Question on Diabeties & Bell's Palsy

If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.

Dear Dr. Spence,
I am a diabetic. My feet feel like they are on fire and my friends tell me that I have nerve damage. What can I do outside of cutting them off?
Signed,
En Fuego

Dear En Fuego,
Diabetic neuropathy is generally an inevitable consequence of long-standing diabetes mellitus. It appears related to the length of time with the disease as opposed to absolute blood sugar control, though certainly brittle diabetics may be more quickly susceptible. It is secondary to the detrimental effects of elevated blood sugars on peripheral nerves and tends to affect the hands and the feet in a "stocking-glove" distribution. Patients describe anything from burning pain to shooting, aching, numbness or needle-like pain. Patients may be treated with a variety of agents. Traditionally, anti-depressant medications like amitriptylline (elavil) have been utilized to treat the problem, but side effects like sedation have often limited their use. Other agents, i.e. valproic acid (depakote) or gabapentin (neurontin) have proven efficacious as well. Recently, I have successfully used pregabalin (lyrica), though cost may be an issue. Our clinic has been participating in a pharmaceutical study using a novel agent known as ALD5854 that appears to block delta opioid receptors and thus block pain. This class of drugs, known collectively as DORAs, may be effective in treating neuropathic pain while minimalizing side effects and the potential for dependence. I encourage any patient with painful diabetic neuropathy to contact us (482-5802). The study is only one month in duration but does pay approximately $350 to eligible participants. Not only does this study potentially open the door to a new class of agents that may alleviate pain, but it helps supplement your income.

Dear Dr. Spence,
What is Bell’s palsy? How do I treat it?
Signed,
Droopy

Dear Droopy,
Bell’s palsy is a paralysis of the facial nerve that is presumed secondary to viral syndromes. Most cases are short-lived but can be quite distressing. I have actually discussed this topic previously, but I thought it may be interesting to share some more recent data on treatment options. Data from the New England Journal of Medicine suggests that there is no benefit in treating patients with anti-viral medications like acyclovir (a popular choice among physicians). It is clear that a ten day course of an oral steroid (either prednisone or prednisolone) is most effective. The researchers recommend prednisolone 25 milligrams twice per day for ten days – treatment must be initiated within 72 hours in order to increase the likelihood of neurologic recovery.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.