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#1 | |||
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Member
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Quote:
I have the same symptoms as you except for the numbness. Vibration was normal. I had an EMG/NCS twice. One year apart. Both came out normal for Large nerve N. I finally had a skin biopsy this past Fall. It showed I have small nerve neuropathy. Did you find out what is going on with you? Did the cymbalta alter your tests. I tryed cymbalta but it was horrible. How much neurotin are you taking? Im taking lyrica but thinking about changing to neurotin/gabapentin because of bad side effects . Hope your doing better! |
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#2 | ||
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Magnate
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--repeat skin biopsies from the same locations at eighteen months, forty months, and seventy months have shown somewhat increased nerve fiber density each time; on the last one I am back to about the 18th percentile, which certainly corresponds with re-enervation and the improvement in symptoms.
Of course, we'll never know what was normal for me before all this started, and what percentile I would have been at then. Can you list the reference ranges from your skin biopsy? I am not aware of any changes to the numbers, but it is possible your numbers are normed to your age and gender (I am male and was 43 at time of first skin biopsy; it is known that "normal" intraepidermal nerve fiber density does decrease with age). |
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#3 | ||
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Junior Member
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With regards to the biopsy, I must caution you and others about the results. I am seeing Dr. James Berry at Mass General who specializes in SFN and he explained the difficulties of biopsy. He said at one time he did them frequently but discovered in too many cases the nerve counts were normal or near normal when there was clearly a problem. He also saw cases where the nerve counts were abnormally low and there was no associated problems. He definitely uses them when the neuropathy appears to be advancing rapidly. But in general, when the neuropathy is not advancing, it does not take him in any new diagnostic direction.
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#4 | ||
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Member
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For t hose asymptomatic patients, how can they subject themselves to skin biopsy when they dont have symptoms of discomforts in the first place? I'd like to understnd what the doctor meant about his precaution of getting a skin biopsy. My skin biopsy last year showed normal result but my pain is getting worse than when it started. |
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#5 | ||
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Junior Member
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My take away from discussions with Dr. Berry is that he did not see strong enough correlation between nerve counts and symptoms to take him in a different diagnostic direction for cases where symptoms did not advance. Hence he has stopped doing skin biopsies, except in cases where symptoms are rapidly advancing. My wider point is that skin biopsies have their place but maybe not for those with stable symptoms. Following his protocol you might be a candidate for another skin biopsy. |
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