Hello again! I recently. Have been dx'd with small fiber neuropathy by skin punch biospy on foot and ankle. I really appreciate the responses that I have received and begs me to ask my doctor more questions at our next appointment. One suggestion raised was Dorsal Root Ganglion involvement and after doing a lot of reading on the subject it seems to Be a logical step to take. However, being as I've been struggling for 15 years With his and have finally found a dr. Who at least bothered to test me, how do I go about broaching he subject without alienating him. It appears in the past whenever I question a. Dr. It becomes a very touchy subject and in then end told to live With It. I do not want to alienate this dr.as I feel he may be he last one I see that can provide answers.I also wonder why he only tested 2 sites instead of the required 3 that would have told the SFN is not only in my foot. Also as I have exCeSsivee sweating, frequent UTi's, IBS, difficulty. Urinating, a Qsart test would clarify. Autonomic involement, but yet again I am fearful of saying anything. If. Anyone out there can think of a diplomatic way for. Me to handle this I would be eternally grateful!! Also the. Dr has put me on Methotrexate. Has anyone else tried this and how did it help?thAnk you again for your responses!! Thank God I found this site!!

If you'll google: how to talk to a doctor you'll find a number of articles on how to do that effectively.
This article may also be helpful/of interest.

Doc

Well, I have a couple of comments.

1) if you DO have damage in the dorsal roots, there is not much you can do about it. Ability to repair this damage varies genetically from person to person. Healing is all one can expect, as there are no RX drug treatments for it.
Symptom reduction (palliative care) is all that is available.

2) But if your doctor suspects, autoimmune factors, then methotrexate is one drug he/she may try.
Examples of conditions that are autoimmune are Sjogren's and
lupus.

One cannot really control doctors... or force them into anything IMO. They do what they do and that is that.

I would consider those chronic UTIs however, because many drugs that treat these infections can cause PN. Doctors are not going to support this contention, because they typically ignore and avoid any culpability and will not blame other doctors or testify against them. IBS can result from deranged bacterial flora in the gut, which comes about from multiple or long term antibiotic use. So when patients have multiple medical issues, and get various treatments, the situation may become what is called iatrogenic---doctor caused. Doctors consider this a consequence of treatment, and typically do not explain this to the patients. Also this is termed benefit vs risk. In general the doctor makes this decision and typically does not involve you.
At times they may inform, but many times they do not.

If the doctor is ordering methotrexate, then he must be thinking autoimmune. What tests have you had for this?

I would not 'question' the doctor, but instead implant the ideas/thoughts you have in the way that he would think they are his ideas...if you know what I mean. You can also start by saying, "what are your thoughts on..." This opens the door for him.

Yes, I call this "going in the back door"... It is very helpful when training children and pets too! LOL In essence you let them think it is THEIR idea, but it is you who implanted it.

Neurologists can be the worst when it comes to being arrogant and stubborn however.

Also I'd like to remind: People on methotrexate are typically given folic acid with it, because the Methotrexate depletes it in the body.

Hello again and thank you for your info on both topics! I was prescribed folic acid to go with ( actually instructed to take it at least 24 hrs after the methotrexate. Your advice in dealing with doctors is Very sound, however this "etting the dr. Think it was his idea never works for me. For 15 yrs I've tried this route and still, here I sit without firm dx..It is as if they already made up their mind before I say a word. The latest in particular is the most frustratingg at the moment. Although I am grateful he did the skin punch biopsy,When giving me the results of the skin biopsy, he was adamant that the burning skin on my upper torso IS NOT from SFN, when he onlly biopSied the foot and ankle. From everything I've read so far tellS me he couldn't possisbily come to that conclusion without doing a third site for non-length dependant SFN. (The biopsy on foot came back positive, ankle negative. And why would he only do The 2 sites when info on performing this test says the "gold standard" is 3 sites? However by rx''ing methotexate does that mean he is rethinking tht position? Sjoren's Syndrome (which he may/may not investigate me for) includes non-length dependant SFN if I am right). How do I make him think it would be his idea to do a third biopsy when he was so adamant? Even Sjorgen's is only a small percentage of NLD SFN. My own GP was actually angry (and made sure I knew he was) with me for trying to find answers initially to what is happening to me. Telling me to stop doing my own research- I am not a. Doctor,, that there is nothing medically wrong with me. ThiS is what they said to me on suCh instances that I had DVTs, Pulmonary Embolism, bowel hemorage from parisites, numerous kidney infections, and these were not all from the same doctor. I know I must sound paranoid, and maybe to a degree I am, but I am so tired of passively waiting for evidence to become so obvious that they can't help but see my complaints are valid..thank you for letting me vent, and I pray that you. Can advise me how to at least get the third siite done so they have a more reliable starting point to invetigate,, that is, IF they DO investigate. I don't see him for another few months so I've even considered written correspondance as I truly think he is my last hope for getting answers. Thank you again and I apologize for the length of this post.