[invisable]

I had my skin biopsy, they took a punch from (very) high upper thigh, (very) low calf (almost to ankle) and foot.

The Dr. said it will show if nerve count is normal in these areas, but that I could have a normal count and still have nerve damage!?!

He left the room and never came back for me to question him.......

Can anyone help me understand this?

What is the sence of test if it doesn't detect nerve damage?

[Tulips]

Hello

I am glad it's done! I don't k ow about your question but I am glad three spots were done.

How was it?

I am sure others can Answer that question for u

[glenntaj]

--are interpreted according to the McArthur protocols, named after the main researcher at Johns Hopkins where the procedure was invented.

There are specific "norms" that were set up at the time to make diagnostic classification easier (and possibly insurance re-imburseable). In short, after a lot of samples were taken from both "normal" peopkle and neuropathy sufferers, it was decided that if one had an intraepddermal nerve fiber density belows the fifth percentile determined from these many samples, or above the ninety-fifth percentile, that would be considered an indication of definite nerve dysfunction. Other factors go into the diagnosis, including whether the nerves show swelling or excessive branching, but the numerical criteria has been the one most reported when the results are compiled.

Of course, as my neuro pointed out, owing to individual variation, one might have nerve damage that hasn't yet reached either of those percentiles, as it's very difficult to know at what level of density one started at before one's damage process, as none of us have the procedure until we have symptoms. To me, if one began at the fifttieth percentile (if we could know that) andhas dropped to the twelfth, that's an indication of damage, though it likely wouldn't meet the criteria for a definite diganosis of small-fiber neuropathy.

Since I have the protocols and the numbers, I ask people to report the numbers from their biopsies; I think anything near the percentiles is likely an indication that something has happened.

[echoes long ago]

Originally Posted by glenntaj

--
Of course, as my neuro pointed out, owing to individual variation, one might have nerve damage that hasn't yet reached either of those percentiles, as it's very difficult to know at what level of density one started at before one's damage process, as none of us have the procedure until we have symptoms. To me, if one began at the fifttieth percentile (if we could know that) andhas dropped to the twelfth, that's an indication of damage, though it likely wouldn't meet the criteria for a definite diganosis of small-fiber neuropathy.

some doctors have a very difficult time with this concept. they insist its still in the normal range. Back in 2001 as part of my job i had a pulmonary function test and i was a runner at the time and my fev1 was 115% which means my forced expiratory volume was 15% higher than expected for someone of my age, height and weight. One month later after i had a large exposure to some very toxic, caustic and irregular shaped particles which get lodged in the lungs and cannot be expelled, i went to a pulmonary specialist and my fev1 was 80% 80% is the bottom number considered still normal. I said yes but i dropped 35% in one month i need some aggressive treatment asap. The pulmonologist said but its still normal. i couldnt get him to see it. needless to say i went elsewhere. you would think it would be easy to see and interpret but not all doctors can do that.

[amit]

Sometime the problem can be - neurotransmitors or ions channals that are not working properly, but there is no nerve demage.