In addition to alpha-lipoic acid, my doctor put me on Levaquin. Amazingly, the shoulder pain, chronic gall-bladder infection, swallowing problems, ankle swelling and chronic stomach ulcer went away. The numbness in my feet and fibromyalgia did not disappear but got better.

My point is that one of the symptoms of bartonella is numbness of the feet. It is rarely looked at as the cause of peripheral neuropathy. I had none of the diabetic or circulatory problems that normally cause it. I am still scratching my head as to why my now-retired doctor did not diagnose it earlier. It would have made my recovery from Lyme disease so much easier.

DEAR READER: Bartonella henselae, also known as cat-scratch disease, is a bacterium that enters the body at the site of the scratch. Adult cats can spread the disease, but it more commonly comes from kittens. Lymph nodes, primarily those around the arms, head and neck, become swollen. Lack of normal appetite, fever, headache, fatigue and transient peripheral neuropathy may result. Those commonly infected are people with a compromised immune system.

Lyme disease presents with the same symptoms, so it is no wonder your physician would have zeroed in on that possibility. You can perhaps understand why some diseases and disorders are discovered following a process of exclusion. The symptoms are the same, and, at times, the treatment is the same.

The Levaquin you were prescribed is a broad-spectrum antibiotic used to treat bronchitis, pneumonia, skin infections, the sinuses, UTIs, ears, chlamydia and more.

You are correct that peripheral neuropathy is not commonly linked to cat-scratch disease. It is not one of the more common symptoms, but there is a definite link that should not be overlooked when making a diagnosis. Thank you for writing and sharing your interesting case.

DEAR READER: Neuropathy can be defined as a disorder or disease of the nervous system. Because you provide limited information, I cannot determine which form, if any, you might have. Unless your toe fracture was quite traumatic, it’s my guess it’s not likely to have resulted in neuropathy.

Autonomic neuropathy refers to damage to nerves over which we have no control, such as those of digestion, perspiration, blood pressure and heartbeat. Symptoms can include dizziness and fainting on standing (orthostatic hypotension), caused by a drop in blood pressure; gastroparesis (difficulty digesting food), causing diarrhea, constipation, nausea, vomiting, heartburn, loss of appetite and bloating; exercise intolerance, during which the heart rate remains stable despite the level of activity; hypoglycemia (low blood sugar) that presents with palpitations, sweating, an elevated heart rate and shakiness; and diminished pupil reaction that causes problems with adjusting from light to dark. Causes include alcoholism, diabetes, chronic illnesses such as Parkinson’s, nerve injury, atrophy (wasting away of one or more muscle, organ or nerve), medication for IBS or overactive bladder and more.

Peripheral neuropathy is the outcome of nerve damage resulting from infection, injury, toxin exposure, diabetes and high cholesterol. Other possible causes include vitamin B deficiency, alcoholism, kidney, liver or thyroid disorders, specific viral or bacterial infections, HIV/AIDS, hepatitis C and more. The onset of symptoms may be gradual but includes muscle weakness or paralysis, sensitivity to touch, burning, tingling or sharp pain and numb extremities.

Testing might include blood work for thyroid, liver, kidney, glucose (sugar), cholesterol and vitamin levels. Electromyography (EMG) can measure the electrical signals in the peripheral nerves, and a nerve-conduction study will measure how quickly the nerves carry those electrical signals. A CT or MRI, noninvasive X-ray-like images, can determine whether there is a herniated disk, tumor or other abnormality present.

Treatment will depend on the underlying cause of the disorder that must be addressed for relief. Over-the-counter pain relievers, prescription medication and transcutaneous electrical nerve stimulation (TENS) might be appropriate. Speak with your physician to determine the cause for your neuropathy and, if appropriate, request treatment. He or she knows your medical history and can assist you better than I can. Adverse interactions between medications are common, and I can’t direct you in this regard.

In the interim, foot massage will aid circulation, exercise should reduce the pain and help control blood-sugar levels, proper diet will ensure the ingestion of essential nutrients, and discontinuing alcohol and cigarettes may improve circulation. There are a number of topical ointments available that contain capsaicin, a warming ingredient. The effect of these ointments should improve symptoms.

Because I mention two possible causes for the condition, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Diabetes Mellitus.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

My husband has peripheral neuropathy. He is not diabetic and the pain is mild. He needs a cane to keep his balance when walking and is losing function of his hands. In November 2006 he was in hospital for treatment with massive IV steroids and IV immunoglobulin. Each treatment lasted four hours. Unfortunately, they made him very sick and he was forced to stop.

We are willing to try anything to improve the function of his hands. Where can I get nitroglycerin spray for him?

DEAR READERS: Nitroglycerin is a prescription medication. Most pharmacies carry it but without physician approval you cannot purchase it. Speak with your husband’s neurologist about this possibility.

He may also wish to try prescription Neurontin which has been proven useful in lessening the pain of neuropathy.

A final option is Vicks VapoRub or similar store brands. Many of my readers have had amazing success by simply rubbing the product on the affected areas two to three times a day. It is also inexpensive, safe, easy and best of all, doesn’t require a prescription. I recommend your husband give this a try first and move onto the other options should it not work.

To give you related information, I am sending you a copy of my Health Report “Dr. Gott’s Compelling Home Remedies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Now my question. It is a bit complex but I will try to be concise. In 2005 I started developing symptoms of peripheral neuropathy. After a consult with my family practitioner and a few preliminary tests that were negative, I was referred to a neurologist. While waiting for the appointment, I discontinued my Zocor and a mild antidepressant to see if symptoms declined. (One of Zocor’s side effects is neuropathy.) Within a few weeks to a month the symptoms declined somewhat. The neurologist continued with more tests. Most of them were normal. The milder neuropathy symptoms were and still are present but intermittent.

When the results of my protein studies came back, including the paraneoplastic panel, my striated muscle levels were elevated. Because of this, my neurologist ordered a lung scan which was negative. At that point I was told to just wait and see if I had any symptoms that might suggest lung cancer.

Since I am proactive in my health care, I did my own research online and found that small cell lung cancer can be preceded by peripheral neuropathy before the onset of disease. Several existing studies suggested that regular follow up testing was advised because waiting for symptoms can result in poor prognosis if covert cancer is present. I reviewed this information with my family physician who agreed with the wait and see approach of the neurologist.

I had a repeat paraneoplastic panel one year later (2006) and the striated muscle portion was still elevated but lower than the first test.

Is there anything you would recommend? Should I ask for a referral to a different specialty? I am not looking for trouble but on the other hand, I do not want to ignore a problem if there is something I should or could be doing.

DEAR READER:
Your physicians have addressed your problem using excellent medical care. If agree with the wait and see approach, especially given the fact that your blood test improved during 2006. I do not know the cause of your neuropathy (nerve malfunction). If your symptoms are stable or improving, I would not worry too much. If you truly feel uncomfortable, speak with your neurologist or ask for a referral to another doctor for a second opinion. If your symptoms start to worsen, see your neurologist who should order more tests and address possible issues, including treatment options.

Continue with your yearly monitoring and follow your physician’s advice. Good luck and let me know how this turns out.