My neurologist prescribed 10 milligrams of baclofen for the few leg cramps I was getting at night. I declined after hearing the side effects from my pharmacist. Because the weather was hot, I decided to try a high-carb sports drink, which took away the cramps until the weather changed.

I have always been a heavy user of Vicks VapoRub, so I began massaging it onto both feet — bottom and top, heels and toes. My chiropractor also suggested 1/8th teaspoon of cream of tartar mixed with water at night.

Seven years later, I have a little numbness in spots but no pain and only cramps at night when my feet get cold. I also take 100 milligrams of vitamin B6 along with the alpha-lipoic acid per day. My neurologist agrees that the Vicks will keep the nerves alive, and the exercise by massaging keeps the muscles strong. Please tell people. I do. Thank you.

DEAR READER: Let’s start with the simple case of your leg cramps. Many people experience cramping of the feet and calves after exercising or profuse sweating because the body’s electrolyte balance is disturbed. Sports drinks can help bring this back into balance, thus eliminating the cramps. Other home remedies include soap under the sheets, pickles, pickle juice, supplemental potassium and several others.

Now, on to your peripheral neuropathy. This condition is caused by damage to the peripheral nerves in the feet, legs, hands and/or arms. Causes can be untreated or poorly controlled diabetes, chemotherapy or radiation side effects, improper diet or injury. When the cause cannot be found, the condition is labeled idiopathic.

Common treatment includes prescription nerve blockers such as gabapentin. Another treatment that has received a lot of positive review is Anodyne therapy. Home remedies range from topical mentholated chest rubs to dietary vitamin and mineral supplements and topical ointments containing capsaicin. Massage may also be beneficial since its aids circulation.

The cream-of-tartar remedy offered by your chiropractor is new to me, but if it works for you, stick with it. I cannot think of any harm it could do, especially given the minimal amount used.

Alpha-lipoic acid is an antioxidant made by the body and is present in every cell. It is both fat- and water-soluble. It has been shown to lower blood-sugar levels, kill free radicals and improve symptoms of autonomic neuropathy (damage to the nerves of the heart associated with diabetes). It is currently being studied as a part of a treatment program for glaucoma, stroke, brain disorders and liver disease. It is too early yet to tell whether it is beneficial.

Because of your success, I am printing your letter in the hopes that it may help others. I also ask for feedback from my readers about their experiences.

To provide related information, I am sending you copies of my Health Reports “Dr. Gott’s Compelling Home Remedies” and “More Compelling Home Remedies.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

I noticed a tingling feeling in my left middle finger, left foot and then my right foot. I went to a podiatrist, who prescribed gabapentin. I am now taking 300 milligrams three times a day, but it doesn’t seem to be helping. It is a disturbing feeling that keeps me awake at night until I finally fall asleep from exhaustion. During the night, the tingling seems to go away, but as soon as I start walking, it starts up again.

I read an article that mentioned a person taking a statin drug for more than five years can develop peripheral neuropathy. I was on 40 milligrams of Zocor that was increased to 80 milligrams five years ago. I’ve been cutting the pill in half for a year following a cholesterol reading of 163 and now take L-thyroxine, furosemide, aspirin, folic acid, fish oil, vitamin C, potassium, calcium with vitamin D, iron with calcium, and vitamins B6 and B12. The neuropathy began six months to a year ago. Muscle and nerve biopsy tests showed no damage, nor do I have diabetes according to the blood work ordered.

If peripheral neuropathy results from statin drugs, why aren’t patients told this when they are given them? If I stop taking the statin, would or could the neuropathy go away?

DEAR READER: I am surprised your physician did not advise you of the possible side effects of the Zocor he prescribed. A year or more ago, there was a great deal of media coverage regarding debilitating calf-muscle cramping and tingling that resulted from the use of statin drugs. In the defense of drug companies, not everyone will experience similar side effects. Some people can successfully be prescribed almost any medication without side effects. However, others can’t tolerate them and must find alternative control for their medical issues. There is no need to alarm patients needlessly; however, they do have a right to know what they might expect.

This brings me to a related issue. When a physician prescribes any medication, it is his or her obligation to verbalize any possible side effects. Should that not happen, the patient should ask what to expect when taking something new. When this is accomplished, the patient and physician can make an educated decision as to whether a drug is appropriate or simply not worth the risk.

You list the surgical procedures you underwent but don’t indicate whether you have any cardiac issues that your physician is attempting to micromanage. I occasionally get criticized by my colleagues when I indicate a reading is normal, only to find there are extenuating unknown circumstances for wanting levels substantially lower. That said, I don’t know what your cholesterol readings were prior to the Zocor, but you certainly might be managed on a lower dose than the 80 milligrams. That decision is best left to your physician, who knows your complete medical history.

Give your doctor credit for testing you for diabetes, which carries the symptom of peripheral neuropathy, and kudos to you for supplementing B6 and B12 for possible deficiencies.

To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

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.

DEAR READER: There are a number of possible causes, including exposure to cold, hypothyroidism, peripheral neuropathy, peripheral-artery disease and Raynaud’s. Many disorders share symptoms, so you might need some follow-up.

If you were exposed to extreme cold without adequate protection, exposure could be the answer. Perhaps you were outside for a long time in frigid temperatures without benefit of socks, footwear or warm boots.

Hypothyroidism (low thyroid) is easy enough to determine with a simple blood test but is often accompanied by a number of other symptoms, such as fatigue, that you don’t mention. If it is time for an annual physical examination, ask your physician to test you for a thyroid disorder. Include cholesterol and blood-sugar levels. If abnormalities exist, it is likely simple medication will help you.

Peripheal neuropathy is caused by nerve damage and commonly presents with numbness, tingling and a burning sensation. This certainly might be an answer.

Raynaud’s is an interruption of blood flow to the extremities caused by exposure to cold and made worse by emotional stimulation. Symptoms include burning, tingling, pain on exposure to cold and whitish/blue skin, followed by redder skin when circulation improves.

Peripheral-artery disease is a common problem involving circulation that occurs when there’s an insufficient flow of blood to the hands, legs and feet. A person may complain of cold extremities, foot ulcers that fail to heal and intermittent claudication (pain or discomfort in leg muscles after walking a certain distance). I would expect, and perhaps incorrectly, that you are too young to suffer from PAD.

Discontinue smoking if you currently do so. Exercise to improve your circulation. Cover your feet with socks and warm slippers or shoes, even when at home. Avoid excess coffee, chocolate and other caffeine-containing products that constrict blood vessels. Substitute green and black teas that contain flavonoids, as they help support blood-vessel health. While I have no personal experience and cannot endorse the alternative, magnesium taken in doses of 1,000 milligrams daily is purported to relax blood vessels and promote blood flow. Too much magnesium, however, can cause diarrhea, so be careful not to overdo it.

Have a thorough examination by your primary-care physician or see a specialist to determine whether there is an underlying cause for your symptoms. Ask about the possibility of an ultrasound or angiography, which will identify blocked or narrowed arteries.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER:
Peripheral neuropathy causes pain, numbness, tingling, or burning of the extremities. It can result from infection, exposure to heavy metals or other toxins, infection, metabolic disorders, and more. Symptoms vary from person to person, depending on the types of nerves affected. Those with alcoholism, vitamin deficiencies, diabetes, rheumatoid arthritis, thyroid, kidney, liver or specific autoimmune disorders are at high risk for the condition. I cannot determine from your letter what caused your problem; nevertheless, the point now is to improve your quality of life.

There are a number of treatments available. For mild cases, over-the-counter pain relievers or the application of medicated chest rub to the affected areas may be all that is needed. For more severe cases, prescription antiseizure medications, such as Neurontin, or pain patches, like Lidocain, may used. If these steps fail to provide improvement, seek out a pain specialist or visit a pain clinic.

I don’t expect you to be pain-free at the age of 90, but your neurologist should be able to keep you more comfortable than you are. Pursue the issue and don’t stop until you are satisfied with the progress. Good luck.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. 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.

I am a cancer survivor and have suffered with this condition for more than eight years. I have severe burning, tingling and pain in my feet due to chemotherapy. Then a few years ago my sister-in-law came across an article about neuropathy in a magazine. The article talked about a new treatment called Anodyne therapy.

After doing some research, I decided I had nothing to lose and gave it a try. I had a total of 16 treatments at a local outpatient therapy center. After only six treatments, the pain in my feet was much better. The throbbing and burning were totally gone.

I have closed a copy of the company’s brochure for your interest. For your readers who want to know more, I suggest they go online to www.anodynetherapy.com or call 1-800-521-6664.

Apparently the testing of this treatment was done on people with diabetes, but let me tell you it worked for me and I do not have diabetes. I guess that neuropathy is neuropathy, regardless of the cause. I have been pain free for more than a year now. Before this treatment, my neuropathy was so severe I nearly required a wheelchair.

My primary care doctor and oncologist had not heard of this treatment but after showing them some information about it, they both gave me their approvals. Medicare paid for nearly all the cost. I hope that you feel this letter is worthy to print your column as I am sure it will help many neuropathy sufferers out there.

DEAR READER:
I have not had any experience with this treatment, nor had I ever heard of it before you letter. However, your story is very compelling, as is the brochure you kindly included.

Neuropathy has many causes, the most common being diabetes and cancer treatments. Trauma, infection, exposure to toxins and metabolic conditions can also be causes.

Irreparable damage occurs to nerves which lead to burning, tingling, numbness and pain. The most common areas where this condition occurs are on the bottoms of the feet but as it progresses, the tops of the feet, ankles and lower legs may become affected. It can also affect the fingers and hands.

Most physicians refer patients to a neurologist who can perform testing to determine the extent of the damage. Once the severity is known, treatment can begin. This will also depend on the cause. Treatment must also include treatment of any possible underlying condition. Generally, this stops or slows the progression of the neuropathy. For those with no known cause (idiopathic) or those have untreatable causes, such as side effects from cancer treatment, there are several medications available.

Mild cases may be relived with the use of over-the-counter pain relievers such as ibuprofen. The most common side effects include stomach upset but most have no adverse reactions.

Moderate to severe cases may require prescription medication such as non-steroidal anti-inflammatory or narcotics. Lidocaine patches (a type of pain reliever) can be applied directly to affected areas up to three times a day. Narcotics can cause dependency and other serious side effects which limit their use. Lidocaine patches have very few side effects, the most common being rash at the site of application.

Anti-seizure medications such as Neurontin (gabapentin), Lyrica (pregnable) or Tegretol (carbamazepine) can provide relief for many sufferers. Side effects can include drowsiness and dizziness.

A final option is antidepressants. Tricyclic antidepressants can often provide relief by interrupting chemical processes in the brain and spinal cord that cause one to feel pain. Cymbalta, another type of antidepressant, has also shown positive results in treating neuropathy caused by diabetes.

Alternative treatments can include heat and/or massage therapy. Some sufferers have had success with acupuncture and still others with unconventional methods such as a thin application of medicated chest rub to the areas.

There are certain steps that individuals at risk for developing this condition can take to reduce or prevent it from occurring. Any medical condition that can cause nerve damage must be under strict control. A healthful diet rich is whole grains, lean meats, fruits and veggies can also be helpful.

As for Anodyne therapy, I can only say that it sounds intriguing. I urge interested patients to speak with their primary care physician or neurologist. If they have not heard of it, go online or call to request more information for their review.

To give you related information, I am sending you copies of my Health Reports “Managing Chronic Pain”, “Compelling Home Remedies” and “More Compelling Home Remedies”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My feet are now showing some nerve damage. Any help would be appreciated.

DEAR READER:
Metformin is an oral medication prescribed for people with type II (non-insulin dependent) diabetes. The normal dosing for oral medication is 500 mg taken twice daily, while the extended release form is taken once daily in a 500 mg tablet. Therefore, I am rather surprised you are on 2000 mg daily. This appears to be a hefty dose with less than perfect results. Normal blood sugars run in the 70-150 range, with lower readings in the morning and higher readings in the evening and after meals. To have a morning reading of 160 on this elevated dose is somewhat disturbing.

The nerve damage in your feet sounds like peripheral neuropathy to me, a condition that causes pain and numbness of the extremities. It can result from infection, traumatic injuries and is seen commonly in poorly controlled diabetics. Symptoms often improve over time once the underlying condition is treated.

Lactic acidosis has been reported in some people on metformin. The condition presents as muscle or abdominal pain, lightheadedness, shortness of breath, weakness, sleepiness and a slowed heart rate. Individuals should avoid alcohol while taking this drug, as it lowers blood sugar readings and can increase the risk of lactic acidosis. As with so many other drugs, several medications can interact with metformin, so advise your physician of anything else you might be taking, including herbal supplements and over-the-counter medications. He or she will then be able to determine if the drug is right for you.

In response to your cinnamon regimen, this product has been used for many conditions, including stomach disorders, nausea, vomiting, diarrhea, gas, and bloating. Most recently, scientists have discovered as little as ½ teaspoon daily added to the diet may reduce blood glucose levels. Cinnamon can be added to your toast, sprinkled over cereal, or a stick can be swirled into coffee or tea. Having reported this, I should add that this therapy does not work for everyone. In fact, I often feel that if an individual concentrates on adding a supplement for a specific purpose, he or she rapidly becomes aware of everything consumed. This is likely to lead to better dietary choices that result in better readings.

Review your concerns with your primary care physician. He or she might choose to switch you to another drug in the same class, but in a lower dosage that will provide better results. You might also consider asking for a referral to an endocrinologist who specializes in diabetes. Such a physician will be armed with the newest drugs and research results available. Perhaps one such drug will be right for you.

To give you related information, I am sending you a copy of my Health Report “Diabetes Mellitus”. 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.

After going to an internist, three neurosurgeons and a rheumatologist, I was diagnosed with peripheral neuropathy. Nothing any of the doctors prescribed, nor any of the treatments I had made a difference. I then saw a doctor who practices acupuncture and after many sessions, my hands regained function. I am thankful I had the courage to try this alternative treatment and I thank you for being open to hearing what works for patients and sharing that information with your readers.

DEAR READER:
Peripheral neuropathy is sometimes difficult to diagnose. It commonly results from a traumatic injury, infection, exposure to toxins, and metabolic problems such as diabetes.

It begins with a gradual numbness of the hands and/or feet that can spread upward into the legs and arms. Its signature is burning, often sharp, electric-like pain. Muscle weakness or paralysis, a lack of coordination and an extreme sensitivity to touch can be a part of the condition.

Common causes are vitamin B deficiency, rheumatoid arthritis and other auto-immune diseases, kidney and liver disease, HIV/AIDS, an under-active thyroid, and exposure to poisons or heavy metals.

Treatment provided by your physician will depend on the extent of the neuropathy. Mild forms might be treated with over-the-counters, while more severe cases might require prescription pain killers, anti-depressants, lidocaine patches, and anti-seizure medications. Home remedies include exercise, hand and foot massage, avoiding prolonged pressure, eating healthful meals, and cessation of smoking.

Acupuncture is somewhat questionable, since scientific research cannot demonstrate if it is effective against any disease. I can only say that if it worked for you when all else failed, you at least were able to find relief from the pain you experienced. Perhaps this will help other readers; however, I would suggest they first travel the traditional route of primary care physician, rheumatologist and neurosurgeon. There’s a pretty sophisticated group of physicians out there who can help many people with health problems. Thank you for sharing your success story.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. 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.

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.