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 Prevention is Key

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 There is presently no cure for HNPP. Some symptoms, however, can be treated.

HNPP is a unique neuropathy in that activity plays a very large role in the development of pressure palsies. This makes it different from most other neuropathies. And because of this, the individual needs to take a particularly active role in identifying activities which cause symptoms. There is a three step trial and error process people can use:

1. If you have any signs of a pressure palsy developing - STOP what you are doing. Symptoms may begin with tingling or numbness or weakness. Sometimes it is too late to stop the damage once symptoms are felt.

2. Analyze what were you doing both immediately before you developed the pressure palsy and in the days before it developed. Is weather playing a part in your symptoms?

3. Learn from what happened and change the way you do that thing in the future. Maybe you will need or want to give it up entirely. But doing it for a shorter period of time or less frequently the next time may enable you to continue that activity. Using a machine/tool to do the work or getting someone to help you may also work.

But be aware that trying to prevent episodes of pressure palsies will be a trial and errror process. There can be more pressure palsies as you learn about your HNPP. Also there may be times where a pressure palsy simply cannot be avoided. Having one develop during sleep is a common occurence also. Consider this a learning process. Self blame or others blaming you should be avoided.

People are usually advised to avoid leaning on their elbows and crossing their legs. This is the standard lecture from neurologists

Wrist splints can be worn at night and/or when palsy episodes are present. A padded wrist splint s considered better than one that is not padded. For individuals who do a lot of leaning on their elbows, elbow pads, such as those used by skate boarders can be worn. Elbow pads may also be found in medical supply catalogs. A foam pad can also be added to the bed (on top of the mattress) to lessen pressure on elbows.

In most cases, physical therapy is not needed for a pressure palsy episode. A ‘tincture of time' can be the best treatment because the nerve needs time to restore the myelin. I have learned from a physician and physical therapist that weakness is a much greater concern than the numbness. If a weak arm or leg is present and caused by a pressure palsy (not the progressive disease), then the affected part should be used, but used minimally in order to give it a chance to heal.

The 'used it but don't use it' message can be confusing. "Use it " means is that the affected part needs to move around some in order to keep joints and muscles mobile and blood flowing to the limb in order to promote healing. "Don't use it" or using it minimally means that you should "baby' the affected part, in order to give it a chance to heal. Avoid fatiguing it. Use it less than you would normally use it. If you can't quite do something, don't try to do it.Don't push! Listen to your body and use it as you are able, which is not the same a using it as much as you would like. Don't try to resume normal use until you feel that you have completely healed.

There is no treatment for permanent numbness.

AFOs (Ankle Foot Orthosis) or foot braces can be used for permanent foot drop or balance problems and in some cases of temporary palsy episodes of the leg. The use of AFOs does vary among physicians. Some feel that should be prescribed early to avoid knee, hip and back problems. Others feel that AFOs can cause more pressure palsies and should be more or less a last resort.

For individuals having more than 1-2 pressure palsies episodes, more steps can be taken to make adaptations and reduce the chances of re-injury. For example: using larger barreled pens, a food processor, an electric screwdriver, an ergonomic work station, etc. A few sessions with an Occupational therapist can help identify ways to reduce the stress to the nerves and keep active.

Surgery for carpal tunnel syndrome may relieve the symptoms for a few years. But in most cases the symptoms do recur. For some the surgery does not help at all. A second surgery should be avoided as it usually makes things worse. Surgery to move the ulnar nerve in the elbow should be avoided.

For pain, there are a variety of drugs that can be used. The antidepressants and anti-seizure drugs seem to help nerve pain and are many times the first drugs tried. (see section on pain for more information).

 

What else can I do?

Make taking care of your body more of a priority. Your body now has to deal with hnpp - however and whenever it may develop. Make sure your body is in optimum shape to deal with it.

Keep your weight under control. Should you end up being one of the 10-20% with more significant problems with your HNPP, you may find that your activity is fairly restricted. Shedding the excess, when it is hard to move is nearly impossible.

Keep your blood pressure under control.

Watch those Cholesterol levels. The website mannamania has some excellent information on fats and cholestrol as well as eating healthy in general. There is considerable information there about diet supplements also.

Eat a balanced diet, avoiding or minimizing fat intake as much as you can. And watch the salt and sugars too.

Don't smoke or chew. If you do, keep trying to quit. Have you figured out deep down WHY you smoke/chew?

Exercise at least three times per week (as able). Do all the little tricks to make you walk more such as parking the car in the furthest slot away from the door.

Use alcohol in moderation only. And PLEASE don't drink and drive (we lost three family members to a drunk driver in 1994).

Keep up to date on your preventative maintenance checks - monthly self breast or prosate exams; semi-annual dental cleaning and checks; annual (or ?) mamograms, pelvic exams pap smears, prostate checks, etc.

And last but not least, drink plenty of water, brush, and floss.

Last Updated:2/00

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