More medical problems for Glenn Beck

Glenn Beck announced on Friday that he will be taking off a few days to undergo medical testing.  The past year has been tough for the 46 yr. old controversial Fox News commentator. Last November, he had his appendix removed for appendicitis, and in July reported vision difficulties called macular dystrophy. Now Beck is having trouble with the feeling in his hands and feet:  “I have been losing feeling in my hands and my feet and I have been feeling tingling in my hands and my feet, and it’s traveling up my arms and it’s just a very bizarre sensation. It almost feels like I’m wearing gloves at times…”  Beck was told by physicians that a problem with “small fibers” may be involved and he plans to go “out west” for a complete evaluation.

Beck also claims that this medical conditions may be due to spiritual wounds: “There’s a physical reason, but I believe physical, mental and spiritual are all tied…you can’t injure the soul of someone and not have physical wounds appear eventually…a lot of physical things, a lot of mental things are from spiritual wounds and vice versa.” We won’t speculate on the cause of Mr. Beck’s medical problems, but we have recently done a few stories about the connection between stress and medical conditions (see, for example, the story on Michael Douglas and stress).

The term “small fibers” probably refers to a condition called small fiber neuropathy. It is a nerve problem of the smallest nerve fibers in skin and typically affects  sensation the affected areas. These nerve fibers are a part of the nervous system called the peripheral nervous system. It encompasses the nerves that start beyond the brain and spinal cord. One set of peripheral nerves relay information from your central nervous system (brain and spinal cord) to muscles and other organs. A second set relays information from your skin, joints, and other organs back to your brain.

Peripheral neuropathy occurs when these nerves don’t work properly, resulting in pain, loss of sensation, inability to control muscles, and other possible problems. More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis.

Small fiber neuropathy is named after the specific portion of the peripheral nervous system that is affected. Small nerve fibers are the nerve fibers near the skin’s surface that carry sensation. They are frequently unmyelinated, meaning they don’t have a fatty layer of insulation called myelin, and they conduct nerve impulses relatively slowly. They carry mostly pain and temperature sensation. Nerves to muscles and other sense organs (like pressure touch) are usually myelinated which conduct nerve impulses faster.

The key symptoms are insensitivity to heat and/or cold. There may be other nerve  symptoms  common to all neuropathies, such as tingling, numbness, muscle weakness, cramps, pain and other symptoms. Symptoms in peripheral neuropathies tend to occur in the longest nerves first, so the most common locations for symptoms are the hands and feet (see diagram).

Although diabetes mellitus is the most common identifiable cause of small fiber neuropathy, many other cases are idiopathic- meaning their cause is unknown. The diagnosis of small fiber neuropathy requires special testing as routine nerve conduction studies are often normal.

Treatment is primarily symptomatic. Sometimes treatment is also preventive care- especially in those with decreased sensation or temperature insensitivity.  People may fail to sense that they have been injured from a cut or that a wound is becoming infected.  (Loss of pain sensation is a particularly serious problem for people with diabetes, contributing to the high rate of lower limb amputations among this population.)

For more information about small fiber neuropathy, click here to go to the Resounding Health Casebook on the subject.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.


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