MrsD,
A while back I got a prescription for anti-depressant from my doc, but never took it. Now I see that I may really benefit from taking it, so I need to speak with my doc again. The prob is, I have days that I'm so depressed I cannot handle it, don't know what to do with myself, etc., and I have other days that (for the most part) I don't feel that I need the anti-dep, which makes the situation all that much more confusing.
Does Elavil come in a liquid? You see, the prob with me taking other medications is that most don't come in a liquid and I have real diffculty swallowing pills (And if anyone here can help me out with that, that would be great )
I did have vitamin B12 checked and I was slightly low. Doc gave me the pills which I somehow managed to swallow (they were really tiny), although it took a lot of effort, for close to 2 months, and then kind of stopped it. The same with B6, was taking those as well (my B6 levels were even lower than B12). I know B12 comes in a shot, and that maybe something to consider, but I don't know about B6.
I have to check if my Vitamin D was tested.
Thank You!

glenn,
Thanks for writing. Sorry you have so much going on, but glad to hear that you have most of it under control. I never did the skin biopsy. Dr. Latov said that the results can be negative at times, even if someone may be experiencing all the symptoms of small fiber neuropathy. So I figured what is the point of actually doing it? Whether the results are positive or negative, I will still need to be treating the same symptoms. What are your thoughts?
It's amazing that your neuropathy seems to be resolving, even if it's resolving slowly. I hope it continues this way for you until you are neuropathy free.

aeb105,
Thank you for writing. Other than stress, I cannot figure out what causes the symptoms to get worse, or slightly better. There is never a time that I am pain free. My body aches all over and I feel burning specifically in upper and lower extremities, although quite often it feels like my entire body is on fire, 24/7, but the burning may become more or less severe at times, although I haven't been able to figure out what makes it burn more/less as much as I tried. I know lying down is sometimes worse than when I am active, doing an activity and keeping busy, but that is not always the case. I was thinking that maybe when I'm busy with other things and try not to focus on the pain so much, it seems better, but when I'm lying in bed, I tend to concentrate on the pain more, although I'm not sure.
I do wake up in the morning in a lot of pain, burning all over, feeling really achy in all my muscles. At times, this improves a little as I beging going about my day, only to once again sting me a few hours later. In short, I'm not sure what is causing the symtoms to getter better or worse, but I'm always in pain.
I was recently diagnosed with erosive gastritis as well, and am currently taking medication for that. But that has gotten much better already and I feel that it is the least of my worries right now.
I have not tried Alpha Lipoic Acid and Acetyl-L-Carnitine. Are these pills? Do they come in liquid? Can they be dissolved?
I have great difficulty swallowing pills which prevents me from trying various medications.

I started out that way too. Now I have a heel lift in every pair of shoes just for the convenience. You can get them sometimes in those catalogs that come to every senior citizen's house that offer everything! Sorry, flip-flops are out however! Joan

I had the same and I think some of the burning was because of that. If you are on Prevacid you need to be taking B-12 and other B vitamins because Proton Pump Inhibitors drain your body of these vitamins. This in turn will make the burning worse. I didn't know about this and was on Prevacid as well for about 1.5 years and found that once I got off, things got better. You can take DGL Licorice and Marshmallow Root to ease and get rid of Gastritis.

Alpha Lipoic Acid and Acetyl-L-Carnitine are pills that you can take, you can get them from Walmart. Actually just buy the Walmart brand of Alpha LipoicAcid/ Acetyl-L-Carnitine and see if you can tolerate it. If you cannot, like me let me know and I will tell what else might be beneficial.

For the ups and downs you need to take fish oil at least once a day. This will balance your swings and raise you a bit. I also take Taurine because it has a balancing effect as well. These things you can get at Walmart. I don't swallow pills well either, but I know that having some releif and making my problems better is the best path. My throat feels scarred and to get around problems with the pills, you can take with yogurt, or some kind of food and then a drinik. You will get good at padding the pills with food and making them go down easier.

Magnesium Oil might help with the burning as well. I order Swanson's Utra Magnesium Oil Spray. In addition, I take Gotu Kola for the a bunch of reasons related to neuropathy. Bacopa is the one I took when I was pretty depressed. You can get them online or at the Vitamin Shoppe. These are just some of the things that I do that help. Let me know if you try and if it doesn't help can make other suggestions. A lot of this is experimenting and finding a regimen that works, is healthy and is tolerable.

there are liquid forms of both alpha lipoic and r lipoic acid as well as acetyl l carnitine. if you do a search for that on the internet several sites come up for each. you can also get methycobalamin b12 from jarrows and leave it under your tongue or chew it so you dont have to swallow it. Amitriptylene (elevil) is a very small pill. Wellbutrin which is also an antidepressant and a very small pill worked very well on my nerve pain.

I too can't swallow horse sized pills so I try to buy gel caps or liquid forms. I use Wellesse liquid calcium w/ vit d...it's quite palatable. This is a must for me for leg cramps. I also use liquid L carnitine. Got both from Iherb.

I had some citracal pills and they were so gigantic, I crushed them into powdered form and because they were so gritty, I sprinkled them on applesauce and swallowed them that way. If I can't see the size before purchasing, I avoid tablets and look mostly for gelcaps.

I use Maalox multisymptom for my calcium:
It is instant dissolve--just chew them up and they turn into easy to swallow "mush". Each one is 1000mg of calcium carbonate.
They are very inexpensive at WalMart.

--agreed, one can have a small-fiber neuropathy and not show signs of small-fiber de-enervation on skin biopsy according to the MacArthur protocols, which define signs of de-enervation as intraepidermal nerve fiber density below the 5th percentile that was determined by norming it on a fairly small sample of people not suffering from neuropathy. There is considerble variation in people's small-fiber density, though--for one thing, it tends to naturally reduce as we age--and sometimes, since there would have been no reason to do biopsy to enumerate the fibers prior to symptoms, one could have shown a significant drop from what one's "own baseline values" would have been and still not drop down below the fifth percentile, and therefor get a reading of "normal' nerve fiber density when it fact they may have personally have experienced enough of a drop to have symptoms.

But--this is important--even with normal density ranges--the biopsy can show excessive branching and selling of the fibers themselves, which is definitely indicative of a neuropathic process. That may point to a small-fiber neuropathy diagnosis even without being below the fifth percentile (I certianly had this). Often in that case one has caught the process at a moment before one has dropped to "abnormal" levels, and a follow up biopsy might show even lower values.

In my case, for example, my first skin biopsy showed I was at the second percentile for intraepidermal nerve fiber density at the ankle and about 4% at the thigh, but if I'd had a few more fibers at the thigh that reading would have been normal. A subsequent biopsy 18 months later showed that I had started to re-enervate; then I had reached the 11th percentile at ankle and 12th at thigh, which is technically a "normal" result. But, of course, I still had some symptoms, and it was obvious I had suffered considerble de-enervation at a prior point. But at this point, I was not showing nearly as much swelling and damage of individual fibers.

My sense is that my original starting point, before all this, would have been at a much higher percentile (30? 50? 70? No one will ever know; there was no reason to get a biopsy then), and I did experience a major dimunition of fibers. I am unlikely ever to get back to my original percentile, but may re-enervate enough in time (re-enervatioon can go on for years if one has overcome the original de-enervation process, and doesn't start another) to have minimal symptoms, given that I continue to keep my blood sugar in check, take healthful supplements, etc.

I will always be thankful that I did show an "abnormal" count--it was the only unequivocally abnormal test I ever had in the whole investigatory process and provided evidence that this was not "all in my head"--an all too common designation too many of us have been slapped with. It's for that reason alone at times I would recommend the procedure, if one can get it, insamuch as it is not invasive or difficult--a few shots of Novacain/Xylocaine, a few 3mm samples taken, a few band-aids, and you're done--and if it does show abnormality, while one hasn't found a cause, one has documented that the symptoms are caused by something "real", which gets a little more respect from doctors, pharmacists, SSI boards, and friends and relatives.

Miriam...

The Elavil used in 10 or 25mg strength are very tiny tablets.
You can put one on applesauce and knock it back without even feeling it. The doses used for PN are really not high enough for antidepressant actions. Most doctors use Cymbalta (but this drug does not have supporting evidence to help heal peripheral nerves) now for people with pain/depression issues.

The larger doses of Elavil are larger tablets, approaching a regular size aspirin. They are all coated so they slide down easily.
Larger doses are not usually given.

I'd get that Vit D tested. Studies are appearing now, that Vit D can reduce need for pain medications. Most people with chronic illness are low in D. I have videos on our Vitamin forum ...the links are in the sticky at the top of that page. Low D is also a factor in depression.