♪ Bob and Brad ♪ ♪ the two most famous
physical therapists ♪ ♪ on the internet. ♪ - Hi folks, Brad Hynek Physical Therapist. - Hey, I'm Chris the Pharmacist. - Bob's not with us today, I think he's out golfing, having some fun somewhere else. - Atta boy. - But today we are going to
talk, the title is Neuropathy, causes, symptoms, with at-home treatment and medications. We're going to talk about what you can do yourself and the medications, how they work in some
good information on that. Chris will give us his expertise. Before we go any farther, we got to get more
business out of the way. - We've got to get some
business out of the way. - I'm not so good at this,
Bob usually does this part. So anyways, the giveaway is coming up
and what the giveaway is, this is a sweetheart. This is our Q2, a massager. And it is just a delightful thing. I like this, one of my favorite ones. And if you go to
bobandbrad.com right here. - There we go. - Yes. You can go click on the giveaway site. Oh, the tab, the tab that says giveaway, go to there. It'll explain to you how
to get into the contest, so you can win one of those. Also go to the Facebook, it's pinned to the top of the page for a 60 second version of our video. Go to Twitter, Instagram, - Can't forget the TikTok. - The TikTok. And also for the long version, I think we will have this
one on a podcast as well. - All right. - I'm not sure because
we have some exercises at the end that are going to be helpful for a neuropathy as well. Anyways, shall we carry on Chris? - I think we should. - I do want to mention with neuropathy, we're talking about, you're going to go through
some of the details on it. You can explain it much better than I, but for this channel, we're related physical therapy and almost always in my experience, and I think most PT's would agree, neuropathy is associated with diabetics. In our, in our field. You could have neuropathy from
other diagnosis's as well. We're going to talk about it. - I mean, there's a lot
of things out there but. - Say a few of them. - Post-herpetic neuralgia. I mean, you could have just an injury, a spinal injury. - Okay. So there's some clear logical things. - Because there's a lot of
things that can cause it. - MS. - Yeah. - But again, so the treatments are going to be similar for those, but we will kind of relate to the diabetic because it is so prevalent
in that diagnosis and that's our experience. So what is neuropathy? Can you explain that?
- I hate to say it, it's not a real long flowery explanation, but basically neuropathy is that burning, stinging, pain, numbness that you get and how does it develop? It basically, you know, with the diabetic in mind, if our sugars are high and a lot of times our sugars are high, that means our cholesterol is high. - So blood sugars. - So a circulation doesn't
bade the nerve real well due to high blood sugars
and probably cholesterol. So as a result, the nutrients and oxygen that your blood flow carries, does not bade those nerve cells and they are not healthy. And as a result of that,
they kind of die off. So for lack of anything better to say, and so you just don't get what they call better neuronal transmission. So just think of it as
a highway in your body and just the signal is interrupted. And so you don't get that good, nice confluence signal
going back and forth like a nerve would. - So what, what are the most
common locations in the body? - Well, a lot of cases
with diabetic neuropathy, a lot of times it's going
to be below the knee. So you're going to see a lot
of problems right down here, which is why foot care is
so important for diabetics. - Okay. - And we'll, we'll touch
on that as we go forward. But I mean, you can get it. There's things that you can have. You can have problems in your gut, particularly with a diabetic, but you can also have
problems in your legs. You can have it and it can
send to your arms and hands. So it just kind of depends
on where it is on you, but the treatments in most
cases are going to be similar, which is going to be pharmacological and physical therapy related. - Okay. And in my experience, and I've talked to Bob about this too. Usually it's below the knees, both sides typically. - Well, that's why we worry about, especially like the diabetic foot. - Yeah. Symptoms, what kind of symptoms do they typ- do these people
typically complain of? - You know it's kind of, you know they'll come in and they'll, and they kind of manifest
themselves over time. So, I mean, the longer you're a diabetic, the more opportunity you
have to become a patient that has neuropathy. So the less well controlled
your blood sugars are, and the longer you have diabetes, the more likely you are to get neuropathy. But they come in and they're
going to complain about tingling, burning, pain,
numbness, you know, even to the point where, you know, a diabetic with bad diabetic neuropathy could literally have a rock in their shoe, they could be walking
around in all day long and they won't even know it. So they lose that sensation and they might have like
something very vague or just like, eh, but you know, it could have been one of my foot felt that way yesterday too. So it's so important to, as a diabetic, and number one is to check your feet daily to make sure there's no
little nicks, cuts, blisters. - Sure. - Cause those are the things that can lead to infection and other problems. - So with that, say there is a little stone in there and you walk on it, You did not feel it as a
result of the neuropathy, that stone may break the skin open. Then you have an open sore. - Correct. - And because of the lack of circulation, that can get infected and that it's slow healing
because of the diet, that diabetic side effects and it can actually lead to an amputation. - Yeah. That is, that's the worst case
scenario that we're gonna. So the things that we're going to talk about today guys, are just, you know, we want to make sure
that we're controlling our blood sugars, we're exercising well, we're eating well, we're using our medications appropriately. - Sure.
- And those are the things that will help to stave it off. - So I do want to mention one other thing as a therapist, one thing that we deal with a lot with people with neuropathy, if they have numbness in
their feet or their legs, you cannot feel the ground or the surface that you're on, which dramatically increases
your risk for falls. Cause your balance is heavily dependent on the feedback back
from your proprioception, back from your feet where
they're touching the ground. And it just really makes
a big difference on, on your balance and a
fall risk goes way up. So we do deal with that, we're not going to talk
about that too much in, this is probably all we're
going to mention for now. We have balanced videos
out there with that, those treatments are self treatments are available and we have
videos on those as well. Can we go right to diet? How can these people with neuropathy change or manage their symptoms? - Yeah, absolutely. I mean
that the thing that, you know, everybody, you know, we know neuropathy has no cure. That seems kind of damning
for a lot of people, but at the same time
we can make it better. And so one of the simple
tools that we have is just eating well. And so if you're a diabetic, that means going to the
leaner proteins, you know, your fibrous fruits and veggies, those types of things. - Some examples leaner proteins, we're talking about meat. - Yep. So we're going to
go poultry like chicken, we'll go with fish. You know so lean beef like grass fed beef, very lean protein. - Sure. - Eggs. For our vegan folks, I mean, it's going to be your nuts,
your legumes, you know, so there's gonna be good protein sources. So you're going to watch
your leafy green vegetables. That's going to help with the B vitamins, that's going to help with
nervous system development. - Spinach. - Spinach, kale, broccoli. So all the things your mother loves, Brussels sprouts. There's another one. Alf, you know, alfalfa sprouts. I mean, there are, there's a
lot of good stuff out there. - Sure okay.
- But I mean, you know, just eating well, helps our body with the
nutrients that it provides it. So it's going to actually help
with the circulatory system. It's going to help keep our
weight at a better level. So, cause I mean, if
we're going to McDonald's, we're going to just eat
and fries and chips. I mean, that's going to create problems from a circulatory standpoint, it's going to cause problems
from a blood sugar standpoint. Cause these fast process foods, so like we always say, we don't want anything in a box. - Right. So whole foods are ideal so. - In the grocery store, down the aisles, we got all these quick,
make things are, you know, open it up, open up the
rapper and just eat. Those health food bar things that usually are not healthy. - They're not as healthy as what they were advertised to be. Unfortunately, I mean we try and pack. I mean, there's a lot of sugar and other processed things in there that unfortunately,
particularly the diabetic too, and that's one of the
things with advertising that makes it so challenging is, oh, well I'm having this particular bar and it seems like it's going
to be a nutritious choice. - A health bar, it says
health bar right on it. - Yeah they show people climbing mountains and everything else. And it's you think it's going
to be a good thing to have, And all of a sudden it's
made with tons of sugar or high fructose corn syrup and things of that nature. - A big one that I always
look for now is yogurt. I used to just think yogurt was yogurt. And I start looking at the sugar content, - There's a ton. - There's as much sugar
in a thing of yogurt is can of Pepsi with all the sugar. And it's like, whoa. - It's kind of the it better
tastes, the worse it is. - Exactly. So be careful, look at your labels. - But you know, let's talk about yogurt. Yogurt is a great, to me,
it's kind of a power food you know, if you get it
like a plain vanilla yogurt, that's not. So what can you do? Add blueberries, add
raspberries, add some walnuts. You know, you can add
the sweetness yourself. - Yeah. That's my recipe. I do blueberries, blackberries, walnuts, flax seed and chia seed. - Yeah and, and all those products, nutritionally have actually
kind of nutraceutical properties that will help your body. I mean, you have the flavonoids
in those dark berries. So I mean, those help
with your circulation. They help with anti-inflammatory action, so there's a lot of nutrient, nutrient dense things in that. And then the yogurt it's got the protein, it keeps you full. So it's good for your muscles, it's good for your bones
cause it's got calcium and vitamin D. - So I do want to mention, because a lot of times people say, oh, you stick to your genre. So, you know, he's a
pharmacist, I'm a therapist, but we're talking about
pretty basic health. I think, I think we're
covering a basis pretty safely. - Oh yeah. I don't think
we're too far out of our lane. - Yep. Should we go on to the next thing? - Yeah - Exercise. Why do you need to exercise? If you're got neuropathy,
how's that going to help? - Well there's a lot of different reasons, but, but specifically, I mean, what happens when we exercise? Our heart rate comes up. So if our heart rate comes up, we're challenging our circulatory systems, so that helps to bade those nerves, the nerves and the muscles. So it gives them some oxygenated blood that also is carrying nutrients from the, hopefully the good foods we've just eaten. And so that will help the body to develop and hopefully get stronger
and more endurance and hopefully improve some
circulation and moderate some of those neuropathy symptoms. - Right. - Signals and symptoms that you have. So when you have better circulation, you have better strength,
better coordination, better appropriate inception as a result of exercising because these things all
kind of build on one another. We hopefully help to
minimize some of those diabetic neuropathy symptoms. So it's never going to be a cure guys, but it certainly could make them better and make your life a lot safer, more effective, longer,
happier, healthier. - Let's move on to medications in regards to neuropathy and the diabetic. Can you briefly go over some of the most common ones and some information? - Yeah I mean, your physician is going
to take into account, what's going to be best for you when you have neuropathy. But I mean, there's probably the, what I, what I see most often in my world, the big three are probably going to be pregabalin, generic Lyrica, Gabapentin, generic Neurontin, and then duloxetine, generic Cymbalta. So those three are all widely recognized and used for treatment for neuropathy. I mean, Lyrica, pregabalin actually, it's, it's one of it's actually, it's what it's known for. - Okay - And the nice thing, the advantage of
pregabalin over Gabapentin for a lot of people, they work similar to kind
of like Coke and Pepsi. So they have similar properties and they do similar things in the body, which is to actually
improve neurotransmission and minimize pain. So basically that's what
they believe is how it works. And so with that, if we can diminish the
pain and discomfort, a drug like for Pregabalin,
it takes a lower dose. So it was less side effect prone. - Sure. - It acts faster than Gabapentin, and the problem, the difference between
those two drugs is pre, Pregabalin, a lower dose
creates a nice effect. So we have to be careful because there is some addictive potential. So we, we have to be mindful of that. Caution with driving, because of dizziness and drowsiness are two primary side effects. And you'll see that
with Gabapentin as well, but where they delineate, the Pregabalin works
better in a lot of cases. Whereas as Gabapentin you keep having to take bigger and bigger doses to get the same type of effects. And when we go to those
bigger and bigger doses, what happens? Well, we have more side effects, so more dizziness, more drowsiness, little bit of forgetfulness. So things that we have to be careful with and, you know, so those are things that, you know, again, your doctor is taking that into account and your pharmacists
gonna be talking to you about watching for things. - Sure. - So we do want you to be mindful. And the other one that
I didn't really touch on was the antidepressant
Cymbalta or Duloxetine. And that's actually a works, it's got, it raises serotonin, it raises norepinephrine or noradrenaline. So those are two different
neuro-transmitters. So they actually work, they help with the body's nervous system to minimize pain and also to help improve neuronal transmission is what they believe happens with the medications. - Okay. - So, well tolerated, generally not a lot of
side effects associated with that either, so it's safe. It certainly, isn't a great alternate, cause you know, there can
be pain with neuropathy. - Sure. - And so it's an alternative
to using opioids, which also is something that
has their own series of bad. That's kind of where
the utility came from. - That's a whole other video there. - Yup. Long video but I mean, so those are the kind of the main three, but any antidepressant and
any antiseizure medication, just to kind of just
kind of envelope them in, will have benefits for neuropathy. And sometimes if one,
let's say pregabalin, Gabapentin or duloxetine
doesn't work for you. Your doctor can try some
of the more atypical things like maybe an old school antidepressant, like a tricyclic amitriptyline or something to that effect but. Those are the things that your doctor would do based on your conversations, your appointments and your follow up. - That's pretty individual. - Exactly. - All right now, the next
thing we're going to do, is this is actually going
to be a two-part video. This is the end of part one. We still have to cover on
a more of my aspect of it, showing you some exercises
to improve your circulation, help that neuropathy out, particularly from the knees down. And we're going to talk about footwear and shoes along with that, because it goes along with the exercise. Extremely important
thing with the footwear. It's good information so, stay tuned. We'll have the next video. I'm not sure when it's going to come out, but we'll have the too laid together to be within a week or two. So good luck on this and we'll see you on the next part two. - All right. Buy guys. (upbeat tune)
