LOL, we just have to tell ourselves that we are fine... It's tough though. You have an amazing attitude from what I can tell through your writing.

Mere

Well, lol, some days are not so good, good, good......Hello down there, there, there.....

I think next time I see my neuro, I am going to ask him if it is time to repeat that skin biopsy? I am curious....I don't know tho if they will want the expense to satisfy my curiosity.

Echo-y is a good way to describe how my 'core' feels.

I can think of some other words to describe my core at times... Echo-y is a good one though.

I did read on the Therapath site that it is helpful for the neurologist to see the results of skin biopsies from time to time. To get an idea of progression.

Mere

I am glad you understand. When I say echo-y, my docs look at me like I am nuts.

Yes, I just love that puzzled face that doctors like to make.

'Echo-y' sounds very logical to me...

Mere

I had my first Skin Punch Biopsy about 3 years ago, which confirmed SFN. I am having another one done tomorrow morning for the same reason you mentioned...curiosity. And my neuro agreed that it would be helpful by way of monitoring progression as well.

My first biopsy was taken at my right ankle and right hip. The hip was supposed to be the "control" to help determine how bad the ankle was. My pain was, and still is, mostly in my feet but both biopsies (ankle and hip) showed up as "abnormal" with very low small fiber nerve density.

I was originally diagnosed with peripheral neuropathy. That was wrong...I saw a specialist and they repeated the EMG's and its now small fiber neuropathy. At first I was relieved that it wasn't PN. Now, I'm not sure if I should be relieved. I'm waiting for my PCP to get the report and then I guess we'll figure out where to go from here. I guess I'm still stunned by this and kind of depressed and bummed out about it.

--is just a subset of peripheral neuropathy, referring to preferential damage to the smaller, unmyelianted or thinly myelinated fibers that subsume the sensations of pain, temperature, and many autonomic functions.

It cannot be detected through standard nerve conduction studies or EMG's, as these only measure larger, myelinated sensory and motor nerves. Sometimes quantitative sensory testing or specialized autonomic testing, such as sudomtotor axon reflex testing, reveals it, but the current gold standard is skin biopsy to measure intraepdiermal nerve fiber density and condition. (There are also some other non-invasive methods being tested to detect small-fiber damage, such as refractive light microscopy, but these seem to have a way to go yet.)

Small fiber neuropathy IS PN.

Anything outside the spinal cord is PN...small fibers are considered outside the spinal cord.

EEO3,
There are 2 main systyems.... the Central nervous system, and the Peripheral nervous system. The Peripheral system is anything outside of the central system.
Neuropathies (damaged nerve cells- either large or small) occur within the peripheral system, more frequently. (I think because there are more nerve cells there).
PN encompasses any nerve cell damage, anywhere in the body (hands, arms, legs, feet, stomach, heart, etc) that is not in the central (spinal column and brain) system.