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Autonomic Neuropathy

Autonomic neuropathy

By Mayo Clinic Staff

Autonomic neuropathy occurs when the nerves that control involuntary bodily functions are damaged. This may affect blood pressure, temperature control, digestion, bladder function and even sexual function.

The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.

While diabetes is generally the most common cause of autonomic neuropathy, other health conditions — even an infection — may be to blame. Some medications also may cause nerve damage. Symptoms and treatment will vary based on which nerves are damaged.

Signs and symptoms of autonomic neuropathy vary based on the nerves affected. They may include:

  • Dizziness and fainting when standing caused by a sudden drop in blood pressure.
  • Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.
  • Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men and vaginal dryness, low libido and difficulty reaching orgasm in women.
  • Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
  • Sweating abnormalities, such as sweating too much or too little, which affects the ability to regulate body temperature.
  • Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
  • Exercise intolerance, which may occur if your heart rate stays the same instead of adjusting in response to your activity level.

When to see a doctor

Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes and it’s poorly controlled.

If you have type 2 diabetes, the American Diabetes Association (the Association) recommends annual autonomic neuropathy screening for people with type 2 diabetes as soon as you’ve received your diabetes diagnosis. For people with type 1 diabetes, the Association advises annual screening beginning five years after diagnosis.

Many health conditions can cause autonomic neuropathy. It may also be a side effect of treatments for other diseases, such as cancer. Some common causes of autonomic neuropathy include:

  • Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
  • Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).
  • Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
  • Injury to nerves caused by surgery or radiation to the neck.
  • Treatment with certain medications, including some drugs used in cancer chemotherapy.
  • Other chronic illnesses, such as Parkinson’s disease, multiple sclerosis and some types of dementia.
  • Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
  • Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Factors that may increase your risk of autonomic neuropathy include:

  • Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You’re at greatest risk if you have had the disease for more than 25 years and have difficulty controlling your blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases.Additionally, people with diabetes who are overweight or have high blood pressure or high cholesterol have a higher risk of autonomic neuropathy.
  • Other diseases. Amyloidosis, porphyria, hypothyroidism and cancer (usually due to side effects from treatment) may also increase the risk of autonomic neuropathy.

First, you’ll probably see your primary care physician. If you have diabetes, you may see your diabetes specialist (endocrinologist). However, you may be referred to a specialist in nerve disorders (neurologist).

You may need to see other specialists depending on the part of your body affected by neuropathy: for example, a cardiologist for problems with your blood pressure or heart rate, or a gastroenterologist for digestive difficulties.

Arrive at your appointment well-prepared. Here are some tips to help you prepare yourself and know what to expect from your doctor.

What you can do

  • Ask about any restrictions before the appointment. Find out if you should do anything in advance, such as fasting before certain tests.
  • Write down any symptoms you’re experiencing, even those that may seem unrelated to autonomic neuropathy.
  • Make a list of all medications (including over-the-counter), vitamins or supplements that you take.
  • Ask a family member or friend to come with you. Bring someone who can help you remember the information you and your doctor discuss. Family members can learn more about autonomic neuropathy if they attend appointments with you. For example, if you don’t know when your blood pressure is too low, you may pass out (faint). Your family members will need to know what to do.
  • Write down questions to ask your doctor.

Since appointments can be short, prepare a list of questions before you go. Some basic questions to ask your doctor about autonomic neuropathy may include:

  • Why did I develop autonomic neuropathy?
  • Could anything else cause my symptoms?
  • What kinds of tests do I need? Will I need to do anything to prepare?
  • Is autonomic neuropathy temporary or chronic?
  • What are the available and recommended treatments for autonomic neuropathy?
  • What are the treatment side effects?
  • Are there any alternatives to the treatment that you’re suggesting?
  • Is there anything I can do on my own to help manage autonomic neuropathy?
  • I have other health conditions. How can I best manage those with autonomic neuropathy?
  • Do I need to follow a special diet?
  • Are there any activity restrictions that I need to follow?
  • Do you have any printed materials or recommended websites that you can share with me?

Don’t hesitate to ask additional questions that may come up during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared to answer these types of questions to allow more time for your own:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Autonomic neuropathy is a possible complication of a number of diseases, and the tests you’ll need often depend on your symptoms and risk factors for autonomic neuropathy.

When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy (such as diabetes) and have symptoms of the condition, extensive testing may not be necessary. Your doctor may perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

When you don’t have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy but don’t have risk factors, the diagnosis may be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.

Your doctor may perform tests to evaluate autonomic functions, which may include:

  • Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
  • Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
  • Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
  • Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through four capsules placed on your forearm, foot and leg, while a computer analyzes the response of your nerves and sweat glands. You may feel warmth or a tingling sensation during the test.
  • Thermoregulatory sweat test. During this test, you’re coated with a powder that changes color when you sweat. While lying in a chamber with slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
  • Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary symptoms, a series of urine tests can evaluate bladder function.
  • Ultrasound. If you have bladder symptoms, your doctor may do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.

Treatment of autonomic neuropathy includes:

  • Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you’ll need to tightly control blood sugar to prevent autonomic neuropathy from progressing.
  • Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms

Your doctor may recommend:

  • Modifying your diet. You may need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also may help. Slowly increase fiber to avoid gas and bloating.
  • Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
  • Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. Increasing dietary fiber also may help relieve constipation.
  • Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines. Medications usually used to treat high blood pressure and cholesterol may also be prescribed for managing diarrhea.
  • Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil), can help treat nerve-related abdominal pain. Dry mouth and urine retention are possible side effects of these medications.

Urinary symptoms

Your doctor may suggest:

  • Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder’s capacity and retrain your bladder to empty completely at the appropriate times.
  • Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
  • Urinary assistance (catheterization). During this procedure, a tube is guided through your urethra to empty your bladder.
  • Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction

For men with erectile dysfunction, your doctor may recommend:

  • Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and changes in color vision.If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution and medical discretion. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
  • An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

  • Vaginal lubricants. Vaginal lubricants may decrease dryness and make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms

Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:

  • Medications that help raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor may suggest a drug called fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.Other drugs that can help raise your blood pressure include midodrine and pyridostigmine (Mestinon). Midodrine may cause high blood pressure when lying down.
  • Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
  • A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure. This is generally only recommended for very severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs.

Sweating

If you experience excessive sweating, your doctor may prescribe:

  • A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headaches, loss of taste and drowsiness. Glycopyrrolate may also increase the risk of heat-related illness (such as heatstroke) from a reduced ability to sweat.
  • Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting out of bed. Flex your feet and grip your hands for a few seconds before standing up, to increase blood flow.Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.
  • Elevate the bed. If you have low blood pressure, it may also help to raise the head of your bed by about 4 inches by placing blocks or risers under the legs at the head of the bed.
  • Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids, and opt for low-fat, high-fiber foods, which may improve digestion. You may also want to try restricting foods that contain lactose and gluten.
  • Diabetes management. Try to keep your blood sugar as close to normal as possible. Tight blood sugar control can help lessen symptoms and help to prevent or delay the onset of new problems.

Several alternative medicine treatments may help people with autonomic neuropathy. Remember to discuss any new treatments with your doctor to ensure that they won’t interfere with treatments you’re already receiving or cause you any harm.

Alpha-lipoic acid

Preliminary research suggests this antioxidant may be helpful in slowing or even reversing neuropathy that’s causing blood pressure or heart rate problems, but more study is needed.

Acupuncture

This therapy, which uses numerous thin needles placed in specific points in the body, may help treat slow stomach emptying. More studies are needed to confirm what acupuncture’s role is in treating autonomic neuropathy.

Electrical nerve stimulation

Some studies have found that this therapy, which uses low-energy electrical waves transmitted through electrodes placed on the skin, may help ease pain associated with diabetic neuropathy.

Living with a chronic condition presents daily challenges. Some of these suggestions may make it easier for you to cope:

  • Set priorities. Accomplish the most important tasks, such as paying bills or grocery shopping, and save less important tasks for another day. Stay active, but don’t overdo it.
  • Seek and accept help from friends and family. Having a support system and a positive attitude can help you cope with the challenges you face. Ask for or accept help when you need it. Don’t shut yourself off from loved ones.
  • Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care doctor to discuss possible treatments.
  • Consider joining a support group. Ask your doctor about support groups in your area. If there isn’t a specific group for people with neuropathies, you may find that there’s a support group for your underlying condition, such as diabetes.Some people find it helpful to talk to other people who truly understand what they’re going through. Support group members can offer camaraderie, as well as tips or tricks to make living with autonomic neuropathy easier.

While certain inherited diseases that put you at risk of developing autonomic neuropathy can’t be prevented, you can slow the onset or progression of symptoms by taking good care of your health in general and managing your medical conditions.

Follow your doctor’s advice on healthy living to control diseases and conditions, which may include these recommendations:

  • Control your blood sugar if you have diabetes.
  • Seek treatment for alcoholism.
  • Get appropriate treatment for any autoimmune disease.
  • Take steps to prevent or control high blood pressure.
  • Achieve and maintain a healthy weight.
  • Stop smoking.
  • Exercise regularly.
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How can a Service Dogs help those with Invisible Illnesses.

Service Dogs can being a big plus for those with invisible illnesses.  Depending on the illness and what is needed,   For instance,  A Service dog, can open refrigerator door, cabinet door, retrieve water for the patient, grab snacks, bring a blanket, bring clothes to the patient, shoes, pick up objects off the floor that the patient dropped but most of all some dogs can be trained to detect seizures, drop attacks, fainting spells and worn the patient before it occurs, specially for children to prevent accidents or serious injuries.

The Con is, to find a good trained service dog, could be as high as $17,000 plus training.  Local organizations might have people that have donated for others to get the service Dog, so make sure you check or local organizations in your area, they may be able to help with the cost in the dog or the training.  Another Con a lot of people with invisible illnesses have allergies, so in picking a service dog, make sure to consider the Allergy factor, Poodles, labradoodles are a fantastic choice because they don’t shed.

Having a Service dog should never be something to be embarrassed about, but can be for some.  But from someone who has a invisible illness, I would love a service Dog to help me detect when I am going to have a drop attack, or pick up something off the floor because If I bend over I get so dizzy, nausea, vomiting, ect, to me it would be a blessing, but the for a disabled person on disability, its just not in the funds.  But for those who can afford it!!!! What a blessing to that patient.  Child or adult.

 

Kelly

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What is POTS !!!!!!!!

What is Postural Tachycardia Syndrome?

Postural orthostatic tachycardia syndrome (POTS) is one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. OI describes a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. The primary symptom of OI is lightheadedness or fainting. In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS are relieved by lying down again. Anyone at any age can develop POTS, but the majority of individuals affected (between 75 and 80 percent) are women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods. POTS often begins after a pregnancy, major surgery, trauma, or a viral illness. It may make individuals unable to exercise because the activity brings on fainting spells or dizziness.

Doctors aren’t sure yet what causes the reduced return of blood to the heart that occurs in OI, or why the heart begins to beat so rapidly in POTS.  Current thinking is that there are a number of mechanisms.  Some individuals have peripheral denervation (neuropathic POTS); some have symptoms that are due to sustained or parosyxmal overactivity of the sympathetic nervous system (hyperadrenergic POTS); and many individuals with POTS have significant deconditioning.

Is there any treatment?

Therapies for POTS are targeted at relieving low blood volume or regulating circulatory problems that could be causing the disorder. No single treatment has been found to be effect for all. A number of drugs seem to be effective in the short term.  Whether they help in long term is uncertain.  Simple interventions such as adding extra salt to the diet and attention to adequate fluid intake are often effective. The drugs fludrocortisone (for those on a high salt diet) and midodrine in low doses are often used to increase blood volume and narrow blood vessels. Drinking 16 ounces of water (2 glassfuls) before getting up can also help raise blood pressure. Some individuals are helped by beta receptor blocking agents. There is some evidence that an exercise program can gradually improve orthostatic tolerance.

What is the prognosis?

POTS may follow a relapsing-remitting course, in which symptoms come and go, for years. In most cases (approximately 80 percent), an individual with POTS improves to some degree and becomes functional, although some residual symptoms are common.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) and other Institutes of the National Institutes of Health (NIH) conduct research related to POTS and support additional research through grants to major research institutions across the country. Much of this research focuses on finding better ways to prevent, treat, and ultimately cure disorders such as POTS. NINDS-funded researchers are investigating if low levels of the hormone aldosterone contribute to low blood volume in individuals with POTS, and if high levels of angiotensin II, a peptide that helps regulate blood volume, leads to decreased adrenal sensitivity.  Other NINDS-funded research is investigating the hypothesis that POTS is a syndrome of different subtypes, with different underlying mechanisms.  Additionally, the NINDS funds the Autonomic Rare Diseases Consortium to further understand disorders such as orthostatic hypotension and hopefully alter the course of disease.

NIH Patient Recruitment for Postural Tachycardia Syndrome Clinical Trials

Organizations
Column1 Column2
National Dysautonomia Research Foundation
P.O. Box 301
Red Wing, MN 55066-0301
ndrf@ndrf.org
http://www.ndrf.org External link
Tel: 651-327-0367
Fax: 651-267-0524
Dysautonomia Youth Network of America, Inc.
1301 Greengate Court
Waldorf, MD 20601
info@dynainc.org
http://www.dynainc.org External link
Tel: 301-705-6995
Fax: 301-638-DYNA

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

Last Modified December 2, 2015

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