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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19656
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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A 71 year old friend of mine, female, dedicated organic gardener

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A 71 year old friend of mine, female, dedicated organic gardener for decades who mainly lives in Colombia, S America, who is by no means decrepit, who lives a busy and full healthy active life,surrounded by fresh home grown food, clean air and spring water and a caring family(though who does tend to overdo it and Colombia can be a very stressful place to live in for Europeans) , complains regularly that over the last 5 years she has experienced slowly creeping numbness in her feet. Her feet to her feel cold sometimes whereas to an outside touch they're warm. She works barefoot a lot in her garden. Apart from at one time being anemic and possibly beginning to develop cataracts in her eyes, she's amazingly healthy for her age and hospital test on the blood .etc come out positive. She has none of all those other awful symptoms that seem to go with numbness in feet and indicate things like multiple sclerosis,etc, but is worried and would like to understand just what is going on. She had some form of hepatitis 20 years ago and has a definite tendency to be accident prone where her legs are concerned, taking this usually as an indication to slow down in her work. Her daughter is a masseur and reflexologist but she says that foot reflexology seems to have no effect whatsoever on her. Is it just a simple pinched nerve somewhere or something else, and ,if so, what ? She also takes VitaminB12 regularly as that has been recommended. She's a damm sight more healthy than most people I know including people much younger, usually has bags of energy and is also a therapist of the emotional release school and keeps herself healthy in that manner, and also by living in a supportive community. Any ideas what to do? She also stands a lot doing kitchen work, but usually gets loads of rest. Farm work is strenuous in the morning but slackens off in the afternoon. She does tend to take on masses of responsibility as she's very good at this but it wears her down a lot sometimes as people can lean on her too much.
It will help if you could provide some further information:
One of the primary questions is the pattern of the altered sensation.
Is the altered sensation affecting all the different surfaces of the foot, such as a sock?
Or is the pattern more of a strip along a particular surface or two of the foot, such as a strip along the upper aspect of the foot?
What was the hospital test on the blood that was positive?
Was the recommendation to take vitamin B12 based on a blood test that showed a low level of vitamin B12?
If so, was the level rechecked to show that it was normal?

I had asked for some additional information, but have not heard back, so wanted to address what information is available.

Although it would require a proper evaluation to make a proper diagnosis, the pattern of the symptoms can give a suggestion of the cause of the symptoms, as I noted above. If the pattern is like a sock (or stocking), that pattern is more suggestive of a peripheral neuropathy. If the pattern is more like a strip on one portion of the foot or leg, that is more suggestive of pressure on a specific nerve, which can occur at the spine or along the course of the nerve as it travels to the foot.

The vitamin B12 warrants some specific discussion because a vitamin B12 deficiency is one of the possible causes of a peripheral neuropathy. If there was a documented deficiency, then there should be verification that supplementation has resulted in adequate levels of vitamin B12.

If the pattern is more suggestive of pressure on a nerve, it would be reasonable to try an over the counter anti-inflammatory medicine, as controlling swelling associated with inflammation may relieve pressure on the nerve.

If you have any further questions, please let me know.

Customer: replied 4 years ago.

Sorry to be so late in responding. She reports basic numbness on the ball of the foot to begin with that appears to be spreading very slowly on the rest of her foot. No pain or tingling sensations. Nothing similar on hands or other extremities. The vitamin B12 was just something she heard about and when she was anemic all sorts of vitaminB was recommended. The blood tests were for a diabetes check and turned out normal.

I'm sorry for the delay in responding, but I was away from the computer.

It still is not clear if it is a stocking pattern or a strip pattern, since it could have spread over the foot in either pattern. It is not unusual that a layperson may have difficulty clarifying the pattern, and it is more effective if she were to see a physician to perform a neurologic examination. Once the pattern is established, then the next step in the evaluation can be performed.

As part of the evaluation, it also would be appropriate to check the level of vitamin B12, as a vitamin B12 deficiency could be the cause of the symptoms and oral supplementation may not be adequate to correct a deficiency.

Customer: replied 4 years ago.

What other things could a layman do for evaluation.?She lives up a mountainside pretty far away from "civilisation"

A layperson cannot perform an evaluation, but it is reasonable for her to try a course of an over the counter anti-iflammatory medicine, which may help ease pressure on a nerve, as noted above.

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