Neuropathy: Numbness only, no pain

Posted by John, Volunteer Mentor @johnbishop, Sep 10, 2020

When I was first diagnosed with idiopathic small fiber peripheral neuropathy and numbness was my only symptom, my neurologist told me that I am one of the "lucky" few who didn't also have pain and other associated symptoms of neuropathy. I knew there were others out there but yesterday I met my first member on Connect who has a similar diagnosis. I want to thank that member for joining Mayo Clinic Connect and sending me a private message that I would like to answer here to start this discussion.

Hello @afirefly, Welcome to Connect. You mentioned being diagnosed with large fiber demyelinating predominately sensory peripheral neuropathy at Mayo Clinic. The neurologist's recommendation was exercise and balance exercises. Your symptoms are less than one year and are primarily progressive loss of sensation in your hands and feet. You also said aside from occasional muscle cramps in your calves and dyesthesias in hands and feet, you experience little discomfort. Your greatest concern now is the degree of disability you will have as the numbness progresses.

I can tell you that we think a lot alike. When I walked out of the neurologists office with similar symptoms of just numbness in the feet and lower legs with no pain – and no recommendations for treatment, I was pretty down. I was told to let them know as the condition progressed and my biggest fear at the time was not being able to drive myself. That's when I started doing my own research and found Mayo Clinic Connect after being diagnosed with idiopathic small fiber PN.

You have some really good and thoughtful questions which I will try to answer the best I can.

Question: Although you have improved on the Protocol, did you ever have complete loss of sensation in your feet? I ask because I truly dread the possibility of total sensory loss in my feet.

Answer: I never had a complete loss of sensation in my feet. At the worst, they felt numb and sometimes tingly but not painful, just uncomfortable. They mostly always feel cold and after being diagnosed with lymphedema I have to wear compression socks which doesn't help the numbness feeling. I have noticed that it seems like I've had some feeling returning ever so often when I'm exercising on my crossfit exercise bike. I use it several times a day for 30 to 45 minutes when I can to build up leg and arm strength. I recently purchased a device called a Sand Dune Stepper to work on my balance issues. I do think it helps and I've noticed a little more feeling in the bottom of my feet – if that makes sense for numb feet. Website – https://www.sanddunestepper.com/
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Question: Assuming you have little or no sensation in your toes and the soles of your feet, are you still able to drive a car?
If yes, would you kindly tell me what maneuvers/measures you have used over the years to compensate for the absence of feeling in your feet while driving?

Answer: I am still able to drive a car. The numbness was always a concern in my mind but never kept me from feeling the pressure of placing my feet on the pedals and pushing them down or letting them up.
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Question: Assuming you have little or no sensation in your toes and the soles of your feet, how difficult is it for you to walk? Before my neuropathy, if my foot was in a position too long it would "go to sleep" from lack of circulation to the nerves. The sensation would return seconds later once I changed my foot position. However, I don't believe I would have been able to walk on that sleeping foot until the circulation had been restored. Please tell me if there are/were any maneuvers/measures you have used over the years to compensate for the absence of feeling in your feet while walking.

Answer: When I was in my late 40s, my wife would sometimes tell me that I walk like an old man and now I am one and still walking the same. I've always been slow getting up and slow to take the first steps when walking. I guess I would call it trying to be careful because I wasn't sure of my footing. I think recognizing that your feet may not be as steady is a good thing and keeps you alert when walking. I struggle with walking any distance due to lower back issues. I recently had some physical therapy to learn some back and stomach muscle strengthing exercises which has helped some. Now I just have to execute a plan to do them often.
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Question: You indicated that the cost of the old Protocol was under $10/day (prior to 525 Protocol) several years ago and that the current 525 Protocol is $6.44/day. Does that mean Protocol 525 these days costs somewhat less than the old (original) Protocol?

Answer: Each item in the original protocol lasted a different number of days so the cost was more spread out and roughly calculated at under $10/day. The new 525 Protocol is a 30 day supply for $6.44/day ($193.20). It's also fewer pills to swallow which I really like. The Ramp up version is different due to the R-ALA in the regular 30 day supply. The daily R-ALA dosage is 1200 mg which causes some people to have stomach problems so the ramp up is to gradually increase the dosage to get use to the higher amount. I never had an issue because I was already taking supplements for the PN from my research and was taking that amount of ALA before I found the original protocol. Related discussion — Have you tried the new Protocol 525 product for neuropathy relief?: https://connect.mayoclinic.org/discussion/have-you-tried-the-new-protocol-525-product-for-neuropathy-relief/
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Question: Do you use orthotics or inserts in your shoes? Special shoes?

Answer: I've tried some orthotics and different inserts but don't always use them. I found some felt/wool inserts that I like during the winter time as an extra cushion. I do like Sketchers because of the memory foam cushion and comfort. I used to wear the canvas shell ones but my neurologist told me it would be best to wear shoes with good side support for walking. So, I try to choose slip-ons with good side support made out of leather. There is another discussion on Connect you might find helpful for shoes – If the shoe fits…right?: https://connect.mayoclinic.org/discussion/if-the-shoe-fits-right/
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Question: Besides daily foot exams, lotion to your feet, and avoiding barefoot walking, are there any other measures you use to protect your numb feet?

Answer: For me, this all started with a trip to the ER after waking up one night to go to the bathroom and when reaching the bathroom seeing blood all over the floor and trying to figure out where it's coming from. Surprised was I to see it pumping in a small stream from my ankle. Long story short, I unconciously rubbed my feet during the night and I had a hang nail on my big toe which tore the skin and part of a vein close to the surface. After that episode, I always wear white short loose socks to bed and I apply lotion to my feet and legs to keep them moisturized. I think that also helps with the healing process when you think that there are tiny sensory nerves just under the skin and it helps to keep the skin moist to protect them.

Hope this helps…let me know if I missed anything or if you have any other questions. We have a great group of members with a lot of experience here on Connect.

John

Thank you John for your lengthy and thoughtful reply to my questions and for starting a Neuropathy Numbness subgroup. The large response to this new subgroup suggests the subgroup will be relevant to many. Your posting and that of others suggest exercising the muscles within the numb area will temporarlly reduce the numbness. Conversely, in my experience, static pressure on a portion of my foot or fingers seems to temporarily worsen the numbness. You mention doing balancing exercises. Does your neurologist believe your small fiber neuropathy is contributing to your imbalance?
Imbalance is certainly a symptom of a large fiber sensory neuropathy.

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@johnbishop, I can not find the words to express how happy I am that you started this subgroup and to heartily thank @firefly for posting excellent questions privately which prompted you to start this sub group! My cardiologist referred me to my neurologist because of numbness in my feet. The neuro ordered extensive blood and urine tests. I then was tested with the electrodes and pin pricks and told I had peripheral neuropathy and he ordered the diabetes test because tests conducted revealed no definitive cause for the PN. That test revealed prediabetes. On my second visit, I was prescribed Metanx, which I believe is a vitamin supplement.

I've been following the neuropathy group closely but while others mentioned numbness, nearly all also write of pain which I don't have, just the numbness and tingling which are advancing up toward the knees. Now I am beginning to experience some numbness in my hands but again no pain. As others shared the specific types of neuropathy they'd been diagnosed with, I have continued to wonder why I haven't been told more specifics. No mention of small fiber or large fiber or other so I have no clue but will ask at my next annual appointment.

I have had many of the same questions and concerns that @firefly mentioned. The neuro told me that this is a slowly progressing disease and when asked if p.t., water therapy, acupuncture or specific exercises could help stimulate the nerves or slow down the advance, I was told there was no effective treatment. It is a relief to learn that others diagnosed with neuropathy experience symptoms like mine. I have been feeling like an odd ball in the original group and felt like questions about fear of the loss of ability to drive or type or increasing issues with balance or the coldness I've had for years in both hands and feet were trite in contrast to what so many members were challenged with. I've seen Protocal mentioned in the other group but don't know what that is. Is it a medication or process one follows in trying to maintain the level of function? My sincere thanks for starting this sub-group.

Also haven't received daily digest or new posts for 2 days and hoping there isn't another computer glitch on my end? Nothing in spam folder. I got to this thread by opening an earlier post.

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@fiesty76

@johnbishop, I can not find the words to express how happy I am that you started this subgroup and to heartily thank @firefly for posting excellent questions privately which prompted you to start this sub group! My cardiologist referred me to my neurologist because of numbness in my feet. The neuro ordered extensive blood and urine tests. I then was tested with the electrodes and pin pricks and told I had peripheral neuropathy and he ordered the diabetes test because tests conducted revealed no definitive cause for the PN. That test revealed prediabetes. On my second visit, I was prescribed Metanx, which I believe is a vitamin supplement.

I've been following the neuropathy group closely but while others mentioned numbness, nearly all also write of pain which I don't have, just the numbness and tingling which are advancing up toward the knees. Now I am beginning to experience some numbness in my hands but again no pain. As others shared the specific types of neuropathy they'd been diagnosed with, I have continued to wonder why I haven't been told more specifics. No mention of small fiber or large fiber or other so I have no clue but will ask at my next annual appointment.

I have had many of the same questions and concerns that @firefly mentioned. The neuro told me that this is a slowly progressing disease and when asked if p.t., water therapy, acupuncture or specific exercises could help stimulate the nerves or slow down the advance, I was told there was no effective treatment. It is a relief to learn that others diagnosed with neuropathy experience symptoms like mine. I have been feeling like an odd ball in the original group and felt like questions about fear of the loss of ability to drive or type or increasing issues with balance or the coldness I've had for years in both hands and feet were trite in contrast to what so many members were challenged with. I've seen Protocal mentioned in the other group but don't know what that is. Is it a medication or process one follows in trying to maintain the level of function? My sincere thanks for starting this sub-group.

Also haven't received daily digest or new posts for 2 days and hoping there isn't another computer glitch on my end? Nothing in spam folder. I got to this thread by opening an earlier post.

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@fiesty76 You mention feeling that your symptoms were trite compared to others. But you are such a valued member with very insightful contributions. These are a help to others. My purpose is to help my wife with any info I can learn here as well as be of service any way I can to others here. To me there is no other point. I am happy John started this discussion for you and others who have numbness but no pain. Best to you, Hank

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@afirefly

Thank you John for your lengthy and thoughtful reply to my questions and for starting a Neuropathy Numbness subgroup. The large response to this new subgroup suggests the subgroup will be relevant to many. Your posting and that of others suggest exercising the muscles within the numb area will temporarlly reduce the numbness. Conversely, in my experience, static pressure on a portion of my foot or fingers seems to temporarily worsen the numbness. You mention doing balancing exercises. Does your neurologist believe your small fiber neuropathy is contributing to your imbalance?
Imbalance is certainly a symptom of a large fiber sensory neuropathy.

Jump to this post

Hi @afirefly, I haven't talked with my neurologist since my diagnosis in 2016. I think my balance issues could be related to several autoimmune conditions but if I had to make a non medically educated guess, I think it's mostly due to degenerative arthritis in my lower spine and the fact that I have difficulty walking any distance due to leaning forward but not quite as bad as Camptocormia (bent spine syndrome). I've been doing PT exercises to improve my posture and strengthen the lower back but probably not as much as I should be doing. I'm a work in progress 🙂 Here's some more info on balance issues – 5 most common balance problems seniors experience: https://www.sunriseseniorliving.com/blog/september-2017/5-most-common-balance-problems-seniors-experience.aspx

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Gentlemen,I have couple of questions for you , so I can more easily john the discussion.I also have
been diagnosed with Peripheral-neuropathy, and am very active in the intense research of a cure or relief.My conclusion is the practise of Neuroplasticity. , which I started July 1 this year , and my condition is improving, slowly, but surely.. I have numbness in both feet ankles calfs, up to both knees.Apart from new brain exercises, I have modified my diet, to provide more indurance. If you could answer the following questions, I may be able to provide you , hopefully, a couple of facts, I have learned. I have a indoor stationarybike and selection of weights.
1. Your current age.
2.your age on experiencing initial numbness
3. Age when diagnosed by Neurologist of P N
4..Any other serioss medical conditions.
5. Daily tablet, medication etc.
6.current fitness condition or assessment.

I would also be very happy to receive any tips or advice . I live in Australia. Best wishes and regards

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@user_che214927

Gentlemen,I have couple of questions for you , so I can more easily john the discussion.I also have
been diagnosed with Peripheral-neuropathy, and am very active in the intense research of a cure or relief.My conclusion is the practise of Neuroplasticity. , which I started July 1 this year , and my condition is improving, slowly, but surely.. I have numbness in both feet ankles calfs, up to both knees.Apart from new brain exercises, I have modified my diet, to provide more indurance. If you could answer the following questions, I may be able to provide you , hopefully, a couple of facts, I have learned. I have a indoor stationarybike and selection of weights.
1. Your current age.
2.your age on experiencing initial numbness
3. Age when diagnosed by Neurologist of P N
4..Any other serioss medical conditions.
5. Daily tablet, medication etc.
6.current fitness condition or assessment.

I would also be very happy to receive any tips or advice . I live in Australia. Best wishes and regards

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Hi Barry @user_che214927, I have done much of the same things you have except for trying neuroplasticity. I'm doing well without it but I'm keeping an open mind and if I get down I may dig deeper into trying it starting with watching all of the videos to see if I can absorb it without the reading (hate reading technical and lengthy books 🙂) — TED Talks and YouTube Videos on Neuroplasticity: https://positivepsychology.com/neuroplasticity/#ted-neuroplasticity

1. I'm 77 (Do you remember Cookie, lend me your comb – 77 Sunset Strip 😂 gone are the hair days)
2. Numbness in toes and bottom of feet started in my late 40s
3. Diagnosed by Neurologist with idiopathic Small Fiber PN at 73
4. High Blood Pressure/Hypertension, PMR, Lymphedema, Degenerative Arthritus, Sleep Apnea, BPH – hey, my glass is half full!
5. BP medication pills
6. Condition – better than I deserve! Finally controlling my weight, exercise two to three 30 minutes sessions daily on my Teeter recumbent cross trainer and elliptical, daily back and shoulder PT exercises. Now practicing alternate fasting to lose and then maintain a good weight for myself. Started my weight journey in my 50s at 330 lbs, now weigh 216 lbs with a goal to maintain a weight of 200 lbs. I was a snack-ahololic who ate his fair share of doughnuts back in the day. Sadly I learned too late in life of how it affects your health and I think it's responsible for most if not all of my health conditions. But as my momma always told me, I am a work in progress.

Oh yeah…and I hate wearing compression socks for my lymphedema but it's a small price to pay to keep it under control. The tightness of the compression socks seems to give me some feeling back in my feet. I can actually feel the bottom of the feet when I'm peddling on my cross trainer. Not sure I have any tips for you Barry. At 89, you are doing fantastic and my goal is to get where you are now!

Hoping you have a great weekend Barry!
John

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@johnbishop

Hi Barry @user_che214927, I have done much of the same things you have except for trying neuroplasticity. I'm doing well without it but I'm keeping an open mind and if I get down I may dig deeper into trying it starting with watching all of the videos to see if I can absorb it without the reading (hate reading technical and lengthy books 🙂) — TED Talks and YouTube Videos on Neuroplasticity: https://positivepsychology.com/neuroplasticity/#ted-neuroplasticity

1. I'm 77 (Do you remember Cookie, lend me your comb – 77 Sunset Strip 😂 gone are the hair days)
2. Numbness in toes and bottom of feet started in my late 40s
3. Diagnosed by Neurologist with idiopathic Small Fiber PN at 73
4. High Blood Pressure/Hypertension, PMR, Lymphedema, Degenerative Arthritus, Sleep Apnea, BPH – hey, my glass is half full!
5. BP medication pills
6. Condition – better than I deserve! Finally controlling my weight, exercise two to three 30 minutes sessions daily on my Teeter recumbent cross trainer and elliptical, daily back and shoulder PT exercises. Now practicing alternate fasting to lose and then maintain a good weight for myself. Started my weight journey in my 50s at 330 lbs, now weigh 216 lbs with a goal to maintain a weight of 200 lbs. I was a snack-ahololic who ate his fair share of doughnuts back in the day. Sadly I learned too late in life of how it affects your health and I think it's responsible for most if not all of my health conditions. But as my momma always told me, I am a work in progress.

Oh yeah…and I hate wearing compression socks for my lymphedema but it's a small price to pay to keep it under control. The tightness of the compression socks seems to give me some feeling back in my feet. I can actually feel the bottom of the feet when I'm peddling on my cross trainer. Not sure I have any tips for you Barry. At 89, you are doing fantastic and my goal is to get where you are now!

Hoping you have a great weekend Barry!
John

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@johnbishop @user_che214927
John, Barry, you both are doing fantastic work on yourselves. Barry you look great, you do too John (in the article Lee linked to). I admire you guys for the work you are doing on yourselves. I have a difficult time with indoor equipment. I get too bored, even with a tv on. So I hope to continue taking exercise outdoors as long as I can. Best, Hank

PS: Barry I have started the brain book by Doige. It starts out interesting from the first page.

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Both of his books are magnicent reading, also cutting edge info As I mentioned to you previously, both books need to be STUDIED, not just read, until, we really understand.And again, the first book, ' The Brain That Changes Itself, especially chapter 7, ON PAIN.But, again, the book number one MUST, BE READ FIRST!

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@johnbishop Hi John what is the cause of cold feet all the time I have socks on its 85 out .I'd this part of neuropathy symptoms Can't get a hold of Dr so Dr John what do you think?

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@lioness

@johnbishop Hi John what is the cause of cold feet all the time I have socks on its 85 out .I'd this part of neuropathy symptoms Can't get a hold of Dr so Dr John what do you think?

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Hi @lioness, maybe a Dr. Suess 🙂 who knows how to use searches to find information. Only a doctor can maybe give you a specific cause of cold feet if they can pin down a diagnosis. Poor circulation along with some underlying conditions are possible causes – Cold Feet: https://www.foothealthfacts.org/conditions/cold-feet.

I wear socks to bed. My wife doesn't like cold feet either 😂

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@johnbishop I've been waiting for weeks for a referral but guess I,ll have to keep after Dr for one Yes my husband was so warm he kept my feet warm I take medicine for circulation

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@lioness

@johnbishop Hi John what is the cause of cold feet all the time I have socks on its 85 out .I'd this part of neuropathy symptoms Can't get a hold of Dr so Dr John what do you think?

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Hello @lioness and @johnbishop, just wanted to ask if you have the same problem with your hands and fingers? I have Raynaud's disease and my fingers and toes are so cold they hurt! Also, they can blanch and turn Pure White in places and then after that, a very dark blue and almost blackish looking. Best fix for that is to get them in some warm or other safe type of heat water for a while.

I have to wear gloves all day and even then when I'm immobile, which is a lot, they are wrapped inside my rolled up heating pad.

A rheumatologist can diagnosis you. I also have to wear socks and/ or have my feet underneath my winter weight down comforter at all times when immobile.

I am sorry to hear about your problem and hope you get diagnosed and that some heat can help you when you are able.

Warmest regards, Sunnyflower. 😊

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