--a visit to the Cornell Weill Center for Peripheral Neuropathy on Madison Avenue and E. 60 th Street in Manhattan (phone is 212-888-8516).

A number of us in the NYC area, including myself, have gone through here at one time or another; it is a major research facility into small-fiber neuropathy from many causes, including celiac/gluten sensitivity, diabetes/impaired glucose tolerance, and autoimmunity, as well as a clinical practice.

Major problem may be getting a quick appointment, as they are very booked. But they give a very thorough initial evaluation (mine was on the order of two hours), they can do skin biopsy and nerve conduction studies right on site, and they will conduct exhaustive evaluations (bring all your test results to them if you can).

Be prepared, though--many small-fiber predominant syndromes remain stubbornly idiopathic; the doctors there will even tell you they often suspect autoimmune mechanisms but that the antibodies involved may be unique to that person or otherwise as yet unidentified.