Neuropathy – Pins and Needles in your fingers and toes. Who knows?

Podcast Transcript

Music (Intro).

Speaker 1: 0:02

Well , bone connect , foot bone . Bone connect , heal bone . Heal bone connect ankle bone .

Speaker 2: 0:12
Hello, and welcome to the Bone and Joint Playbook with Dr. John s tips for pain-free aging. Dr. John S is a board certified orthopedic surgeon with over 35 years experience in the Dayton, Ohio area. He is also a clinical fellowship trained surgeon in total joint replacement from Harvard. Today’s topic is neuropathy and how to know you have it and what can be done. This episode is brought to you by Ted’s

Speaker 3: 0:37
Authentic Greek salad dressing and marinade. It’s healthy, gluten free , and delicious. You can find ted’s in Dayton, Ohio at Dorothy Lane Markets, health Foods Unlimited and Dots Markets. That’s Ted’s authentic Greek dressing and marinade. Thanks, Ted.

Speaker 4: 0:54
All right , folks, we’re back again. It’s , uh, start of summer 2023, and we’re here with Dr. John Hurst with the Bone and Joint Playbook. Hello, Dr. ERs .

Speaker 5: 1:04
Hi, Terry . How are you?

Speaker 4: 1:05
Good. I’m excited. You’re, tell me exactly what we’re gonna talk about today.

Speaker 5: 1:11
Well, today’s podcast is called Pins and Needles in your Fingers or Toes. Neuropathy, who knows? You’re

Speaker 4: 1:18
A poet, you know that.

Speaker 5: 1:20
Well, I’ll leave that up to other people, <laugh> , but if they all say it, it must be true.

Speaker 4: 1:24
All right , so , uh, again, we want to thank Ted Sal dressing for sponsoring this episode and Ted’s part of your family. Is that true? Just real quick background,

Speaker 5: 1:31
He’s my father-in-law. Ted is , uh, from Greece and he , uh, was in the restaurant business for years. Developed his own , um, salad dressing that he uses as a marinade and obviously , uh, puts on salads and it’s , uh, got all these great qualities, you knows , sugar free , gluten free , yeah , dairy free and preservative free . So it’s, it’s really healthy and it’s a great, great thing to marinade your , your chicken and, and meats or just put on your salads.

Speaker 4: 1:56
So, so , uh, you can get it locally here in Dayton, but I’m sure you can order online and things like that. Well,

Speaker 5: 2:01
The online is coming, Ted’s, again , with the nineties here and , uh, is gonna hopefully have , uh, online ordering available soon. Uh, it’s not quite here yet, so it’s a niche market right now, but , uh, we’re hoping it’s gonna go , uh, global soon. All

Speaker 4: 2:15
Right . So today we’re talking about neuropathy. And let me impress you with some of my craziness here. Neuro nerves, apathy disease. Correct. Is that, is that how it’s kind of put together?

Speaker 5: 2:25
That’s a good way to look at it. Patho means , uh, disease of, or a problem with the nerves, and that’s what we’re gonna talk about today.

Speaker 4: 2:32
So , uh, tell me about how many people have this, this problem.

Speaker 5: 2:36
Well, a lot of people have it , uh, and you’ll see some of the, the , the reasons people get it are due to some , uh, illnesses they may have. And it may be a complication or a , um, uh, a side effect of some of the medications they take. We’ll talk about medicines, illnesses that can lead to interrupt these . But also, there’s 3 million new cases diagnosed in the United States every year.

Speaker 4: 2:57
Every year. So once you get it, you have it and there’s no going back.

Speaker 5: 3:00
Well, that’s not true because we’ll find out that there’s some types that are called compressive neuropathy , and everybody’s heard of carpal tunnel syndrome, and that could be a simple compression of one of your , uh, wrist nerves called the carpal , uh, tunnel nerve. It’s the median nerve, and as it goes through a little tunnel in the wrist, it can be , um, compressed or irritated. Sometimes we look at that as , uh, somebody who’s doing repetitive , uh, duty activities at work. Perhaps you’re using a jackhammer, you’re using a hammer, perhaps you’re using your mouse on your computer , uh, all day, all night, and doing , uh, repetitive positioning of that wrist to put the nerve in an unhappy position. Pregnant women can get it with fluid gain that they get, and anything that crowds the nerve in that little canal, whether it’s fluid or inflammation, or some people have, we’ve talked about rheumatoid arthritis or they get inflammation of the lining of some of the tendons and some of the joints. Anything that crowds out a nerve or compresses it can lead to symptoms of a nerve problem or what we call neuropathy. So

Speaker 4: 4:03
What is it , tell us, explain in simple terms what a nerve is. What does it do?

Speaker 5: 4:07
Well, that’s a great question because nerves are real important for us. They do two things. They give us feeling and they give us the ability to move muscles, which help us move around and use our bodies. Um, the, the part of a nerve that gives you feeling is called the sensory portion. And the ability for you to , uh, feel that a teapot is hot and not burn yourself is due to the feeling you get in your fingers. And the , uh, ability of a , um, a nerve to give you , uh, sensitivity to know you’re stepping on a small pebble in your foot is also due to these , uh, what are called tactile sensors that some nerves carry and give feedback to the brain to say, Hey, you’re stepping on a jagged rock. You don’t want to cut your foot. Conversely, we’re gonna talk later about people who have neuropathy or numbness in their feet, and people have had this in multiple , uh, parts of the foot that’s called a polyneuropathy, where more than one nerve is involved. Uh , we talked about a single nerve called a mono neuropathy, which is like carpal tunnel, where a single nerve gets pinched in a place by compression. A poly neuropathy would be multiple nerves. So there are nerves that go to the outside of your foot, the top of your foot, different, different places that cover it. Much like a sprinkler system covers your backyard. So if, if a poly neuropathy of your foot occurs, say from diabetes or some other illness, you may lose that feeling on the bottom of your foot. All of a sudden you step on a , a sewing needle, you don’t even know it’s in your foot. All of a sudden you then realize it’s red, it gets infected. You could lead to, you know, you know, part of your , uh, foot need surgery or having a , a much more serious problem because you’ve lost that protective sensation or feeling in the bottom of your foot. So nerves are important for a lot of things we do in everyday activities, but they’re also important to treat, to avoid things that could be complications as, as a nerve problem progresses. So,

Speaker 4: 6:04
Which, which of these nerves are we talking about in typical for neuropathy?

Speaker 5: 6:08
Well, there’s, there’s , uh, it’s typically the, what’s called the peripheral nerve sy nervous system. And peripheral nerves mean the part that go to your arms and legs. There’s a central nervous system that involves your brain and spinal cord. And even though some of those nerves from the spinal cord, we talked about pinched nerves of the low back and neck and a previous podcast, those nerves do go, go down the leg or down the arm and give you feeling or make, you know , certain muscles move. So a pinched nerve can give you this numb tingling in your fingers , um, or toes , uh, much like a , a nerve compression can, or much like a complication of diabetes, or we’ll talk about some other , uh, causes of things that cause this peripheral neuropathy. And the neuropathy is just a , a general term that you started the , the podcast with. That just means the nerve’s unhappy.

Speaker 4: 7:00
So, real quick , uh, cuz I’m a layman, right? As a neurologist, somebody who deals in nerve disease, is that who you go to?

Speaker 5: 7:08
That’s correct. But again, I always

Speaker 4: 7:09
Thought they were brain. I thought these guys would brain

Speaker 5: 7:11
Well, no, they do that. Okay . But certainly they, again, they’re gonna , uh, a good, what’s called neurologic exam involves finding the problem, first of all. So we try to call it localizing the lesions. So if you’re, if you are walking , um, a little crooked and, you know , dizzy or unsteady, you could have , uh, a brain tumor. You could have , uh, a central nervous system in the brain or in the spinal cord, disecting your muscles. You might be walking funny cuz you have a needle in your foot. And you know, if you just look on the bottom of the heel, there’s a red area and a dark spot where the needle went in and you can’t feel that. So a neurologist or a good healthcare provider does a good physical exam, takes a history and puts everything together with their exam. They check your reflexes, they check your, what are called cranial nerves. Those are in the central nervous system. They move your eyes, make you smile, give you the ability to , um, you know, look from side to side with your eyes and , uh, uh, effect obviously smell and other what are called brain functions in the head. The cranium obviously is your head. So we’re talking now about , uh, more the nerves that are in the arms and legs. Sure. Those would be affecting muscle strength. So when you have difficulty lifting your arm, you may have a nerve problem, a pinched nerve going to the muscle that lifts your arm. But we also talked previously about rotator cuff tears. That’s a muscle tear. That’s just simply the , the muscle that attaches to your arm bone is detached. It’s like a rope that can’t lift an awning, and that’s not a nerve problem, that’s a muscle problem. So a a , a healthcare provider should examine the patient look and see, is this a weakness problem? Is this a nerve problem? Is this a, you know, a problem in the brain? Is this a problem in, you know, a certain part of the body that, that the physical exam helps us pinpoint. And getting back to your question , uh, a neurologist is the peak of the mountain on very excellent physical exams for nerve problems. Got it. Because they’re looking for things in your brain, things that could be neurologic issues like Parkinson’s or , um, Lou Gehrig’s disease or , uh, a tumor or some other problem that’s very important to treat. But also by saying, Hey, we can do some tests on the arms and legs. We call them EMGs or Electrograms. They help pinpoint where a nerve problem is and tell us how bad it may be.

Speaker 4: 9:34
So what , what are some of the signs of how somebody who has neuropathy?

Speaker 5: 9:39
Well, in , in the title you saw pins and needles. Yep . But obviously the other things would be numbness, it’d be tingling, it can be burning, it can be a stabbing sharp pain. Is

Speaker 4: 9:48
This ongoing all day long or is this just random every now and then? Well,

Speaker 5: 9:52
They usually are fairly consistent. And again , um, you know, if , if we’ve all had our hands outside , uh, in the cold, for instance, and you’re throwing snowballs without gloves on, your hands get really cold and you come in to rewarm ’em and then they start burning and tingling as they somewhat wake up, I guess, right. As we rewarm them. Um, those feelings are temporary in that case because it was just a , a temperature change. But if you, if you could think about having damage to the end of the nerves from the complications of diabetes, which are usually due to p sugar control or from the , uh, complications of some medications. There are certain chemo agents. We get patients with cancer that are particularly , um, uh, associated with , um, painful nerve feelings. And that that’s, I always give you one long doctor name in a podcast, but a dysesthesia would be a painful feeling. And , uh, it , in other words, a burning, stabbing discomfort in the nerves. Those are very uncomfortable. And sometimes the medications have to be cut back or changed if you’re treating a , a tumor that’s sensitive to that drug. But the drug has more side effects that, that the patient can’t tolerate. Is

Speaker 4: 11:05
There, is there an age that just usually sets in or is there a type of person that’s usually hits more than than others?

Speaker 5: 11:12
No, it’s not. It’s not so much that it’s the, it’s the , um, unfortunately for, for most people, they, they aren’t gonna remember my p monic. But mine monic for peripheral neurosis is called cascade ’em up. And the first letter stands for a, a problem that can lead to a neuropathy. So the C could be, some of the cancers have a, what’s called a paraneoplastic syndrome, where an associated nerve problem develops, but it’s from the cancer. There’s a for alcoholism. So people that drink a lot can get damage to their nerves. We talked about , um, um, what are called autoimmune diseases or rheumatologic diseases, lupus things like , um, um, things where the body’s own cells are attacking the body. Um, there are , uh, other names for that called collagen vascular diseases that lab work or , uh, a good physician or a healthcare provider can diagnose with certain tests. Um, we talked about diabetes and diabetes is probably the most common cause of a neuropathy that we see. And there’s two kinds of nerves that we’re gonna talk about with diabetes, not just the ones that are called peripheral nerves in the arms and legs, but there’s also a , another type of nervous system called the autonomic nervous system. And that regulates what’s called a fight or flight response, which means when you hear footsteps in a park behind you, your your body starts turning on a autonomic , uh, nervous system response. You’re either gonna have to run real fast or turn around and fight somebody called fight or flight. And when it does that, these nerves help with blood flow to certain parts of the body. You know, you don’t need to digest food at that point. You need to get ready to get your muscles ready, get blood flow to your brain, your eyes get a little more open, you get ready as a , uh, a person who’s evolved from , um, trying to stay alive in a situation like that. Sure. So when those nerves get outta kilter, they affect the bowel. They can affect the bladder, they can affect your GI tract. Obviously with , uh, some of the diabetes complications where the stomach doesn’t empty very well. Um, there’s other things , um, where people faint or get lightheaded when they stand up too fast. And there are little nerves that regulate the blood flow in the vessels to the, to the neck and brain that therefore , um, you have to be careful if you have this neuropathy that you don’t stand up and you get lightheaded and faint, then you fall hit your head and then you have a , a bleed in your head. So those things have to do with things called postural hypotension, where the posture change doesn’t allow the blood flow to get up to the brain in time. And the nerves normally would regulate how a vessel responds to position changes. Um, so that getting in the weeds too much with that, the , um, diabetics get more of those, what are called autonomic problems. And it all goes back to more , uh, blood glucose control. So people that are diabetic need to know what their A1C is, which is a , which is a three month report card called your hemoglobin a1c. And if that number’s under seven, your diabetes is in good control, your complications of diabetes, things like neuropathy, right. Eye problems, kidney problems, heart problems all go down. And this is, this is the neuropathy portion of one of the complications of diabetes, which is probably the most common thing healthcare providers see in the form of , uh, causes of neuropathy. But we did talk about some other things. Uh, one of the ease in my pneumonic is , uh, endocrine. So low thyroid levels , um, can also lead to neuropathy. Um, there are things that affect the , um, the kidneys , uh, more , uh, esoteric things that you don’t need to worry about on a podcast. So again, most of the things are things a good , uh, physical exam may help diagnose or simple lab testing. We talked about an emg, which is a nerve test Sure. That your , uh, provider may ask for. It’s not fun,

Speaker 4: 15:10
By the way. I did not enjoy it.

Speaker 5: 15:11
Right. There’s three things though that an EMG does. It tells you, number one, is there a nerve problem, yes or no, right ? I’ve got this shooting pain down my leg. Is it a bone problem, is it a muscle problem or is it a nerve problem? If the EMG is abnormal, it’s checking what’s called conduction of a nerve, electrical velocity. And I tell people it’s much like the phone lines between your house and grandma’s. And if birds are like chewing on the line between two telephone poles, you know, a good, a good lineman will say, here’s your problem right here. Right. So the MG says, is there a problem, number one? Number two, where’s the problem? Is it in my back, my leg, or my foot? Um, and three, how bad is it? Is it mild, moderate, or severe? So even though the test is uncomfortable, cuz it has to kind of, it’s like a little tiny shock. Yeah. They’re, they’re, they’re like your , um, electrician coming to the house trying to check your , uh, outlet, trying to wonder why your toaster doesn’t work. So, you know, if you’re dealing with electricity, you’re gonna get some , uh, shocking outcomes.

Speaker 4: 16:10
Uh , so tell us a little bit about the treatments. I know we’ve, we’ve spent some time now talking about what it is, how it affects you, but what are the treatments that you might see out there?

Speaker 5: 16:20
Well, the, you know, in in , in the world of medicine we always say may you never know what you prevent <laugh> . So in, in people that are using , um, um, perhaps a , a mouse and they’re working at their desk all day and their fingers go numb. The position your arm and hand are in may be affecting that carpal tunnel nerve. You may wanna get a little wrist splint that has side stays in it to keep the wrist from bending. That’s why some people with carpal tunnel symptoms have numb and tingling at night. They wake up, they squeeze their hands or they shake ’em a lot. And what they’re doing is doing two things. One is they’re milking fluid out of the hand, which reduces the fluid in the carpal tunnel. Right ? We talked about how pregnant women or fluid excess states may lead to , um, crowding of that nerve in the tunnel. But the other thing you do when we sleep, we don’t know what our wrists and arms are doing. And if you bend the wrist , um, down , uh, you’re kinking the nerve, much like people who sleep with their elbow bent can get a funny bone nerve entrapment, right. Called a tardy nerve. And then their little finger goes to sleep with that. So at night you can literally get a little splint that holds the elbow straight or you can go to your sports store and get a , a knee pad and put it on the front of your elbow so that it doesn’t bend when you’re asleep, which makes your, your ulnar nerve, which is your funny bone nerve , uh, happier during sleep. So that’s a preventative measure. Um,

Speaker 4: 17:48
So are there medications that are on the market that help people? What , what are the top three medications you might prescribe for

Speaker 5: 17:53
This ? Well, the, the simplest thing we, we try to start with are some vitamin replacements. There are certain B vitamins, B one , B6 and b12. Number one, if they’re deficient levels of those, they can cause the neuropathy to manifest itself. So we talked about drugs that cause it, there are deficiencies of certain vitamins and vitamins help help with um, uh, some of the things our cells do to perform their function. So , uh, you know, we’ve heard of people that are sailors with vitamin C deficiency getting scurvy or people with vitamin D getting bone issues. That’s why vitamin D is helpful for prevention of osteoporosis in , in the neuropathy world replacement with B one , which is thiamin , b6, which is um, uh, perine and then B12 is uhs , uh, coba , uh, just call it b12, it’s a lot easier <laugh> . And uh , and then uh , what you can do is just take a few of those supplements, those help. But there are regular medications. Also. Your Dr. May prescribe what’s called gabapentin, which is a , a , a medicine with a trade name called Neurontin. That’s the simplest thing to start with because it helps nerve pain exclusively. Um, and if your pain down your leg goes away taking gabapentin, most of the time you would have indirect evidence that may be a nerve problem. Right. And it’s side effect is mostly drowsiness. So we usually start people on a low dose three times a day between 103 hundred milligrams. And then those are prescribed by your physician to make sure they don’t interact with other medicines. If they make you tired, they’re actually better to take sometimes at night cuz they help you sleep better and sometimes you , that’s what I do. That’s right . Double up on your meds at night. And worse thing you do is have a better night’s sleep. Uh , there isn’t more expensive medication called Lyrica, another nerve medicine insurances don’t always pay for that. But if you have a problem with the gabapentin, usually they’ll cover the second , uh, nerve medicine. So it’s really not something you want to use narcotics for. Uh , certainly some people will do their local anti-inflammatories. We talked about things like Advil and Aleve and things that are what are called anti-inflammatories, but in the long run they have a lot of side effects. So sure . In our podcast on safe alternatives, we know things like curcumin, boswellia , some of the herbal remedies are, are useful. Fish oils are really helpful for some , what’s it called? Termin ? Termin ? Uh , well turmeric and turmeric curcumin both come from the curry plant. And we talked about turmeric being a little harder to absorb from the GI tract. So only about 3% of turmeric gets taken up by the gut. Um, so it doesn’t really, it’s not that useful to you. Curcumin is a more active form. And then we talked about adding black pepper extract to curcumin, which increases uptake by like 2000%. So wow, you can get , uh, a lot of that information from the podcast on safe alternatives with doses and , uh, a lot of that information. And your healthcare providers , uh, or health health store owners probably know a little bit about some of the safe alternatives. So

Speaker 4: 20:55
How , how , how about , we talked briefly before we started this podcast about the right fitting shoes are are things that help you, you know, mitigate the , the pain or help relieve the pain?

Speaker 5: 21:07
Well that’s a great question Terry , cuz especially in diabetics who have problems with feeling in their foot, we talked about if they would step on something sharp and get a cut, they may not feel it. Well the same thing happens with a new pair of shoes. When you and I put on a pair and we think these are great and we wear ’em for a little bit, if if it’s rubbing on the outside of our foot, we just take ’em off. If you can’t feel that right, you may end up with a red area that then gets a breakdown area called an ulcer that may lead to , uh, an infection or redness , uh, or drainage and deeper problems into the bones so you can have a whole , um, set of complications occur. So I recommend any diabetic who gets a new pair of shoes, only wear ’em for a short period of time, make sure they’re wide enough. Um , all our feet

Speaker 4: 21:54
Pretty flatten

Speaker 5: 21:54
A little bit as we get older. I always tell people, if you’re a size nine shoe, you may be a nine and a half as you get older. So get shoes that have plenty of room and then just wear ’em for a short period of time and look at your feet when you take your socks off and make sure there’s no red areas. And if you’re a , a provider for somebody who’s maybe got some dementia or they have some diabetes issues, you can look at their, you can look at their feet , uh, after they get their shoes to be sure they don’t have something starting , uh, before it gets to be a problem. That’s a a , a bigger issue.

Speaker 4: 22:25
So , uh, we talked briefly about all these different topics. So what , what are the complications if this goes untreated?

Speaker 5: 22:32
Well again, the complications we see are that you can burn yourself. If you, if you’re not , um, let’s say you’ve got numbness in your fingers and you have like a severe carpal tunnel problem, the tips of your fingers may not let you tell that that teapots hot or even the bath water’s hot. So we always recommend putting the tip of your elbow in the water first, much like you do before a baby gets in, right? You always check the water so you wanna avoid a burn or, or doing something that , uh, a normal sensation in a finger or or toe would know. Um , we also wanna avoid , uh, we talked about, you know, stepping on something sharp or getting a , uh, a compression problem. And again, we talk about the nerve giving feeling, but if a nerve then gets , uh, affecting the , the movement part called the motor part of a nerve, now you’ve got a foot drop or you have a inability to lift your, your your hip up or you can’t straighten your elbow, or there’s a function now that you’ve lost. And, and that can be, as we said, a pinched nerve in your spine. It could be coming from your neck or low back. It could be uh , uh, there could be a tumor, neuro tumors of nerves that occur in the arms or legs and they can push on the nerve and give you the symptoms. And it’s literally a growth in the tumors. There are things called neuros, just like there’s , uh, tumors of muscle or fat or bone. So any, any, any time cells go , um, into a multiplication or replication process that’s outta control. That’s what happens with, with cancers. Now, they don’t have to even be all malignant either. There are benign tumors that are , um, tumors of a tendon sheath or of a , of a nerve. And they’re , some neuros are not cancers, but they are , uh, enlargements of , uh, the tissue around a nerve. So again, sometimes you can tap on that nerve, you get a little tingle sign. They call it a tenal sign. Um, so again, a good physical exam, seeing your doctor after symptoms aren’t getting better or lung you should a family doc, right? Sure. Or your healthcare provider, whoever that is. And a lot of us people see what are called physician extenders. Now your physician assistant nurse practitioner, your , um, uh, PAs, your , uh, chiropractors, they’re all these people are frontline healthcare providers. And , uh, they will sometimes get the ball rolling or start with simple things. And if those aren’t improving , um, I always tell my patients, if you’re not seeing an improvement with what you’re doing, you need to see somebody else and get another opinion or find somebody else. As you said, a neurologist, a specialist who does, maybe if it’s a hand problem, go see a hand surgeon , uh, go go where uh , you can get the answers to uh, your problem. So is

Speaker 4: 25:20
There anything I haven’t asked you about neuropathy? Have we co because we covered a, a large wide area in a very short period of time.

Speaker 5: 25:27
Yeah, I would just say that there are times certainly where surgery will solve a problem. Also, there’s a , we talked about carpal tunnel and um , you know , there are , there are ways to take the pressure off the carpal tunnel nerve, especially when the nerve is, is is , I call it unhappy. You’re starting to get muscle weakness in the thumb. Yep . The nerve is very compressed. I tell people nerves are a lot like , um, electric wires. They have a , like a black coating on the outside. If you’ve lost the black coating, you’ve got nerve damage. And so when you take the pressure off that nerve, it can still take four to six months to get all the numbness outta your fingers. I just tell people when you cross your legs in a movie and fall asleep, cuz it’s a lousy movie you make up , may wake up with your foot asleep and it doesn’t wake up right away. Well that’s cuz it’s been compressed for an hour. Right, right. Well if you can imagine a nerve that’s been compressed for months, it’s losing its function. So there are times where we’ll recommend surgery like a carpal tunnel release that can be done with a small incision in the palm. There are doctors , uh, who are doing it even in, in my group in oa doctors.com who can do that through a scope. It’s called an endoscopic carpal tunnel release where the recovery’s quicker. Sometimes you can even do both hands at the same time. Uh , there is a thing in the foot called tarsal tunnel, which is a foot purple tunnel entrapment of a nerve behind the inside of your ankle. Um, and there are times, as , as you know, we talked about pinched nerves to the back where that nerve is going down your leg and you now have a foot drop . You not only have numbness, but now you can’t lift your foot an ankle up and down. Well that nerve is pretty unhappy. And you know, if a , we talked about a , if a spine surgeon sees your MRI or CAT scan, your back matches your clinical symptoms. So if you have a, you know, if you have a pinched nerve on the left and a right foot problem, those don’t match. But

Speaker 4: 27:16
It’s , it can repair itself, right?

Speaker 5: 27:18
Yeah, it can regenerate. And nerve regeneration occurs slowly though. It’s about an inch a month. Right. So if , if you said, well how fast is that numb , it’s gonna come back, well from your wrist to your fingertips, you can use the, the middle portion of your finger as a , about an inch barometer for that. And it’s gonna take maybe six months to get to the tips of the fingers. Well,

Speaker 4: 27:39
When I , when I had my neck injury right, they , they said it was gonna take a long time. Cause I have stick with my fingers,

Speaker 5: 27:44
Think how far that had to go.

Speaker 4: 27:46
Now I still have issues and they say that’s it. It’s , it’s as good as it’s going to

Speaker 5: 27:49
Get. Yeah. Usually after about a year and a half, your nerve issues are, they’re harder to resolve the further away they are from where the nerve right comes from. And they usually, they come from our spinal cord. So , um, you know, it’s just like that, that far piece of grass that the sprinklers aren’t quite hitting. Right. <laugh>. So, you know , further you are from the, from the, from the hose. Um , um, at the , at the , at the house there , the, the , the more difficult it is to get the flowers happy.

Speaker 4: 28:16
All right , so we’re gonna wrap this one up cuz we kind of hit our heard , hit our , hit our mark here. So I want to thank you for telling us all about neuropathy cuz this is one of those conditions that I do have issues with, with my hands from my neck issue. Uh, and it sounds like there’s all kinds of interesting ways to approach this from a doctor point of view. I do have one final question for you though. Do you ever get offended when somebody says, look, it’s not brain surgery. You know, they’re not going, Hey, it’s not knee, knee replacement surgery doc. Do you ever get offended by the fact they’re always referring to brain surgery as like the peak?

Speaker 5: 28:50
No, because you , if you knew what brain surgery’s like, you’d never wanna do it. <laugh> . Um, so it’s , um, you know, there are things in medicine that are extremely complicated and there are some simple things. And you know, again, I think most of the things neurosis are they , they can be simple, but they can be a real nuisance for people too. And Sure. And so, you know, again, trying to , uh, recognize ’em early, treat them as soon as you can or find the underlying problem again, most of the things in medicine , um, are there for a reason. And, you know, everybody sees the , you know, the flowers are wilting, but it could be a lot of reasons. Right. It could be, you know, your sprinkler line’s broken, you didn’t pay your water bill. Right. You’ve gotta figure out the reason. And that’s , uh, I’ll leave you with Occam’s razor for that

Speaker 4: 29:34
<laugh> .

Speaker 5: 29:34
We’ll talk about William of Aham at a later podcast. All right .

Speaker 4: 29:37
Well, Dr . Er , I wanna thank you again for this great conversational on neuropathy. This has been The Bone and Joint Playbook book with Dr. John. I see you again

Speaker 1: 29:47
Connect .

Speaker 6: 29:50
Thank you for joining us today on this episode of The Bone and Joint Playbook with Dr. John u . Tips for pain-free aging. Please join us again for another episode produced by Terry O’Brien .