Roberts-Grey, Gina
Neurology Now: August/September 2016 - Volume 12 - Issue 4 - p 18–21
doi: 10.1097/01.NNN.0000490550.78705.00 Features: Cedric the Entertainer
As a stand-up comic, television and film actor, director, musician, and game show host, Cedric Kyles has built a career around making people laugh. Known as Cedric the Entertainer, the 52-year-old Missouri native gained national prominence in 1992 when he appeared on the HBO comedy series Def Comedy Jam. Four years later, he landed his first acting role on The Steve Harvey Show. Since then, he has appeared in dozens of movies, including Barbershop and Barbershop 2: Back in Business, and the animated films Ice Age and Madagascar. He also stars in and is a co-creator and executive producer of TV Land's The Soul Man.
PHOTOGRAPH BY JEMAL ...
Recently, though, he's been using his natural charm, mellifluous voice, and sense of humor to deliver a serious message: If you have diabetes and you experience pins-and-needles pain in your hands or feet, talk to your doctor about it. It could be peripheral neuropathy, a nerve disorder that is a real and treatable condition associated with diabetes.
Cedric signed on to produce “Step On Up,” a series of public service announcements for the American Diabetes Association (ADA), after realizing his father, Kittrell, had been silently enduring debilitating pain in his feet for quite some time. “Our family had no idea it was happening,” says Cedric, who blames his father's stoicism on misguided machismo. “My father is like most men. Our male ego gets in the way. To look strong or macho, we don't talk about our aches and pains. We'd rather sweep health issues under the rug than be vulnerable and admit to someone that something may be wrong,” says Cedric. That's especially true for African American men, he says. “There's a tendency to not want to know about any health problems, and that's dangerous.”
LIVING WITH PAIN
In 2008, Kittrell was diagnosed with type 2 diabetes, a diagnosis he kept secret from his son for eight months, says Cedric. About a year later, Kittrell began experiencing painful tingling sensations in his legs, but he never connected it to diabetes or discussed it with his family or doctor. “We didn't know he was living with such intense symptoms,” says Cedric. “It's amazing that he tolerated what he did for so long without saying something to anyone in the family, his friends, or, perhaps more importantly, to the doctor. He just tried to grin and bear it.”
Like Kittrell, many people with diabetes don't recognize the symptoms of nerve pain or understand that it is a complication of diabetes, says Kamal R. Chémali, MD, a neurologist and director of Sentara Neuromuscular and Autonomic Center in Norfolk, VA. Symptoms can range from numbness or a reduced ability to feel pain or temperature changes to tingling or burning sensations, sharp pains, cramps, muscle weakness, and increased sensitivity to touch. “Although diabetic neuropathy can develop in the hands and arms, it most commonly affects the nerves in the legs and feet and results when chronic high blood sugar damages nerve fibers,” says Dr. Chémali.
A WORLD NARROWS
STEP ON UP Cedric th...
Left untreated, nerve pain can cause infections or create balance problems that may lead to falls and can slowly erode a person's quality of life. Before admitting to his pain, Kittrell gradually withdrew from family functions and activities he enjoyed, including the father-son golf games he and Cedric shared.
“He would still go occasionally, but he started complaining a lot more than was usual for my dad,” says Cedric. Or, he would cancel at the last minute saying his feet hurt.
ACTIVE ENTERTAINER C...
Even when the pair did hit the links, the outings weren't the same, says Cedric. Kittrell couldn't play 18 holes because of pain and numbness in both feet. “He wouldn't say anything, but later I learned he felt like his feet were going to sleep.”
Eventually, the pain became too difficult to bear alone, and Kittrell started talking about it with his family, who encouraged him to discuss his symptoms with his doctor.
DIABETES EDUCATION
“The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and nerves affected,” says Robert G. Smith, MD, PhD, a neurologist at Houston Methodist Neurological Institute. Types of nerve damage include peripheral neuropathy, which affects the extremities; proximal neuropathy, which causes muscle weakness, most commonly in the thighs and hips; autonomic neuropathy, which may affect the digestive system, blood pressure, bladder, and other daily functioning; and focal neuropathy, which tends to affect only one nerve or just a few nerves, most often in the head, torso, arm, or leg.
“It's possible to have just one type or to experience symptoms of several types,” says Dr. Smith. About 60 to 70 percent of people with diabetes have some degree of diabetic nerve pain, according to the National Institute of Neurological Disorders and Stroke. Research published in Diabetes Care, a journal of the American Diabetes Association, says women are 50 percent more likely to experience symptoms than men.
GETTING A DIAGNOSIS
Since nerve pain can't be seen on an x-ray or detected in a blood test, physicians rely on the patient's ability to describe his or her symptoms and a physical examination to check reflexes, muscle strength, and sensitivity to touch, pressure, vibration and/or position changes, says Dr. Smith. “Other routine assessments like blood pressure, heart rate, and weight are also performed to monitor for overall changes.” In addition, the physician would complete a comprehensive foot examination to check circulation and skin tone. “It's recommended that people with diabetes have a comprehensive foot exam once a year to check for neuropathies or assess changes in those already diagnosed with diabetic nerve pain,” says Dr. Smith.
When patients describe limb numbness or pain, a physician might perform tests that record the electrical activity of muscle tissue and nerves, to rule out other conditions such as spine-related nerve damage.
SYMPTOMS AND CONSEQUENCES
Of the four types of diabetic neuropathy, peripheral neuropathy is the most common. It typically affects the feet and legs, but symptoms can spread eventually to the hands and arms, says Dr. Chémali. “The usual sensation is tingling, which patients describe as ‘pins and needles.’ Other sensations include coldness, stiffness, and tightness like a rubber band.”
“Symptoms are often worse at night, when patients are off their feet and resting,” says Dr. Chémali, who adds that depending on the affected nerves, the symptoms can range from mild to disabling. Kittrell experienced pain both at night and when he was standing and walking, says Cedric.
Untreated, the pain and tingling or numbness may manifest as an inability to sense the position of the feet or legs or even weakness of the feet (a footdrop), and patients may start falling, says Dr. Chémali. “In the worst-case scenario, patients may develop gangrene and need a limb amputated,” he adds.
NERVES UNDER STRESS
Experts do not know exactly what causes diabetic peripheral neuropathy. One theory is that injury to the blood vessels supplying the nerves leads to the loss of nerve fiber, says Dr. Chémali. Another is that increased and prolonged exposure to high blood sugar levels leads to the accumulation of sugary proteins in the nerves, which triggers a series of changes that eventually damages nerves from stress and inflammation, he says.
But this complication is not inevitable, says Dr. Chémali. “We don't know what percentage of patients with diabetes will develop peripheral neuropathy, but we do know that early detection of diabetes and tight control of the disease can stabilize and occasionally reverse symptoms in the early stages. Once diabetic neuropathy progresses, it becomes much harder or almost impossible to reverse the symptoms.”
The most effective way to reduce the odds of experiencing this painful complication is to lower your risk of developing type 2 diabetes in the first place, says Dr. Smith. That includes following a healthy diet and getting exercise or some physical activity every day. A regular sleep pattern is also important; studies have demonstrated that adequate sleep promotes a healthy weight, which, in turn, lowers the risk of type 2 diabetes.
TREAT IT RIGHT
Medications used to treat nerve pain include antiseizure drugs and antidepressants. According to the 2011 American Academy of Neurology (AAN) guideline on treatment for painful diabetic neuropathy, strong evidence exists to support the efficacy of pregabalin (Lyrica), the antiseizure drug. Two other antiseizure medications, gabapentin and sodium valproate, are moderately effective, as are the antidepressants amitriptyline, venlafaxine, and duloxetine. In 2004, the US Food and Drug Administration approved duloxetine and pregabalin for nerve pain.
Other treatments rated as moderately effective by the AAN guideline include four opioids (dextromethorphan, morphine sulfate, tramadol, and oxycodone controlled-release), electrical nerve stimulation through the skin, and capsaicin cream, which is made from chili peppers.
Cedric says Kittrell not only takes medication, he also has improved his diet, avoids alcohol, keeps his blood pressure under control, and follows his doctor's recommendations for good foot care—all of which have helped calm his symptoms and regain control of his life.
PROACTIVE STEPS
Cedric recognizes that diabetes and nerve pain could be part of his future—but he's taking steps to prevent that.
Knowing he can't manage a complete lifestyle overhaul, he's sticking to small tweaks, including eating more fruits and vegetables and choosing lean proteins whenever possible. “There are no more middle-of-the-night pancakes after I finish a [stand-up comedy] set. Instead I eat berries, salads, fish, and other sensible foods.”
He also aims for 30 minutes of physical exercise a day. Some days that's simply walking while talking on the phone or rehearsing; other days he's in the gym or on the golf course. “Exercise can come in many forms, but the most important thing I've learned is to get—and stay—moving.”
And he checks his ego at the door.
“This journey with my dad has taught me not only about diabetic nerve pain but also about the importance of men speaking up about any health issue that's bothering them,” says Cedric. “I won't make the mistake of keeping quiet about any health question or problem. My well-being is too important to allow a little pride to get in the way.”
Peripheral Neuropathy Resources
* American Academy of Neurology for a free brochure and video; http://bit.ly/PN-brochure; http://bit.ly/PN-video
* American Chronic Pain Association; http://theacpa.org; 800-533-2331
* American Diabetes Association; http://diabetes.org; 800-342-2383
* National Institute of Diabetes and Digestive Kidney Disease; http://niddk.nih.gov/Pages/default.aspx; 301-496-3583
* National Institute of Neurological Disorders and Stroke; http://ninds.nih.gov; 800-352-9424
Steppin' Up for People with Diabetes
In November 2014, Cedric the Entertainer partnered with the American Diabetes Association (ADA) to produce a series of public service announcements called Step On Up. Cedric has also appeared at a variety of national and local events to educate the more than 29 million Americans living with diabetes about the symptoms of diabetic nerve pain and the importance of talking to their doctors about those symptoms. “It's all about speaking up,” he says.
In November 2014, Cedric appeared at the ADA's “I Decide” to Stop Diabetes Day in Chicago. Last year, he spoke at the association's 2015 diabetes EXPO in Houston and encouraged attendees to take a diabetic nerve pain assessment. He's also appeared on numerous television talk shows, urging people with diabetes and their families to talk to their doctors about symptoms that could be caused by neuropathy.
“This is an important message for everyone, but especially minority communities, because diabetes affects African Americans and Hispanics in greater numbers. They all are at risk of diabetic nerve pain, and I'm glad to be able to use my celebrity to get this message across about not wasting time or letting pride stand in the way of getting yourself checked out.”© 2016 American Academy of Neurology
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