What is Autonomic Neuropathy?

Autonomic Neuropathy
One of the hallmark conditions that can occur with diabetes is neuropathy, a misfire in the nerves that impacts feeling and function. There are several types that can affect your body in different ways, but one version — autonomic neuropathy — affects the background functions of your body. That makes getting an accurate diagnosis critical.

What is autonomic neuropathy?

Autonomic neuropathy, also called dysautonomia, affects the nerves that control your involuntary bodily functions. When these nerves are damaged it impacts your blood pressure, temperature control, digestion, and bladder function.

The problems occur because the nerve damage makes it harder for your brain to send messages to your organs and parts of the autonomic nervous system, including your blood vessels, heart, and sweat glands.

What symptoms are common?

The symptoms you experience are directly tied to the part of your autonomic nervous system affected by the neuropathy. Pay attention to these symptoms, and talk with your doctor if they appear.

  • Dizziness and fainting when standing
  • Urinary problems, including incontinence, difficulty starting or sensing a full bladder, and an inability to empty your bladder.
  • Digestive problems, including feeling full after only a few bites, loss of appetite, diarrhea, constipation, bloating, nausea, vomiting, and heartburn.
  • Lack of signs of low blood sugar, such as shaking.
  • Sweating too much or too little, making it harder to regulate your body temperature.
  • Difficulty adjusting your eyes from light to dark.

How is autonomic neuropathy treated?

There are several things you can do to treat your symptoms and minimize the impact. Consider these steps:

  • If you experience nausea or feel full after eating small amounts, work with a dietician to plan your meals.
  • Take medications to accelerate your digestion and reduce diarrhea.

Preventive steps

Slowing the progression of autonomic neuropathy is possible, and it can greatly minimize your symptoms. To limit the impact of the condition as much as you can, follow these tips:

  • Control your blood sugar. Keep it between 80-130 mg/dL before eating and under 180 mg/dL after.
  • Avoid alcohol and smoking.
  • Get appropriate treatment for any autoimmune disease.
  • Control your blood pressure, keeping it below 130/80.
  • Maintain a healthy weight.
  • Exercise regularly, shooting for at least 30 minutes of exercise five times weekly. Biking, running, walking, or swimming are good options.

Making a few lifestyle changes can also lead to improvements:

  • Posture changes: Stand up slowly to decrease dizziness. Tense your leg muscles when standing to increase your blood pressure.
  • Elevate the bed: If you have low blood pressure, raise the head of your bed by approximately 4 inches.
  • Digestion: Eat smaller, more frequent meals. Increase fluids. Choose low-fat, high-fiber options, and restrict lactose and gluten.

If you suspect you have autonomic neuropathy, consult your doctor immediately, particularly if your diabetes isn’t well controlled. Even more, you’ll likely be screened for autonomic neuropathy every year after you receive your diagnosis if you have Type 2 Diabetes.

Contact the Amputation Prevention Centers of America if you have any questions.

After Foot Amputation — What’s Next?

Foot Amputation

A foot amputation can be a scary procedure to face. But, completing a successful operation is your surgeon’s job. Your work begins after the procedure.

Knowing what to expect after a foot amputation can help you toward a speedy, healthy recovery. Your hospital staff will give you medications to alleviate pain and fight infection, but you need to know more. Here’s what you can anticipate:

In the hospital after your foot amputation

After moving to your hospital room post-recovery, nurses will change your bandages and will teach you to do so, as well. You will also start the early stages of physical therapy with stretching and some gentle exercises.

Perhaps, most importantly, you will receive information and guidance about your prosthetic foot (if you’re choosing to get one).

At home 

If your healing progresses well in the hospital, you’ll likely go home after a few days. Once there, be sure you follow your surgeon’s instructions about bathing, activity level, and physical therapy to ensure your best recovery.

Physical therapy starts with gentle stretching and will progress to exercises that will improve your muscle control, enable you to resume daily activities, and help you regain independence. It will also include practice with your prosthetic or assistive devices.

Only take pain medications prescribed by your doctor. Even taking an aspirin can increase your bleeding risk.

If you experience swelling, redness, bleeding, worsening pain, numbness, or tingling, contact your surgeon immediately. These symptoms could be normal, but they could also indicate a need for immediate attention.

Inpatient rehabilitation

If you have additional health problems or you’re not recovering your mobility quickly, your doctor might recommend an inpatient rehabilitation facility.

Healthcare providers will focus on wound healing, rebuilding your strength, preparing your leg for the prosthetic, and improving your mobility. They will also teach you how to care for your new prosthetic.

Ongoing rehabilitation

Prosthetics: If you opt for an artificial foot, you’ll need to be fitted properly, learn how to care for it, and how to walk.

It’s possible your leg will still be swollen when you get fitted for your first prosthetic. If so, you’ll receive a temporary one, getting the permanent one within six to 12 months.

Mental health: Losing a limb can be emotionally traumatic. You can develop feelings of depression, anxiety, grief, denial, and suicide. If you feel any of these emotions, contact your doctor immediately. Your care team has support resources.

Complications

Even successful surgeries carry risks. Blood clots and infections can occur with amputations. If left untreated, these problems can cause nerve pain, phantom pain (pain felt in a removed limb), and bone spurs at the end of your leg.

Contact your surgeon if you experience any complications. While it might be possible to correct the problem with medication, there’s a chance you could need additional surgery.

Ultimately, going into your amputation surgery with a clear understanding of what your next steps will be could put you on a path to a quicker, healthier recovery. If you know what to expect, you can be better prepared.

If you have any questions about a foot amputation, contact the Amputation Prevention Centers of America.

Protect Yourself from Charcot Foot

Charcot Foot

If you have diabetes, you face the possibility of developing many foot problems, including ulcers, non-healing sores, and even amputation. But, there’s another condition you should know about and watch out for: Charcot foot.

Also called Charcot arthropathy, this condition weakens the bones in the feet of people who have peripheral neuropathy. It also attacks the joints and soft tissues. Over time, it can cause painful sores and actually change the shape of your foot.

Why does Charcot foot happen?

Your bones naturally lose calcium when injured, and, according to the Cleveland Clinic, that makes the bones weaker and more susceptible to further damage. The numbness from peripheral neuropathy increases the danger. If you can’t feel a sprain, a break, or an infected or lingering sore, you’re more likely to continue walking on your foot normally. In some cases, slow healing from a foot surgery can be responsible.

What happens?

Prompted by injury that often doesn’t get timely treatment, your bones lose the calcium that keeps them strong. At that point, your foot can start to lose its shape, and your arch can drop below your toes or heel. Doctors often call this “rocker bottom.”

Additionally, your toes might curl, and your ankle can become twisted and unsteady. Any misshapen bones can also press against your shoes, creating new sores that can also get infected and lead to amputation.

What to look for?

Diagnosing Charcot foot can be difficult, according to a study published in American Family Physician, because it mimics other conditions, including cellulitis and blood clots. Initial X-rays and lab tests can also often look normal.

However, there are some symptoms, other than the fallen arch, that can make you suspect Charcot foot. If your foot becomes reddish, warm to the touch, or swollen, talk with you doctor. You should also be concerned if you have instability in your ankle, any misalignment of the bones that form the joint, or a strong pulse in your foot.

Can you prevent it?

Yes, you can do things to potentially side-step Charcot foot. Follow this list for better foot health:

  1. Get regular check-ups with a foot doctor who has experience treating diabetic foot problems.
  2. Check your feet daily for swelling, redness, warm spots, and sores. Check between your toes, too.
  3. Wash your feet daily, and dry them thoroughly.
  4. Always wear socks and shoes.
  5. Keep your blood sugar levels under control — between 80-130 mg/dL before eating, under 180 mg/dL after.
  6. Take extra care to avoid injury, particularly while exercising.

 
Overall, if you begin to see these changes in your feet — especially if your foot begins to change shape — contact your doctor immediately. Any delays can result in further damage to your foot that could lead to infection or amputation.

For questions, please contact Amputation Prevention Centers of America.

Diabetic Amputation & Neuropathy — Is It Inevitable?

Diabetic Amputation
Diabetic neuropathy — nerve damage caused by high blood glucose levels — affects between 60 percent and 70 percent of individuals with diabetes. If you have it, your diabetic amputation risk will be higher. In fact, more than 50 percent of all amputations annually are associated with diabetes.

According to the National Institutes of Health, approximately 86,000 people undergo foot amputations yearly. But, you can reduce your likelihood if you understand the role neuropathy frequently plays in amputations.

How Neuropathy Causes Problems

The nerve damage and reduced sensations in your feet make it far easier for you to sustain injuries and get infections. Because you can’t notice any discomfort, ulcers, infections, and gangrene can develop easily, and poor circulation makes it harder for you to heal.

If the infection can’t be controlled or the wound won’t heal, amputation is a likely outcome to remove dead tissue. Of the roughly 15 percent of all diabetics who develop a foot ulcer, 24 percent will face amputation.

In some cases only toes or parts of the foot are removed to salvage as much healthy tissues as possible. But, if the infection has spread, doctors might have to remove the entire foot or leg. Amputations require several nights in the hospital and up to 8 weeks of recovery time. Prostheses, assistive devices, and home adaptations can help with rehabilitation.

Ways to Reduce Risk for Diabetic Amputation & Neuropathy

You can reduce your chances for developing an injury that ends in amputation.  Following these suggestions can help keep your feet in tact:

  1. Don’t smoke. It constricts the blood vessels, decreasing circulation.
  2. Get routine foot check-ups. Examine your feet daily, using a mirror to see them if needed. Have a medical provider check them regularly, as well.
  3. Control your blood sugar. Keep your levels between 70-130 mg/dL before eating and under 180 mg/dL after meals.
  4. Eat healthy. Choose lean meats, fruits, vegetables, fiber, and whole grains. Avoid sugared juices and sodas.
  5. Get at least 30 minutes daily. Swimming and walking are good options.
  6. Practice good foot care. Wash and dry your feet thoroughly every day, putting cornstarch between your toes to minimize moisture. Keep your toenails trimmed short. Apply a thin layer of petroleum jelly to your feet to reduce cracking. And, wear well-fitting, closed-toe shoes and dry socks without elastic at all times.
  7. Don’t remove warts or callouses with scrapers or scissors. It can leave your feet open to infection.
  8. Keep moving. Wiggle your toes and twist your ankles several times a day.

 

When to Talk With Your Doctor

Even if you follow these tips, problems could still arise. See your doctor if you have any of these issues: fungal infections, splinters, ingrown toenails, corns, bunions, callouses, plantar warts, chilblains, hammertoes, dry skin, gout, and heal pain/spurs.

Although diabetic neuropathy greatly increases your likelihood for foot injury and possible amputation, following these steps can give you the greatest chance for avoiding this surgery.

Contact the Amputation Prevention Centers of America for more information on diabetic amputation and neuropathy.