I had mine sent to bako labs...here are the results.

right calf 4.10 fibers/mm ---- evolving sfn
left calf - 3.56 fibers/mm --mild sfn

scared..dont know the next steps.

Hi Panther,

Sorry to hear you're developing SFN. That said, at least you know what you're dealing with, which is not always the case for everyone. Also, your skin biopsy numbers are not that bad and suggest it's mild at this juncture.

Is it safe to assume a Neuromuscular Neurologist ordered the small skin biopsy? The next step is they should be advising treatment and looking for a cause. Has the doctor discussed the results with you yet?

All the best,

Cliffman

Never heard it described as "evolving" I dont like the way they make that sound.How do they know it's evolving after ONE biopsy?

I like that it says mild, that is supposedly what mine is although it's really painful at times. Get on the supplement regimen and change your diet until (or if) you get a diagnosis of a cause.

There are folks at this site who will walk you through the best options. You can see some of the supplements I take in my signature.

If you are prescribed drugs like Lyrica or gabapentin understand that they dont cure anything they just mask the symptoms. For some folks they dont even work at all. You can decide whether its worth it or not.

What were your numbers. I think anything below 7 in distal leg biopsy is reduced numbers

What were your numbers. I think anything below 7 in distal leg biopsy is reduced numbers

Hi
My sugar levels are

89 in fasting 8 hrs

137 2 hr glucose tolerance

B 12 425 recently 534

B1 80





QUOTE=Patrick Winter;1190667]Never heard it described as "evolving" I dont like the way they make that sound.How do they know it's evolving after ONE biopsy?

I like that it says mild, that is supposedly what mine is although it's really painful at times. Get on the supplement regimen and change your diet until (or if) you get a diagnosis of a cause.

There are folks at this site who will walk you through the best options. You can see some of the supplements I take in my signature.

If you are prescribed drugs like Lyrica or gabapentin understand that they dont cure anything they just mask the symptoms. For some folks they dont even work at all. You can decide whether its worth it or not.[/QUOTE]

hi cliffman

No. What were ur numbers. How do you say it is mild? Will it get worse over time?




Sorry to hear you're developing SFN. That said, at least you know what you're dealing with, which is not always the case for everyone. Also, your skin biopsy numbers are not that bad and suggest it's mild at this juncture.

Is it safe to assume a Neuromuscular Neurologist ordered the small skin biopsy? The next step is they should be advising treatment and looking for a cause. Has the doctor discussed the results with you yet?

All the best,

Cliffman [/QUOTE]

DIAGNOSIS: A. SKIN, RIGHT CALF, PUNCH BIOPSY: - INTRA-EPIDERMAL NERVE FIBER DENSITY IS MILDLY DECREASED (4.10 FIBERS/MM ). - PAPILLARY DERMAL NERVE FIBERS ATRETIC AND SLIGHTLY DIMINISHED. - SEE COMMENT. COMMENT: Immunohistochemical studies and morphometric analysis disclose a mildly diminished number of all small myelinated (A-delta) and unmyelinated (C) nerve fibers within the epidermis. In addition, fibers within the papillary dermis are atretic and are slightly decreased in number. The depressed number of fibers following immunohistochemical analysis using anti-PGP 9.5 antibodies is indicative of early-evolving small fiber neuropathy**. The published specificity below the fifth percentile, (less than 3.8 fibers/mm), is 97% (in the context of an appropriately fixated post-biopsy specimen). Reference: Ebenezer GJ, P Hauer, C Gibbons, et al. J Neuropathol Exp Neurol 66(12):1059-1073, 2007. **If this analysis appears discordant with this patient's clinical exam, verification of appropriate fixation (complete submersion in Zamboni's fixative, duration >10 hours but <36 hours, maintained refrigeration (without freezing), and appropriate anesthetic technique (infiltration around biopsy site, but not within it), would be indicated. Based on the epidermal nerve fiber density analysis in this case, one potential clinical course for this patient could include a dietary supplement containing Alpha-Lipoic Acid (≥600mg daily) and Benfotiamine (600mg daily). When clinically indicated, such products may be helpful to both diminish the symptoms of neuropathy, and to improve overall epidermal nerve health. Additionally, investigators have shown benefit to using combination therapy that includes L-methylfolate, methylcobalamin (B12) and pyridoxal 5’-phosphate (B6). References: Ziegler D. Effect of 4-year antioxidant treatment with alpha-lipoic acid in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes 2007; 56(Suppl.1):A2. Luong KV, et al.. The impact of thiamine treatment in diabetes mellitus. J Clin Med Res 2012; 4(3):153-160. Walker M, et al.. Improvement of cutaneous sensitivity in diabetic peripheral neuropathy. Rev Neurol Dis 2010; 7(4):132-139.

B. SKIN, LEFT CALF, PUNCH BIOPSY: - INTRA-EPIDERMAL NERVE FIBER DENSITY IS MODERATELY DECREASED (3.56 FIBERS/MM ). - PAPILLARY DERMAL NERVE FIBERS ATRETIC AND DIMINISHED. - SEE COMMENT. COMMENT: Immunohistochemical studies and morphometric analysis disclose a moderate decreased in the number of small myelinated (A-delta) and unmyelinated (C) nerve fibers within the epidermis. In addition, fibers within the papillary dermis are atretic and diminished in number. The depressed number of fibers following immunohistochemical analysis using anti-PGP 9.5 antibodies is indicative of established small fiber neuropathy**. The published specificity below the fifth percentile, (less than 3.8 fibers/mm), is 97% (in the context of an appropriately fixated post-biopsy specimen). Reference: Ebenezer GJ, P Hauer, C Gibbons, et al. J Neuropathol Exp Neurol 66(12):1059-1073, 2007.




Based on the epidermal nerve fiber density analysis in this case, one potential clinical course for this patient could include a dietary supplement containing Alpha-Lipoic Acid (≥600mg daily) and Benfotiamine (600mg daily). When clinically indicated, such products may be helpful to both diminish the symptoms of neuropathy, and to improve overall epidermal nerve health. Additionally, investigators have shown benefit to using combination therapy that includes L-methylfolate, methylcobalamin (B12) and pyridoxal 5’-phosphate (B6). References: Ziegler D. Effect of 4-year antioxidant treatment with alpha-lipoic acid in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes 2007; 56(Suppl.1):A2. Luong KV, et al.. The impact of thiamine treatment in diabetes mellitus. J Clin Med Res 2012; 4(3):153-160. Walker M, et al.. Improvement of cutaneous sensitivity in diabetic peripheral neuropathy. Rev Neurol Dis 2010; 7(4):132-139.







CLINICAL INFORMATION: A. Rule out neuropathy; right calf. B. Rule out neuropathy; left calf. GROSS DESCRIPTION: A. Received in Cryoprotectant is a 3-mm punch biopsy for further processing. B. Received in Cryoprotectant is a 3-mm punch biopsy for further processing. MICROSCOPIC DESCRIPTION: A. Representative fifty micron-thick frozen-tissue sections were taken for immunohistochemical analysis. Antibodies directed against PGP 9.5 demonstrate reactivity within surface epithelium to the degree listed above (a mild decrease in the number of intra-epidermal fibers). Scattered varicosities and axonal swellings are noted. Intra-dermal nerves appear slightly faint and diminished in number. Routine stains fail to demonstrate evidence of associated vasculitis or amyloid deposition. B. Representative fifty micron-thick frozen-tissue sections were taken for immunohistochemical analysis. Antibodies directed against PGP 9.5 demonstrate reactivity within surface epithelium to the degree listed above (moderate decrease in intra-epidermal fibers). Scattered varicosities and axonal swellings are noted. Intra-dermal nerves appear slightly faint and diminished in number. Routine stains fail to demonstrate evidence of associated vasculitis or amyloid deposition.

You are the first person I've seen that your doctor used Bako Labs......my Foot/Ankle dr used the same company. Most on here are Therapath Labs if I have that correct.

I like the Bako reports as they explain everything in detail. And add suggestions for treatment.

Not much detail on mine as my #'s were 0.....yep....zero.....nada....nothing there.

I had 2 punches on the left leg above the ankle and one result was 0.00 and the other 0.06.

My doctor explained that with Bako results it's 0 to 15.....15 being the best and that they are able to work to regenerate #'s 4 and higher which is GREAT news for you.

I was pre-diabetic when I receive a cancer dx and had 6 rounds of chemo (taxol-carbo).

The wording on my biopsy was Severe Small Fiber Neuropathy -- escentially (sp?) devoid of Fibers A and C. It did not mention any suggestions for treatment as I believe the report spoke for itself.

I cried when the dr explained my dx but not because I was upset but I cried because I was so relieved to finally have a dx and a name for what was causing all my pain.

I'm so sorry you are going through this but I have high hopes that with treatment you will begin to regenerate the fibers. I'm sure your doctor will work with you through this.

As for me.....I had 3 different doctors telling me that I needed a good pain mgmt. dr......I was scared to death of winding up at a pill mill so I put off going to pain mgmt. for a year.

Finally breaking down and going was the best possible decision for me as the 3 dr's were correct and I've been in treatment with my pain dr for over a year now.

Please keep us posted. We care

Debi from Georgia

Mine was done through Therapath I don't think the numbers correlate. They have a different rating standard. It's a little confusing how they do it. Seems like where yours was done is a little more clear and easier for the layman to understand.