DEAR DR. DONOHUE: I have burning in my toes. I have been told it is peripheral neuropathy. I have tolerated this condition for four years. Now it is getting worse. It’s gotten to the point where it is difficult for me to wear shoes. Do you know of any help or relief? – B.M.

This happens to be National Peripheral Neuropathy week, a week devoted to spreading the word about this common disorder that affects millions upon millions of Americans and Canadians. Peripheral neuropathy is an awkward name for such a prevalent affliction.

“Peripheral” refers to nerves in the body’s periphery – the arms and legs, mostly. “Neuropathy” indicates damage to nerves. Nerves have two functions. One is bringing from the brain messages that tell the arm or leg muscles to move. These nerves are motor nerves. Other nerves bring sensations from the skin that it is too hot or too cold, that it hurts or that it itches. Those nerves are sensory nerves. You have sensory peripheral neuropathy – burning pain coming from your toes but the toes are actually healthy. Motor neuropathy leads to muscle weakness. And some people have both motor and sensory neuropathy.

Causes are many. In extremely rare instances, deficiencies of vitamin B-12, B-6 or B-1 can be the cause. Sometimes the body’s immune system attacks the nerves. In other instances, neuropathy is an inherited condition. Quite frequently, a cause cannot be determined. Drugs designed to control seizures often control the pain of neuropathy. An example is Lyrica. Antidepressant medicines such as Elavil and Cymbalta also are used for neuropathy pain. Lidoderm, a lidocaine skin patch, can be helpful. Lidocaine is a pain-deadening agent.

The best advice I can give you is to contact the Neuropathy Association (1-888-PN FACTS;, a friend you don’t know you have. The association can provide you with information and tips on how to control pain and can introduce you to the millions of others who are in similar circumstances.

DEAR DR. DONOHUE: Please print information about a silent heart attack. What is it? – M.C.

Most often, people having a heart attack complain of squeezing or crushing chest pain that might spread to the neck, the jaw, the left or right shoulder or the left or right arm. A silent heart attack is an attack that occurs without pain. Around 20 percent of heart attacks are silent. Diabetics and older people are more likely to have such attacks. In all other respects, a silent heart attack is the same as a painful heart attack.

The booklet on heart attacks explains how and why they occur and how they are treated. Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: When a person has herpes, can that person spread it by sitting on a toilet seat? I was under the impression that only sexual contact spreads the disease.

After having a visitor who has genital herpes and who used our toilet, my husband washed the seat with alcohol. Was that necessary?

I’m sure other people have this concern, and perhaps they don’t invite family or friends who are infected to their homes. – R.M.

ANSWER: Herpes transmission occurs when fresh, virus-containing tissue (skin) of an infected individual has direct contact with susceptible tissues of an uninfected person. In other words, it’s skin-to-skin transmission. “Susceptible tissues,” in addition to skin, include the mouth, lips and genitals. Ordinary skin surfaces can be infected if there’s a breach in the skin and it contacts herpes-infected skin. The herpes virus dies at room temperature and by drying. Your husband didn’t have to do the alcohol thing.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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