Skin Biopsy Report from Cleveland Clinic
 

Distal leg: Intraepideramal nerve fiber density is reduced, about 3.4 fibers/mm

Distal thigh: Intraepidermal nerve fiber density is normal, about 8.0 fibers/mm

Proximal thigh: Intraepidermal nerve fiber density is normal, about 8.3 fibers/mm.

Impression: This biopsy is a mild distal small fiber sensory neuropathy.

Is this more of a definitive diagnosis than the EMG / NCS studies? (see previous post for those results.) Normal, abnormal.....after a $40K work-up I still am not sure what to think.

I was taking 2400 mg of Neurontin but cut that back to 1200mg because of swelling / pitting edema, that is not normal for me. Alpha Lipoic Acid 600mg per day and Tramadol 50mg as needed. The doc from CC wants me to be tested for Gluten Intolerance but that will wait until after the first of the year because of a change in insurance and having to meet a new deductible. Won't kill me to wait a few more months. Besides, I have 2 sisters-in-law that have celiac sprue and I have never had any of the symptoms that were experiencing when they were diagnosed.

Again.......would love to hear comments, suggestions or just a hello. Was officially diagnosed (or so I thought) back in Jan. and am still adjusting. Life is good right now. Don't know if it is the alpha lipoic acid or a remission period. Either way.....it feels good to be where I am right now and I am sending out good thoughts to all. :circlelove: Enjoy what is left of the summer.......I dread winter!! Wish I could hibernate then........what the heck, might even come out a few pounds lighter!! :Dancing-Chilli:

I have less than 2 in my distal leg, and am still ambling around 6years after that biopsy....

So, it looks to me, that it is PN....but, I wonder still if IVIG could help?

Small fiber cannot be definitively diagnosed except by skin punch biopsy, and now that you've had that you have a specific name to put on your neuropathy.

Here is my microscopic description from the Cleveland Clinic done 2/1/10:

3-mm specimens from the distal leg, distal thigh and proximal thigh

Impression: Non-length dependent small fiber sensory neuropathy. The neuropathy was greater at the higher punch on the thigh than at the other two sites.

How in the world can you tolerate so much neurontin? I couldn't titrate from 100 mg a day and had to quite because of inability to focus eyes or function. Lyrica was even worse - that lasted one 75 mg capsule.

Glad to hear that you are in a "remission." That must be grand.

Sheltiemom

Does look like--
 

--you at least have the beginnings of a small-fiber neuropathy.

This might be the primary situation, or it might coexist with neuropathy of larger fibers (and/or symptoms from spinal compressive forces--there are certainly those who have "complicated" processes).

I'd be very interested to hear the results of those gluten tests--especially in people with non-celiac genetic profiles (DQ1 as opposed to DQ2 or DQ8), the presenting symptoms of gluten sensitivity are often neurological, not gastrointestinal. The Gluten File speaks about the work of Dr. Hadjivassiliou in this realm quite extensively:

http://sites.google.com/site/jccglut...ationsofgluten

I am glad you are feeling better in any event. I thought of you while I was driving home on Monday... all day long hundreds of miles. My hands were talking all the while after about noon....
"hello, remember me? Carpal tunnel?" I have a cushioned steering wheel cover but my right hand especially was very problematic. I had to move it, shake it, and rest it every 10 minutes. It seems better now, but I used my brace on it all summer and when I arrived home.

I also am putting a cushion between my knee and the door...as the meniscal trigger point on that lateral side doesn't like pressure there anymore! That seemed to help and even worked a little for my foot.

Beautiful hummingbird. What kind?

I had 14 sandhills just a few feet from my patio door day before yesterday! Needless to say, I stayed indoors until they left.

This is a fledgling ruby throat-- that is the only type we have in our midwestern areas. (all the other hummingbirds are in the West and S.West.) Thanks for the compliment.;)

We also have the cranes. But we only saw one this year.
But in the past about 4 yrs ago across the bay, there was a nest which had fledglings, and we heard the commotion as the adults taught the young ones how to hunt in the marshy water for food. They were making the strangest noises. We couldn't see them, but they carried on for over an hour. We saw some folks come down to the shore during this and they could see better. I wouldn't think it was a mating ritual that late in summer? Our area also has blue herons and night herons, as well. I found a night heron sitting on the edge of our pontoon one early morning. We also have lots of kingfishers..many more this season. I have some other pics in my album up now too. I managed a pileated shot this year which is very rare since they don't come near people often.