[stan t]

Went to Vanderbilt Neurology today. PN ruled out. Although I have pain, numbness, tingling in my feet Dr says symptoms not PN. I'm glad I don't have pn but I know there is nerve damage in my feet. When I asked the Dr. what my diagnosis was he said "foot pain of unknown origin. " Well I already knew that! Dr also said to take gabapentin instead of lyrica because the body metabolizes lyrica into gabapentin and of course the generic is cheaper than the brand name. resident dr spent 1 1/2 hrs. with me going over my many
issues. many kudos for that. What do you do if you have these symptoms but
no pn? Will nerves heal if I don't have pn?

[glenntaj]

--to rule out neuropathy of ANY type?

I say that as EMG/nerve conduction studies can only gorssly measure the activities of larger, myelinated nerves; it's possible to have small-fiber neuropathy even with "normal" results on a wide range of standard tests.

Generally, small-fiber neruopathy is only confirmable through quantitative sensory testing, autonomic testing (QSART/sweat tests and the like), or through the gold standard of skin biopsy for determination of intraepidermal nerve fiber condition and density, which very few centers do (and I don't remember Vanderbilt being one of them).

[JB63]

Originally Posted by stan t

Went to Vanderbilt Neurology today. PN ruled out. Although I have pain, numbness, tingling in my feet Dr says symptoms not PN. I'm glad I don't have pn but I know there is nerve damage in my feet. When I asked the Dr. what my diagnosis was he said "foot pain of unknown origin. " Well I already knew that! Dr also said to take gabapentin instead of lyrica because the body metabolizes lyrica into gabapentin and of course the generic is cheaper than the brand name. resident dr spent 1 1/2 hrs. with me going over my many
issues. many kudos for that. What do you do if you have these symptoms but
no pn? Will nerves heal if I don't have pn?

I'm with Glenntaj on this one about testing for PN. I know it differs from place to place and that some PN is obvious and easily picked up. However, this is a disease that is evasive, insidious, and sometimes masqurading as something else with a bagillion causes and triggers.

I had a foot drop that was not recognized by my internist, NP, endo, oncololgist, a big university spine center, and the head of ortho surgery. My complaint was I could not move my foot and I had electrical shocks in my hip and down my leg. I started seeking treatment in Dec of 2010 2 months after it started when I realized it wasn't a sprain that was going to get better.

1 1/2 hours of interview is sort of standard with a neuro. Since late April this year, I had about 180 lab tests on blood, urine and spinal fluid, 2 cat scans, 5 mris, and 3 sessions of EMG/NCV on legs and right arm (deferred left arm due to lymph node dessection from mastectomy) that were over 2 1/2 hour per limb. These were done over 5 visits in which I was closely examined for signs of progression, thankfully none.

Initially I was told it was not PN, that my peripheral nerves were fine, after testing it was PN. You could go crazy trying to cope. PN can take its time to appear in lab work, false negatives are known to happen, some forms may or may not show up in testing which does not rule it out.

[stan t]

Originally Posted by JB63

I'm with Glenntaj on this one about testing for PN. I know it differs from place to place and that some PN is obvious and easily picked up. However, this is a disease that is evasive, insidious, and sometimes masqurading as something else with a bagillion causes and triggers.

I had a foot drop that was not recognized by my internist, NP, endo, oncololgist, a big university spine center, and the head of ortho surgery. My complaint was I could not move my foot and I had electrical shocks in my hip and down my leg. I started seeking treatment in Dec of 2010 2 months after it started when I realized it wasn't a sprain that was going to get better.

1 1/2 hours of interview is sort of standard with a neuro. Since late April this year, I had about 180 lab tests on blood, urine and spinal fluid, 2 cat scans, 5 mris, and 3 sessions of EMG/NCV on legs and right arm (deferred left arm due to lymph node dessection from mastectomy) that were over 2 1/2 hour per limb. These were done over 5 visits in which I was closely examined for signs of progression, thankfully none.

Initially I was told it was not PN, that my peripheral nerves were fine, after testing it was PN. You could go crazy trying to cope. PN can take its time to appear in lab work, false negatives are known to happen, some forms may or may not show up in testing which does not rule it out.

small fiber neuropathy was ruled out by skin punch biopsy. I have no weakness or other neurological signs that would point to a large
fiber neuropathy. emg and nerve studies also were negative. My skin punch biopsy was sent off to a place called Bako labs.

[JB63]

Originally Posted by stan t

small fiber neuropathy was ruled out by skin punch biopsy. I have no weakness or other neurological signs that would point to a large
fiber neuropathy. emg and nerve studies also were negative. My skin punch biopsy was sent off to a place called Bako labs.

Wow!!! You had the big time work up and then some! Frustrating to have the symptoms but not the illness-- only in terms of treatment and recovery. I am glad that you do not have PN and would not wish illness on anyone.

You are on meds given for nerve damage, unknown cause of pain, and the meds are working? That's kind of telling, isn't it.

Fortunately nerves can regenerate, rate of recovery is dependent on the cause of the damage and if there are still some ungoing factors. Many variables including age, general health etc. are involved. Sometimes only time will tell. My case- I was told it would take years for the axons to repair to regain strength and function in my legs and my foot will most likely remain unchanged.

[stan t]

Originally Posted by JB63

Wow!!! You had the big time work up and then some! Frustrating to have the symptoms but not the illness-- only in terms of treatment and recovery. I am glad that you do not have PN and would not wish illness on anyone.

You are on meds given for nerve damage, unknown cause of pain, and the meds are working? That's kind of telling, isn't it.

Fortunately nerves can regenerate, rate of recovery is dependent on the cause of the damage and if there are still some ungoing factors. Many variables including age, general health etc. are involved. Sometimes only time will tell. My case- I was told it would take years for the axons to repair to regain strength and function in my legs and my foot will most likely remain unchanged.

I'm not sure how much the meds help. I can't stand or walk without pain but for a few minutes. Won't know how much the meds help unless I quit the neurontin. I think the cause of nerve damage was 20+ years working on concrete.

[echoes long ago]

stan how long have your symptoms been ongoing? sometimes it takes a while for damage to progress enough to show up on emg/ncs. i second that hope that you dont have PN.

[stan t]

Originally Posted by echoes long ago

stan how long have your symptoms been ongoing? sometimes it takes a while for damage to progress enough to show up on emg/ncs. i second that hope that you dont have PN.

echoes, I had shooting electrical foot pain two years ago, I am doing better now since I stopped working on concrete, but I still have a lot of pain, tingling and numbness. thanks

[glenntaj]

Quite often, problems with the spinal cord and nerve roots can exactly mimic the symptomology of more peripheral problems; part of the reason that investigations into neural symptoms are such a long and costly process of elimination.

[pabb]

yeah, I am with Glenn on this, I would be checking spine for impingements.