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.

http://www.nlm.nih.gov/medlineplus/ency/article/000714.htm

http://www.neillneill.com/alcoholic-neuropathy

http://www.bettermedicine.com/article/alcoholic-neuropathy

http://www.learn-about-alcoholism.com/alcoholic-neuropathy.html

http://www.ajcn.org/content/9/4/398.full.pdf

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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:

Don't Ignore Your Patients Sleep History when Pain and Fatigue are Present

• 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.

http://ajrccm.atsjournals.org/content/159/1/213.full

http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics

http://www.sleeplessnomore.com/

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8145&news_iv_ctrl=1221

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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 http://neuropathydrprofessionals.com

http://www.medicinenet.com/neuropathic_pain/article.htm#tocd

http://pain.about.com/od/typesofchronicpain/a/neuropathic_causes.htm

http://www.neuropathy.org/site/PageServer?pagename=About_Symptoms

http://www.joslin.org/info/diabetic_neuorpathy_nerve_damage_an_update.html

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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 http://neuropathydrprofessionals.com

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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!”

Why?

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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