Thanks for the replies to my post.

The basis for the diagnosis was a skin biopsy. The current diagnosis is idiopathic small fiber neuropathy. There are several areas that look suspicious as a potential causal factors and I'll get into them below, in no particular order. Before I get into that, my neurologist ordered a great deal of bloodwork that was pretty comprehensive in terms of potential causes, and included in this were the various B vitamin readings among numerous other things. Here are what I believe are the three leading areas of suspicion, again in no particular order.

1. Blood Sugar history: for years, my fasting glucose has bounced back and forth between high normal (90s) to pre-diabetic (between 100-110 and with a peak of 118). My most recent was 109. My A1Cs have been always normal (usually around a 5.4)

2. Alcohol - Drank excessively from mid the mid 90s to a couple of years ago when i cut back to moderate, weekend only drinking. Then, in an effort to see if I could improve the small fiber neuropathy, a little over 7 months ago I quit entirely. I have not had a drink since early January of this year.

3. Autoimmune - This area seems to have possibly moved up the list of suspects, but heck, I don't know. I have consistently had "moderately positive" ANAs since the docs started checking that two years ago. All subsequent follow-up tests, the more specific ones, have come back negative. However, in late April/early May, an MRI of my spine inadvertently led to the discovery of small amounts of fluid around my lungs and heart, i.e., pleural and pericardial effusions. I had also been experiencing some muscle/joint stiffness prior to this discovery (although my small fiber neuropathy symptoms had seemed to have gone into hiding at that time!). The discovery of these small effusions led me to being sent to a rheumatologist on the basis that something systemic might well be going on. Bunch of blood work done, again a moderate positive ana but the more specific antibody tests negative. Also, the rheumatologist said she saw something under one of my fingernails with the capillaries that is often present in people with autoimmune disorders. Was put on a trial of plaquenil starting a little more than a month ago.

Bottom line, I think those three areas I described above, and I realize that those areas are pretty broad, all have some basis for being considered the causal factor. I used to in my mind bounce back and forth between the blood sugar and alcohol as the leading two candidates. But with the recent developments in the autoimmune area, I'm certainly not so sure about 1 and 2 anymore.

My sfn symptoms historically seem to come and go. As I said in my original post I have had many weeks at a time where there are virtually none and then they come on with some fury and might last a few days/weeks, and then go back and forth. My symptoms include usually burning feet and bladder issues. But sometimes also include dry eyes and bloating.

So, that's kind of my history. I'm currently under the care of a neurologist and rheumatologist.

I sure wish I could get to the bottom of what's going on in an effort to treat this better, if possible. Anyone on here have any thoughts based on what I've said as to what they think might be going on with me?

Thanks in advance for any helpful observations/suggestions!