a water hose.  When the hose is running wide open, the flow is smooth and uninterrupted.

Now put a kink in the hose.  The flow of water all but stops.

The herniated disc is the kink in the hose.  It puts pressure on the nerves and stops the proper flow of blood and oxygen and that results in nerve damage.

And nerve damage results in compressive neuropathy, usually in the feet and legs.  If the pressure is not relieved, the damage to the nerves can be permanent and you can end up with life long issues.

Treatment Options

When you’re diagnosed with a herniated disc and compressive neuropathy, the first goals of treatment are:

∙           Pain relief – first and foremost

∙           Address any weakness or numbness in your feet, legs and lower back

∙           Prevention of additional injuries

As a NeuropathyDR® clinician you have access to and training in a specialized protocol that’s ideal for treating the patient with a herniated disc and compressive neuropathy.  A good starting point for treatment is

∙           Bed rest followed by increased, prescribed and controlled activity

∙           Chiropractic manipulation to get the spine back into proper alignment and take pressure     off the herniated disc and nerves

∙           Treatment with the neurostimulation to open up nerve channels and stimulate nerve repair

∙           Exercises to reduce pain and strengthen the muscles in the back

∙           Dietary counseling to address any other underlying medical issues

As a health care professional specializing in neuropathy you can offer these patients the best chance possible for avoiding permanent nerve damage from their herniated disc and the best chance for sparing themselves future pain.

Let us help you reach these patients in your private practice and treat them.

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This is REAL Health Care Reform!

My work with peripheral neuropathy patients and incredible powerful social media communications with them has taken some very interesting twists and turns lately…

This has all caused me to take a real hard look at what really reforming health care should mean.

Take for example, the following communications I have received from patients in some on-line forums.

“In order for this to be an option in a state where you don’t have doctors trained in this, am I understanding that I would have to have my doctor talk with Dr. Hayes and co-ordinate therapy that way? Also, my neuropathies have been diagnosed as idiopathic peripheral neuropathy but are probably genetic as mom has same issue…I am on a plethora of meds and yet am wheelchair bound when out for any length of time because of the pain. Also, have had the Dellon Procedure with no help. Would appreciate any info you could offer….”

“I suffer from neuropathic pain in my feet and legs from a spinal cord tumor. Everything I read talks about peripheral Neuropathy from diabetes. I wondering if their are different kinds of neuropathy? And what kind I have to determine what kind of treatment I should look for. Anything will be helpful…”

Success and healing are both so formulaic…

“Hi all, I Live in …, 5 Years ago I was told to suffer about a Neuropathy, I feel pain on my face and my teeth…It’s like to have my face completely blocked..Anyone else has some symptoms as me?? ..I tried Gabapentin, Patiox, Laryxol ,and now I’m trying with Cimbalta …but without result. Thinking to stop taking pills. Any suggestions?
My neurologist always tells me my bloody values are ok..but still suffering..
Thanks for any help you can give me and sorry for my bad English…Hope someone understood…”

These are but a few of the communications I now receive daily from around the world.

I do my best to answer all of these inquires, mostly by messaging, though more and more patients from around the world are reaching out with phone calls about our work.


And these comments are only on one condition I have had the opportunity to share with doctors and patients during the last year.

Nonetheless a few months back, this really got me thinking.

What do patients really need from their doctors, nurses and physical therapists?

And I can tell you, more than anything else just a simple human connection.

The ability to ask questions. The ability to engage in meaningful conversations. The ability to have a frank discussion about treatment options, and when less treatment is better, the very best things they can do at home to help themselves recover.
Interestingly, when questions are answered, in my experience and I’m sure yours as well, the utilization of more expensive procedures can be reduced and sometimes eliminated.

All because the basic human need of being heard is met.

However, there is little if anything in the current system, which fosters, let alone allows enough of this very basic doctor-patient communication.

In many cases, it seems extended consultations with our patients are becoming a lost art. This is one reason many patients are increasingly turning to the Internet for their answers.
So, what can you do?  I would suggest you start by making your practice, more powerful and effective in its communication with the outside world. Really go to great lengths to educate your patients in the community, through modern tools.  Like content rich and friendly Social Media. Like Instant Patient Newsletter.

Offer services like telephone and e-mail Consultation services. And yes, in most cases you should be charging for these.

Because, in reality, it is these conversations which often lead both doctors and patients to the greatest treatment breakthroughs.

Videoconferencing and telemedicine are another very real option. Instant messaging is another very powerful tool, which currently is under utilized.

And what about converting your traditional education materials such as in office workshops to on-line events. If they are good, patients will readily share these with their friends and families. From one computer and cell phone to another!

All in the comfort of their home, or even anywhere else they choose.

Doctor, in my opinion this is a real healthcare reform.  It has enormous benefits to you, your patients and community but only if you take the steps to learn and start implementing all these modern tools in your practice.

Really strive to make practice more user-friendly.

Go out of your way; use those little human touches combined with significant doses of effective multimedia technology.

And you’ll likely never have to worry about keeping your reception area filled.

John (:

When you ready to step up and learn to help these patients, just go HERE


What’s Most Important To Seriously Ill Patients?

If your patients suffer from neuropathy, one of the most important things for them to realize is that “no cure” is never the same as “no help!”  It’s an unfortunate truth: so far, peripheral neuropathy (sometimes we’ve seen it referred to incorrectly as ‘neurophy’) has no actual cure, and most nerve damage is permanent.  That’s an awfully grim prospect for most patients to hear, but the chronic nature of neuropathy only means that our developing options for treatment is even more important, not less.

When you apply the NeuropathyDR® methods for neuropathy treatment with a patient, you will really be addressing two things: managing the patient’s symptoms, and improving their overall quality of life.  The two are interconnected in almost every way: never forget that improving the quality of life for someone with a chronic condition like neuropathy is often the very best treatment we can provide!

In addition to the often-discussed pain, neuropathy has the potential to greatly impact a patient’s mobility.  Between motor neuropathy (which affects the strength in the limbs directly), difficulty walking due to foot pain and joint stiffness, and difficulty with manual dexterity and fine motor skills, it’s no wonder that many neuropathy patients have trouble doing simple tasks they once found easy; things the people around them still have no trouble at all doing!  The frustration that goes along with mobility loss can be almost as bad as the pain itself.  A clinical study from Queens University published in Anesthesia & Analgesia even suggests that the impact of neuropathy on a patient’s mood aloneis enough to be considered a serious symptom!

Your Patients Need Your One on One Expertise To Get Well!

NeuropathyDR® clinicians use a neuropathy treatment method which includes several known techniques and we are continuously testing newer technologies too! NeuropathyDR® Clinicians actually take new courses every single month, so they are never “stale”!

Every patient’s case is unique—no two cases of neuropathy are exactly alike—so it’s important that develop your treatment plan together with each patient.  Be sure to pay attention to any information your patient may provide, and Don’t forget to ask for feedback!  Be sure to ask what seems to be working, what eases the patient’s pain, what helps their overall mobility, and what might not be having any effect at all.  All these things are important, and will inform the best way to approach a case.

Our patient, Beverly, came to us about six months after major surgery.  Beverly had been undergoing radiation for breast cancer, and was experiencing severe pain in her hands and feet, as well as tightness and inflexibility in her spine and limb joints.  Over the course of 5 weeks, we treated Beverly with electro- stimulation, among other therapies to address her pain and range of movement.

Beverly’s pain lessened only incrementally over the time we treated her, but she let us know that the real improvement she experienced was in her range of movement!  Sure enough, our examination found that her range of movement had increased measurably (in some areas as much as fifty percent), and overall tightness in her back was reduced.  Needless to say, being able to move more freely will greatly impact Beverly’s quality of life—many patients stress that their mobility is what they miss most of all while living with peripheral neuropathy.

One of the factors that allowed us to help Beverly as much as she did was that she was very forthcoming about her symptoms, her improvement, and—also importantly—when a treatment wasn’t helping.  Neuropathy is complex, and different patients will benefit in various ways from different neuropathy treatments.  In Beverly’s case, we were able to provide her with a home care kit which she was able to use to treat her flexibility and pain at home.  Even though she still lives with neuropathy, Beverly now knows how to make sure her condition won’t keep her from getting on with life!

Helping patients control symptoms and improve their overall quality of life is what we’re all about at NeuropathyDR®.  If you treat patients like Beverly, we’re here to help you give them the best care.  Don’t hesitate to get in touch with us if you have any questions about how to help the people in your care live to their fullest!


Motor Neuropathy- A Different Game Plan

If you read the NeuropathyDR® blog frequently, you know that we tend to focus on bringing you the latest research and methods as they apply to treating neuropathy pain.  As you are aware, though, with peripheral neuropathy, pain is only one component.  This week, we’re going to talk about how neuropathy can affect a patient’s muscles, also called motor neuropathy.

There are essentially three kinds of motor neuropathy.  The first is the overall weakening effect of the muscles, especially in a patient’s extremities, which often accompanies peripheral neuropathy.  This can occur because the nerves which control motor function in the muscles have become damaged, or—in the case of a compression neuropathy—constricted.  The second kind is called multifocal motor neuropathy, and takes place when a patient’s immune system itself begins to attack their own nerves, as can happen after a series of infections or after an illness.  The third kind is Hereditary Motor Sensory Neuropathy, which, as the name suggests, is genetic in nature.  Hereditary Motor Sensory Neuropathy, or HMSN, occurs when there is a naturally-occurring deterioration in the nerves that control a patient’s muscles, causing those muscles to not be used, become weak, or even atrophy.

Motor neuropathy usually starts in the hands and feet, and can affect the full extension of a patient’s fingers and toes.  In addition to the dexterity problems this obviously causes, it often also has a visual appearance of “clawlike” fingers.  The condition is degenerative, getting worse over a period of months and years.  Twitching and spasms can also happen in affected limbs.  While motor issues associated with peripheral neuropathy usually accompany pain, tingling, and numbness, multifocal motor neuropathy involves no pain (only the motor nerves are affected).  Generally, none of the varieties of motor neuropathy are life-threatening.  Nevertheless, they can all severely impact your patients’ comfort and quality of life, especially if they are left untreated.

There is no substitute for appropriate PT and Rehab in Motor Neuropathy

When we met our patient Robert, he complained of a steady and declining loss of strength in his feet, which he had experienced over the past 4 years.  Robert had had cancer during that time, culminating in having his prostate removed.  His motor neuropathy caused Robert to have trouble walking or standing for long periods, and he even had trouble feeling his feet on some occasions.  He also complained of shooting pain, tingling, and soreness in his feet, all typical calling cards of peripheral neuropathy.  Since in cases of multifocal motor neuropathy, the sensory nerves are usually unaffected, Robert’s pain and numbness ruled that out.  Sure enough, when we performed a battery of tests, we found that Robert’s sensation to vibration was all but absent in several places on his feet.

Robert did not respond with the typical level of relief we usually see after treating a patient with electro-stimulation.  Over the course of three treatment sessions, Robert’s level of strength and comfort in his feet did not change in any meaningful way.  While this is unusual, it highlights an important theme: neuropathy is a complex problem with many symptoms and manifestations, and no single therapy technique or tool—even those with a very high rate of success—can stand on their own as a complete treatment.  For us to help our patients effectively, we have to encourage broader, overall adjustments to their lifestyle.

We designed just such a treatment for Robert, intended to produce more long-term benefit, as his short-term progress was not substantial.  Motor neuropathies require an extensive level of treatment, sometimes pharmaceutical and sometimes homeopathic, and usually involving some level of regular exercise and controlled diet.  Robert is currently improving steadily, and is seeing his NeuropathyDR® clinician as prescribed to monitor his condition and progress.

If your patients are complaining of weakness or pain in their limbs, they might have peripheral neuropathy.  If so, we can help you provide the best care possible.  Contact NeuropathyDR® right away and we will help you answer their questions and train you to provide therapy and treatment for specific neuropathy symptoms.  We can even put patients in touch with you who will benefit from your help managing their neuropathy.


Can You Really Help Guillain-Barre Syndrome?

One of the more rare acute types of peripheral neuropathy you will encounter in patients will be Guillain-Barre syndrome, also sometimes called Landry’s paralysis or Guillain-Barre-Stohl syndrome.  This autoimmune disorder causes the immune system to deteriorate the nervous system, which in turn causes the muscles to weaken very fast.  Due to its autoimmune nature, Guillain-Barre tends to present most frequently in people who have recently recovered from another type of infection, like a lung or gastrointestinal sickness.

The condition only affects about one or two in every 100,000 people, far fewer than most of the more common neuropathy types, and it most commonly targets patients between 30 and 50.  Because signals travelling along the nerves of a patient with Guillain-Barre are slower, it can sometimes be detected through nerve-conduction studies, as well as by studying the cerebrospinal fluid.

Most patients with Guillain-Barre present with ascending paralysis (loss of strength in the feet and hands that migrates towards the core), along with typical polyneuropathy symptoms such as pain and tingling in the extremities.  Perhaps most serious of all, Guillain-Barre syndrome often presents alongside autonomic neuropathy, making it very dangerous to the overall health of a patient’s internal organs.

There is still a lot we don’t know about Guillain-Barre syndrome, such as why it attacks some patients after an infection and not others, or what actually sets it in motion to attack the nerves.  We currently refer to it as a syndrome, as opposed to a disease, since there is no disease-causing agent we can prove to be involved.  As of yet, there is also no known cure, but with proper treatment, clinicians who are trained in the NeuropathyDR® methodologies are able to manage its symptoms and restore quality of life to their patients who suffer from it.

Our patient Louise was diagnosed with Guillain-Barre Syndrome over 20 years ago.  The onset was sudden; Louise just woke up one morning and her foot felt funny; by the end of the day she was having trouble walking unassisted.  In only a few days, Louise needed two canes just to get around.  For two decades, this was how she lived; in constant discomfort from the neuropathies common with Guillain-Barre, every day worried that the condition would degenerate and that her legs would just stop being able to bear her weight (even with support).  Even simple things like crossing her legs or driving were difficult.  Fortunately, Louise found a NeuropathyDR® clinician who was able to help!

By the time she came to us, Louise had been living with Guillain-Barre and its complications for more than 20 years.  Her mobility had continued to deteriorate, and she was now also experiencing pain in her lower back and difficulty turning her neck.

You can offer your patients the best chance possible with proper training...

We treated Louise with our NeuropathyDR® methods of adjustive procedures to restore mobility in the affected joints, as well as ultrasound and the use of electronic stimulation to affected nerves.  Over a five-week period, Louise’s painful neuropathy symptoms subsided drastically and mobility began to re-emerge in her legs and back.  At a checkup two months later, Louise was starting to regain feeling and continuing to improve!

After her treatments with NeuropathyDR® , Louise wrote to us that, in light of her newly-regained mobility, she finds herself afraid to hope that she will get feeling back in her legs after all this time.  She has been following-up with her clinician as scheduled, and her condition is continuing to improve.  There is hope that you can help your patient, no matter how long they may have been living with Guillain-Barre or any other type of neuropathy.

If you treat patients who have been diagnosed with neuropathy, or conditions that contribute to it such as Guillain-Barre syndrome, we want to help you treat their case more effectively.  NeuropathyDR® is an invaluable resource to clinicians; we have the information and training you need to be your most effective.  We can even help refer patients to you in your area who could benefit most from your care. Don’t wait to start helping your patients get—literally—back on their feet;  contact us and we’ll get started!

“Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.”

A lot of your patients have heard that there is no cure for neuropathy, and they get discouraged.  As someone in the medical profession, you want to be able to dispel this misconception that your patients will just have to live with their symptoms!  NeuropathyDR® can teach you the non-pharmaceutical means to lessen their pain and improve their life.   “No cure” isn’t the same thing as “no help!”

A great example of a patient we have been able to help with the NeuropathyDR® methodology is Susan.  Susan is a diabetic in middle age who has suffered for more than twenty years with neuropathy symptoms.  Most prominently, Susan has tingling and severe pain in her feet, with the same problem less severely in her hands and arms.  Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.

When she came to us, Susan was taking prescription-strength Advil several times a week for the pain in her hands and feet.  Medication has its place, and can be effective in some cases, but it is too often the first—and last—course of action medical professionals resort to when it comes to neuropathic pain.   NeuropathyDR® promotes newer, non-pharmaceutical methods that have been proven to reduce pain and numbness in cases like Susan’s.  After we applied the NeuropathyDR® protocols, Susan’s symptoms subsided drastically and her quality of life began to improve.

Especially in the short term, we want to help reduce the overall level of chronic pain and restore any mobility that might be lost.  In a case like Susan’s, the NeuropathyDR® protocols target three specific areas of treatment:

  • Specifically-directed manual therapies to correct aberrant motion or misalignment in areas of the spine and pelvis, as well as addressing the soft tissue contractures in the neck, legs, feet, arms, and hands.
  • Our NeuropathyDR® nutrition protocol, consisting of a daily regimen of combined nutrients that have been proven to be supportive of the nervous system in slowing the progression of neuropathy and healing damage.
  • Finally, the application of neuro-stimulation in the affected areas.  We use a waveform treatment in the office and at home that opens up nerve pathways to let them heal.

Susan’s treatments recurred three times a week for five weeks, for a total of fifteen treatments.  Following each treatment, Susan reported that the level of pain and tingling had subsided by two-thirds or more.

Powerful Manual Therapies are Key…

After applying the NeuropathyDR® protocol, Susan noticed a terrific improvement in her lifestyle.  In her own words, her energy level tripled, and the inflammation and pain in her feet had reduced by ninety percent.  Our objective tests, going by a round before and after the treatments, showed that Susan’s spasms in the lumbar and thoracic paravertebral muscles had improved by seventy percent.  Her range of motion without pain had also increased by seventy percent, and her ability to sense heat, cold, and vibration had drastically improved.  Perhaps the biggest lifestyle-boost of all, Susan experienced much less pain when walking after applying the NeuropathyDR® methods for five weeks.

We followed up with Susan three months after her treatments with us, and she was continuing to do extremely well.  She has been diligent about keeping up her assigned home-care treatments, and she visits her clinician as-needed for checkups.  Especially in-light of her twenty-year struggle with neuropathy, the degree of Susan’s success is remarkable.

If you treat patients like Susan who suffer from neuropathy symptoms, we are a valuable resource to help you treat them.  Contact us with specific questions and to learn the NeuropathyDR® methodologies we have developed.  Our protocols are proven to work—don’t let your patients go without proper care!

Another Niche: Become an expert in Entrapment Neuropathy Care!

Entrapment Neuropathy:  More Than Just Carpal Tunnel!

Last week we discussed carpal tunnel syndrome (CTS), one of the most common forms of neuropathy affecting a single nerve (mononeuropathy).  What many of your patients might not know is that carpal tunnel syndrome is only one of the entrapment neuropathies common in the upper limbs.  The other entrapment neuropathies are not as well-known in the mainstream as CTS, and so patients who suffer from nerve symptoms in their forearms and hands frequently jump to conclusions!  We’re here to help you set the record straight.

An entrapment neuropathy, also called nerve compression syndrome, occurs when a nerve is wedged or “pinched” against a bone, inflamed muscle, or other internal mechanism in the arm.  Aside from the median nerve (the one associated with CTS) there are two main nerves that help to control the arm and hand: the radial nerve and the ulnar nerve.  Both are susceptible to compression, and the results can be painful!

Entrapment occurs under a number of conditions, most commonly:

  • When there is an injury originating at a patient’s neck or a disease of their cervical spine
  • When your patient’s elbow has been injured due to fractures or improper use
  • When your patient’s wrist has been injured due to fractures or Guyon canal alignment problems
  • An aneurysm or thrombosis in the arteries

    Make no mistake, entrapment neuropathy patients need non-surgical specialist care!

  • Factors commonly associated with peripheral neuropathy, such as diabetes, rheumatism, alcoholism, or infection

The radial nerve runs the length of the arm, and is responsible for both movement and sensation.  Radial neuropathy usually occurs at the back of the elbow, and can present with many of the common symptoms of neuropathy such as tingling, loss of sensation, weakness and reduced muscle control (in this case, your patient will often complain of difficulty in turning the palm upwards with your elbow extended).

A number of palsies affect the radial nerve, such as:

  • Saturday night palsy (also called Honeymooner’s palsy), where the radial nerve is compressed in the upper arm by falling asleep in a position where pressure is exerted on it by either furniture or a bed partner
  • Crutch palsy, where the nerve is pinched by poorly-fitted axillary crutches
  • Handcuff neuropathy, wherein tight handcuffs compress the radial nerve at the wrists

Two main conditions affect the ulnar nerve: Guyon’s canal syndrome and cubital tunnel syndrome.  Guyon’s canal syndrome is almost exactly the same in symptoms as carpal tunnel syndrome (pain and tingling in the palm and first three fingers), but involves a completely different nerve.  Guyon’s canal syndrome is caused by pressure on the wrists, often by resting them at a desk or workstation, and is frequently experienced by cyclists due to pressure from the handlebars.

Nearly everyone has experienced cubital tunnel syndrome: it’s the “dead arm” sensation we’ve all felt when we wake up after sleeping on top of our arm!  Sleeping with the arm folded up compresses the ulnar nerve at the shoulder, causing it to effectively “cut off” feeling to your arm.  As you and your patients all probably know from experience, this sensation is unsettling but temporary.

Diagnosis for all compression neuropathies is fairly consistent.  We advise a visual and tactile examination of your patient’s arms, wrists and hands, along with a test of the patient’s independent range of motion (as mentioned before, difficulty extending the elbow could indicate radial nerve damage).   Blood or nerve tests can help establish underlying conditions that may contribute to neuropathy.  The Tinel and Phalen tests will also help determine loss of dexterity and sensation that could indicate a compression neuropathy.   MRI or x-ray scans are common to pinpoint the specific location of a compression.  Contact NeuropathyDR® if you have any questions about your patient’s symptoms or the correct way to check for compression neuropathy.

Similar to carpal tunnel syndrome, most cases of entrapment neuropathy are mild. Treatment for these mild cases involves ice, rest, and a change in habits of motion or stress that are causing the symptoms.  For more severe cases, you might choose to prescribe painkillers or anti-inflammatories, and in extreme cases, a surgical solution is sometimes justified.

If you would like to know more about how to treat patients who suffer from compression syndrome or other types of neuropathic pain, NeuropathyDR® can help!  As a training resource we can help you treat your patients, as well as help the patients you can benefit find you!


Autonomic Neuropathy: More Dangerous than You Think

Autonomic Neuropathy: More Dangerous than You Think

If you read our articles often, you know that we usually talk about peripheral neuropathy in terms of the pain and inconvenience it can cause for your patients.  We usually write about quality of life, but it’s also important to know about a much more serious element that can threaten the lives of the people you treat: autonomic neuropathy.

Autonomic neuropathy is the term that means damage has been done to the nerves that control the automatic functions of your body.  These functions include blood pressure, heart rate, bowel and bladder emptying, and digestion.  When the nerves are damaged, these functions can start to behave incorrectly.  It can be dangerous and even life-threatening when this happens.

If your patients are presenting with symptoms of nerve damage like numbness or tingling, loss of motor control, sexual dysfunction, dizziness and sweating, or loss of hot and cold sensation, they may also have more serious damage to the nerves controlling your organs.

Nothing builds a powerful specialty practice like incredible results!

Many cases of autonomic neuropathy accompany cases of peripheral neuropathy that have more easily-noticed symptoms.  With autonomic neuropathy, a patient’s body can have trouble controlling their blood pressure, they might not digest food correctly, or they could have problems regulating their body temperature.  These conditions are dangerous!

Make sure your patients know they could be at serious risk!

Autonomic neuropathy isn’t a disease of its own, and it’s not caused by any one thing.  If your patients  suffer from injuries, have had an amputation, or even spend long amounts of time sitting still, they can be at risk of developing nerve damage.  As you probably know, though, autonomic neuropathy goes along with a disease or condition, such as:

  • Alcoholism
  • Diabetes
  • Cancer (specifically, chemotherapy)
  • HIV or AIDS
  • Lupus

If you work with patients who suffer from any of these conditions, be on the lookout for autonomic neuropathy.   Don’t rule out a patient just because he or she doesn’t have any of the “peripheral” symptoms!  Even if they are symptom-free, a patient might have damage threatening their organs.  We can’t emphasize enough that catching neuropathy early, especially the autonomic kind, gives you more treatment options and is the best way to help your patients.  Don’t forget: we’re talking about a life-threatening condition!

How can you determine if a patient’s organs are in danger?

Ask questions.  Patients can be shy about their lifestyle, exercise, diet, habits, and so on, but they’re the best source of information.  Remind them that you are here to help, not to judge.  It is vital to know any symptoms they might have, or any relevant medications or existing conditions that might contribute to neuropathy.

If you have any questions about how to examine a patient for signs of neuropathy, contact us! NeuropathyDR® has the resources you need to detect autonomic neuropathy early.  Most commonly, an examination of the extremities for infections or sores is a good first step, along with testing for blood pressure irregularities.  For autonomic neuropathy in particular, an ultrasound can help determine if the internal organs are functioning correctly.  There are also a number of other tests that are specific to certain organs such as the bladder, stomach, or lungs.

For autonomic neuropathy, taking the best care of your patient can mean a couple of different treatments used together to keep them healthy.  Several kinds of medications are available which will help slow the effects of nerve damage and reduce the symptoms.  Contact us for guidance on specific medications that might help; it can vary from patient to patient.

It can also be helpful to instruct patients about ways to make your everyday routine more conducive for living with neuropathy (again, NeuropathyDR® is a valuable resource for you in this area).  Patients usually have to adjust their diet, and certain kinds of exercise may be more dangerous to people with neuropathy.  We can help you find the best foods to recommend to your patients, as well as help develop exercise plans that are safe and beneficial to them.

There’s no absolute cure for neuropathy, but becoming a NeuropathyDR® doctor will equip you to help your patients when it comes to keeping them safe from the different kinds of neuropathy.  Remember, don’t wait!  The earlier you catch neuropathy, the better you can help!



Helping Your Diabetic Neuropathy Patients

If you have patients who are living with diabetes, chances are you are no stranger to making diagnoses of neuropathy.  While some patients (even those who do have nerve damage) might experience no symptoms at all, about 60 to 70 percent of diabetics experience pain, soreness, loss of sensation, tingling in the extremities, and even digestive problems—or other conditions related to organ complications—all symptoms of peripheral neuropathy.  Diabetes is, in turn, one of the most common causes of neuropathy overall.

A patient’s risk of developing diabetes-related neuropathy actually increases with age and extenuating health considerations (such as being overweight), partially because patients who have problems with glucose control for extended periods of time—25 years or more—are more susceptible.

The best defense against diabetic neuropathy is to get and keep blood sugar under control.

So, what causes a patient who has diabetes to develop neuropathic symptoms?  Research is occasionally unclear on the subject, but it is generally agreed that exposure to high blood glucose (high blood sugar) has a negative effect on nerve condition.  Of course, this is in addition to other conditions or lifestyle factors commonly associated with causing or exacerbating neuropathy, such as injury, metabolic inconsistencies, inherited traits, or substance abuse.

There are a few kinds of neuropathy associated with diabetes, the most common being peripheral neuropathy (this is the type usually referred to when people simply say “neuropathy;” but we’ll get to the other types in a moment).  Peripheral neuropathy is characterized by pain, numbness, tingling, and loss of motor function, among other sensation-related symptoms.  This type is written about extensively, and can greatly impact quality of life for its sufferers.  Most treatments available to medical practitioners target peripheral neuropathy, so the good news is, there are plenty of ways for you to treat this type.

Focal and proximal neuropathy result in muscle weakness and pain, and typically target a specific nerve grouping.  These types of neuropathy are commonly characterized by weakness in the legs, causing difficulty standing and walking.  This type of neuropathy often accompanies peripheral neuropathy, so be on the lookout for patients who experience weakness alongside loss of sensation or soreness.

Autonomic neuropathy, as the name implies, causes changes in autonomic bodily functions.  These include bowel and bladder functions, sexual responses, and digestion.  Autonomic neuropathy can be life-threatening in extreme cases, as it also affects nerves that serve the heart, lungs, and eyes.  Especially troubling to diabetic patients is the resulting condition of hypoglycemia unawareness, which can obliviate the symptoms most diabetics associate with low glucose.

It is recommended for any diabetic patients to receive at least an annual foot exam.  If neuropathy has already been diagnosed, a patient’s feet should be examined much more frequently.   Additional to diabetic amputation concerns, you should test your patient’s protective sensation by pricking their foot with a pin, or running monofilament across their skin.  If your patient has lost protective sensation, he or she could be at risk to develop sores that might not heal properly, leading to infection.  If you have any questions about the proper methods to use in examining diabetic patients for neuropathy, contact NeuropathyDR®.  We can be sure you have the tools and knowledge you need!

For other types of neuropathy, properly-trained clinicians should perform a check of heart rate variability to detect how a patient’s heart rate changes in response to changes in blood pressure and posture.  Ultrasound imaging is also useful to diagnose autonomic neuropathies and to ensure other internal organs such as the kidneys and bladder are functioning properly.

To control diabetic neuropathy, it is important to advise patients to maintain a tight blood sugar control and a healthy diet (this methodology is advisable for diabetics in general, of course).   Even if a patient does not have symptoms of neuropathy, regular checkups are wise.  NeuropathyDR® can train you to spot warning signs of factors that could endanger your patients’ nerve function or even be life-threatening.  In addition, we can help you treat pain symptoms by providing valuable information about appropriate medications.

If your patients have diabetes, they are at risk!  Don’t let neuropathic symptoms go unchecked.  Remember, the sooner neuropathy is diagnosed, the easier it will be to treat and to slow the progression of this degenerative condition.  NeuropathyDR® clinicians are trained to identify the various types of neuropathy and recommend the treatments that help their patients retain their quality of life.  If you have any questions about treating patients who have or might have diabetic neuropathy, contact us!



Neuropathy and Exercise/Rehab For Your Specialty Practice

Neuropathy and Exercise

Pain, muscle control problems, and overall health complications can make even everyday activities for your patients suffering from neuropathy harder to manage.  For some of those patients, the prospect of exercising will seem not only unrealistic but an almost ironic misplacement of their priorities.  As you know, though, exercise is important for everyone. In your patients, it can actually help control blood sugar and slow down the progression and symptoms of the condition.

Exercising regularly greatly decreases anyone’s risk of diabetic neuropathy, and has been shown to control symptoms and deterioration in neuropathy patients  by elevating overall blood flow to the limbs and controlling cardiovascular atrophy.  Depending on a patient’s specific type of neuropathy, the areas affected, and the extent of their damage, neuropathy patients should be advised to adjust conventional workout routines to accommodate their condition.  Advise patients with neuropathy to consult you before they begin any workout program.  When they do, be sure to inspect their feet and legs for signs of potential problems, and make sure their shoes are properly fitted so as to avoid neuropathy-related injuries.  Contact us if you have any questions about how to advise patients interested in starting a fitness program; NeuropathyDR® has resources that can help.

Here are some general guidelines to pass along to patients, to help them avoid neuropathic complications:

  • To use silica gel or air midsoles
  • To use polyester or polyester/cotton blend socks to keep their feet dry
  • To avoid any workout clothes that rub against their skin in the same area.

Ann Albright of the Division of Diabetes Translation in Atlanta cautions that neuropathy patients will want to steer clear of most repetitive or weight-bearing exercise, such as running, walking, or extensive weight training (although some sources advocate weight training as beneficial, in moderation).  So which exercises are the most beneficial while reducing risk?

There is no substitute for appropriate PT and Rehab in Specialty Practice

Swimming is one of the best exercises to recommend, as it is an activity adaptable to any age, fitness level, or degree of neuropathy symptoms.  Swimming is also a full-body, “no-impact” workout, and so is less harmful to a patient’s joints, legs, and feet than most other forms of exercise, without sacrificing circulation.  As such, it is highly recommended for almost anyone.

Bicycling, rowing, and use of a stationary bicycle are other excellent, low-impact activities that can be safely integrated into a neuropathy treatment program.  Some organizations have even developed exercise programs for senior citizens suffering from neuropathy, incorporating a heavy emphasis on seated exercises.

In the event a patient does not have regular access to facilities or equipment for more extensive exercise, there are some basic exercises you can teach that can help your patients control their dexterity and neuropathy symptoms:

  • For hands, touch the pad of your thumb with your index finger, running the finger down to the base of your thumb. Then, repeat the movement with the index, middle, ring, and little fingers. Do this exercise several times.
  • For legs and feet, straighten one knee and point your foot.  Flex your ankle five times, then circle your foot five times in each direction, clockwise and counterclockwise.
  • To increase balance, try this exercise: from a standing position, rise up slowly on your tiptoes, and then rock backward onto your heels. Keep your knees straight, but try not to lock them.

Additional precautions are vital for neuropathy patients to observe.  Advise patients that, after every workout session, they should remember to check their feet and any relevant extremities for blisters, irritation, or sores. These could be vulnerable to infections, which themselves could elevate risk for amputation.

It is especially important for neuropathy patients to be mindful of their heart rate and blood pressure.  Especially if they suffer from autonomic neuropathy, which can greatly increase risk of heart failure or cardiac arrest, advise them of their limitations when it comes to exercise.  There is an appropriate level of exercise for almost everyone, even those with heart risks, but the degree of exercise you advise will obviously vary on a case-by-case basis.

Finally, be sure to make your patients aware that neuropathy sufferers are at high risk when it comes to overheating, since some types of neuropathy can reduce the body’s ability to temperature-control.  Advise them to keep a close monitor on their body temperature, and to let you know immediately if their sweating seems overly profuse or the opposite, less than normal.

If you have any questions about how patients diagnosed with neuropathy should exercise, contact us. NeuropathyDR® can answer your questions and has the resources you need to help your patients stay fit, healthy, and active while living with neuropathy!,,20189334,00.html,,20188832,00.html


Helping Patients with Alcohol Induced Neuropathy

One of the most serious—but rarely discussed—conditions resulting from extended alcoholism is alcoholic neuropathy.  One of the reasons for its relative obscurity in the public discourse, aside from difficulties inherent in any discussion of substance abuse, is that much of the empirical evidence linking neuropathy and alcoholism is somewhat vague.  Still, there is ample correlation to assume a causal link.

Alcoholic neuropathy presents in patients similarly to other forms of neuropathy, with tingling and numbness in the extremities, loss of heat and cold sensation, loss of fine motor control, impotence in men, and so on.  All this is accompanied by the chronic pain typical in cases of peripheral neuropathy.  Because of the areas of the mind and body targeted by the alcohol, it is common for alcoholic neuropathy patients to exhibit outward signs of intoxication even when sober, such as slurred speech, stumbling gait, and clumsiness.  The American Journal of Clinical Nutrition says that, in severely affected patients, the legs and hands may be nearly useless to the point of paralysis and sensation may be entirely absent in extremities.  In these cases, the skin can also be dry and atrophic.

The specific causes of alcoholic neuropathy are difficult to pin down, and thus, the case can be tricky to diagnose.  If a patient has a known history of alcohol abuse, that is, of course, a good place to start.  Generally, a pattern of heavy alcohol use for a period of ten years or more will be accompanied by neuropathy symptoms.  A leading theory contends that the cause of alcohol-related neuropathy may be the combined effect of direct nerve-poisoning by the alcohol itself, coupled with the long-term poor nutrition that often accompanies alcohol abuse.  Alcoholics typically exhibit erratic eating habits, resulting in poor overall nutrient intake, and the damage to organs reduces the absorption of nutrients from food.  Of course, difficulty in motor control resultant from neuropathy often exacerbates the malnutrition, as the patient becomes socially uneasy about mealtimes and self-conscious about feeding themselves.

Nerve damage from alcoholism is usually permanent.  The first order of business in treating patients with alcoholic neuropathy is to bring the drinking and nutrition problems under control.  If alcohol consumption is not severely limited and adequate nourishment is not supplied, additional treatments will be futile and symptoms will almost invariably compound. Beyond this, treatment seeks three main goals:

  • To control symptoms
  • To maximize and restore function (quality of life)

    Alcoholic Neuropathy requires extraordinary measures to slow or treat…

  • To prevent further injury to the patient due to neuropathic vulnerabilities

Most treatments address these three tenets simultaneously.  Pharmaceutical treatments include the use of painkillers, either prescription strength or over-the-counter (such as analgesics).  When treating patients with alcoholic neuropathy, it is advisable to recommend the lightest use of pain medication possible, as the patient in question is by definition susceptible to habitual substance abuse.  Be sure to monitor use of any medications very carefully.

Because of the underlying nutritional deficit usually at the root of alcoholic neuropathy, some patients may benefit from a system of nutritional supplements.  A dietician or other qualified staff person in your office should be consulted to ensure the proper replenishment of nutrients necessary to prevent the spread of neuropathic symptoms.  Parenteral multivitamins are also useful in many cases to assist nutrition.

Several new lifestyle habits can help patients adjust to living with alcoholic neuropathy, such as carefully monitoring the temperature of bathwater to prevent burning, inspecting themselves and their clothing and footwear for points of rubbing or wear on the skin, and so forth.  In alcoholics, the establishment of these habits (which are themselves advisable for all neuropathy patients) can be instrumental in the replacement of the undesirable dependency that caused the problem.

Although nerve damage is usually permanent, the prognosis for sufferers of alcohol-related neuropathy can be very good if the alcoholic successfully refrains from indulging the dependency and works to replenish nutrition.  It is important to emphasize to patients that substantial recovery from degenerating neuropathic symptoms will not be seen for a period of several months.  Of course, subjective improvements in lifestyle and health will begin almost immediately when abstaining from an alcohol dependency as a result of general detoxification.

If you have patients you believe could be suffering from alcoholic neuropathy, we are here to help you determine for certain how best to proceed!

Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from alcohol abuse-related neuropathic symptoms.




The FULL Imact of Sleep, Sleep Apnea and Neuropathy


If you treat patients with neuropathy and pain, you’re probably very familiar with complaints about lack of sleep, trouble staying asleep, and general restlessness at night.  It’s hardly surprising, given the intensity of many neuropathic conditions, that they make it tough to rest.  Insomnia (lack of sleep) affects almost half of the overall population, but among neuropathy sufferers, that ratio jumps to over seventy percent (according to the Journal of Pain Medicine). Experts recommend between seven and nine hours of sleep for most adults, regardless of their age or gender, an intimidating goal for people whose chronic pain keeps them up at night.

Research suggests that sleep apnea, a common cause of insomnia, can actually cause peripheral neuropathy, as well. Beyond a mere relationship, studies have shown that apnea is a high-risk condition among the insulin-resistant, which could likely be affecting incidents of neuropathy among diabetics in very direct ways. Some doctors have reported that treating patients with obstructive sleep apnea has actually helped their cold or numb extremities recover, indicating another condition (possibly Raynaud’s phenomenon) masquerading as neuropathy.  If patients suffer from sleep apnea, CPAP treatment may be a viable avenue to explore to address their tingling or loss of sensation.

Regardless of the root cause, your patients’ pain can intensify in the evening hours, both in reality and in their own perception (fewer distractions of the day can cause a patient to focus more on their pain the closer they get to bedtime).

Insomnia from neuropathy can perpetuate its own problem, too.  Not only is your patients’ neuropathy prodigious when it comes to nighttime restlessness, but the resulting lack of sleep can make the pain even worse!  Rest is essential to recovery and treatment, and a patient’s lack of sleep can lower their pain threshold drastically.  Take into consideration that insomnia, diabetes, and other imbalances related to neuropathy can also contribute to high stress, depression, and mood disorders, and your treatment plan become that much more complicated.

If you’re treating patients whose insomnia could be caused by neuropathy (or vice-versa), NeuropathyDR® can provide the tools and information you need to help them get a good night’s sleep.  Specifics vary from patient to patient, of course, but here are some general guidelines that might be useful:

  • Instruct them to keep a regular sleeping schedule.  Getting to bed and getting up at the same times each day is one of the best ways for them to teach their body to sleep correctly.
  • Patients should limit their intake of caffeine and any medication that incorporates a stimulant, especially in the evening hours.
  • Avoiding heavy foods in the evening is important.  Metabolism continues hours after we eat, and the resultant energy boost can be bad for sleep.  Many cultures eat their biggest meal of the day in the morning and only a small snack at dinnertime for this reason.
  • Turning off the TV and computer a few hours before bed is a good idea.  Mileage varies from person to person, but electronics tend to stimulate the senses.  Suggest a book or quiet conversation, instead.
  • Counsel patients to adjust their environment to be ideal for sleeping.  They should layer covers to ensure they stay warm but not hot, and should minimize light and noise.

In addition to great care from you as a first line, there are a number of herbal and natural sleep aids as well, which may help insomniacs fall asleep quickly.  Sleep expert Elizabeth Shannon recommends entertaining a number of stress-relief methods, psychological conditioning, and homeopathic solutions for insomnia before resorting to pharmaceutical sleep aids, which can often form dependencies and, over time, exacerbate the problems associated with restlessness.

Of course, for severe chronic pain, prescription medications may be necessary.  Ultram, oxycodone, hydrocodone, and acetaminophen, codeine, and morphine might be used in more extreme cases. Some antidepressants or anticonvulsants could be valuable as well, depending on the specific symptoms your patient is presenting.  Benzodiazepine and nonbenzodiazepine anti-anxiety medication is also occasionally helpful, again, depending on specific symptoms.  If you have questions about pharmaceutical sleep aids, NeuropathyDR® can help provide guidance for you.

Be sure to remind patients that altering their sleep pattern won’t happen overnight (so to speak)!  It could be three to four weeks before any changes made to their routine begin to have meaningful impact on their success.  Often, since changes in routine can be unsettling in themselves, restlessness can become worse before it gets better.  Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from neuropathy to get the rest they need.

How To Reassure Patients with Severe Symptoms

If your patients are presenting with tingling, numbness, burning sensations, or motor function issues, they may be suffering from peripheral neuropathy.  Neuropathy can be tricky to diagnose, but becoming as informed as possible about its symptoms, treatments, and which of your patients are the most susceptible will equip you to effectively recognize this painful and often dangerous condition.

The main symptoms of peripheral neuropathy with which you and your patients should be familiar are:

  • Shooting pain or burning sensations
  • Weakness or loss of dexterity in the arms and legs

    Falls Due To Sensory Impairments are Frightening...

  • Tingling and numbness, especially in the extremities
  • Loss of fine motor control (dropping things frequently becomes an issue)
  • False sensory signals (reduced ability to sense temperature, sensations of being touched or wearing gloves, hats, or stockings when they are not

Other symptoms can also occur, of course, resultant from the above: sleep deprivation, restlessness, inability to sit still, irritability and nervousness, and so on.

So many groups are at-risk for neuropathy, it is practically guaranteed that learning to identify, diagnose, and even treat the condition will be a valuable asset to your practice and to the lives of your patients.  Spotting neuropathy early in a patient can mean the difference between debilitation and a comparatively normal life!

Some of the most common causes of neuropathy include (this is a partial list!):

  • Diabetes
  • Chemotherapy (increasingly over the past few decades, as cancer treatments become more and more effective)
  • Kidney disorders
  • HIV
  • Nerve damage from injury or surgery
  • Shingles
  • Genetic diseases such as Ataxia, or even hereditary neuropathy

Discussing Neuropathy with your patients can be challenging.  Start by making certain your patient understands whatever underlying cause is behind the neuropathy (diabetes, for example, is the most common).  Explain the symptoms of neuropathy, and encourage the patient to identify any they may be suffering, even intermittently.  Don’t forget to reassure them that, while there is no miracle cure for neuropathy, it is both common and very treatable in terms of pain.  Also, be certain to emphasize the importance of monitoring their condition for signs of further degeneration or additional symptoms (as these could be signs of dangerous progression).

Medical Treatment options for neuropathy vary widely, and are rapidly changing with technology and as we learn more about the condition. Some studies recommend non-steroid painkillers such as Motrin or Aleve for mild cases of pain, whereas cases involving more pain usually require prescription  pain reducers containing morphine or similar.  Surgical treatments also utilize implants.  Of Course external therapeutic devices should always be applied by the most qualified neuropathy treatment specialists.

Where your patient’s neuropathy is resultant from chronic or persistent illness, management of that underlying illness is, of course the priority.  Proper control of diabetes, appropriate physical therapy after an injury or surgery, or treatment of other relevant conditions will, in almost all cases, help to minimize neuropathic injuries.

Patients suffering from neuropathy are already familiar with its discomfort, and inconvenience to their lives.  It is important for you both to realize that many types of neuropathy can also be very dangerous, even life-threatening.  It is not uncommon for neuropathy to be degenerative and, if left unmonitored or untreated, it can cause intestinal blockages or complications in the function of bodily organs.  Needless to say, take no chances!

While there’s no cure for neuropathy, there is plenty you can do to help your patients enjoy healthier, full lives while living with the condition.  Early intervention with a NeuropathyDR® clinician is the best route; we put at your disposal all the resources you will need to effectively treat and advise your neuropathy patients.

For more tips on your patients or growing your specific practice, contact us at


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Maximum Patient Benefit and Recovery-CCTxs

Patient Co-Treatment Plans CCTxs

One of the biggest clinical lessons that has come from our work with peripheral neuropathy patients is just how powerful “Patient Co-Treatment Plans” can be.

Traditionally, we might think of patient components of recovery from illness as a relatively passive home care program such as “just take these twice a day” or “do these exercises”.

Clinical Co-Treatment Plans (CCTxs) involve much more specific, multifaceted approaches to patient care, that not so surprisingly yield often greater results in several areas than just professional advice or professional treatment programs alone.

Some of the keys to CCTxs success lie squarely in getting the patient to accept responsibility for all the components needed to foster maximum results. Commonly observed side benefits may include enhanced family support, approval and greater involvement of other health care providers and especially reduced use of pain and psychotropic drugs.

CCTxs typically consist of dietary advice, timed exercise and stretches, massage, oral and topical medications and supplements and in the neuropathy patient, use of the Clinical Co Treatment Kit.

You CAN Learn to Help More Patients with CCTxs

With just a little foresight, the same principles can and should be applied to a vast array of health conditions.

We have found it extraordinarily beneficial to specifically package CCTxs with custom iPhone®/ipad® Apps, DVDs and books, newsletters and exercise books or sheets.

Be sure that any supplementation or medication is always supplied with detailed written instructions. We attach specific, written and sometimes color coded instructions to each bottle or applicator.

But the real key to success is indoctrinating your staff and patient families from the outset that your approach to treatment mandates CCTxs.

You see, when you mandate patient co-operation as part of case acceptance, patient compliance is usually greater. There are also far fewer questions about fees, length and extent of care. The value added benefits of dealing with your office as opposed to a competitors becomes readily apparent. Most of all, your role as teacher with these patients can reduce office stress levels and interrupting phone calls dramatically!

But another less thought of benefit from running your professional health care practice in this way becomes positioning and marketing.

When the community understands the depth of your concern is far greater than making payroll, referrals seem to magically follow. It becomes Disney-sequel- patients can’t resist telling others. New Patient flow tends to come like a freight train with patients and their families who are clamoring for this type of care.

Of course, this is especially true as we move towards a public system of healthcare in which these “touches” have all but vanished forever.

So, how do you actually implement CCTxs in practice?

Obviously, take a look at what’s out there and don’t reinvent he wheel. If you are a neuropathy clinician, we’ve already done all the work for you!

By the same token, if you have an idea, first sketch it out. Be sure to include all the components needed to foster not only patient recovery, but also compliance.

Keep in mind, today, you must build in all the appropriate self-care tools, including books, DVDs, and now especially those that will “push” information in a consistent, replicable manner.  Timed information and self-help content that will also allow for patient (or a family caregiver) self determined interaction.

I’m clearly talking about automated SMS (mobile device text communications) and mobile device apps, which will have an ever-expanding role in private health care practices.

In the coming days, I’ll be showing you precisely how all of this technology can be tied together seamlessly with CCTxs to not only educate your patients, but also become part of the vast repertoire of social media as well as traditional marketing and private practice development and management.

The future success of private practice will mandate such an approach.

Stay tuned to

Do You Engage in Dabbling or Mastery?

Very often when I look at a practice and its owners that are really making things happen a very simple fact emerges. Out of every conversation and analysis one simple fact emerges. When I look at productivity and results in all areas of life and practice, it is clear that those who are the happiest, most productive and profitable have engaged completely in one area and department at a time.

Quite simply, from my very first telephone contact with these offices, it becomes readily apparent analysis of every step has taken place behind the scenes.
And quite obviously, they have trained their staff to answer the phone impeccably. Happy, polite, willing to help anyway they can.

Now of course, this is something I regularly do with enjoyment. I can tell so much about a doc and his practice, based upon how the staff answers the phone. Timing, attitude, how questions are handled, are they organized? And are all their tools obviously at their fingertips?

In fact, if your not doing great at the moment, ask three friends to anonymously call your office. Two as new patients with no health insurance. You should listen in. You may however be shocked
When it comes to collections at the counter its “Here’s your options Mrs. Jones, would you like me to put the entire week (month) on the same card?”

Here’s my point. Those who build powerful practices, and indeed personal lives continuously aim to master each area! No, its never perfect, and always requires measurement and attention, but none the less the process is in place via policies, procedures and trainings.

Clinically, it’s also very important to your patients!

It is vital that your patients experience you as a "Master" clinician.

Now in my office, new patients still tell me over 30 years later, “That was the best exam I have ever had in my entire life!”


Because on each new patient I still insist on a thorough pre-exam presentation by my aides, yes even interns, and from my clinicians complete vitals, thermogram, ROMs with instrumentation, chest and carotids auscultation, VBA screenings in C-Spine cases, abdomen when indicated, on and on.

But why?

It’s because my mentors taught me, and I was smart enough to pay attention, that the most powerful practices are built upon mastery, not dabbling!

As I said in the beginning, one very simple fact emerges – Masters get everything done while dabblers struggle seemingly forever.

I see this principle frequently when something goes wrong in an office.

For example, a doc gets all pumped up over introducing a new service, or technique to the practice. The guy that sold her on it has had really great results, referrals and profitability. Case studies and referrals.

So, she brings IT back to the office, gets the staff all revved up, but in so doing actually takes them off other areas central to the practice, does not allow time for effective marketing or training, and in reality introduces this new procedure in a half hearted way.

So of course, when things don’t turn out right, there must be something wrong with IT.

I’ll give you the antidote to this practice management pandemic, but I’ll warn you in advance, side effects may include nausea and heartburn. Might even cause stronger visceral and emotional reactions.

The antidote is to vow RIGHT NOW to take each area of your practice, each of the 12 Key areas I identify, and set up the time and systems to go back and master each one!

And yes, it is a constant process (which is why frequent staff huddles and meetings are necessary). And recognition that the needs for approaching practice in this way actually expands as you grow.

This is why our 12 secret platinum coaching programs are so powerful, and our practice makeovers are so very effective.

It’s because they force you into detailed analysis and corrective action.

And as you introduce something new, you must devote time to study, implementation, marketing, pricing, and potential rough spots with implementation.

Here are just 5 things on my list that too often get overlooked:

1. Dedicated business owner study, admin and planning time. 2. Dedicated staff time for marketing and admin. 3. No clear instruction or policies for patients. 4. Lack of effective pricing and collecting at the time of service. 5. Ineffectively conveying to the patient everything about your office (from your website to your treatments) that constantly reinforces in their minds they made the right choice!

The docs that pull this off behave emotionally and physically as effective CEOs.

Mastery vs. dabbling. In this world, your choices will be readily apparent.

But so will be the results! A powerful, profitable practice and enviable lifestyle that you so deserve!

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Pull Back or Leap Forward in 2012?

Pull Back or Leap Forward in 2012?

A timely perspective on building a phenomenal practice that delivers a lifetime of patient value and permanent income.

Looking back, about 4 years now after first writing about Commanders of Change™ as a progressive new breed of private practice owners, little did I realize how prophetic it would be. Those in private practice we see doing the best even in this brave new world are commanding their own change, and reinventing themselves, and their practices. Despite the outside world. They have indeed learned to Practice by Design ™.

Those having extraordinary difficulty in private practice are instead practicing by default.

Its no secret, things are very different in your patient’s lives now too. More than just an election year uncertainty. Entire pillars of American society are shifting very, very quickly.

So, here’s the simple choice. Learn new systems, grow, and become more patient-centric while reinventing your practice, yourself and your future.

Or, do nothing, and wish things were like they used to be. Either way, recognize it is a choice that will have profound consequences on the rest of your life.

I am not saying it’s easy. If it were, all chiropractors, physical therapists and medical physicians in private practice would easily gross six and seven figure incomes. For some of us, it’s the most difficult issue in life right now.

I do however speak from experience when I tell you that the direction you take now, because it is such a pivotal time can mean dominating your given market area, building a powerful, profitable practice knowing you are fulfilling your professional destiny, and having that extra income committed to permanent interest bearing investments that can give you a lifetime of freedom.

Or, failing to act decisively, quickly, while gathering all the tools and information you must have regardless of who or what tries to dissuade you can mean closing your doors.  It’s this simple.

Do you hang around with naysayers or dwell upon how tough things are while distressing about loss of income and your investments?

It’s your choice.

Or, have you instead asked for help where you need it, moved forward with a clear vision of the future instead of regrets about the past.

While you are reviewing or reformulating your game plan, here are some of the critical areas that need special attention.

First, are you and your entire team communicating the true value, the most meaningful benefits about what you do, and simultaneously making it easy for those who want more of what you have to offer raise their hands and buy more?

Do you talk only about pain, covered physical therapy or chiropractic visits, or ‘Longer, healthier life with the energy and physical capacity to engage your passions to their fullest’?  Do you teach them how to be continuously “Looking and feeling spectacular?” And “Having more energy than people 10-15 years younger’?

Because, this is exactly what your health care does for people.

How Are You Going To Practice in 2012?

If you are not currently fully engaged along these lines, this is where I advocate you spend lots of time investigating how the practice development programs we have developed for you can best be deployed to make all this your reality too.

Always remember, these are the patients that tell everyone about their doctors. And gladly pay for everything you do. And come back year after year with their kids and grandkids.

Next, is your team crisp, efficient, friendly and understanding? Do they go out of their way to make the office a place people love to come to, and tell everyone they know? Do they also fully support you or stress you out way too much? This also, is a choice. Your choice.

As a vital referral driving and expanded patient care network, what is the quality of your healthcare professional relationships? Have you aligned yourself with like-minded MDs, DCs, PTs,  DMDs, DPMs, etc?  Do they refer easily back to you in complete confidence? Do you work to continue to help them as well as their patients?

Most importantly, do you have a clear vision, and a step-by-step game plan to make this all a reality?

A long ago, I wrote how to develop a step-by step implementation game plan. If you are having difficulty with any of these critical areas instead of going into overwhelm dedicate some quiet time, a day or two out of the office if need be, use the simple system I developed for you and just get it done.

And remember, this is where good coaching and modern tools and systems are priceless.

I look forward to hearing your success story this year!

PS This is a perfect day to begin with a new perspective and mentoring program.

For more information, go to


Alternative Therapies for Your Chemotherapy Induced Neuropathy Patients

Alternative Therapies for Your Chemotherapy Induced Neuropathy Patients

One of the more challenging patient populations you can treat is the chemotherapy induced peripheral neuropathy patient.  They’ve already been through the cancer diagnosis and are either in the midst of chemotherapy or they’ve finished their treatment.

Just when they think they’re done with all the side effects of chemotherapy, they’re visited with[1]

–       Shooting pain

–       Burning and numbness

–       Tingling in the hands and feet

–       Inability to sleep because of the pain

These Patients Require All Your Skills!

Can you imagine the frustration?

Chances are really good that no one told them that chemotherapy induced peripheral neuropathy (CIPN) was a potential side effect of their treatment because, let’s face it, no one can really predict which patients will develop chemotherapy induced peripheral neuropathy.  Why bring it up if you don’t know for certain that it’s going to happen?

For many, their symptoms last well beyond their chemotherapy.

For your CIPN patients, the first option is, of course, drugs to deal with the pain.  But many chemotherapy induced peripheral neuropathy patients are choosing to be more proactive and do everything they can to alleviate their current symptoms and lessen the possibility of permanent nerve damage.  They don’t just want to take a pill to make them feel better. They want to give their bodies the best treatments available.

What Else Can They Do?

More and more CIPN patients are opting for what used to be called “alternative medicine” treatments.  While many think of anything outside of conventional medicine as “alternative”, that’s really not accurate.  Alternative treatments are defined as anything not approved by the Food and Drug Administration.  The treatments we’re talking about here are more complementary or integrative therapies.  In other words, they’re therapies used in addition to and to complement traditional medicine, not taking the place of it.

Because of the growing popularity (and effectiveness) of these complementary and integrative therapies, the medical community has actually named them – Complementary and Alternative Medicine.

Some complementary and alternative therapies providing good results for chemotherapy induced chemotherapy patients are:

–       Cancer treatment specific diets

–       Herbal supplements

–       Non-herbal supplements (like Vitamins B6 and B12, alpha lipoic acid)

–       Acupuncture

–       Massage therapy and Reflexology

–       Exercise

–       Homeopathic and ayurvedic medicine

Any of these therapies, in the hands of skilled practitioner, is a great complement to your chemotherapy and other cancer treatment and can provide substantial relief from chemotherapy induced peripheral neuropathy pain.  Offering these services to your chemotherapy induced peripheral neuropathy patients is an excellent way to treat the whole patient and not just the symptoms.

Involve Their Oncologist

Before you start any Complementary and Alternative Medicine treatments with your chemotherapy induced peripheral neuropathy patients, talk to their oncologists.[2] Make sure that what you’re planning to do will not have an adverse effect on their chemotherapy regimen (some antioxidants do).  Always keep the oncologist in the loop on what you’re doing to complement or following a chemotherapy regimen.

Why These Complementary and Alternative Medicine Treatments Work

Many of the Complementary and Alternative Medicine regimens we mentioned above will help deal with and even alleviate some chemotherapy induced peripheral neuropathy symptoms.

The body is a finely tuned instrument and all the systems work together.  Massage therapy, acupuncture and Reflexology can help with muscle pain and stimulate the systems within the body to fight the cancer.

Certain supplements can help give the body the nutrients and vitamins it needs to repair itself and eliminate the possibility of permanent nerve damage caused by chemotherapy induced peripheral neuropathy.

Treating the Whole Patient By Working With The Whole Team

None of the medical specialties treating chemotherapy induced peripheral neuropathy patients operates in a vacuum.  You all need to know what the others are doing.

Luckily, most oncologists these days are familiar with the Complementary and Alternative Therapies chemotherapy patients are turning to for relief from the chemotherapy induced peripheral neuropathy symptoms.  Make sure that you involve your patients’ other treaters in your care by communicating with them.  By integrating your Complementary and Alternative Medicine treatments into the overall treatment program, you have a much better chance of giving your patients the optimum results they deserve.

When you are ready, let them know you’re there to help them.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at



Helping Patients with Acute Kidney Failure

Most people think that acute kidney failure would present with symptoms too obvious to ignore.

They expect to be bedridden…deathly ill…in and out of the hospital…

What they don’t realize is that acute kidney failure often doesn’t cause noticeable symptoms.  Many times it’s detected when the patient is already in the hospital for something else and evidence is found through tests.

As a clinician, especially a NeuropathyDR® clinician specializing in treating patients with neuropathy, that makes your job especially tough in reaching out to these patients and getting them in for treatment before it’s too late and permanent damage is done.

Most of the time, you won’t see these patients until they have[1]

∙           Swelling, especially in the legs and feet

∙           Cramps, muscle twitching or muscle weakness

∙           Little or no urine output

∙           Thirst and a dry mouth

∙           Dizziness

∙           Rapid heart rate

∙           Nausea, vomiting and loss of appetite

∙           Confusion

∙           Anxiety or restlessness

∙           Pain on one side of the back just below the rib cage but above the waist

∙           Fatigue

These are all symptoms of acute kidney failure.  And the root cause of many of these symptoms is a serious complication of kidney failure – uremic neuropathy.  Uremic neuropathy or neuropathy associated with kidney failure is a very common complication of kidney failure.

The sad thing is that by the time they’re exhibiting several of these symptoms, their uremic neuropathy may have already done serious damage to their body.  If you have patients with conditions like lupus, diabetes or hepatic (liver) failure, they’re especially prone to acute kidney failure and uremic neuropathy.  Your best bet to treat them effectively and keep them off dialysis and off the transplant list is to educate them.  The more they know about the possibility of developing uremic neuropathy from acute kidney failure, the more likely they’ll be to show up in your office for help before they have irreversible problems.

First, explain uremic neuropathy…

What Is Uremic Neuropathy[2]?

Uremic neuropathy is a type of neuropathy caused by an increase in uremic toxins in the blood (the toxins urine usually removed from the body when the kidneys function properly.) The severity of their uremic neuropathy is directly linked to the severity of their kidney failure.  If their kidney failure is acute, their uremic neuropathy is pretty serious.

How Can Kidney Failure Lead to Neuropathy?

Neuropathy is one of the worst results of chronic kidney disease.  Acute kidney failure damages the kidneys.  When the kidneys are damaged fluids, waste products and toxins build up in the body.   Because many organs and bodily systems (particularly the nervous system) are directly affected by this build up of toxins, acute kidney failure leads to overall poor health and inflammation and nerve damage.

Once the nerves are damaged, they cease to function properly.  One complication leads to another and, in 20% to 50% of patients with acute kidney failure, they’ll develop uremic neuropathy.

Treatment and Prognosis

Your patient’s best course of action is to catch their kidney issues before they become acute and they develop uremic neuropathy.  Unfortunately, once the kidneys are that severely damaged, dialysis and possible kidney transplant are virtually inevitable.

That’s why you need to impress upon your patients how vitally important it is that they not ignore symptoms and that they seek treatment immediately once they notice a problem.  Acute kidney failure and uremic neuropathy are not conditions that just get better on their own.

As a NeuropathyDR® clinician you have a wonderful protocol to assist you in working with your patients and their whole medical team to treat and manage your underlying condition before they become acute.

Some programs you can offer your patients are:

∙           Diet Planning and Nutritional Support

They need to give their bodies the nutrition they need to heal.

A low protein diet is best for patients with kidney disease.

If your patient has diabetes, they need to follow a diet specifically designed for diabetics and to control their blood sugar.

∙          Individually Designed Exercise Programs

If your patient is experiencing dizziness, rapid heart rate, extreme thirst or issues with impaired sensation in their feet and legs, they have to be very careful with their exercise program.  You can design an exercise program specifically for them that will allow them to exercise but not push them beyond what their body is capable of.  And, even more importantly, continually monitor their progress and adjust the program as needed.

These changes in conjunction with medications and possibly more involved medical intervention will make it easier to live with acute kidney failure and uremic neuropathy. Early intervention with a NeuropathyDR® clinician is still the best policy if they have any of the underlying conditions that can cause uremic neuropathy.  If they already have symptoms, start treatment immediately.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at








Caring for Patients With Sexually Transmitted Diseases and Peripheral Neuropathy

The peripheral neuropathy patient population is growing.

That’s understandable when you look at the increase in

•      Diabetes

•      Cancer

•      Autoimmune diseases like lupus, Guillain-Barre’ Syndrome

But there is another fast growing peripheral neuropathy patient population that often goes unnoticed.

Patients with sexually transmitted diseases or STD’s[1] such as:

•     HIV/AIDS

•     Genital Herpes (or any one of the large number of herpes-simplex viruses)

•     Gonorrhea

•     Syphilis

•     Chlamydia

•     Hepatitis B and D

•     HPV (Human papillomavirus infection)

Or some combination of these diseases.

These patients can be some of your most challenging.  Many are reluctant to discuss or even acknowledge that they have an STD.  By the time they’ve developed symptoms of peripheral neuropathy and seek treatment from a specialist in treating neuropathy, they could be facing serious nerve damage.

You could be playing beat the clock to head off permanent damage.  Your first order of business is to educate them on peripheral neuropathy, how they developed it and what they need to do to help themselves.

Explaining How Their STD Caused Peripheral Neuropathy

Many sexually transmitted diseases are caused by viruses or bacteria[2].  Viruses and bacteria can attack nerve tissue and severely damage sensory nerves. If those nerves are damaged, your patient is going to feel the pain, quickly.

The virus that causes HIV, in particular, can cause extensive damage to the peripheral nerves.  Often, the progression of the disease can actually be tracked according to the specific type of neuropathy the patient develops.  Painful polyneuropathy affecting the feet and hands can be one of first clinical signs of HIV infection.

Any of these viruses or bacteria can cause nerve damage and the resulting peripheral neuropathy.  Many patients understand the more common symptoms of their illness but they don’t understand why they would have nerve damage.  Once they understand exactly why they’re having

•     Muscle weakness

•     Muscle cramps

•     Inability to feel sensation

•     Numbness or tingling

•     Burning

•     Loss of reflexes

•     Blood pressure problems

•     Sweating too much or too little

•     Heart rate issues and inability to feel chest pain

•     Bladder control issues

•     Diarrhea or constipation

•     Difficulty swallowing because your esophagus doesn’t function properly

•     Bloating

•     Erectile dysfunction

•     Heart burn

•     Inability to feel sensation in your hands and feet

They will better understand why you’re recommending the treatment your recommending.  Chances are that when they were diagnosed with a sexually transmitted disease, they understood how it would affect their sex life and the more intimate aspects of their lives.  They had no idea that their STD could cause serious nerve damage as well.  Understanding exactly how these illnesses can cause peripheral neuropathy and serious nerve damage will make for a much more compliant patient.

The Best Course of Treatment

If your patient presents with any of these diseases and they’ve developed peripheral neuropathy, start treatment immediately.  The earlier you start treatment, the less likely they will be to develop permanent nerve damage.  Your NeuropathyDR® protocol offers one of the best chances these patients have for minimizing or even avoiding permanent nerve damage from peripheral neuropathy.

In addition to the NeuropathyDR® protocol and specific drug therapies designed for the particular condition, you also need to work with your patient on lifestyle issues.  Specifically,

•     Getting plenty of rest

•     Pacing themselves and limiting their activities

•     Exercising  regularly – walking, swimming and yoga are great exercises for neuropathy patients

•     Take care of their skin and limiting exposure to the sun

•     Quitting smoking

•     Eating a healthy, well balanced diet

•     Keeping high blood pressure under control

•     Always practicing safe sex to protect their partners and themselves

As a NeuropathyDR® clinician you can offer these patients the best chance possible for avoiding permanent nerve damage from their sexually transmitted disease.

Once you’re trained in the NeuropathyDR® treatment protocol and ready serve this challenging and fast growing patient population, let us help you reach them.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at