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About a month ago I was driving to Santa Cruz and noticed a tingling in my fingers. It got worse when I put my hands up on the steering wheel and better when I rested them on the bottom. During this two-hour drive, it was a struggle to keep my fingers from falling asleep. Soon after, I began to wake up often during the night, having to reposition my hands so they would stop tingling.
My first fear was of neuropathy. I asked myself, "Is this how it starts?"
Before I confronted that possibility, I wanted to rule out other things. I went to my chiropractor who thought one of my cervical neck vertebra was out of alignment. He adjusted my back and neck, but it provided no relief.
Diagnosis From a Friend
I finally told a friend about how, when I push down on my wrist, sparkles and fireworks seem to run up to my fingers. He said, "That sounds just like carpal tunnel syndrome."
His words hit me hard. "Don't I have enough to deal with with diabetes?" I thought. "This can't be happening to me."
He told me what carpal tunnel syndrome (CTS) means. CTS occurs when the median nerve is compressed where it passes through a narrow tunnel of bone and ligament in the wrist. The tendons in the carpal tunnel may swell, pinching this nerve. It can be caused by a number of things, like performing repetitive motions such as typing. People with diabetes are 15 times more prone to CTS than the general population. (Journal of Hand Surgery, January 1995).
CTS is most common in insulin-dependent patients and is not associated with neuropathy.
I called my doctor and got an appointment for the very next morning. He strongly suspected CTS, but referred me to a neurologist for the actual diagnosis. He suggested wrist splints and vitamin B6 at 100 mg/day.
His nurse was sure I wouldn't want to walk through the waiting room wearing my new wrist splints-she just handed them to me. I had to ask her to show me how to use them. Splints in place, my next stop, several days later, was with the neurologist.
The neurologist had me lie down, and responded to my questions with short answers while he ran electrical currents through my nerves. I asked him about my doctor's recommendation, and the neurologist told me there is no evidence to support the idea that vitamin B6 helps CTS, and that overuse can actually cause neuropathy. He also told me there are no exercises that will help. "Overflexing the hand can actually make things worse."
I asked about injections of cortisone, a steroid which reduces inflammation. He replied, "Why would you want to introduce more fluid into a spot that is already tight?"
He cautioned that if the splints don't work, I will need surgery. He said that most people with CTS don't need surgery, but people with diabetes need it more often because neuropathy is more prevalent. No one knows why people with diabetes get neuropathy, but he told me it has "something to do with blood deficiencies in the sheath around the nerves."
I Saw the Physiatrist
I gave the physiatrist, who is also an osteopath, permission to re-run all the tests the neurologist had done while a resident intern watched. He was very comfortable with my many questions, and he answered them all cheerfully.
Although he ran electric currents through my nerves much like the neurologist did, these new tests hurt much more. I had to yell "Ouch!" very loud before he turned down the voltage and stopped the test. Then he stuck a large needle into the muscle of my thumb and hooked me up to his computer. He wiggled the needle around until he got what he needed. I yelled "Ouch!" again, and he finally stopped.
Nerves Heal Slowly
His diagnosis was the harshest yet. He determined that my left hand is in worse shape than my right, and that the nerve damage started long before I felt the tingling. (I remember feeling prickling in my fingers two years ago, but it went away by itself that time.) He told me that it takes a nerve a month to heal one inch, and that people with diabetes heal even slower. Unfortunately, the healing begins only after the trauma to the nerve has stopped. He said surgery is a real possibility if I don't see some improvement soon.
Contrary to what the neurologist said, the physiatrist recommended a shot of cortisone in my worse hand. He said it might help, so I watched as he brought out a big fat syringe. Even though I looked away while he slowly plunged the cortisone directly into my wrist, I almost passed out. I had to lie back on the examining table while my world went from color to patchy black and white. This was especially surprising for a guy who gives himself four or more insulin injections every day. The cortisone also caused my blood sugar to shoot up for two days.
A New Regimen
He wrote out instructions for me, and went over them carefully:
All in all, I really like this doctor. We're in a partnership, and although he was the teacher, he treated me like an equal.
The Home Front
When I told Nadia about the possibility of surgery, I could see the worry in her eyes. I felt bad about having to tell her, and wondered to myself what she must be thinking: "Is he falling apart?"
She said later that maybe this is what getting old is all about.
As it turns out, the fact that I have two small kids may be part of why I have CTS. I hold them in my left arm while I do other tasks with my right hand, like opening a door with a key. I'm sure you can picture the angle your wrist is in when you've got a 20 or 30 pound baby in one arm.
Where I Stand
This has all happened so quickly. It's been less than a month since I first noticed my tingling fingers. Because I have diabetes, everything is more complicated-nerve damage, my ability to heal, the emotional toll of one more health concern. If my nerves are being damaged, I don't want to wait too long for surgery.
I am doing as the physiatrist told me, and I am taking multiple vitamins along with C, zinc, and B complex, including 100 mg/day of vitamin B6.
If anyone has any tips or suggestions, or has experiences to share about CTS and diabetes, please call me at (800) 473-4636.
Jun 29, 2007
8 comments - Nov 1, 1995
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