Brief Answer:
Neuropathy following chemotherapy

Detailed Answer:
Good morning and thank you for your question.

As far as gout is concerned you would want to confirm the diagnosis first and make sure that you are not having either symptoms of joint pain or elevated levels in the blood stream of urea due to something to do with medications you may be taking because this is a commonly overlooked issue. If that's not the case then, you will need to check with your doctor to see if referral to a rheumatologist is going to be appropriate if the case is complicated because of your breast CA situation or whether your primary can handle it by choosing appropriate medications such as colchicine and allopurinol and following labs. I've found in some of my patients that very high dose CRYSTALLINE POWDERED VITAMIN C at 2500-3000mg. daily is very good for preventing gout attacks. It doesn't work as robustly in cutting off the acute attack but I've a few patients who do very well with using it as a preventative. Remember, I'm not talking about tablets or Emergen C or anything like that. I'm talking about pure CRYSTALLINE POWDER of ascorbate or ascorbic acid which I tell patients in the U.S. they can find in plenty of supply at a reasonable prcie at WHOLE FOODS which is present in every State.....they need to have more! HA! Read your labels on doses but typically with the WHOLE FOODS preparation of Powdered Vitamin C 1/2 teaspoon= 2500mg. That's all you need to dissolve in a drink or sprinkle on food once daily or you could do 1/4 teaspoon TWICE DAILY and see how that works in the prevention of gout symptoms.

As far as the neuropathy is concerned I would first be absolutely sure that you are not nutritionally deficient in dietary elements that chemotherapy has a reputation of depleting such as FOLATE, VITAMIN B12, PYRIDOXINE, and RIBOFLAVIN. Vitamin B12 levels in your case should be a minimum of 400 if not slightly higher because of the chemotherapy you've received and the type of toxic damage that has occurred necessitating a bit more robust replacement amount than someone who may simply be a bit nutritionally defiicient. I would also check Vitamin D levels and make sure they were at least 60-80 in blood because this is a fairly commonly overlooked caused of metabolic neuropathy that is not caught and independent from the activities of Vit. B12 and folate, etc. You may also try a good round of Alpha Lipoic Acid if none of the foregoing pans out to anything significant. I've had some neuropathic patients respond very nicely to anywhere between 100-200 mg. tablets 3-4x daily.

Please be aware that I would recommend giving each step of replacement therapy- if found deficient a minimum of 3-4 weeks to work at XXXXXXX doses before deciding it is not working and moving.

If you've accomplished all those steps and still no satisfactory healing has occurred then, anti-neuropathic agents other than gabapentin that have been successful against various forms of neuropathy caused by chemo or radiationtherapy in many of my cancer survivor patients are things such as:

1. Lyrica (pregabalin)
2. Capsaicin cream (peppercorn cream)...applied locally....it burns a bit and has to be applied a least a couple of times per day but it does work....trick here is not to use it excessively so your body doesn't get refractory to its effects (gets used to)
3. Pamelor (Nortriptyline...should be titrated slowly over a period of 4-5 weeks to a XXXXXXX dose of 50mg. taken all at bedtime). Trouble with this drug are side effects of dry mouth, GI upset, and in some people it interferes a bit with sleep....in others, they tell me they never "slept so good!"....go figure.
4. Some antiepileptic drugs such as Tegretol and even Dilantin can act as antineuropathic agents. These need to be titrated slowly and monitored by their blood levels so they don't become excessive.
5. Then, there are drugs such as cymbalta, topiramate and Mexiletine (save this one for last because you'll need an EKG before you start using this medication.....but it works very well for painful neuropathies).

One other thing in neuropathy....we are TREATING THE PAINFUL OR POSITIVE SYMPTOMS of abnormality....we are NOT treating NUMBNESS....no medications available for this symptom....that has to come back on its own if possible.....Medications for neuropathy treat POSITIVE symptoms of pain, tingling, feelings of heat and cold, burning, etc.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 25 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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