Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Understanding Peripheral Neuropathy and How To Manage It
Tingling toes. A strange electric buzz that won’t let you sleep. We sat down with Dr. John Morren, Director of the Neuromuscular Center at Cleveland Clinic, to unpack what truly drives peripheral neuropathy, how to read the early signs, and which treatments actually help you function and rest again.
We trace the most common causes—diabetes and the broader metabolic syndrome—while surfacing underrecognized risks like rapid weight loss, malabsorption after bariatric surgery, chemotherapy, infections, alcohol, and hidden vitamin pitfalls. B12 deficiency takes center stage as a treatable driver; we talk real thresholds, why neurologists aim above 400, and how methylmalonic acid exposes low B12 even when standard labs look “normal.”
Looking ahead, we explore AI as augmented intelligence: tools that flag high-risk patients in primary care, prompt simple screening steps, and sharpen EMG and nerve conduction studies to detect nerve damage earlier. It’s not man versus machine; it’s smarter care through synergy, personalizing treatment and expanding access without losing the human touch.
Welcome to the Speaking of Women's Health Podcast. I'm your host, Dr. Holly Thacker, and I am so glad to be back in the Sunflower House for a new edition of a podcast on everything you wanted to know about peripheral neuropathy. And I am so happy to be welcoming an incredibly special guest joining us. He's Dr. John Morin. And we're going to talk about peripheral neuropathy. And hopefully, we're going to touch on also an area that he's got a lot of expertise and interest in the exciting topic of AI, artificial intelligence, and medicine. But first, uh, let me tell our listeners a little bit about Dr. John Morin. He is the program director of the Neuromuscular Medicine Fellowship at the Cleveland Clinic, and he was just named the director of the neuromuscular center at the Cleveland Clinic. He is an associate professor of neurology at Cleveland Clinic, the Lerner College of Medicine at Case Western Reserve University. His journey into the field of medicine began at the University of the West Indies for his medical education. And then he went on to do an internship and residency at Cleveland Clinic in sunny Florida. But then he came to Cleveland to do a fellowship here at the Cleveland Clinic in Cleveland, Ohio. And he is board certified in electrodiagnostic medicine, neuromuscular medicine, and neurology. So he's a bit of an overachiever. I'm sure his mother is very proud of him. Welcome, Dr. Morin. We're so thrilled to have you on our podcast.
Dr. John Morren:Well, I'm thrilled to be here. Thank you for having me.
Dr. Holly Thacker:So I would like to just start off by asking you about and explaining to our listeners what is peripheral neuropathy?
Dr. John Morren:So uh peripheral neuropathy could be defined by the two labels in the name. So peripheral, the far-flung areas are affected first. And what's happening? Nerve damage. That's what neuropathy means. So, you know, for neurologists, most folks would say, hey, if you're a neurologist, you're a brain specialist, right? And it's true, the brain is the center of my universe, but it's not everything in the nervous system. Uh the brain needs these wires, these nerves to do its bidding. So in peripheral neuropathy, these very important wires, they start getting injured and the damage starts happening at the far-flung area. So think about your feet. Your feet are kind of the farest part of your body from your brain. So those nerves, by the time the nerves travel all the way to your feet, they're very thin. And when they're thin, they're vulnerable. So if you have any type of nerve damaging culprit roaming about your body, the first nerves they're gonna go after will be those vulnerable uh nerves in your feet. So patients usually start with feet symptoms.
Dr. Holly Thacker:And now how common is peripheral neuropathy?
Dr. John Morren:You know, it is actually quite prevalent. Think about it. That's one in 11 Americans uh would have peripheral neuropathy as we get older. So just above the age of 30, it increases in prevalence above one in 10. So that's about 20 to 30 million Americans with peripheral neuropathy out there.
Dr. Holly Thacker:Wow. And so um, some of the more common causes of uh peripheral neuropathy and things that people can be aware of to maybe try to prevent problems.
Dr. John Morren:Yeah, probably not too surprisingly, diabetes and not just diabetes, the metabolic syndrome. You know that metabolic stew that usually occurs with uh diabetes, not just the high blood sugar, but the the cholesterol and the triglyceride uh increases the obesity and overweight status. That uh that combination, what's called the metabolic syndrome, is actually the driver for uh neuropathy in over 50% of cases. And by the way, if you have diabetes, you know, 50% of patients with diabetes will eventually develop some form of peripheral neuropathy. So that's why it's the leading cause. Other common causes would be nutritional, um, especially in patients who have malabsorption. And there's a lot of um weight loss surgery now, and uh that's a big risk factor. Um there's a lot of um medications that promote rapid weight loss, and that contributes as well. The other uh major culture would be so-called toxic causes, and that includes excessive alcohol use um and even excessive vitamins like vitamin B6. And this is an important uh, you know, I try to evangelize this. You know, people think vitamins are a good thing. So, you know, if if you take a lot of a good thing, it should be very good. Um, and that's okay with many micronutrients, but certain ones are actually um uh harmful to nerves, including vitamin B6 or peridoxine. So we uh this is something you know we've done a lot of uh advocacy around. Um another category of uh contributors would be autoimmune conditions, um especially conditions like Shogun syndrome and Rupus.
Dr. Holly Thacker:Yes. Um and I think that's really important. I know years ago B6 used to be used in super high doses to treat PMS or mood symptoms. And um a lot of people think that just because something's over the counter that it's safe and effective and they can take whatever dose. And I mean, I just see people on so many supplements, and sometimes they don't even know why they're on them. And uh things that aren't food or drugs don't have to be regulated by the FDA. And so I always wonder about uh contamination. Um so can you tell us about some of the symptoms of peripheral neuropathy?
Dr. John Morren:Sure. So I tell folks, you know, nerves do they kind of belong to two major species the nerves that cause us to jet to generate force or strength or power. So that's the motor nerves, and then nerves that allow us to feel things, the sensory nerves. So when you get nerve damage in peripheral neuropathy, you get symptoms that are both motor and sensory. Quite often the sensory symptoms start up first. So typically a patient would come in the office and say, Doc, this started with numbness and tingling in my toes and feet, and over time it moved up, and now it's at the level of my knees, and I'm now feeling it in my hands or fingers. And that's a typical so-called length-dependent pattern of these symptoms, typically numbness and tingling being the initial ones, and later on you'll have more symptoms, and that might be um gait unsteadiness, or problems walking and uh and balance and eventually getting into stumbles and falls, and sometimes you end up with foot drop on both sides. The important thing though is that these symptoms tend to be a mirror image uh going on on the other side. So it's not one-sided, it's what we're called symmetrical, and uh and that's a key uh feature of peripheral neuropathy.
Dr. Holly Thacker:Now, can you tell us uh are there any gender uh differentiation? Or are women more at risk than, say, men for peripheral neuropathy?
Dr. John Morren:So uh to date, majority of studies show that there's no major uh susceptibility of women uh versus men. So um so those differences aren't traditionally appreciated. However, we're getting um UA data that suggests actually um there might be some skew to what's women for certain uh drivers of peripheral neuropathy, like autoimmune conditions, especially Shrogan's disease and lupus.
Dr. Holly Thacker:Yes.
Dr. John Morren:You know, autoimmune conditions, as you know, are four times um uh prevalent in women versus men, so that's a major driver. And some recent studies are also pointing to uh women with diabetes. So if you have a patient with diabetes and uh that patient is a woman, uh she would have a higher chance of having more of the painful diabetic neuropathy category of disease, which uh which means then we need to be uh particularly attentive to our uh patients with diabetes who are women to screen and to ask those questions. As you know, uh women tend to actually bear pain a little bit better than men. I'll say that, and I see that a lot in my in my practice, including the testing I do, that could be uncomfortable at times. Um so we it's something we should be a little bit more um vigilant about.
Dr. Holly Thacker:That is interesting how people have different uh pain thresholds and uh uh the perception you know of pain, and everyone is kind of wired uh individually. I remember my son when he was um interning with one of our dermatologists who was doing most surgery on a husband and wife team, the exact same skin cancer, and they would shift from room to room because they do it one layer at a time. And he was so impressed with how much the man seemed to feel more pain than the female. But it certainly is individual. And uh diabetes and diabetes and the metabolic syndrome is something I just keep seeing increasing uh amounts, and it's really very uh concerning. Can you talk about some of the other risk factors besides elevated sugar and alcohol um for other types or risk factors for causing peripheral neuropathy?
Dr. John Morren:Sure. Um, you know, as we age, uh we tend to see an increased prevalence, as I'd mentioned before, and that probably is linked to the fact that as we get older, we tend to um have a high risk for you know some of these chronic illnesses, which are vascular risk factors, you know, the as you call it, diabesity or the metabolic syndrome. Um another one that I'll uh I kind of hinted to is rapid weight loss, especially in the context of uh weight loss surgery, because malabsorption of these uh important nerve-supporting micronutrients uh could could be at play. Um, certain occupations, you know, heavy metals like lead and mercury can uh can can lead to peripheral neuropathy. And if you're in occupations where you have those exposures, it'll be um something to consider. Um there are infectious causes of peripheral neuropathy like HIV and even HIV medications. Uh, some of them have a uh high propensity to cause peripheral neuropathy. I can't um I can't leave out chemotherapy. Um a whole host of different chemotherapeutic agents have perfil neuropathy as a very uh frequent adverse effect. And some of the worst peripheral neuropathy I've seen uh occurs uh in the wake of certain chemotherapies, especially those based on uh taxol compounds and platinum.
Dr. Holly Thacker:And certainly we have a lot of breast cancer survivors in our practice at the Center for Specialized Women's Health at the Cleveland Clinic, and uh I know those symptoms can be so annoying. Sometimes they do seem to get better, but other times they don't. Um and I've been struck with despite the fact we have overnutrition in terms of calories with so much weight and sugar and diabetes problems, we still have so many vitamin deficiencies. And you were mentioning some of the B complex vitamins, particularly vitamin B1, which on our speaking of women's health.com website, we have a list of uh of uh foods rich in vitamin uh and B12. And I used to routinely check for B12 deficiency in pretty much everybody over 65, or if they were like a strict lacto-ovo vegetarian without milk or eggs or meat. But then I started doing 60, now 55, now I'm down to 50. I am shocked at the number of women in my practice that I find who have B12 levels under 300, which some of the lab ranges say that's okay, but I've heard neurologists say that really they want your level way over 300. And I wondered if you had comments on B12 or that vitamin in particular.
Dr. John Morren:Yeah, you're you that's a very important point. B12 um is B12 deficiency is a major driver for peripheral neuropathy. And it's um it's one of those treatable ones. It's it's one if we could prevent, it's great, and if we catch it early, we can actually make the biggest difference and changing the trajectory of somebody's nerve health in the future. Um, yes, there are patients they may have malabsorption syndrome, as you know, there's uh autoimmune uh variety of pernicious anemia that sets you up for having um severe B2L deficiency, but there are many patients we don't quite know why. Um, to your point, they don't have restrictive diets and things like that. Um, so it's worth screening. Um, yes, us neurologists, we like to see that level above 400, although the reference range will have it like somewhere about 230 or 250. Um and because we do see this relative B12 deficiency still causing neurological complications, including um peripheral neuropathy. And uh, you know, for those who are providers in the audience, you know, I add a methylmalonic acid level. You might have normal vitamin B12 levels, and the MMA, the methylmalonic acid uh level being elevated will expose uh B12 deficiency in an additional 10% of patients. So we like treatable things, and that's a low-hanging fruit, and it's one well uh working up to to m to uncover if it's there.
Dr. Holly Thacker:Now, in terms of evaluating for like toxic exposures, do you do like blood level panels for lead, uh heavy metals? Um I I know some of the functional medicine people cut the hair and assess for heavy metals in the hair. I just wonder how you go about assessing that, or you only do it if you think the person has an occupational exposure, but how do you know someone in their household's not poisoning them? I always wonder about these things.
Dr. John Morren:Yeah, yeah. These are these are fair questions. Thankfully, you know, peripheral neuropathy from heavy metal poisons is very rare. Um, and depending on the particular uh agent, and you could, you know, a good history and knowing the particular occupation, the exposures will inform which one of these heavy metals you may want to look at. And to your point, um depending on on the particular agent, you may need to do um urine screen plus blood screen plus hair and nails. Um and I think you know, this probably uh beyond the scope of of our podcast today to get into that. But whenever you suspect it though, and you feel that you may need help, reach out a neuromuscular provider, we'll probably be your friend to help you navigate that. If you're a provider working up a patient with this, obviously a medical toxicologist is um is there for you too if we're dealing with something that is uh not garden variety.
Dr. Holly Thacker:And and when you're dealing with uh a patient that has peripheral neuropathy, um obviously probably most commonly in in people with elevated blood sugars as well as you know alcohol use, which a lot of people minimize their alcohol use. And um we had a recent podcast going over alcohol problems and some of the specific issues in women. Um when it's idiopathic and you've evaluated it, or even if it's diabetic or or toxic related, is there any specific um recommendation that you make for vitamins? Like um, I know metanics is FDA approved, which is methylated vitamins for those patients with diabetic neuropathy. Sometimes I have recommended that, um, just like I recommend a lot of seropholin brain wellness or NAC methylated vitamins for the brain with M-acyltealcysteine for glutathione and alpha-lipoic acid. I wondered if you had any any comments about those supplements or any other supplements for peripheral neuropathy.
Dr. John Morren:Yeah, you know, that that's a really uh good uh point. I'll the you also mentioned idiopathic, and probably will be remiss if I didn't say about 30% of almost a third of patients with peripheral neuropathy, no matter how we look, uh we can find the culprit. And um that's why it gets the label, you know, idiopathic or cryptogenic peripheral neuropathy. And uh that yeah is a challenge in in in in multiple ways, but we uh low cure doesn't mean no care, right? We we do what we can to uh treat symptoms and uh reduce burden of of disease on patients. So when it comes to the um so so-called natural alternatives of nutraceuticals, there's um an emerging body of data that's showing that there are some signals uh to support their use. It's not overwhelming in many of the real rigorous studies. Among the uh the nutraceuticals, though, alpha lipoic acid seems to take the lead in terms of objective data showing not only some symptomatic relief for things like tingling, burning, prickling, but also some neuroprotection and possibly nerve repair. Uh so it's the it's the one I often prescribe. I lots of my patients are on alpha lipoic acid. It's usually 600 milligrams of my mouth once daily. Um, but this dose can be adjusted uh based on individual profile. Um some of the others I'm a little bit careful about. A lot of the um, you'll see there are a lot of products that combine alpha lipoic acid with uh numerous other antioxidants and micronutrients, including B6. And um I see a lot of folks with elevated B6 levels, and the only source we can identify are these um component supplements that that basically fold in B6 with multiple other agents. So it's uh it's one we have to be careful about.
Dr. Holly Thacker:Very interesting. You have been listening to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, the executive producer or executive director of Speaking of Women's Health, Lee Cleck Ars, our executive producer. She's so helpful. And I run our Center for Specialized Women's Health and our Women's Health Fellowship, and I am speaking to the head of our neuromuscular center and fellowship, Dr. John Morin. We're talking all things peripheral neuropathy. The one interesting comment that I uh have to make as a uh menopause specialist, someone who studied the ovary and estrogen deficiency, and someone who um has really enjoyed getting a lot of neurologic um or consultations from my neurology colleagues in women with neurologic problems, is it certainly seems like estrogen loss um makes the peripheral nerves more irritated. And some women can even have unusual symptoms that we call performication, which is tactile hallucinations. They feel like things are crawling on their scalp or they can't stand for anyone to touch them and they're more irritable. And certainly any neurologic condition in the brain or peripherally seems to get worse when a woman loses estrogen, which is why I've over my practice got to see so many interesting women with multiple sclerosis and myasthenia gravis and Parkinson's and so on. So I think that's kind of important to optimize estrogen. And obviously, women become estrogen deficient consistently at midlife if they're not treated, whereas males don't because they make testosterone with converted to estrogen, and that's why they have less osteoporosis. That's why I was wondering if there was any sex differential if their peripheral nerves are less likely to get irritated at all, or have less likely to have those kind of uh peripheral neuropathy symptoms.
Dr. John Morren:I think it's an active area of research. Um we don't have any hard data to kind of um to say that that exactly happens the way we anticipated based on the hypothesis. But I suspect though, that just like you said, I I do see um postmenopausal women who come with some of these more diffuse symptoms. And if they if they're what we call centrally sensitized, and you're kind of implying this that any uh nervous system disturbance, especially it's if if it involves uh the sensory pathway, it kind of gets amplified. Um so uh you know, and the symptoms run the gamut. I I know I just said numniscent tingling, but I hear words like uh burning, prickling, bug scrawling, electrical zap-like sensation, sunburn feeling, sizzling. Um these are you know words for my patients, and uh and that that's frustrating sometimes for patients to express. Like, I don't know how to tell you, Doc, but it just doesn't feel right. Um, and uh so I re so I I empathize with them and uh and and you know thankfully there are medications um that can help alleviate the burden of symptoms, and we can talk about those. Um so we we are we are able to help.
Dr. Holly Thacker:And so talk to us about some of the treatment options from at-home treatments to medication to physical therapy or other um assistive activities.
Dr. John Morren:Right. So uh, you know the treatment for symptoms kind of starts with an assessment of symptoms burden. Uh I I don't think um we necessarily will put patients on medications unless we believe that the benefits are gonna outweigh the risks. So I like to tell patients less is more, believe it or not. I believe that, you know, I I'm not um here to just add to your polypharmacy or add to your long medication list. So sometimes, for example, if symptoms are fairly mild, we don't need to do much. Or we could start something natural. And uh although the you know, alpha lipoic acid may take the pain score a couple notches on a um on a pain scale, that might be sufficient for somebody in fairly mild and limited symptoms. Even topicals are there, you know, we could use latocaine gel, capsis, and cream, and uh again avoid systemic adverse effects as we uh as we do that and not take a pill or something like that. So but when it comes to you know more robust symptoms that uh hamper quality of life. And unfortunately, a lot of neuropathic symptoms get worse at nighttime, which means it can disturb sleep, but if it disturbs sleep, then you know you have more daytime fatigue and it's a it becomes a snowballing effect. So adequate treatment of neuropathic symptoms is is a very important upstream move. So we have medications that reduce things like tingling, burning, prickling, and some examples would be like gapapentin, pregabolin, diloxetine, and there's a whole host of of these. Um so we could unleash that. So that those are some of your, you know, your pharmacological approaches. There are non-pharmacological approaches as well. Um, you know, from things like TENS units, you know, people who got acupuncture. Um, and you know, thankfully we don't have to use this very often, but for very severe and refractory cases, even spinal cord stimulator implantation is an option. Um unfortunately we don't have medications or or therapies that address numbness. I know some patients, sometimes they don't have a lot of painful symptoms, but they have numbness, and that's uh that one has been a little bit more difficult to um address with medications or other forms of therapy. Um alpha lipoic acid has uh shown some uh help with that in in some uh limited case series, and uh uh so the evidence there is is evolving. Now, motor symptoms, things like balance, um, and you know, again, if if peripheral neuropathies is advanced, we are talking about significant fall risk. That becomes important to manage as well. Um by this time, you're at risk for having um tissue breakdown and and things like that in your feet. So inspecting your feet, getting comfortable shoes, well-cushioned shoes, good arch support, having a podiatrist on your side is going to be important physical therapy, obviously, for you know, um, retraining gait and improving balance and preventing faults, um, getting the right braces when you have um like foot drop. And these things are all part of the the wider you know picture of treatment.
Dr. Holly Thacker:Now, talking about medications, um, I was recently coming across uh a report that looked at a large series of patients that was noting perhaps a higher risk of cognitive decline in those on gabipentin, brand name neurontin. And I I wondered do you think it's dose related? Is it age-related? Is it too soon to say? Do you generalize that to all the pain anti-convulsant medicines, including uh pregabelin lyrica?
Dr. John Morren:Yeah, I think interestingly, a lot a fair amount of patients have brought this up because I guess you know these studies are making its way through, you know, mainstream media. And um, you know, the com one of the commoner adverse effects of GABAPentin and similar medications is this, yeah, call it cognitive blunting, we could call it brain fog and things like that. Because um indeed these were initially anticonvulsants, so they were meant to make nerves less excitable. Um so again, less is more if we could get away from these, we do. But uh by and large, I I do believe that with my vast experience, uh, including many colleagues who prescribe these prescribed medications um uh to many of our patients over many years, um, the vast majority of patients do well cognitively. So it's it's certainly um one of those situations where you you have to individualize the care. Um, if I see a patient already has significant risk factors for cognitive decline, probably not the medication I would choose. Um and uh I would say I could leave the vast majority of patients on their cognitive A game by using these medications judiciously. There's a way to minimize the dosing, the way there's a way to time the dosing and stuff so that you would minim minimize the the cognitive blunting adverse effect.
Dr. Holly Thacker:That's all very interesting. We use a lot of off-label um gabapentin to treat vasomotor symptoms. And of course, in the history of menopause field, uh women used to be given barbaturates to drug them basically for having symptoms. And now we have a lot more elegant, specific candy neuron inhibitors that you know affect the part of the hypothalamus that isn't involved in temperature stimulation. So luckily we have more specific options, and of course, you know, hormone therapy for most women is is generally an option. So um I'm always interested in in these class of medications and also in giving people relief because obviously chronic pain can be very, very draining. Um getting back to the alpha lipoic acid, um, on our website, Speaking of Women's Health, we have a list of foods um that have alpha lopoic acid in them. But when you're using it for neuropathy, um you're using it in much higher doses than what you would get nutrient-wise, right?
Dr. John Morren:Correct. Correct.
Dr. Holly Thacker:Yeah. And um certainly a lot of medications like we know that can affect B12 levels that we were talking about earlier, like metformin glucophage to treat diabetes, can lower B12. And the PPIs for stomach acid blockers that you know people are on, that is always a trigger for me to check B12 rather than to wait till they have neurologic problems. I wondered if there's any other classes of medicine that as a neurologist that specializes in neuromuscular disease, does it ring bells like, oh, this could be a risk factor or this could affect something in the patient's profile?
Dr. John Morren:Well, when it comes to B12 itself, um, you know, there are certain parts in medication labor to bacarbia, especially if it's delivered, um, there's a duetinal administrative uh form of the medication that has also been associated with B12 deficiency. Um medications that are some antibiotic classes, um like even nitrofluento, can uh can be seen uh to cause uh peripheral neuropathy as well. I I I will say though, the the big classes that that we mentioned are the foremost. If you look long, you know, far down enough many uh medication uh adverse effects lists that are put out there, you would see um numbness and tingling. So I don't want to create um a great phobia around um some of these um tried and true medications have been around for a while. Um but you know, I I would say certain antibiotics can uh can be associated with peripheral neuropathy. If you're on chronic long-term antibiotic, I think it might be something you want to highlight to your uh to your neurologist because you might want to uh see if there's a more neurofriendly alternative if you're on one of those that are known to cause.
Dr. Holly Thacker:That's an that's an excellent tip. And uh we we just had a post uh podcast on um preventing bladder infections, chronic UTIs, and nitroforantoins given to a lot of women to take, you know, post-coidally to reduce um uh bladder infections. And that's when you can use local vaginal estrogen to prevent UTIs in a lot of women. Uh that might be better choice. And obviously, antibiotics like I remember in my inpatient days, gentomycin affecting, you know, the inner ear and the eighth cranial nerve is so so sensitive. Um so this has been so great. We'll have to bring you back, but before we go, just a little teaser about um artificial intelligence. If you can tell us a little bit about that and how you think that will play into medical care, patients' lives, our lives.
Dr. John Morren:Yeah, it's a very exciting time to be alive, certainly in healthcare as well. And I know, I know, you know, it's uh it's it this brings a lot of dread for some and even for those who are adopters or who are open minded, there is a healthy fare. And I think we need to have a you know uh a healthy fare about um AI and medicine. This is a high stakes environment, and uh but what I add. For is really the responsible and equitable judicious use of AI in medicine. And I will say that as great as the AI technologies are evolving, they will not replace human beings. I really believe the appropriate place for AI is in conjunction with human intelligence. And when I say AI, I actually say augmented intelligence because a human in the loop is the important part of what makes AI augmented intelligence. And I say, you know, artificial intelligence plus human intelligence equals augmented intelligence. And this is an equation of not additive benefit, but synergy. So what it allows us to do, we have to admit, as much as we are trying to improve the talent pipeline in healthcare, we we need to extend ourselves and provide uh care to more patients to improve access, to triage better, to pick up certain conditions much earlier than we're picking them up. And uh this exceeds our ability to do with the with the human resources we have, and AI allows us to uh to be extended in certain ways. Um and you know, I I see it as allowing for hyper-personalization of medicine, for example. I it's not gonna be too far down the road where we will be uh having certain embedded AI technologies in a primary care office that will let a primary care doc who has to keep so many things in mind and do so many things, and you you're you're feverishly um trying to get things done efficiently, it might be difficult for you to remember, oh, this patient actually has a very high risk of peripheral neuropathy. So this could be flagged, and based on certain uh unique uh features demographically, uh core morbid, uh core morbid profile-wise, blood results-wise, the provider would be told spatial needs to be screened. Remember, when you examine, just check that pinprick sensation in the feet or monofilament test or whatever, and uh in a busy practice, that will be uh very helpful. I my personal work at the clinic involves using AI in electrodiagnostic technology. We didn't really talk about how you make the diagnosis, yes, history and very important blood tests for finding underlying causes in the conditions that we talked about, but electrodiagnostic testing, commonly called EMG and nerve conduction studies. Um these tests are kind of the um the core foundational objective way of figuring out how uh how what stage neuropathy is, malmoderator severe, how active it is. It might actually hint what's the uh what's driving it. But these technologies are also um optimized with certain AI tools embedded in them, and that's what we're working on. So we can make the diagnosis even before patients complain of the classic symptoms and and probably inform how we manage them based on certain things we can see with the human eye or even here with the human ear, because this is an audiovisual test. Um so you know it's it's an exciting time, as I mentioned, but it really requires uh a human in the loop. And that's what I would say. And I don't think we're gonna be replaced. I say um, you know, uh AI uh will not replace human providers, but human providers who leverage AI will likely replace those who do not.
Dr. Holly Thacker:Well, that's a good way to sum it up. So how can uh our listeners who l live in the Northeast Ohio area or would travel here, make an appointment with you or follow your work or any social media or anything we should get out to our uh listeners?
Dr. John Morren:Well, um I would say my appointment line 216-636-5860 uh would be the way you do it by phone. Most of my patients, they're very internet savvy. So once you jump on an internet search, you would be able to land on our homepage. And it'll be easy, of course, to um to request an appointment, set that up with myself, one of my uh my colleagues here at the neuromuscular center. Um and we're always happy to um to make a difference in patients who we've seen so many patients in their medic in their journey. Um, and uh I what drives me to do what I do every day and club to work is to make those differences in the lives of of patients. Peripheral neuropathy is one of many things we see here. There's a whole host of other neuromuscular disorders. So I'd encourage the listeners to go to our website, uh the neuromuscular center at Cleveland Clinic. And um and you know, the the appointment line uh is is something that allows you to get on very easily. If you have uh an account with the Cleveland Clinic on my chart account, setting up the appointments through my chart is what most of my patients do as well. So I encourage you to do that.
Dr. Holly Thacker:Well, thank you so much, Dr. Morin, for joining us. Uh, if you've enjoyed this podcast, please give us a five-star rating. Share it. You can like us on uh YouTube, on Rumble, and if you don't already subscribe to our podcast, uh you can follow or collect um or listen to us regularly, all for free. So remember, be strong, be healthy, and be in charge.
