An Uncommon Story of Nerves and Blood
• I was a senior resident doing a rotation on Hematology, and a call came from the Neurology floor asking for help, consult on a man who had a bone marrow problem with a low white count.  At the same time he had a neurological problem with ascending, or worsening, "stocking glove" type numbness, also called peripheral neuropa

thy. The word neuropathy means nerve disease, and peripheral means the wiring or nerves outside of the central brain.
• Like a good resident, I first went to the book, and looked up all the causes for both low white count and peripheral neuropathy.  Of course there is a long list of causes for each condition, but only a few conditions to explain a single cause for both problems at one time.
• I came prepared to the floor, and on exam the 40 year-old Atlanta businessman had tiny lines across his fingernails, and in his mouth dark lines along the gums.  These findings indicated possible heavy metal toxicity such as lead or arsenic poisoning, one potential cause of peripheral neuropathy.  There are actually many causes for peripheral neuropathy.  It can result from direct injury to the nerve from trauma, bulging disk, or encroaching bone.  It can also be from indirect nerve injury due to metabolic causes like diabetes or thyroid disease; from drug toxicity, especially certain chemotherapy drugs; or from poor diet or vitamin malabsorption such as vitamin B12 deficiency.  In addition certain infections like herpes virus and shingles can cause this, and it may result from heavy metal poisoning like lead and arsenic; and the list goes on.
• In the privacy of the room I inquired about his social situation, and he responded that he was married.  I asked if he was having an affair and his mouth dropped wide open.  A curious and complex story followed.  He admitted he thought his wife might know about it.
• Indeed upon testing for arsenic, the blood level was sky high.  I learned later that he recovered with treatment; his wife admitted to poisoning him; he did not press charges; and they apparently reconciled their marriage.
• Here was an uncommon cause and end for the common condition of peripheral neuropathy.
• Dr. Rick Holm wrote this Prairie Doc Perspective for "On Call®," a weekly program where medical professionals discuss health concerns for the general public.  "On Call®" is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. "On Call®" airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com.