By Dr. Anthony Policastro

The last two articles have discussed vision and hearing issues in older patients. They are not the only senses affected. The sense of touch also shows increasing incidence with age.

The condition that affects nerve endings in the hands and feet is called peripheral neuropathy. There are two groups of individuals that we see.

One group contains those individuals who have medical conditions associated with neuropathy and loss of sensation. Diabetes is one of those diseases, this is the reason that you see signs in physicians’ offices about removing your shoes if you have diabetes. You might have foot injuries that you cannot feel because of loss of sensation. 

Alcoholism is another condition. Often it is associated with vitamin deficiency due to poor diet. Thus there are a combination of factors. 

Individuals with these types of medical conditions have an incidence of peripheral neuropathy of 45 percent after age 65 years.

For individuals without these conditions we see the incidence increase with age. About 19.3 percent of healthy individuals between 65 and 74 years have symptoms. That number goes up to 31 percent for the 74 – 84 year age group. It is at 58 percent for those over age 85 years.

Symptoms are varied. They might include loss of sensation to touch, they might include loss of sensation to vibration, they might include loss of being able to tell the position of the foot without looking, and they might include loss of ankle reflexes. 

There might be things that are felt that are not normal, including pain, heat and the sensation of pins and needles. 

The symptoms are often worse at bedtime. One reason for this is there are no longer all the distractions that occur during the day. All of a sudden you pay attention to something that you might have ignored all day.

There are a variety of treatments that can be used. Some are simple. The involve things like meditation and yoga. Sometimes a change in sleep position can help. 

There are times when a vitamin deficiency can be present. Vitamin B12 is a good example of this. It is a known cause of peripheral neuropathy. A daily multivitamin is a good idea. It may not prevent more severe deficiencies. However, it can boost your body’s levels.

Omega-3 fatty acids found in fish oil supplements appear to be helpful in reducing neuropathic pain.

Diabetic patients on metformin have a double whammy. Metformin can cause neuropathy as a side effect. Some chemotherapy agents can cause neuropathy as a side effect.

As you might gather from all of this, peripheral neuropathy is common. It also has many causes. There is no simple answer. If you have symptoms and they seem to be worsening, it is a good idea to get them evaluated. That might prevent them from becoming even more of a problem.

Thus, in addition to the optometrist/ophthalmologist and audiologist, a medical evaluation is often the best place to begin. Once you have ruled out serious causes, then you can focus on treating the symptoms.

COVID update- There were 130,000 new cases nationally last week. There were 75 new cases in Sussex County. Both of those numbers are the lowest they have been since the beginning of the pandemic.

There are some people who still deny the high number of deaths from COVID-19 (now at 1,153,730). Those numbers come from death certificates filled out by physicians. 

Physicians are not stupid. They know how to fill out death certificates. They are not liars just putting down a diagnosis when it isn’t the real cause of death. They are not greedy thinking that if they put down COVID-19 they will make more money.

It is a disservice to think any of those things of the medical personnel who worked tirelessly through the pandemic to treat patients and save lives. Instead of being suspicious of them, we need to be thankful for their efforts.

Denial is a powerful psychological defense mechanism. There clearly are a lot of people still using denial to support their underlying incorrect ideas.