Help with a tough neuropathy case please

Help with a tough neuropathy case please

Expand Messages
joshuazvi1
Message 1 of 5 , Mar 16
View Source
Hello NatChatters,

I wonder if I can get come help with this neuropathy case.

Octogenarian male with 20 year history of significant neuropathy and gross sensation abnormalities of entire feet and lower legs bilaterally. Diminished DTRs as well. He is able to dorsiflex and plantar flex both feet with no problem. Neurologist has diagnosed as idiopathic peripheral neuropathy.

Labwork: B12 wnl, MMA wnl, serum folate high (but taking B vitamins), MTHFR wild type, serum protein electrophoresis wnl; all other labs normal including glucose (he has no diabetes). He is hypothyroid and we have him on significant levo doses hoping to get benefit with neuropathy but without success. His last TSH was 0.67.

He is averse to taking many pills but over the past year we have trialed adequate dosing and quality of ALA, benfothiamine, and B complex with metafolin with no benefit and he wanted to stop.

He has trialed gabapentin 300mg TID for 1 month with no benefit and he wanted to stop.

Neurology found no evidence of parkinsonism, assessed it as "mild to moderate fairly asymptomatic idiopathic sensory polyneuropathy” and recommended gabapentin. The patient would like to focus on this this year though. It bothers him a lot.

ROS: noctouria controlled with mybetriq and water restriction at bedtime, constipation managed with psyllium husk

Any help would be greatly appreciated.

Thank you.

Joshua Goldenberg, ND
Bothell WA


Yahoo Renee
Message 2 of 5 , Mar 17
View Source
Hello Joshua,
You reported all other labs normal just checking to see if his iron/ferritin were tested. I also wondered if thyroid antibodies and/or ANA were tested. Wondering about an autoimmune component?

Nutritionally I may consider fish oil, high dose B6 (150-200 mg for a few weeks), and iron depending on labs.

Per neurologist work up I'm assuming Demyelinating disease has been ruled out?

Take care,

Renee Lang, ND, FABNO, MPH
Philadelphia, PA


Shiva Barton, ND
Message 3 of 5 , Mar 17
View Source
Hi Joshua,

Benfotamine can be helpful. I don't remember the dose - can someone else
help with that?
Also, a vegan diet can be curative. Give it a 2 week trial. If no
benefit by then it probably won't be helpful.

Shiva Barton, ND
Winchester, MA
(from the Emily Kane school of question answering...)


Mona Morstein
Message 4 of 5 , Mar 17
View Source
Hello, Joshua,

Measuring folate acid and MTHFR gene problem still does not show us homocysteine, and without that we have no idea if folic acid is normal or not in his body.   I would stop measuring folic acid, and instead measure homocysteine instead.

What is his diet?  Any glucose abnormalities, even minor?

Heavy metals, esp arsenic, go to the nerves.  Any mold potentially in his home?


Mona Morstein, ND, DHANP
Tempe, AZ
www.diamend.info
Official Sponsor of NatChat--Doctors Data Lab


Dr. Joshua Goldenberg
Message 5 of 5 , Mar 19
View Source
Thank you all for these suggestions. Greatly appreciated!

Joshua Goldenberg, ND
Bothell WA
www.DrJournalClub.com