Markham_ Rod; Markham Ryan

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					A Clinical comment on the effects of ReNerv in functional peripheral nerve recovery.
Markham, Rod; Markham Ryan.                                        for peripheral neuropathic        sufferers to
(No peer review conducted, three cases                             support the continued use of this therapy as
only)                                                              an    effective   adjunct      treatment    to
                                                                   physiotherapeutic rehabilitation.
A Clinical comment on the
effects   of   ReNerv    in                                        Aim
                                                                   The aim of this study was to determine
functional peripheral nerve                                        whether any functional peripheral nerve
recovery.                                                          recovery could be obtained by using a
                                                                   topically applied biochemical restorative
                                                                   lotion called ReNerv for the treatment of
Abstract                                                           peripheral neuropathy.

A        recent study to derive a clinical
        comment found that ReNerv is
        particularly   beneficial    for
motorbike peripheral nerve injured sufferers
                                                                   Only two male former motorbike rider
                                                                   subjects of similar age were chosen for
                                                                   mechanically injured peripheral neuropathy
and a diabetic neuropathic sufferer. Two                           and one elderly subject (70+) with diabetic
subjects (Ss) with mechanically-cause                              neuropathy as there were no other suitable
peripheral nerve injury were assigned to                           volunteers with medically documented
receive ReNerv treatment by applying 2 mL                          evidence. A non-blind study was conducted
of the lotion per day on either the foot or                        where ReNerv was given to them marked.
hand. The subjects applied the lotion in the                       The smell was distinctive but the actual
respective locations of numbness and within                        ingredients were unknown to them. The
a 3-week period the symptoms of peripheral                         liquid base is a plant wax derived from
neuropathy      in   both     Ss    diminished                     Simmondsia Chinensis.
significantly. Physical and psychological
measures were completed before and after                           Clinical definition and Background on
intervention, and again at a one-month                             peripheral neuropathy:
follow up. The results showed that the
subjects improved physically, as assessed                          Clinical definition of peripheral neuropathy
by reports of presence of a sense of touch,                        (PN): PN is a condition caused by damage
pain, and feeling heat, and cold on the sole                       to the nerves in the peripheral nervous
of the foot or back of the hand. The subjects’                     system. The peripheral nervous system
belief that their new sense of touch and                           includes nerves that run from the brain and
temperature perception was controlled by                           spinal cord to the rest of the body. Many of
chance happenings decreased significantly,                         these nerves are involved with sensation
signifying not just improvement in their                           and feeling things such as pain, temperature
conditions but also in their belief to be able                     and touch. Peripheral neuropathy is usually
to manage their symptoms. However the                              felt at first as tingling and numbness in the
data gave support to the notion that ReNerv                        hands and feet. Symptoms can be
treated subjects showed significantly greater                      described as burning, shooting pain,
improvement in physical perception via the                         throbbing, aching, and "feels like frostbite"
skin and in one S in joint movement. And at                        or "walking on a bed of coals." 1
the follow-up measurement, the subjects
maintained the improvement in the physical                         Therefore, a nerve injury can result in a
state. The report concluded that although                          problem with a muscle or in a loss of
the      mechanically      injured     subjects                    sensation. In some people, it also causes
experienced significant benefit they also                          pain. To understand nerve injury and
reported some neuropathic pain having                              recovery, it is important to understand the
decreased. The researchers stated that                             different types of nerve injury. The type of
there is evidence of the benefits of ReNerv

                                               Page 1 of 5                             By Markham, R., Markham R.
A Clinical comment on the effects of ReNerv in functional peripheral nerve recovery.
nerve injury will determine the type of
treatment that will be generally needed.                           Nerve Recovery and Regeneration
                                                                   After nerve injury, the nerve will try to repair
Nerve Anatomy                                                      itself by sprouting regenerating nerve units.
As mentioned before, nerves connect the                            These regenerating units will then try to
brain and spinal cord to the muscles and                           grow down the nerve to reinnervate (restore
skin, giving one movement and feeling. If a                        nervous function to) muscle or skin. If they
nerve injury occurs, there is an interruption                      make a correct connection – motor nerve to
in the information being conveyed to the                           muscle or sensory nerve to skin – then
skin or muscles to and from the brain. The                         recovery of muscle function and skin
larger nerves in the arms and legs, which                          sensation will occur. However, if the
are about the size of a pencil, are made up                        regenerating nerve fibres do not make a
of tens of thousands of nerve fibers – similar                     correct connection, then no recovery will
to the makeup of a telephone cable. The                            occur.
nerve fibres are grouped together in bundles
called fascicles. Some nerves – such as the                        Nerves regenerate at the rate of 1.1
median and ulnar nerves in the arm – have                          millimeter per day. Although sensation can
motor and sensory fascicles, giving one both                       be regained even after long periods of
movement and feeling in the hand.                                  denervation (loss of nerve supply), muscle
                                                                   reinnervation will not occur after long
Nerve Injury Classification System                                 periods of time without nerve innervation
Two nerve injury classification systems are                        (nerve supply). Therefore, it is necessary to
outlined below.                                                    get nerve to muscle as quickly as possible if
                                                                   recovery will not occur on its own.
    * A first-degree injury, or neurapraxia, will                  Electromyography (EMG) tests will show
recover within days after the injury, or it may                    muscle recovery before the muscles can be
take up to three months. The recovery will                         seen contracting. If there is no evidence of
be complete with no lasting muscle or                              recovery by three to six months after nerve
sensory problems.                                                  injury, surgery usually is recommended. 2
    * A second-degree injury, or axonotmesis,
also will recover completely; however, the
recovery will be much slower than with a                           Figure 1. shows the subdivisions of Sensory
first-degree injury.                                               Neurons (3),
    * A third-degree injury also will recover
slowly; in addition, only partial recovery will                    Fibre
                                                                               Size           Modality       Myelination
occur. The amount of recovery will depend
on a number of factors; for example, the                           A-
                                                                            13-20         Limb
                                                                   alpha                                     Yes
more scarring in the nerve, the more likely                        (I)
                                                                            micrometers   proprioception

the recovery won’t be as strong, and with                                                 Limb
                                                                   A-beta 6-12
the potential mismatching of sensory and                           (II)   micrometers
                                                                                          proprioception,     Yes
                                                                                          vibration, pressure
motor fibers, the less likely it is that the
nerve will fully recover.                                          delta
                                                                                          Mechanical sharp   Yes
    * A fourth-degree injury occurs when                           (III)
there is dense scar tissue within the nerve,                                              Thermal pain,
completely blocking any recovery.                                  C (IV)                 mechanical         No
                                                                                          burning pain
    * A fifth-degree injury involves complete
separation of a nerve, such as a cut nerve.
(Both fourth- and fifth-degree injuries require                                              Figure 1
surgery for recovery.)
    * A sixth-degree injury is a combination of                    The simplest definition of what constitutes
other types of nerve injury. Recovery and                          diabetic peripheral neuropathy for day-to-
treatment will vary depending on which                             day clinical practice was agreed on at an
types of nerve injury are present.                                 International Consensus Meeting for the
                                                                   Outpatient Management of Neuropathy and
                                               Page 2 of 5                                 By Markham, R., Markham R.
A Clinical comment on the effects of ReNerv in functional peripheral nerve recovery.
was described as "the presence of                                  Nerve graft surgery offers a treatment option
symptoms and/or signs of peripheral nerve                          for peripheral neuropathy. However for most
dysfunction in people with diabetes after                          patients, this option is generally costly and
exclusion of other causes."                                        can cause loss of perception in the area
                                                                   where the nerve graft was taken. Long-term
Diabetic neuropathy is classified into several                     outcomes presently rely on an integration of
syndromes, each with a distinct pattern of                         exercise, lifestyle adjustment, physiotherapy
involvement of the peripheral nerves; a                            and diet (with diabetic neuropathic suffers).
patient often has multiple or overlapping                          Neurological care has been therefore central
syndromes.                                                         to the treatment of these patient groups.

Historically, neuropathy was accepted as a                         There are some drugs that can cause
consequence rather than a cause of                                 peripheral neuropathy. The risk of getting
diabetes only after Marchal de Calvi's 1864                        peripheral neuropathy can sometimes
observations.                                                      increase when the drugs listed here are
                                                                   taken together. The drugs didanosine (ddI ,
Peripheral neuropathies have been                                  Videx), zalcitabine (ddC, Hivid), and
described in patients with primary (types 1                        stavudine (d4T, Zerit) are causes of drug-
and 2) and secondary diabetes of diverse                           related neuropathy. Other potential causes
causes, suggesting a common etiologic                              are isoniazid (INH), ethambutol (Myambutol),
mechanism based on chronic                                         vincristine, metrodinazole (Flagyl), dapsone.
hyperglycaemia. The undoubted contribution                         Drinking alcohol increases the risk of
of hyperglycaemia has received strong                              neuropathy. Taking too much vitamin B6
support from the Diabetes Control and                              can also cause neuropathy. There have also
Complications Trial (DCCT).                                        been reports of neuropathy associated with
                                                                   the protease inhibitor indinavir (Crixivan).
Neuropathies are characterized by a
progressive loss of nerve fibres that can be                       There may be dangers of toxicity from local
assessed noninvasively by several tests of                         anaesthetics as well. “The overwhelming
nerve function, including electrophysiology,                       clinical experience is that correctly
quantitative sensory testing, and autonomic                        administered local anaesthetics do not carry
function tests.                                                    a risk of nerve injury. However, all local
                                                                   anaesthetics are potentially neurotoxic, and
Pathologically, numerous changes have                              this may become apparent when the local
been demonstrated in both myelinated and                           aesthetic is applied in unduly high
unmyelinated fibres, although Schwann cell                         concentrations or at higher than normal time.
changes may be the primary pathologic                              The potential for neurotoxicity with local
change. 4                                                          aesthetic is a function of its potency,
                                                                   concentration, and the length of exposure of
A      relatively   higher     frequency    of                     the neuronal tissue to the agent. Exposure
mechanically-caused        peripheral    nerve                     of the endoneurium to a very high
injuries to the limbs among motorbike riders                       concentration of local anaesthetic may
is expected due to the high level of the                           contribute to neurologic deficit. Under
body’s exposure to the road environment,                           normal conditions, an injected bolus of local
speed, and other factors. Motorbike                                anaesthetics expands until it reaches
accidents tend to be more prevalent among                          pressure equilibrium and the surrounding
males. People with such disabilities with                          tissues. While diffusing to the tissues, the
sensory peripheral neuropathy also suffer                          interstitial fluid rapidly dilutes a local
from social isolation and subsequent                               anaesthetic, and systemic absorption
symptoms of depression contributing to                             assists in decreasing its concentration.
reduce quality of life. The burden of                              However, this may not be the case during
peripheral neuropathic rehabilitation falls                        intrafascicular injection with its concomitant
largely within primary care services.                              trauma, neural ischemia, and possible

                                               Page 3 of 5                             By Markham, R., Markham R.
A Clinical comment on the effects of ReNerv in functional peripheral nerve recovery.
vasoconstriction. Indeed, in several models                        continues to monitor her diet and takes
of nerve injury and using a number of                              insulin injections.
injectable agents, only intrafascicular
injections resulted in a neurologic injury that                    Implementation
can be documented as early as 30 minutes                           Dose: Only 2-3 mLs of ReNerv lotion was
following         intraneural        injection.                    applied lightly on the affected area once a
Intrafascicularly injected local-anaesthetic                       day where numbness was identified on Ss
solutions lead to changes in the permeability                      body and allowed to be absorbed for a 45-
of the blood-nerve barrier, associated                             minute period.
oedema, increased endoneurial fluid
pressure, and consequent nerve-fibre injury.                       Frequency: ReNerv was applied by pouring
In    contrast,    extra-fascicular   injection                    about 2 mLs out of a 50 mLs bottle once a
produces little or no evidence of nerve                            day and every day for one to 28 days.
injury.” 5
                                                                   Timing: Usually it was applied about an hour
Treatment plan                                                     before retiring to bed to sleep at night .
Ss comprehension/active participation: We                          Compliance: Compliance was reported and
had the required Ss comprehension/active                           accepted by the researcher.
Ss characteristics: Two Mechanically-                              Clinical signs: Within 15 minutes there was
caused injuries (one being in the foot and                         a reported tingling feeling in the foot of an
the other in the back of the hand) Ss (MCI)                        MCI. The other two Ss did not report this
Age: late forties years; The MCI – foot has                        sensation. After a four week period,
had sensory neuropathy for 16 months. The                          numbness       in   the     extremities   had
MCI – hand had sensory neuropathy within                           “diminished significantly”. The sense of light
four weeks. One female with Diabetic                               touch, heavy touch, temperature (hot and
Peripheral Neuropathy in a foot Ss (DPN)                           cold) and pain sensation returned. MTAS
Age: 70+ has had this condition for decades.                       was 10 for the MCI S in his hand; at least 7
MCIs had no feeling in the extremity of the                        for the MCI S for his foot, which started
limb (foot or hand) the Markham Tactile                            gaining sensation on the third day of
Scale Assessment (MTSA) of 1 for being the                         treatment; and at least 7 for DPN, which
lowest level of perception to light and heavy                      was on the second day of treatment.
touch. DPN had 5 out of 10 in MTSA.
                                                                   Laboratory markers
Indication (the need for each drug) drug
history: MCI Ss were initially on painkillers
and discontinued after a number of weeks
after the accident. DPN has been and still
continues to have insulin injections.
                                                                            onitoring the Ss for continuing
                                                                            suitability of drug/dose regimen:
                                                                            The current dose regimen appears

Contraindication/interaction: There are no                         Signs/symptoms of effectiveness and
contraindications or interactions with other                       toxicity: There did not appear to be any
medications other than ReNerv helps also to                        signs/symptoms of toxicity as ReNerv is:
promote more movement as reported by the                           topically applied on the skin; only a small
MCI S with greater angle of foot movement.                         amount      is    used;   it   has   active
DPN            has           had          no                       immunohistochemical-related constituents
contraindications/interactions with ReNerv                         that can be safely taken even orally, and
though she only needed it to be applied                            usually are metabolised by the liver and
once only.                                                         kidney within a short period of time once
                                                                   they enter the blood stream.
Continuity of care: The MCI Ss had
rehabilitation after the accident for a number                     Ss compliance: Ss were compliant for the
of weeks but this has discontinued. DPN                            experiment’s requirements.
                                               Page 4 of 5                             By Markham, R., Markham R.
A Clinical comment on the effects of ReNerv in functional peripheral nerve recovery.
                                                                   growth cones, nerve fibres and myelin
Adjust choice of topical application dose: the                     sheath formation. There is an international
Ss can do any adjusting of the topical dose                        patent pending on the formulation, the
if Ss wish. No change of dosage was made.                          manufacturing process and delivery system.

Advice/discouragement         about      over-                     Unwanted symptoms: There were no
consumption of ReNerv: Due to the specific                         unwanted symptoms reported and none
biochemical constituents, and the significant                      were expected.
effects resulting from its use it appears safe
enough and probably necessary to only use                          Recorded adverse reaction: There are no
ReNerv for a short period of time.                                 recorded adverse reactions to ReNerv by
                                                                   the Ss.
Clinical outcome
Therapeutic benefit: ReNerv appears to be a                        Conclusion
suitable adjunct treatment for restoring                           ReNerv appears to be particularly beneficial
relatively    quickly    peripheral    nerve                       for sufferers of peripheral neuropathy of the
functionality from a state of numbness                             extremities of the limbs in terms of
associated with both diabetic peripheral                           restoration of peripheral nerve functionality.
neuropathy      and     mechanically-caused                        It is not unexpected that this finding may
peripheral neuropathy. The Ss applied                              have a direct impact on the number of nerve
ReNerv in the respective locations of                              grafts performed, improved quality of life
numbness and within a four-week period                             and cost savings in terms of medical
found the symptoms of numbness in the                              treatment and the number and lengths of
extremities of the limbs diminished                                hospital visits.
significantly. Physical and psychological
measures were completed before and after
intervention, and again at a four-week
follow-up. However the data revealed that                          Reference:
the ReNerv treated MCI S-foot showed
greater improvement in joint mobility of the                       1. Peripheral Neuropathy - a Simple Fact Sheet from
ankle, in the range of movement than before.                       the AIDS Treatment Data Network,
And at the follow-up four week later, the Ss             
maintained the improvement in emotional                            .html, 10th April 2006
and psychological state. There was no
                                                                   2. Nerve Injury and Recovery, Washington University
subsequent medical treatment.                                      Physicians
                                                                   Division of Plastic and Reconstructive Surgery
There is evidence of the benefits of ReNerv                        Faculty
for peripheral neuropathic      sufferers to             
support the continued use of this therapy as                       eInjury.asp, 10th April 2006
an effective adjunct treatment. The possible                       3. Excerpt from Diabetic Neuropathy, WebMD,
future clinical studies with diabetic                    , Omaha, Nebraska
peripheral neuropathy and mechanically-                  , 10th
caused peripheral neuropathy may appear                            April 2006
to be worthwhile.
                                                                   4. Excerpt from Diabetic Neuropathy, WebMD,
                                                         , Omaha, Nebraska
Safety: ReNerv lotion is safe to use topically           
on the skin as the carrier oil of natural liquid                   neuropathy.htm, 10th April 2006
wax     represents    approximately         95%
concentration of the ReNerv product, 5%                            5. New York School of Regional Anesthesia,
                                                                   Manhattan, NY USA, Admir Hadzic
concentration of Regenerin. Regenerin is a               
combination of active immunohistochemical-                                   th
                                                                   xicity, 10 April 2006
related substances found to have particular
roles in the functioning of schwann cells,
                                               Page 5 of 5                             By Markham, R., Markham R.

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