Q: I have been experiencing a very unpleasant sensation in my feet. It is like they are burning! It first started happening about three months ago and it is getting worse. Initially, I only had the problem at night. Now I feel it all the time. I am 72 years old and have high blood pressure (I take two medications for it). My last checkup six months ago was very good — my doctor gave me a clean bill of health. Someone said I may have restless leg syndrome. I looked it up and it happens at night and my symptoms are there all the time. I think I may need to see my doctor soon for the extra visit. What do you think? — Brad

A: It is always helpful to see your doctor if you have a new problem, especially if it is not going away. I suspect that you may have the beginning of some form of neuropathy. Neuropathy from Latin means something abnormal with your nerves — literally "abnormal nerves."

The most common form is peripheral neuropathy. Just to explain a little bit more, your nervous system consists of two main parts: The brain and spinal cord are called the central system, and everything else is called the peripheral system. This includes nerves which are responsible for feeling (pain, heat, touch), nerves responsible for movement and the last group, the nerves controlling automatic functions like breathing, digestion, posture, bladder function and so on. The latter is also called the autonomic (independent) system, since it does not rely on thinking.

At

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any rate, the nerves affected first are the longest nerves — the ones going to your toes. The nerves responsible for feeling are involved most often. The symptoms are what you have described: numbness, tingling, burning, sharp electric-like pain. One can also experience sensitivity to touch, muscle weakness and bowel and bladder problems if other groups of peripheral systems are involved. If the autonomic system gets affected, patients lose some control of their blood pressure when getting up and get dizzy or even faint. As you can figure out now, neuropathy is a group of problems, not just one particular disease.

What causes neuropathy? If only one nerve or group of nerves is involved — say you only get symptoms in the right hand, the most common reason is trauma (like typing too much). Diabetes is another big reason and can affect all parts of the peripheral system. This is why controlling the level of glucose is so important. A vitamin problem, especially from the B group, is another reason. Underactive thyroid, kidney and liver diseases and excess of alcohol intake come next. Alcohol is important because many people will not report how much they really drink to their physician. Infections,especially HIV, can be responsible. Sometimes we see neuropathy in the group of diseases when our own defense system turns against us. We doctors call them autoimmune diseases (rheumatoid arthritis is a good example).

At times, patients inherit neuropathy. Around 40 to 50 percent of neuropathy cases are never clearly explained. As you can see, sorting it all out WILL require a doctor's visit. You need to expect a solid physical, blood tests and even direct nerve testing called EMG (electromyography). This test will measure the electric activity of the nerves and is very helpful.

Once all the testing is done, the doctor will tell you which type of neuropathy you have and, hopefully, what is causing it. If untreated, neuropathy can result in a number of symptoms and lead to the loss of a person's function. If the affected nerves are responsible for the pain a person may experience, he or she is at risk of injury to the foot and not having it discovered, or they may even accidentally burn their hands or feet.

Treatment of neuropathy focuses on its cause, if one is discovered. Controlling blood glucose, supplementing the thyroid if it is low, and correcting LOW vitamin levels can make a dramatic difference. The other very important goal of therapy is to control its symptoms. Many medications are used: pain medications, anti-seizure medications (they somehow improve the damaged nerve function), antidepressants and topical anesthetic (numbing medication) lidocaine patch. When used under a doctor's careful supervision, these medications improve function and help with pain and numbness.

By now I think you understand that your idea of seeing your doctor is an excellent one! Chances are your problem will be corrected easily and that you will find relief very soon. Best of luck!

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.