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  #1  
Old 08-03-2009, 03:10 PM
JimOfAllTrades JimOfAllTrades is offline
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Massage as therapy for Diabetic Neuropathy

This is not a request for medical advice, I'm under the care of a doctor, and in fact have a regular appointment in a couple of days where I'll ask this same question. But I would like to know if any one else has experience or knowledge in this area so I can be as prepared as possible for the doc.

Short question:
Can a leg and foot massage temporarily alleviate the numbness in the feet associated with Peripheral Neuropathy?

Longer explanation:
I have Peripheral Neuropathy (being treated with neurontin daily) and high blood sugar (being treated with both glucosamine and glipizide daily). My understanding is that the neuropathy is almost certainly a side effect of the high blood sugar, which causes problems with the nerves and reduces blood flow.

The neurontin seems to have stopped most of the tingling and stabbing pains, and I don't think the neuropathy is spreading. But my feet still feel numb and kind of swollen (although they are not swollen) pretty much all the time now.

Last week I had occasion to have a full body "deep tissue" massage. The first time I've ever had any sort of professional massage. In the process, naturally, they massaged my legs and feet.

Over the next day or so it seems to me that the numbness in my feet was somewhat less. This is hard to gauge on a one time event because the symptoms are never constant, there are always good days and bad. But if part of the cause of the neuropathy is decreased blood flow, I can see how a massage might help.

So that brings me back to the question: Is there any solid evidence that leg and foot massage can help alleviate the numbness in the feet associated with Peripheral Neuropathy? Or am I just seeing the placebo effect and wishful thinking?

Bonus follow up question: If massage can help, do I really need to pay someone $40 a pop, or could I (or my wife) just thoroughly massage my lower legs and feet on a regular basis? What the masseuse did on my lower legs and feet didn't seem terribly complicated or precise. Although that applies to everything I have no knowledge about.

Bonus follow up to the bonus question: As my blood sugar comes down long term (and it is already way down from where I started) can I expect some permanent alleviation of the symptoms from that?
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Old 08-03-2009, 09:07 PM
KarlGauss KarlGauss is online now
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Hmmm. Interesting questions.

I'm not aware of any "solid" evidence that a massage can ameliorate the symptoms of diabetic peripheral neuropathy. I suppose that if a person was having pain from the neuropathy, it's conceivable that the massage might act as "gating*" and thereby reduce the discomfort. Still, that would only give relief during and perhaps shortly after the massage.

As you've alluded, a massage is more likely to promote increased blood flow. So, if some of the symptoms were actually due to ischemia (inadequate blood flow) and not neuropathy, the massage could help. In fact, things like numbness and pain can definitely be a result of ischemia.

I doubt that there's anything special about the massage a pro gives to your feet compared to what you, your wife, or anyone else can do. A rub is a rub (IMHO).

There is fair evidence that improved glucose control will lead to improvement in the symptoms of diabetic neuropathy. But, it doesn't happen quickly so try to be patient. And, to be candid, the literature in that regard generally shows that the improvement is not dramatic in most cases. Still, some people do get major benefit although it's not that common.

In the meantime, stop smoking (if you do). That has been shown to help neuropathy (and, of course, the circulation, too). Make sure your cholesterol and BP are being assessed, monitored, and treated as needed. All too often, people with diabetes overemphasize the importance of sugar control. In truth, addressing the other risk factors (as above) is probably even more important.

Good luck!

Karl Gauss (MD, FRCPC)

*if you don't know what I mean by "gating", let me know and I'll elaborate.
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Old 08-04-2009, 01:14 AM
JimOfAllTrades JimOfAllTrades is offline
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Quote:
Originally Posted by KarlGauss View Post
Hmmm. Interesting questions.

I'm not aware of any "solid" evidence that a massage can ameliorate the symptoms of diabetic peripheral neuropathy. I suppose that if a person was having pain from the neuropathy, it's conceivable that the massage might act as "gating*" and thereby reduce the discomfort. Still, that would only give relief during and perhaps shortly after the massage.
(snip)
In the meantime, stop smoking (if you do). That has been shown to help neuropathy (and, of course, the circulation, too). Make sure your cholesterol and BP are being assessed, monitored, and treated as needed. All too often, people with diabetes overemphasize the importance of sugar control. In truth, addressing the other risk factors (as above) is probably even more important.

Good luck!

Karl Gauss (MD, FRCPC)

*if you don't know what I mean by "gating", let me know and I'll elaborate.
Karl, thanks for the information.

I haven't heard the term gating (outside of electronics) so I would like to hear about it when you have the time.

I think we'll try some more massage, just to see if it does seem to give relief. Can't hurt, I suppose.

One thing I haven't been able to get straight is about the cause of the symptoms. Does the high blood sugar cause actual damage to the nerves, and is this the major cause of the symptoms? And what about the circulation? I understand this is why diabetics sometimes lose their feet, but is that caused by the nerve damage or something else?

I don't smoke, so that's a plus. I think my weight is the big negative factor for me that I can address. I'm about 6' and 275 lbs.

The doctor has been keeping track of my cholesterol and BP. The cholesterol is high, but also coming down. She says that since it is coming down as I change my diet and lose a little weight she doesn't want to start meds for it yet until we see where it lands. Basically the same with the BP, which is a little high, usually runs about 135/85.

So I'm hoping that I can lose at least 50 more pounds, and get down to 220 range, and maybe even down to 200.

And I really hope that losing the weight, along with getting the other stuff under control, will get me some additional alleviation of the symptoms. I'm only 53 (53? My god, how did that happen to me?) and the thought of 20 years or more with my feet numb and tingly is kind of depressing. And the thing that really terrifies me is it spreading to my hands.
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Old 08-04-2009, 11:12 AM
mswas mswas is offline
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The only real way that a massage can help a neuropathy is by forcing blood into the area. I worked on a neuropathy in the foot and ankle once on a client and it was one of the most challenging experiences I've had.

Really what any massage therapist will do is try and force blood flow through the area.

Karl Gauss is wrong that 'a rub is a rub'. Couldn't be further from the truth. Some lay people have a natural talent for touch, but there is no substitute for practiced technique and a knowledge of anatomy.

If you are working with a professional I hope they are in some sort of contact with your Doctor, at the very least a note from your Doctor.
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Old 08-04-2009, 02:11 PM
JimOfAllTrades JimOfAllTrades is offline
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Originally Posted by mswas View Post
The only real way that a massage can help a neuropathy is by forcing blood into the area. I worked on a neuropathy in the foot and ankle once on a client and it was one of the most challenging experiences I've had.
But does this actually cause any "healing" of the problem, or is it just temporary alleviation of the symptoms? Not that I'm against temporary alleviation, at this point I'll take what I can get.

But that highlights my confusion. Is the blood flow somehow restricted by the damage to the nerves, or is the damage to the nerves caused by the restricted blood flow? Of course, either way the restricted blood flow has it own problems with increased chance of gangrene and stuff like that.

But if blood flow is also causing (or partly causing) the nerve damage, then it seems to me that increasing the blood flow by whatever means could actually be more than treating the symptoms.

The person who did my massage spent half of the hour lecturing me on how much regular massages cold help my diabetes. But given her several other "woo-woo" type statements and her obvious motivation to gain a client, I'm not inclined to trust her opinion.

Quote:
Originally Posted by mswas View Post
Really what any massage therapist will do is try and force blood flow through the area.

Karl Gauss is wrong that 'a rub is a rub'. Couldn't be further from the truth. Some lay people have a natural talent for touch, but there is no substitute for practiced technique and a knowledge of anatomy.

If you are working with a professional I hope they are in some sort of contact with your Doctor, at the very least a note from your Doctor.
I told the masseuse about my neuropathy, but did not give her any information about my doctor. When I see my doctor on Thursday, I'll fill her in on the massage and get her opinion of the whole thing.

But really, how much knowledge is needed to grab my leg at the knee with both hands, pull down while squeezing, rub my feet all over, lather, rinse, repeat. This seems like all that was done. I mean no offense, I just don't see any real skill set involved for this specific thing.

And are there any peer reviewed double blind studies of the efficacy of professional massage in this area as compared to non-professional massage?
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Old 08-04-2009, 07:33 PM
KarlGauss KarlGauss is online now
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Hey there, RJKUgly. Here's just a bit about so-called "gating".

It may be easiest to illustrate with a classic example. Have you ever seen someone shake their hand quite violently after hitting their thumb with a hammer? You may have done so yourself. That is an example of gating. The idea is that by sending a competing stimulus or signal down the nerves to the spinal cord (i.e. the sensation of your hand shaking), you can overwhelm or drown out the original painful signal.

This short Wiki article may be of interest. The bottom line is the second sentence of the article, i.e. "The theory asserts that activation of nerves that do not transmit pain signals can interfere with signals from pain fibers and inhibit an individual's perception of pain.".

In your case, I wondered whether the sensations induced by the massage may have "drowned out" the painful sensation coming in from the neuropathy.

BTW, as I understand it, the actual site of the inhibition of the painful signal by the second non-painful signal occurs in the spinal cord (not the nerves). This effect can be mimicked by certain drugs which stimulate the same areas of the spinal cord even in the absence of incoming signals. Drugs such as amitrypytlline (Elavil) are the prototypes of this phenomenon and can be, and are, therefore, used as pain relievers (especially for chronic pain).

Last edited by KarlGauss; 08-04-2009 at 07:35 PM..
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Old 08-04-2009, 07:49 PM
mswas mswas is offline
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Originally Posted by RJKUgly View Post
But does this actually cause any "healing" of the problem, or is it just temporary alleviation of the symptoms? Not that I'm against temporary alleviation, at this point I'll take what I can get.
Yes it can result in permanent healing of the problem. In fact the permanent healing of it is more likely than actual temporary relief. In my experience with my one client who had this problem the temporary relief lasted a couple of days. She didn't stick with the treatment out of frustration and exasperation. It's by no means a cure-all but long term it will help because the nutrients in the blood will help replenish the nerve. Repairing nerve damage is difficult as I understand it though.



Quote:
But that highlights my confusion. Is the blood flow somehow restricted by the damage to the nerves, or is the damage to the nerves caused by the restricted blood flow? Of course, either way the restricted blood flow has it own problems with increased chance of gangrene and stuff like that.
Just to be clear, I am not a Doctor and I am speaking from within the limits of my knowledge.

But basically blood helps rebuild damaged tissue, and in my limited experience neuropathy is accompanied by a reduction in blood flow.

Quote:
But if blood flow is also causing (or partly causing) the nerve damage, then it seems to me that increasing the blood flow by whatever means could actually be more than treating the symptoms.
I think it's actually the other way around, or both aspects contribute to the problem. I am not sure what the cause is with diabetes, Karl gave you a better answer than I could regarding that. But I think the nerve damage results in lesser innervation of the arteries and contributes to the lack of blood flow.

And again, limits of knowledge but I think that stimulating the nerves helps them to repair, so massage might help somewhat in that regard.

Quote:
The person who did my massage spent half of the hour lecturing me on how much regular massages cold help my diabetes. But given her several other "woo-woo" type statements and her obvious motivation to gain a client, I'm not inclined to trust her opinion.
Yeah, I would take that with a grain of salt too.

Quote:
I told the masseuse about my neuropathy, but did not give her any information about my doctor. When I see my doctor on Thursday, I'll fill her in on the massage and get her opinion of the whole thing.
A massage therapist should not be touching the area with the neuropathy AT ALL without a Doctor's consent.

Quote:
But really, how much knowledge is needed to grab my leg at the knee with both hands, pull down while squeezing, rub my feet all over, lather, rinse, repeat. This seems like all that was done. I mean no offense, I just don't see any real skill set involved for this specific thing.
Heh, no offense at all, it's a common misconception. First off a massage therapist knows the muscles and should also know the nerve pathways. Also, massage therapy is an art, in that there are proper ways to do it. If you don't know how to give a massage it's harder to sustain it for a long period of time. I can give a massage for three hours straight because I know how to stand and I know the proper techniques, how to rest in between, the proper wrist positioning, the proper stance so I don't hurt my lower back, etc... I also know proper ranges of motion, the appropriate end feels on a joint so I can feel if something is wrong. I personally am quite good at finding trigger points and getting rid of them. A trigger point is when the fascia grows into the muscle and binds it up. Commonly referred to as a 'knot'. Ever had a knot and you tried to get someone to get it out and they just couldn't do it? Well a massage therapist has developed their sensitivity to that. Just like any other manual skill you can train your hands to manipulate soft tissue better than others, like you would expect a jewelry to have more nimble fingers than most people, a massage therapist should have more sensitive hands than most people. I am also trained to look at your posture. Is your neuropathy in both legs or just one? If it's in just one you are compensating by keeping your weight on the other leg and thus developing hypertonicity and possibly cramping in the other leg. Your gait is probably off so therefore you are likely getting pelvic tilt which can lead to Kyphosis, Lordosis or Scoliosis. Is your gait kind of shuffling?

Quote:
And are there any peer reviewed double blind studies of the efficacy of professional massage in this area as compared to non-professional massage?
I am not certain there are. Massage Therapy is unfortunately understudied because studies are underfunded. Unfortunately most of the studies I am coming across are related to HIV. Generally the studies would be regarding the efficacy of massage therapy. Massage Therapy in the medical profession isn't really considered something that needs to be studied versus a placebo, it's pretty much accepted that manual manipulation of myofascia has a medical benefit, so while some studies are done regarding lay people versus professionals most studies just utilize professionals and study the impact of massage on the particular pathology or whatever they are trying to study.

Here is a self-treatment book on the subject. http://www.triggerpointbook.com/neuropat.htm I am very fond of the Travell and Simons Trigger point work but unfortunately did not have the opportunity to take the continuing education on it yet.

Here is something from a Podiatrist's website.

http://drmarcspitz.com/blog/2009/04/...al-neuropathy/

Quote:
All there is no cure, many treatments can help relieve symptoms and slow down the progression of the condition. Neurontin®, Lyrica®and Cymbalta® are prescription medications used to ease neuropathic pain. These medications often have many associated side-effects. The most common ones being fatigue, forgetfulness, a feeling of “being in a fog,” dizziness, loss of concentration and weight gain. Certain vitamins and nutritional supplements such vitamin B complex, vitamin B12, folic acid, acetyl-l-carnitine and alpa-lipoic acid, are helpful in treating neuropathy. Topical medications such Nerve Health + Relief Cream, Neuragen, Nerve Health + Warming Cream, Biofreeze, Healthibetic and Sombra can temporarily relieve nerve pain. Many “hands-on” therapies are also effective in treating peripheral neuropathy including laser, infrared, massage therapy and electrical stimulation such as TENS.
Now, on this message board I couldn't convince you that a professional is better than a lay person, but if they are worth their salt, then they are. Obviously some people just have 'the touch' and can give a great massage, if your wife is one of those people, have at it. But a professional massage therapist should know precisely where the nerves are, know the muscles that surround the neuropathy and understand what other factors of aches and pains that the neuropathy contributes to in other parts of the body.

If you are going to just have your wife do it for whatever reason, I'd recommend getting a basic book on Swedish Massage. Light effleurage and petrissage would be your best bet. Effleurage is the long stroke motion that is meant to move the blood around and warm your skin for deeper work. Petrissage is a kneading motion meant to stimulate blood flow in a particular muscle working on a pumping motion a la milking a cow. There are several petrissage strokes. What I would warn against is your wife working for long periods of time as she can develop carpal tunnel syndrome if her form is bad. Not trying to scare you, this is just something that can happen over a prolongued period of repetitive stress.

A pro shouldn't be using their fingers really, they should be using their hands and transferring the motion from their hips into their arms. The hands and wrists should be pretty stable.
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Old 08-04-2009, 07:55 PM
GythaOgg GythaOgg is online now
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Quote:
Originally Posted by RJKUgly View Post
But does this actually cause any "healing" of the problem, or is it just temporary alleviation of the symptoms? Not that I'm against temporary alleviation, at this point I'll take what I can get.

But that highlights my confusion. Is the blood flow somehow restricted by the damage to the nerves, or is the damage to the nerves caused by the restricted blood flow? Of course, either way the restricted blood flow has it own problems with increased chance of gangrene and stuff like that.

But if blood flow is also causing (or partly causing) the nerve damage, then it seems to me that increasing the blood flow by whatever means could actually be more than treating the symptoms.
As I understand it, the neuropathic damage and the circulatory problems seen in diabetes are separate effects of high blood sugar and are not related to each other....one doesn't cause the other. High sugar levels in the blood over a prolonged period of time cause damage to the nerves and this is neuropathy; they also damage both the large and small blood vessels, leading to circulatory problems, heart disease, and retinal damage in the eye.

Treating diabetic neuropathy is very difficult, and it is not considered to be reversible - the goal is to prevent it from progressing further and to control the pain and discomfort. There are providers who swear by pulsatile insulin therapy, but this is highly, highly experimental and not usually paid for by insurance. The standard thinking is that once the nerve damage is done, it is done.

The problem presented by diabetic neuropathy in the feet is it can set off a chain effect - someone with neuropathy can't feel a sore or injury to their foot, which develops into something larger, is slow to heal due to poor circulation, and becomes infected due to elevated sugar levels. This process can snowball to some very bad places.

The best thing to do to prevent all this is to control blood glucose levels aggressively from the beginning and keep them controlled. All the studies have been very clear on this. Lower sugars = fewer complications. It's worth working hard on.
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Old 08-04-2009, 09:01 PM
mswas mswas is offline
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From what GythaOgg is saying it sounds to me like Massage Therapy really has very little to offer other than relief for secondary symptoms.
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Old 08-04-2009, 09:25 PM
GythaOgg GythaOgg is online now
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From what GythaOgg is saying it sounds to me like Massage Therapy really has very little to offer other than relief for secondary symptoms.
Hey, even some relief is worth going for. So long as the massage therapist and the doctor are aware of the situation and any precautions that need to be taken, it's not going to hurt. It may not improve the neuropathy long-term, but in general, people like and enjoy massages, particularly foot massages, and even if the break is short-term, that can still have a psychological benefit....as well as the other benefits provided by massages. It's just not going to improve the neuropathy.

(Stress has a LOT to do with blood sugar elevations in diabetes. So you get a stress-reducing benefit that helps control BG as well.)
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Old 08-04-2009, 09:44 PM
Liberal Liberal is offline
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My podiatrist prescribes Lyrica for mine. It works great for me. Seldom do I feel any pain, especially after a dosage increase.

I have lost 60 pounds so far, and have about as many to go to get to 200. But I have not been affected by the side effect of increased appetite. In fact, my appetite has decreased, and I'm much more active than I used to be. But I'm suspecting that the reason I have very little appetite is that I'm taking Tranxene for OCD and anxiety. It calms me down, similar to the way Quaaludes used to do back in the day. In my calm state, I just don't care to eat. Not sure why.

Perhaps Karl Gauss (or some other MD) could speak generally about Tranxene's effect on appetite?

Last edited by Liberal; 08-04-2009 at 09:45 PM..
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Old 08-04-2009, 09:50 PM
jackelope jackelope is offline
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I have no knowledge of Diabetic Neuropathy, but:
Quote:
Originally Posted by RJKUgly View Post
Bonus follow up question: If massage can help, do I really need to pay someone $40 a pop, or could I (or my wife) just thoroughly massage my lower legs and feet on a regular basis? What the masseuse did on my lower legs and feet didn't seem terribly complicated or precise. Although that applies to everything I have no knowledge about.
My girlfriend is a massage therapist, so I know a bit about this. Assuming your therapist is thoroughly trained and knowledgeable, she was doing a lot more than simply rubbing your legs and feet the way a layperson would. I was surprised to learn how much anatomical knowledge goes into getting a massage therapist's license; my GF actually dissected a human body as part of her training, in order to see first-hand how everything fits together. What seems like gentle, generic rubbing is probably carefully directed toward certain muscles and blood vessels, as well as timed and practically choreographed for maximum effect.

However, note that I said "if" she was thoroughly trained and knowledgeable. There's a wide disparity among schools and training programs for massage. Next time she's working on you, ask her what she's doing: what muscles she's working, what fascia she's trying to break up, that kind of thing. If she can easily rattle off the scientific names for things like "longissimus" and "sternoclavicular joint," I would think she probably knows what she's doing. However, like you, I would be majorly turned off by the woo-woo stuff and especially by the attempt to sell me more stuff. Don't be afraid to shop around for a therapist you like.

Good luck; I hope you're able to get your health under control.

(Oh, and by the way, the term "masseuse" is somewhat frowned upon these days, as it recalls the days when massage "parlors" were basically where you'd go to get a shoulder rub and a handjob.)
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Old 08-04-2009, 10:07 PM
KarlGauss KarlGauss is online now
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Originally Posted by mswas View Post
Yes it can result . . . (HUGE - SNIP) . . . should be pretty stable.
mswas: Nice post!
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Old 08-04-2009, 10:38 PM
KarlGauss KarlGauss is online now
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Just to clarify a bit, although neuropathy and impaired blood flow often co-exist in diabetes, they don't really cause one and other. But, they do cause problems which multiply each other's effects.

So, although neuropathy doesn't accelerate or increase poor circulation, and vice versa, the manifestations of the neuropathy make the poor circulation more dangerous, and vice versa.

Specifically, in the presence of neuropathy people may not feel pain and may therefore not be aware that they've, say, cut their foot. They keep walking on it causing the cut to go deeper and deeper. On the other hand, the poor circulation means that healing of the sore will be impaired. Likewise, in the absence of an adequate blood flow, infection is much more likely to develop. Unfortunately the net effect of this synergism is often deep, intractable infection. Amputation is then required.

In addition to making the feet insensitive to pain, neuropathy deranges the regulation and control of the dynamic mechanics of the foot. Normally, as a result of intact nerve function, the relationship of the bones, tendons, joints, etc., of the foot is adjusted from moment to moment to distribute pressure equally. In neuropathy, this may not occur, or may be faulty. The result can be inappropriate high pressure on parts of the foot and sole that were not designed for such a load. The result is often a deep sore (an ulcer). As explained above, infection is a common consequence (especially if the blood supply is impaired).

It's also the case that the sequence can be reversed. By that I mean that poor blood supply may be the primary problem and neuropathy secondary. Still, one can make the consequences of the other that much worse. For example, if there's poor blood supply, the skin grows thin and is readily damaged. Sometimes as a result of poor blood flow there can even be tiny areas of dead skin and muscle (and, of course, there can be massive areas of tissue death, as well). But even tiny areas of dead tissue are a potential breeding ground for infection. They may also serve as a focus, or center point, for further problems. If neuropathy happens to be present, for example, then, as noted above, the person may not feel pain. So, should they irritate that small area of dead or damaged tissue, they won't know to stop doing whatever's doing the irritating. The area of dead/damaged tissue grows. I'm sure you can see what can happen subsequently.

So, the bottom line is that it's most common in diabetes for neuropathy and poor blood supply to co-exist (each as a separate complication of the high blood sugar level characteristic of diabetes. Indeed, having one makes having the other more likely simply because if the sugar was high enough for long enough to cause one of the complications, it is likely to also cause the other). Although neuropathy doesn't aggravate poor blood flow, and poor blood flow doesn't cause neuropathy, each sets the person up for a synergistic set of problems that ultimately can lead to deep sores (ulcers), infection, and loss of the limb.

Finally, for honesty's sake, I should point out that one can have a foot ulcer strictly from neuropathy or exclusively from poor blood flow. Those things are less common, though, than having both factors present and contributing to the ulcer. I must also confess that despite my repeatedly saying that neuropathy doesn't cause poor blood flow, it may, in fact, have some effect. Not on the big arteries bringing the blood into the foot or leg, but to the so-called "micro-circulation" where nerve control may normally serve to divert blood to small areas of need, and/or away from areas that don't need as much (at that moment).

Sorry for my longwinded, redundancies-containing post. Sometimes I just can't help myself.
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Old 08-04-2009, 11:18 PM
JimOfAllTrades JimOfAllTrades is offline
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KarlGauss, thanks for the information on gating. I have done some of the things you talk about, including now I find myself occasionally stamping or rubbing my feet when the pain or burning is bad. I just never knew there was a name for it.

mswas Thank you very much for all that! I think I'm going to try a professional one or two more times, and if the relief seems to be consistent, then we'll get the book you recommended and try it ourselves to see how it compares.

Quote:
Originally Posted by GythaOgg View Post
As I understand it, the neuropathic damage and the circulatory problems seen in diabetes are separate effects of high blood sugar and are not related to each other....one doesn't cause the other. High sugar levels in the blood over a prolonged period of time cause damage to the nerves and this is neuropathy; they also damage both the large and small blood vessels, leading to circulatory problems, heart disease, and retinal damage in the eye.
That does help my understanding, thank you.

Quote:
Originally Posted by GythaOgg View Post
The problem presented by diabetic neuropathy in the feet is it can set off a chain effect - someone with neuropathy can't feel a sore or injury to their foot, which develops into something larger, is slow to heal due to poor circulation, and becomes infected due to elevated sugar levels. This process can snowball to some very bad places.

The best thing to do to prevent all this is to control blood glucose levels aggressively from the beginning and keep them controlled. All the studies have been very clear on this. Lower sugars = fewer complications. It's worth working hard on.
I've noticed that small cuts on my feet are taking much longer to heal than anywhere else. I scratched my ankle just enough to make it bleed and scab over on July 5th, and it took until about the end of the month before the scab fell off.

Quote:
Originally Posted by jackelope View Post
However, note that I said "if" she was thoroughly trained and knowledgeable. There's a wide disparity among schools and training programs for massage. Next time she's working on you, ask her what she's doing: what muscles she's working, what fascia she's trying to break up, that kind of thing. If she can easily rattle off the scientific names for things like "longissimus" and "sternoclavicular joint," I would think she probably knows what she's doing. However, like you, I would be majorly turned off by the woo-woo stuff and especially by the attempt to sell me more stuff. Don't be afraid to shop around for a therapist you like.

Good luck; I hope you're able to get your health under control.
Thanks! We will shop around, and I'm going to talk to some people I know about possibly going to a physical therapist as well. Try and suss out all the possibilities, I think.

Quote:
Originally Posted by jackelope View Post
(Oh, and by the way, the term "masseuse" is somewhat frowned upon these days, as it recalls the days when massage "parlors" were basically where you'd go to get a shoulder rub and a handjob.)
Sorry about that! What is the preferred nomenclature?
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Originally Posted by Liberal View Post
My podiatrist prescribes Lyrica for mine. It works great for me. Seldom do I feel any pain, especially after a dosage increase.

I have lost 60 pounds so far, and have about as many to go to get to 200.
If you don't mind my asking, did you do anything special to lose weight. I think for me it's the basic "eat less, eat better, exercise more". But I'm open for tips.

Quote:
Originally Posted by KarlGauss View Post
Just to clarify a bit, although neuropathy and impaired blood flow often co-exist in diabetes, they don't really cause one and other. But, they do cause problems which multiply each other's effects.
(snip)
So, the bottom line is that it's most common in diabetes for neuropathy and poor blood supply to co-exist (each as a separate complication of the high blood sugar level characteristic of diabetes. Indeed, having one makes having the other more likely simply because if the sugar was high enough for long enough to cause one of the complications, it is likely to also cause the other). Although neuropathy doesn't aggravate poor blood flow, and poor blood flow doesn't cause neuropathy, each sets the person up for a synergistic set of problems that ultimately can lead to deep sores (ulcers), infection, and loss of the limb.

Sorry for my longwinded, redundancies-containing post. Sometimes I just can't help myself.
Not long winded at all! Over the last few months as I've been dealing with this, I've been concentrating on medication and blood tests, and not on what was actually going on. And I've felt like an idiot. This is the kind of information I need, if only so I can talk more intelligently with my doctor.
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  #16  
Old 08-05-2009, 01:06 AM
Liberal Liberal is offline
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Originally Posted by RJKUgly View Post
If you don't mind my asking, did you do anything special to lose weight. I think for me it's the basic "eat less, eat better, exercise more". But I'm open for tips.
(Note: I think the proper term now is "message therapist".)

I did two out of the three: I eat less and exercise more. But I eat and drink the things I like. I just flat out decided that if I had to give up Pepsi and hamburgers, then I'd just as soon go on to my maker. My wife, however saw things differently.

To make a very long story short, she found an Internist, a graduate of Duke University, one of the nation's best med schools, who agreed to act as a sort of general contractor for me. I weighed in at his office. 316 pounds. That was then. This morning, I weighed 253.4 (on a Weight Watcher's digital scale).

Dr. W told me that he would treat my COPD, my high blood pressure, and my high sugar level; that he would send me to a podiatrist for my toe pain; that he would send me to a dermatologist for my leg sores; and that he would send me to a psychiatrist for my OCD, anxiety, and panic attacks.

He was brutally honest with me. He told me basically what a local GP had told me a few years back — that it's a miracle I'm alive. My blood pressure was through the roof. My sugar level was high. My lungs were severely congested. But he understood my plight. Exercise of any kind, just walking from one room to another was sometimes exhausting, and he understood that. And I ate like a pig.

The podiatrist was also very helpful, examining me thoroughly and diagnosing me with a peripheral neuropathy in my toe. (It felt like a yellow jacket was sitting on my toe with its stinger stuck inside me.) He prescribed Lyrica, and my pain has all but disappeared. (He also confirmed that I have good circulation in my feet.) The dermatologist diagnosed me with seborrheic dermatitis on my legs, and presribed a cream that worked like magic. The psychiatrist prescribed Tranxene for my OCD, and clonazepam for my panic attacks and a sleep aid.

That was all about three or four months ago.

For some reason, I just started not feeling hungry during the day. And I started doing simple chores around the house, like watering the hanging baskets, checking the roadside for trash and cigarette butts. Things like that. There was a lot of moving around and bending and reaching. It did exhaust me, and I did have to stop often for breaks. But I kept at it, and added new chores over time, like washing out the net in the koi pond.

I decided that the key to the food was the calories. I checked my Pepsi, and discovered it was only 150 calories. So I kept drinking it, but more like sipping it through the day. (After a morning of sipping coffee with cream and sugar ... I always have had to sip on something through the day.) Kool-Aide and tea (standard Southern sweet iced-tea) are fine, too. Now I'm drinking Pepsi Throwback, which is sweetened with sugar instead of high fructose corn syrup.

As far as eating, all I eat, really, is dinner with my wife. And I eat on one of those small dinner plates. Not the standard sized one. The small one that's bigger than a coffee saucer. I eat a little bit, but not much. I seldom eat the whole plate. But it's what I like to eat, whether it's a hamburger, or pork loin, or a hot dog (beef only) all the way. (Down here, that means mustard, chilli, slaw, and chopped onions). I eat what I like, but I just don't eat much. I feel full after maybe half the plate. I do take a senior men's multi-vitamin every day plus extra vitamin D.

The pounds started dropping off really really fast. Like 5 to 7 pounds a week. So fast, that when my Internist heard about it (after I called his nurse to extend my thanks to him), he summoned me in immediately, like two days later. By then I had lost more than 30 pounds. He took my blood pressure. It was 120/80. He asked me about what the other specialists had said and done. He was very concerned that my rate of weight loss was too fast.

After I told him excitedly that I could clip my own toenails now, he asked me what my daily caloric intake was. I told him maybe 600 calories. Maybe 800. He said that was way to small. He ordered me to eat at least 1,200 to 1,400 calories a day. I tried. I really did. I forced down a lunch sandwich that I didn't really want for a few days, but then I stopped, and returned to just eating with my wife. I tried to eat more, but I just didn't want it.

Anyway, now I can run up and down all the stairs in the house. I water about a dozen hanging baskets and plants. I walk all over the property, checking the roadside for trash, then I grab the mail, then along the red tips for paper and stuff just blown in, then I check the garden, wash off the cement outside the garage, feed the fish and change their filter, and lots of other things. I'm currently cleaning out our cellar. I work until I'm dripping with sweat, and then I shower.

I've discarded things I used to need, like suspenders, and a long-handled brush for washing my feet. I now wear a size large pants, instead of 3X large. I actually wear a belt. So much has changed. My wife is delighted, of course. And thanks to the Tranxene, I don't nag her all the time about how things are arranged or aligned. (I used to demand that the coffee cups be turned such that their handles were 30 degrees to the right. Stuff like that.)

Anyway, that's pretty much it. I'm shooting to break 250 now, and once I do, I think 200 will be achievable. My only concern now is the problem of skin retraction. Will it? The doctor didn't know. He said that sometimes it does, and sometimes it doesn't.

I do resistance exercises to increase my muscle mass, in the hopes that my body will take fat from my omentum, which is shrinking. At first, I had to do "old people" push ups. You know, against the wall. Now I'm up to doing women's push ups. (On my knees.) I do about 30 a day, plus old people sit ups, plus thigh and calf exercies. I need to do more push ups, but it's going to take some time for my arm and shoulder muscles to be restored.

So, that's how I did it. No special diet that I will abandon the instant I hit 200. Instead, it's just smaller portions of what I like to eat. I wish you all the success in the world with your battle. I know how it is. If you need me, PM me. I'll help you in any way I can. (No medical advice, of course. Always ask your doctor whether advice people give you is good.) But the most important thing, I guess, is to pick a really really good doctor. Get a graduate of Johns Hopkins, Cedars-Sinai, or Duke University.

All the best.
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  #17  
Old 08-05-2009, 10:17 AM
mswas mswas is offline
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Originally Posted by GythaOgg View Post
Hey, even some relief is worth going for. So long as the massage therapist and the doctor are aware of the situation and any precautions that need to be taken, it's not going to hurt. It may not improve the neuropathy long-term, but in general, people like and enjoy massages, particularly foot massages, and even if the break is short-term, that can still have a psychological benefit....as well as the other benefits provided by massages. It's just not going to improve the neuropathy.

(Stress has a LOT to do with blood sugar elevations in diabetes. So you get a stress-reducing benefit that helps control BG as well.)
Well what a massage therapist can definitely help with is the hyper/hypotonicity that results from the body's compensation to the neuropathy. But it sounds like the 'push more blood into the area' method won't help if it's a result of toxicity (or whatever) in the blood. There are definitely benefits from MT, but it sounds like it can't do anything for the condition directly like it could if it was caused by something else.
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  #18  
Old 08-05-2009, 10:24 AM
mswas mswas is offline
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Originally Posted by jackelope View Post
I have no knowledge of Diabetic Neuropathy, but:My girlfriend is a massage therapist, so I know a bit about this. Assuming your therapist is thoroughly trained and knowledgeable, she was doing a lot more than simply rubbing your legs and feet the way a layperson would. I was surprised to learn how much anatomical knowledge goes into getting a massage therapist's license; my GF actually dissected a human body as part of her training, in order to see first-hand how everything fits together. What seems like gentle, generic rubbing is probably carefully directed toward certain muscles and blood vessels, as well as timed and practically choreographed for maximum effect.
Yeah, we had several cadaver viewings, but we didn't dissect hands on ourselves. We went to a local podiatry school that keeps several cadavers for this purpose.

Quote:
However, note that I said "if" she was thoroughly trained and knowledgeable. There's a wide disparity among schools and training programs for massage. Next time she's working on you, ask her what she's doing: what muscles she's working, what fascia she's trying to break up, that kind of thing. If she can easily rattle off the scientific names for things like "longissimus" and "sternoclavicular joint," I would think she probably knows what she's doing. However, like you, I would be majorly turned off by the woo-woo stuff and especially by the attempt to sell me more stuff. Don't be afraid to shop around for a therapist you like.
From what I understand in Canada (I think the OP is in Canada) the regulations are about twice as strict as they are in the US. I required 1000 hours in NY State which is the most strict requirement in the US, my school requires 1200 hours to graduate. I believe Canada requires closer to 3000 credit hours.

Quote:
Good luck; I hope you're able to get your health under control.

(Oh, and by the way, the term "masseuse" is somewhat frowned upon these days, as it recalls the days when massage "parlors" were basically where you'd go to get a shoulder rub and a handjob.)
Right, masseuse is the French word for a female who gives a massage and has taken on a more illicit connotation that LMTs bridle at. They tried to train us to be upset by it but I can't really get that upset about it. There's a lot of ignorance regarding the field, but that just means you have an opportunity to educate people and change the perception.

As for the woo, I recommend not blowing off Shiatsu. I am quite good at Shiatsu myself and I *LOVE* receiving it. It just feels phenomenal, so what if it's based off of the woo? It's definitely one of my favorite styles, and learning Shiatsu is actually incredibly beneficial to your technique overall because it is a much softer and more sensitive style, at least the way I was trained. But if someone came to me for medical reasons I wouldn't even recommend Shiatsu. If they asked for it, I'd go for it, but I wouldn't try to sell it. It really feels very different. Though some people just don't get anything from it.
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  #19  
Old 08-05-2009, 10:29 AM
mswas mswas is offline
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Quote:
Originally Posted by KarlGauss
Finally, for honesty's sake, I should point out that one can have a foot ulcer strictly from neuropathy or exclusively from poor blood flow. Those things are less common, though, than having both factors present and contributing to the ulcer. I must also confess that despite my repeatedly saying that neuropathy doesn't cause poor blood flow, it may, in fact, have some effect. Not on the big arteries bringing the blood into the foot or leg, but to the so-called "micro-circulation" where nerve control may normally serve to divert blood to small areas of need, and/or away from areas that don't need as much (at that moment).
Yes, this is precisely what I was thinking of when I was talking about the neuropathy contributing to poor blood flow.

And yes the correct term is 'Massage Therapist'.
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  #20  
Old 08-05-2009, 12:46 PM
JimOfAllTrades JimOfAllTrades is offline
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Quote:
Originally Posted by Liberal View Post
(Note: I think the proper term now is "message therapist".)
Good to know, thank you.

Quote:
Originally Posted by Liberal View Post
I did two out of the three: I eat less and exercise more. But I eat and drink the things I like. I just flat out decided that if I had to give up Pepsi and hamburgers, then I'd just as soon go on to my maker. My wife, however saw things differently.

To make a very long story short, she found an Internist, a graduate of Duke University, one of the nation's best med schools, who agreed to act as a sort of general contractor for me. I weighed in at his office. 316 pounds. That was then. This morning, I weighed 253.4 (on a Weight Watcher's digital scale).
- (huge snip) -
So, that's how I did it. No special diet that I will abandon the instant I hit 200. Instead, it's just smaller portions of what I like to eat. I wish you all the success in the world with your battle. I know how it is. If you need me, PM me. I'll help you in any way I can. (No medical advice, of course. Always ask your doctor whether advice people give you is good.) But the most important thing, I guess, is to pick a really really good doctor. Get a graduate of Johns Hopkins, Cedars-Sinai, or Duke University.

All the best.
Lib, thank you. I've been putting off the exercise part because I've been so damn sore from the neuropathy and joint pain (this seems to a side effect of one of the medications) and frankly from lazy habits built over 35 years. But to hear how much you got from simply eating less and beginning small on the exercise is very encouraging. It makes me feel like it's doable instead of some huge wall that I can't even begin to climb.

Quote:
Originally Posted by mswas View Post
Right, masseuse is the French word for a female who gives a massage and has taken on a more illicit connotation that LMTs bridle at. They tried to train us to be upset by it but I can't really get that upset about it. There's a lot of ignorance regarding the field, but that just means you have an opportunity to educate people and change the perception.

As for the woo, I recommend not blowing off Shiatsu. I am quite good at Shiatsu myself and I *LOVE* receiving it. It just feels phenomenal, so what if it's based off of the woo? It's definitely one of my favorite styles, and learning Shiatsu is actually incredibly beneficial to your technique overall because it is a much softer and more sensitive style, at least the way I was trained. But if someone came to me for medical reasons I wouldn't even recommend Shiatsu. If they asked for it, I'd go for it, but I wouldn't try to sell it. It really feels very different. Though some people just don't get anything from it.
Again, it's good to know the correct terminology. You guys probably saved me from some eye rolling at least, and maybe more.

And my ignorance is definitely rampant here. I've heard of Shiatsu but have no clue what it is.

What do you think about those massage machines? My wife has been having some trouble with stiff muscles in her upper back and neck (it was for this that we went to the massage therapist in the first place). We were looking at something like this:

http://www.amazon.com/THUMPER-PROFES...493887&sr=1-87

to use between visits to the massage place. Have any of you found these to be useful?
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  #21  
Old 08-05-2009, 05:38 PM
mswas mswas is offline
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I've never used the Thumper Pro, but the Thumper MiniPro2 is great. The big one might just be orgasmic, I don't know. They can be kind of intense though, if the mini is any indication. The mini is the best handheld massager I have ever used bar none.

Shiatsu is a massage modality that utilize the TCM acupressure points and manipulates Qi. Again, I don't recommend it for medical reasons, but it is a great modality for pleasurable reasons.
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  #22  
Old 08-06-2009, 09:29 PM
JimOfAllTrades JimOfAllTrades is offline
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Quote:
Originally Posted by mswas View Post
I've never used the Thumper Pro, but the Thumper MiniPro2 is great. The big one might just be orgasmic, I don't know. They can be kind of intense though, if the mini is any indication. The mini is the best handheld massager I have ever used bar none.

Shiatsu is a massage modality that utilize the TCM acupressure points and manipulates Qi. Again, I don't recommend it for medical reasons, but it is a great modality for pleasurable reasons.
Thanks!

Sorry I've been away from the computer since yesterday afternoon.

Got back from my doctors appointment a couple of hours ago. She is pleased with my progress but is stepping up the medication. She has doubled the dose of the glipizide, and has decided it's time to attack the cholesterol, so I will now be taking Zocor daily. Blood pressure is slightly high but ok.

Massage she recommends, either professional or via foot whirlpools and such. She says she doesn't know for sure if it will help, but lot's of people enjoy it and it can't hurt.

So now it's time to get more serious about diet and weight. I'm going to take Liberal's example to heart and start simple, but start.

Baring the unusual, next checkup is in three months.
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  #23  
Old 08-06-2009, 09:38 PM
mswas mswas is offline
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Glad to hear it. Get the stuff under control!

And again, I do recommend the Thumper brand of massagers if the MiniPro2 is anything to go by.
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  #24  
Old 08-06-2009, 10:42 PM
JimOfAllTrades JimOfAllTrades is offline
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We should have ours by next week (ordered it online from Amazon). I'll let you know after we use it a little.
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