[QUOTE=en bloc;1136275]I wonder if the biopsy comes back positive, whether you could argue that it was necessary...so insurance will pay.

I asked that question and they said no.

Hi canagirl
Sorry to hear your ER visit was not useful. I had to look up Ativan as it's not a brand name I'm familiar with - expected to see it was some sort of pain reliever like Tramadol but was surprised to see it's from the benzodiazipam class of drugs, often used for anxiety. That they offered you that suggests again that they think your symptoms are imagined!

In your earlier posts I think you said you were in Canada - correct? I'm not sure if there would be many in your area but you might be able to find a Neurophysiologist - a neurologist who specializes in how neurological conditions manifest as physical symptoms in the body. They should be able to recognize the SFN symptoms and recommend the skin biopsy.

Keep working with your good PCP to manage the pain as much as possible - I'm not sure what level of pain reliever medication they can prescribe - or what you've already tried. Maybe they would be willing to consult another doctor within their practice, or elsewhere, to find some solutions.

ER = save your life if you're dying, otherwise $2000 0.5 mg benzodiazepine!

I did find the ER useful once when I had a fish hook lodged in my finger

[QUOTE=canagirl;1136285]
I cannot believe after the negative tests they would not authorize a skin biopsy to confirm what you have.

I'm in Georgia and had to do everything on my own....make neuro appoint, make foot and ankle dr appoint.....both said probably SFN and that a skin biopsy might be in order at a later date.....just very nonchalant do-di-do.....after thinking about it for a week I called the foot and ankle dr's office and asked if he would go ahead and do the biopsy....he said ok and they cleared it with insurance.

Because it was so easy for me it really frustrates me that you are having such a hard time just trying to confirm what you have.

I feel strongly that if I had not had this biopsy I would not have been approved for SSDI (disability).

I felt vindicated when the results came back that I had no A or C fibers left in my feet. DX - Severe Small Fiber Neuropathy. Only option at that point is pain management. Which has basically saved my life. The pain from SFN is off the charts for most people.

This may be a stupid question but do you have a foot and ankle doctor that you can be referred to ?

I've also heard that some dermatologists will perform these biopsy's.

My heart just breaks for you and the pain you are having.

Wish I could do something to help.

Debi in Georgia

IMHO the fact that they offered her a benzo only suggests that they found her to be very anxious, and perhaps on the verge of a panic attack. I don't think canagirl will deny she has been terribly stressed over her affliction and they likely thought some easing of her anxiety might be helpful. Benzos aren't solely for those who are imagining things. I've taken one when needed for most of my adult life. I know what it's like. My mind gets on overdrive at times when problems arise and trying to get it off track is a hopeless cause, at times.

[QUOTE=canagirl;1136285]
If it does come back positive, I'd certainly have a few words to say to that doctor for coding it not necessary!!

Sorry Groucho
I wasn't trying to suggest that Benzo's aren't useful for anxiety - obviously they do help many people who have anxiety symptoms. However canagirl did go to the ER for pain symptoms and they clearly dismissed that medical need.

luckily, ER is free here so it doesn't cost me anything financially. I sent a letter of appeal to my doctor about the skin biopsy test asking her to reconsider her letter to insurance and to review ALL my symptoms. Appointment was so short I only got to talk about a couple of things. She reviewed all my symptoms and has said that she will send another letter to the insurance requesting that they cover the test. She also booked me in for another emg on Tuesday, a referral to another doctor? (message didn't indicate who) and is sending me for more bloodwork. I missed the phone call so I didn't get to ask any questions.

I would second Debi's suggestion to find a good podiatrist. Mine was very instrumental in getting me to a neurologist and getting me properly diagnosed. They see a lot of SFN and are more compassionate than many neurologists.

In my experience once a neurologist knows you have SFN they wash their hands of you as there is no treatment but the diagnosis does usually put you on the fast track for pain management as next to trigeminal neuralgia it is one of the worst pain syndromes.

They are the only specialist I see anymore as they also prescribe braces.

My insurance did not cover the test and said it was experimental, in their opinion.