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-   -   Question about biopsy for small fiber neuropathy (https://www.neurotalk.org/peripheral-neuropathy/217217-question-biopsy-fiber-neuropathy.html)

en bloc 03-10-2015 07:59 PM

A good physician would welcome an intelligent question showing personal interest in ones own health and testing.

Not sure I see much autonomic problems in your symptoms, but I do see signs of Sjogren's...which I know you've considered and been tested for. I can't remember, have you had the lip biopsy?

The sweating, GI and heart arrhythmia (all depending on what it is exactly) could be autonomic. The skin biopsy does look at autonomic fibers as well, so maybe this will provide some useful information for you.

Hopefully soon you will have some answers. Please keep us posted.

MAT52 03-11-2015 12:52 AM

Quote:

Originally Posted by en bloc (Post 1128809)
A good physician would welcome an intelligent question showing personal interest in ones own health and testing.

Not sure I see much autonomic problems in your symptoms, but I do see signs of Sjogren's...which I know you've considered and been tested for. I can't remember, have you had the lip biopsy?

The sweating, GI and heart arrhythmia (all depending on what it is exactly) could be autonomic. The skin biopsy does look at autonomic fibers as well, so maybe this will provide some useful information for you.

Hopefully soon you will have some answers. Please keep us posted.

Thanks I will certainly let you know the outcome.

But I have another question before I go. For three nights now ive hardly suffered any of the usual burning or tingling pain I have been woken by almost every night for about two years now. The wet sensation iny legs had been much less of an issue too. I have had record amounts of intense flashing pain around my body - especially in hands. I have also felt very stiff and sore in my joints and tendons. The main feature of the past few days has been in my head, chest and tummy because I have a flu virus presently and am coughing a lot, experiencing respiratory difficulties and ear, nose and jaw pain. I've gone from a person who never sweats anymore to crazy amounts of sweating in the night.

My main question is, has the small fiber neuropathy gone away for good or is it just refiguring itself while my brain prioritises the nasty flu symptoms? I've done very little exercise at all because ive been bed-ridden with fever and coughing - taking only the odd panadol for pain as Cymbalta clears my body finally. Can anyone shed any light on this development for me and would it affect the results of my forthcoming skin biopsy I wonder?

MAT52 03-11-2015 01:04 AM

[QUOTE=MAT52;1128840]Thanks I will certainly let you know the outcome.

But I do have another question before I go. For three nights now I've hardly suffered any of the usual burning or tingling pain that I have been woken by almost every night for about two years now - glove stocking distribution. The cold wet sensation iny legs had been much less of an issue too. I have had record amounts of intense flashing pain around my body - especially in hands. I have also felt very stiff and sore in my joints and tendons.

The main feature of the past few days has been in my head, chest and tummy because I have a flu virus presently and am coughing a lot, experiencing respiratory difficulties and ear, nose and jaw pain. I've gone from a person who never sweats anymore to crazy amounts of sweating in the night.

My main question is, has the small fiber neuropathy gone away for good or is it just refiguring itself while my brain processes the nasty flu symptoms? I've done very little exercise at all because ive been bed-ridden with fever and coughing - taking only the odd panadol for pain as Cymbalta clears my body finally. Can anyone shed any light on this development for me and would it affect the results of my forthcoming skin biopsy I wonder?

LouLou1978 03-11-2015 02:34 AM

Hi there,


Just with regards to the skin biopsy, when I arrived at the hospital I too was expecting them to do it at 3 sites as this is what I had read.

I questioned this when they proceeded with the biopsy, they told me they do not need to do this. I told them about the non lenght dependent thing and they just dismissed it. I don't think they do they do the 3 sites in the uK.

Mine showed that my nerves were re-generating too much, which was in keeping with neuroinflammation or an autoimmune disease. He also noted it had been seen after chemo, or medication. Mine could be caused by metronidazole. I am still under investigations.

I hope it all goes well for you.

Lou Lou

MAT52 03-11-2015 02:53 AM

Quote:

Originally Posted by LouLou1978 (Post 1128845)
Hi there,


Just with regards to the skin biopsy, when I arrived at the hospital I too was expecting them to do it at 3 sites as this is what I had read.

I questioned this when they proceeded with the biopsy, they told me they do not need to do this. I told them about the non lenght dependent thing and they just dismissed it. I don't think they do they do the 3 sites in the uK.

Mine showed that my nerves were re-generating too much, which was in keeping with neuroinflammation or an autoimmune disease. He also noted it had been seen after chemo, or medication. Mine could be caused by metronidazole. I am still under investigations.

I hope it all goes well for you.

Lou Lou



Thanks Lou Lou. I think mine might have been caused by the combination of Methotrexate and Hydroxichloraquine over a few years as nothjng has flagged up to say it's immune mediated or part of my RA.

How many punch biopsies were done on you in the end - just the one? Hopei haven't offended my GP by querying but I don't want to have bits gauged out as just a tick boxing exercise! I'm really hoping that after two years it has all just gone away suddenly now as third night of not having to wake and spray hands and feet with magnesium oil to cool down! Or alternatively maybe the B12 tablets are at last doing something?

Thanks for your help.

MAT52 03-11-2015 03:59 AM

Quote:

Originally Posted by MAT52 (Post 1128846)
Thanks Lou Lou. I think mine might have been caused by the combination of Methotrexate and Hydroxichloraquine over a few years as nothing has flagged up to say it's immune mediated or part of my RA.

How many punch biopsies were done on you in the end - just the one? Hope I haven't offended my GP by querying but I don't want to have bits gauged out as just a tick boxing exercise. I'm really hoping that after two years it has all just gone away suddenly now as third night of not having to wake and spray hands and feet with magnesium oil to cool my peripheries down! Or alternatively maybe the B12 tablets are at last doing something?

Thanks for your help.

Ps GP responded that he would take two biopsies at least - but no guarantees the histology will be useful of course.

Healthgirl 03-11-2015 05:51 AM

Quote:

Originally Posted by en bloc (Post 1128767)
I'm not sure that would give me a warm & fuzzy if he's never done it and is using instructions. It's not like it's a difficult procedure...very easy, in fact, but still the handling and such of the samples is very important, not to mention getting the correct depth of tissue.

Let me also add that I don't understand why he (or the other place) is only getting ONE sample. That doesn't make any sense at all. I had 3 three from each leg (ankle, knee and thigh). The reason is to assess length and non-length dependent SFN by seeing the density at different levels of the leg. This is very important. You may not need all three on both legs, but at least two should be done on the same leg (ankle and then knee or thigh as the other).

Maybe Glenn will chime in with more details on just how important this is.

Yes, I have heard it is important to take from more than one place. I only had two. It turned out that the spot taken from my mid thigh turned out to be much much worse than the one down at my ankle. It definitely confirmed that the damage is significant and what is happening. Now if they could only find out why its happening:(

glenntaj 03-11-2015 06:03 AM

Most of the time--
 
--the skin biopsy protocol for measuring small-fiber condition and density involves taking samples from just above the ankle and from the upper thigh, at least, as these are the sites that were "normed" in the original Johns Hopkins protocols.

At good academic neuropathy centers, there might also be a sample taken from the knee area, or even from the upper arm just above the elbow, as these sites were also normed by later research.

But there should be at least the two leg samples taken for exactly the reason en bloc mentions--there needs to be a comparison between distal (ankle) and proximal (thigh) sites in order to determine if there is length-dependency or not.

LouLou1978 03-11-2015 10:08 AM

Hi there,

Just to let you know,they took 2 spots next to one another just above the ankle.

Good luck with it.

Lou Lou


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