Small Fiber Neuropathy is an impairment of small nerve fibers that affect the skin and the involuntary muscles. Patients usually experience pain, burning, tingling, and numbness (sensory symptoms) but they can also experience dry eyes, dry mouth, orthostatic dizziness, constipation, bladder incontinence, sexual dysfunction, trouble sweating, or red or white skin discoloration (autonomic nervous system symptoms). Symptoms usually starts in the feet, slowly go up the legs, and then move into the hands.

So what causes Small Fiber Neuropathy? The condition can occur as a result of diabetes, autoimmune diseases (eg. Lupus), thyroid problems, vitamin B12 deficiency, paraproteinemia (eg. amyloid), AIDS, hepatitis C, celiac disease, restless legs syndrome, neurotoxic drug exposure, rare hereditary diseases (Fabry disease, Tangier disease, hereditary sensory autonomic neuropathy, and hereditary amyloidosis) and cancer.

Oftentimes, physical examination and tests, such as Nerve Conduction Studies and Electromyograms, are normal or show mild loss of sensation, so Small Fiber Neuropathy is diagnosed by skin biopsy to evaluate the density of nerve fibers in the skin. Most patients with small fiber neuropathy experience a slowly progressive course, with symptoms and signs spreading to the center of the body over time. Most of these patients will also require chronic pain management.

Treatment of small fiber neuropathy should target the underlying cause and neuropathic pain. Cause-specific treatment is key in preventing or slowing the progression of the disease. First-line choices of pain medications are the anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica), the tricyclic antidepressants amitriptyline (Elavil) and nortriptyline (Aventyl), a 5% lidocaine patch (Lidoderm), and the semisynthetic opioid analgesic tramadol (Ultram). These can be used alone or in combination, at the direction of your doctor.

If you suffer from the symptoms listed above, and your doctor has been unable to find a cause, ask if they’ve tested you for Small Fiber Neuropathy.

The FDA is warning parents and caregivers of infants that some liquid vitamin D supplement products sold with droppers could allow excessive doses to be given to babies, which could be harmful. Talk to your doctor before giving any kind of supplement to your infant, and be sure you know the safe dosage and how best to administer the liquid to your baby.

(FDA, 6/15/10)

Common side effects of the drug included back pain, high cholesterol and urinary bladder infections.

If you suffer from post-menopausal osteoporosis, you may want to talk to your doctor about whether Prolia, or other treatment options, are right for you.

(FDA, 6/1/10)

The drinks causing the most concern are EAS Myoplex Original Rich Dark Chocolate Shake, and two Muscle Milk powders – Vanilla Crème and Chocolate. It may take less than you think to reach your safe daily limit with these products. It takes only three servings of the Muscle Milk powders a day to put you over the limit – and remember that’s servings according to the packaging, not simply the number of whole glasses you may consume. Be sure to check the labels and count “servings,” not glasses, when you consider how much of these protein shakes to consume.

It’s not surprise that those who regularly enjoy a good night’s sleep also enjoy overall better health and longevity. What may come as a surprise, though, is that people who get less than six hours of sleep per night actually have an increased risk of dying prematurely. Even more surprisingly – too much rest can be a detriment as well. Sleeping more than nine hours per night has also been linked to premature death.

So what does this mean for you? Aim to catch seven to eight hours of sleep each night – no more, no less – to optimize your health.

Source: (Sleep, 5/10)

And, of course, it should go without saying that you should try to eliminate these bad habits from your lifestyle. Remember, before beginning a new exercise program you should first talk to your physician, to discover any health problems that may be aggravated by a workout routine. While you’re there, talk to your doctor about a plan to quit smoking as well.

(Archives of Internal Medicine, 4/26/10)

It has been shown to help the brain work better later in life, and in a recent study, older adults with higher vitamin D also demonstrated improved mobility (Experimental Biology 2010 Meeting). It even helps protect us from low levels of radiation.

You’d think with all these benefits, we’d be falling over ourselves to get as much exposure as possible, but that is not the case. Unfortunately, many of us don’t get adequate vitamin D, largely for one reason: its source. Vitamin D is created in the body by exposure to sunlight, something we’ve been warned against getting too much of, lest we end up developing skin cancer.

Fortunately, there is a safe amount of sun exposure, that will still help you increase your vitamin D intake. Most adults can safely tolerate ten to fifteen minutes of unprotected sun exposure per day without suffering any ill effects. I recommend adding a quick walk outside to your lunch routine, if you can spare the time. A little fresh air, exercise, and sunlight can help recharge your mental batteries for the afternoon ahead, as well as help you soak up that vitamin D.

I recommend all adults have their physician check their vitamin D level and aim for a total level at least greater than 30 ng/ml. Recent evidence indicates there may even be circulatory benefits up to a total level of 43 ng/ml.

If brief sun exposure doesn’t seem to be helping, Vitamin D supplements can also be beneficial, if needed. However, these supplement should only be used with the assistance of your physician to avoid toxicity, especially if you want to exceed 2000 IUs per day.

From time to time, you may need an additional boost. Even after taking supplements and getting 10-15 minutes of unprotected sunlight each day, many of my patients are unable to get their levels of vitamin D up. My suggestion: always take your vitamin D supplement with the largest meal of the day, which may boost its absorption by 50%. Why the uptick of absorption at mealtime? Vitamin D is fat soluble, which means the body accepts it more readily when food is present to aid absorption. (Journal of Bone and Mineral Research, 4/10)

This article from MedicineNet.com gives a good overview of potential health problems from consuming a vegetarian or vegan diet.  It also provides a quick list of vegan sources for the nutrients you must be sure to replace in your diet when you stop consuming animal-derived foods.

A full list of the over 40 affected products is available at http://www.mcneilproductrecall.com.

The FDA has approved the first non-drug, device-based treatment for adults with severe asthma whose medications aren’t providing enough relief. The device, called an Alair Bronchial Thermoplasty System, uses a catheter with a tip that delivers a form of thermal energy to the airways.  The catheter delivers radiofrequency energy, heating lung tissue and reducing the thickness of smooth muscle, which improves the asthmatic’s ability to breathe.

Please spread the word to anyone you know who could be helped by this.  Not being able to breathe can be an incredibly frightening experience. Hopefully this new therapy will help prevent that experience for many asthmatics.