Airport to airport

St. Louis Regional Airport sits inside the village of Bethalto, though the mail goes to East Alton. The clinic sits beside the other airport, Lambert, off I-70 at Woodson Rd. Between the two runways is about 30.5 miles and roughly 45 minutes of free-flow driving with no traffic modeled. Take Route 255 or Route 111 south to I-270 and the Chain of Rocks crossing. Then run south on I-170 or Lindbergh until I-70 at Woodson Rd. Wood River and Alton are the near neighbors; Godfrey is up the bluff. The drive is long enough that we plan around it. And one complaint is common enough in this part of Madison County that the page is built around one condition instead of a list.

Why do my feet burn at night?

Burning, tingling, pins-and-needles feet that are worst in bed and numb by morning are a peripheral neuropathy until proven otherwise. In this population the most common cause is metabolic. The American Diabetes Association’s position statement puts distal symmetric polyneuropathy (nerve damage that starts in both feet) in up to half of people with diabetes over the course of the disease. It also records nerve damage showing up in prediabetes, before any diagnosis has been made. The small, unmyelinated (uncoated) fibers that carry burning and temperature are the first to go. They go at blood-sugar numbers most people have been told are fine.

Three things drive it. High glucose and the fat overload that travels with insulin resistance poison the nerve directly. They do it through oxidative stress and a mitochondrion (the cell’s power plant) that cannot keep up. The tiny vessels feeding the nerve stiffen and narrow. So the nerve is starved as well as poisoned. And the food behind both is the cheapest and easiest food in every gas station between Bethalto and the river. It is engineered against the same dopamine circuits that make it hard to stop. The disc and the joint are where it hurts. The bloodstream is why.

What he got wrong for twenty years

Dr. Gurpreet Singh Padda, MD, MBA, MHP spent the first two decades of his career telling patients whose A1C sat in the high fives that the number was not too bad. Come back next year, he said. He was wrong, and he says so. The small nerve fibers in those patients’ feet were already being damaged at those values. The insulin behind the glucose was already doubling. By the time the A1C crossed the line that triggers a diagnosis, the neuropathy was years old. The physiology that changed his mind is why every first visit here draws blood. We check fasting insulin, glucose, inflammatory markers and vitamin D. Then we read the feet against the numbers, not the numbers against a cutoff.

How is neuropathy pain treated while the blood sugar is fixed?

Is it neuropathy or spinal stenosis?

The same terrain reaches the spine. Legs that go heavy after a set walking distance and recover when you sit are neurogenic claudication from spinal stenosis. In a patient with burning feet, it is easy to blame the neuropathy for a problem that is really in the lumbar canal, or the reverse. The exam separates them. Stenosis is measured in distance and eased by leaning on a cart. Neuropathy is worst at rest and in bed. Circulation is cold feet and absent pulses. A Bethalto patient has often carried two of the three for years while each was treated as the other.

What happens at the first visit from Bethalto?

A first visit from Bethalto reads your records before you arrive. It examines the feet and the spine, draws the bloodwork the same morning and ends with a written plan. If a diagnostic block or an epidural is part of it, that is a second trip. No sedation is used, so most patients drive themselves home; if a leg feels weak or numb, someone else drives until that wears off. The metabolic work between visits is coached remotely where it is clinically appropriate, so the drives you make carry a test or a treatment.

Frequently asked questions

Why does a pain clinic want my blood sugar?

Because the burning in the feet, the slow healing of an injured disc and the inflammation around a joint all run on the same insulin resistance. An injection into an inflamed body is asked to hold against a whole-body process. The reasoning is laid out in why a pain clinic checks your blood sugar.

My feet burn but my A1C is normal. Can it still be neuropathy?

Small-fiber damage is documented in prediabetes and at A1C values inside the normal range. That is why the first visit measures fasting insulin and not just glucose. The workup is described on peripheral neuropathy.

Is the ear device the same thing as a spinal cord stimulator?

Two different devices share the name. The auricular stimulator is worn at the ear for about twenty days for diabetic neuropathy pain. A spinal cord stimulator is an implanted lead along the spinal cord for a different set of conditions. Spinal cord stimulation explains who it is for.

How far is the clinic from Bethalto?

About 31 miles and roughly 45 minutes at free-flow speeds by Route 255 or 111 to I-270, over the Chain of Rocks and down I-170 to I-70 at Woodson Rd. Arrival details are on the contact page.

Do you treat the diabetes as well as the pain?

The metabolic work is part of the pain protocol here. It is prescribed by an obesity medicine diplomate and coordinated with your own physician, not in place of them. How records move between offices is on for physicians.

What can be mistaken for neuropathy in the feet?

Numb feet with cold toes and absent pulses are a circulation problem, not a nerve problem. A foot with a wound you did not feel belongs at a wound clinic the same week. And legs that go heavy after a set walking distance and recover when you sit are spinal stenosis. A Bethalto patient has often carried two of these for years while each was treated as the other. The first exam covers the feet and the spine.

Does walking help spinal stenosis pain?

Walking is usually what brings stenosis pain on. The legs go heavy after a set distance and recover when you sit down, and leaning on a shopping cart eases it. That pattern is how the exam tells stenosis apart from neuropathy, which is worst at rest and in bed. Movement is still part of the plan here, prescribed at a level the feet can tolerate.

How can I stop the burning in my feet from neuropathy?

Reverse the insulin resistance, because that is the treatment that changes the disease. Here that means meal timing, removing acellular carbohydrates and industrial seed oils, sleep, morning light and movement the feet can tolerate. Acceptance and Commitment Therapy is on staff. For diabetic neuropathy pain, the NS-100, an FDA-cleared stimulator worn at the ear for a twenty-day protocol, can quiet the signal while that work is done.

Related reading

• Peripheral neuropathy
• Peripheral nerve stimulation
• Metabolic health and pain
• Why a pain clinic checks your blood sugar
• Pain management in Alton
• Pain management in Wood River