Skin biopsy result
 

Hi

I happend to call the lab my sample was sent to, so I can ask if there is a problem as to why my doc only did biopsy on my ankle an not thigh.

Turns out my results are negative and also for amyloid.
He aske if I have spoken to my doc and I said no so he was like oh well you need to talk to them. He thought I already had results. In any case case he said there was no evidence of sfn.
And it depends on what doctor thinks and why he didn't do thigh but he said in your case you didn't need it.

So back to square one!!!


Does this mean I have the symptoms but no damage and nerves are okay. Or am I loosing my mind!!

The news means that you are in the statistical norm or normal.

The cause of your symptoms is not found yet by their standards.

Since you know you have allergies, and eczema, I'd follow that path. A good allergist, or environmental doctor may nail down your culprit.

No damage yet is a good sign. I'd look to your lifestyle critically, and keep a log of all jewelry (nickel allergy), all makeup, food you eat , anything that you consume. Your soaps, pets, etc. Even toxic black mold in any damp area. Chemicals from wells (if you have well water), or exterminators, flea control, pesticides in the yard/lawn, etc.

I'd look into food allergies seriously.

The lab person asked me where my symptoms are and said all over even my face. So he said ya no it would be legs and hands or arms for sfn.

I have read so many people have facial symptoms with sfn so this is confusing

I am going to read what the report actually says

Tulips

Thankyou mrs d

I have moved so many times that I cant pinpoint one place. No water well.
Don't wear jewelry and use makeup like once a year! But let's see

I have seen an allergist before and he did a test with some punch thing and that was normal.
I am going to look for another allergist/ immunologist
Could still be malabsorbtion issue or celiac type or rhumatology.
Lab person said since no sfn or emg clean this could be CNS involved but my MRI is normal and so is EEG.

Tulips
Thankyou

Mrs D
 

Does it matter which leg they do. Should they have done the one that has the worse symptoms?

I really don't know.

Maybe Glenntaj would have some comment since he has had the test more than once.

Don't want to throw cold water here, but non-length dependent small fiber neuropathy definitely can affect the face. It did mine.

My above the ankle biopsy site showed not much evidence of SFN. Lower thigh showed more and high thigh showed most.

But if your docs don't think you needed the higher sites biopsied because above the ankle showed no evidence of SFN, then it's up to you whether or not you want to go with that or ask to have the other two sites done.

Sheltiemom

See this makes me mad. Why not do all three spots in the first place. I had to beg him for this biopsy so maybe he just did it to shut me up and was lazy to do one spot. Every person I read had more then one spot done.

Now I don't have insurance. That was last test on it so this just sucks.

Sheltiemom you had it in face. Was it just as bad burn ing and all?

Tulips,

Sorry to say this, but the face has always been the worst. It's and everything else affected has gotten significantly better, though, during the last two or so months and especially the last few weeks. Take no meds, but do take supplements as recommended here at this very forum by MrsD and others.

It is really too bad that was your last test with insurance. But look at it this way - you had NO evidence of SFN by ankle biopsy. That's good news!

Sheltiemom

Thankyou

But leaves me to wounder what thigh would have shown. I needed more testing but can't now.
So will work on diet and vitamins

Electrolyte imbalance such as low potassium and low calcium causes perioral numbness.

As far as sfn goes, I do think the most likely place for it to show is the ankle or the calf punch. My calves are worse than my feet! Much worse!

I know that you do not have insurance right now... but something to think about for the future.

Mayo Clinic diagnosed me with small fiber neuropathy (and large fiber and limited autonomic). I never had a skin biopsy done. The results of other tests were conclusive enough. I don't know specifically which tests, since I had so many done in the 4 days I was there. But when I looked it up online, it said "Skin biopsy (with an evaluation of the density of intraepidermal nerve fibers) and tests of autonomic nerve function are useful for the diagnosis." (http://www.ccjm.org/content/76/5/297.full)

So, if you get health insurance again.. or if you try several things and get to the point where you decide you want to find out if it is SFN and be tested even without insurance, there are other options for testing. I have no idea how much the tests cost in comparison to each other--but one may be a more reasonable price. Just a thought.

Smae makes a good point.
 

Though the current gold standard for diagnosing small-fiber neuropathy is the skin punch biopsy to check the condition and density of intraepidermal nerves, there are other tests that are available and were done frequently before this test came along, and are still done at some locations. Even so, many of these tests are specialized enough that the average doctor will not be familiar with them. They include:

Quantitative Sensory Testing--a small thermal electrode is placed on various body parts and it's voltage is adjusted so that its tmeperature is raised and lowered; the patient reports what sensations of hot/cold/pain are felt and at what levels they can notice small differences. This is a rough guide of the sensitivity of the small nerves that control pain and temperature sensations. People who cannot notice differences easily or who cannot distinguish temperatures likely have some small-fiber damage.

The Sudomotor Axon Reflex Test--this is used to see if the small-fiber autonomic nerves that regulate sweating are in good working order. The test has three parts and measures resting skin temperature, resting sweat output, and stimulated sweat output. Measurements are typically taken on arms, legs or both. A small plastic cup is placed on the skin and the temperature and amounts of sweat under the skin are measured. To stimulate sweat a chemical is delivered electrically through the skin to a sweat gland.

There is also the bodypowder sweat test, in which one is covered in a fine powder which turns purple when sweat on--the idea here is to see if, when exposed to heat, one sweats within a normal range on various body parts, or too much (hyperhdrosis) or too little (anhydrosis).

There are also autonomic tests to measure blood pressure and heart rate variation under various conditions. These include the tilt table test, a deep breathing test and the Valsalva maneuver. The tilt table test requires that the patient lie on a table that is then raised. The deep breathing test requires the patient to take deep breaths for a minute. The Valsalva maneuver requires that the patient blow into a tube to increase pressure in the chest.

Some places--not as advanced, in my opinion--still do more invasive nerve/muscle biopsies. I don't think these are as warranted or useful for those with smal-fiber symtpoms, but some places love to practice surgery (and bill for it) . . .

BTW, since small-fiber neuropathy certainly doesn't have to show up in a length-dependent pattern--it can show up anywhere in the body--taking only one sample at an ankle seems to show a lack of understanding. Most standard protocols take three smaples--at ankle, thigh, and upper arm--and some can take more, including the face; in fact, a skin sample can be taken any place there is hairy skin.

Yes, thank you! I was trying to find the specific tests, but was having a hard time.

I had theses ones:

Quantitative sensory testing
Body powder sweat test
Tilt table test
Deep breathing test
and I can't remember but it sounds like I may have also had the valsalva maneuver one done, too.

Thank you for explaining the other ways of testing for SFN. :)