Dear Dr. Gott: I am always interested in peripheral neuropathy because it was one of the many later symptoms I developed when I acquired bartonella henselae. However, I apparently acquired the bartonella approximately 16 years ago. I recall a cat scratch from a feral kitten that did not heal for several months. I wasn’t diagnosed until a little over two years ago when I failed to respond to Lyme-disease treatment.
In addition to alpha-lipoic acid, my doctor put me on Levaquin. Amazingly, the shoulder pain, chronic gall-bladder infection, swallowing problems, ankle swelling and chronic stomach ulcer went away. The numbness in my feet and fibromyalgia did not disappear but got better.
My point is that one of the symptoms of bartonella is numbness of the feet. It is rarely looked at as the cause of peripheral neuropathy. I had none of the diabetic or circulatory problems that normally cause it. I am still scratching my head as to why my now-retired doctor did not diagnose it earlier. It would have made my recovery from Lyme disease so much easier.
Dear Reader: Bartonella henselae, also known as cat-scratch disease, is a bacterium that enters the body at the site of the scratch. Adult cats can spread the disease, but it more commonly comes from kittens. Lymph nodes, primarily those around the arms, head and neck, become swollen. Lack of normal appetite, fever, headache, fatigue and transient peripheral neuropathy may result. Those commonly infected are people with a compromised immune system.
Lyme disease presents with the same symptoms, so it is no wonder your physician would have zeroed in on that possibility. You can perhaps understand why some diseases and disorders are discovered following a process of exclusion. The symptoms are the same, and, at times, the treatment is the same.
The Levaquin you were prescribed is a broad-spectrum antibiotic used to treat bronchitis, pneumonia, skin infections, the sinuses, UTIs, ears, chlamydia and more.
You are correct that peripheral neuropathy is not commonly linked to cat-scratch disease. It is not one of the more common symptoms, but there is a definite link that should not be overlooked when making a
diagnosis. Thank you for writing and sharing your interesting case.
Dear Dr. Gott: I read your column daily but have never seen anything on pudendal nerve entrapment. Any information would be appreciated.
Dear Reader: Pudendal nerve entrapment occurs when a nerve in the pelvic area becomes compressed or trapped. It can be the result of post-surgical scarring, pregnancy or trauma. Activities such as riding a bicycle are known to trigger the condition.
Symptoms include pain when sitting that is reduced or eliminated by standing, lying down or when on a toilet seat; paresthesias in the buttock and genital areas; urinary hesitancy and/or urgency; constipation; impotence; sexual dysfunction; and a great deal more.
Treatment varies depending on the underlying cause and how long symptoms have been present. If you are a cyclist, that prolonged activity should be reduced. There are a number of medications — nerve stabilizers, antidepressants or anticonvulsants — that might reduce or alleviate the pain. When all else fails, treatments such as corticosteroid injections or nerve blocks may be appropriate.
Speak with your physician who knows your history and can recommend appropriate advice or medication. Then, if and when conservative measures fail, request referral to a top-notch surgeon for the problem.
To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
Dr. Peter H. Gott is a retired physician and the author of several books, including “Live Longer, Live Better,” “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cookbook,” which are available at most bookstores or online. His website is www.AskDrGottMD.com.