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Old 03-11-2008, 12:41 PM   #1
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Other Neuropathy types

Hi All,
I was recently referred to a neurologist for a tingling/stinging in my heels and buzzing in the front of my heels/back of the arch of my feet. These sensations almost always come up before going to bed or after exercise. I never really have any discomfort while walking, running, or biking and go several days without discomfort at a time. Occasionally (maybe a couple times a month) after excercise and sometimes as i'm trying to sleep, the top of my feet, close to the toes begin to feel hot making me either take my shoes of or walk around on cold tiles.
The neurologist did a full physical exam and did EMG and nerve conductance tests and said all was normal except I had diminished reflexes in my lower extremities (something I believe has been noticed by other doctors before). I asked him explicitly and he said there is no evidence that I have any neuropathy. He put me on a trial of medication for restless leg syndrome. Regardless, I'm going in for a full blood workup tomorrow (B12, thyroid, ferretin, RPR).
My question is, with all his assurances, could this still be a type of neurapathy? I've read online the the small fiber type does not show up in an EMG or NCS. Do my symptoms suggest that type of neuropathy? Any help or advice would be greatly appreciated!
Thanks and good luck to everyone.

 
Old 03-12-2008, 11:03 PM   #2
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Re: Other Neuropathy types

Quote:
Originally Posted by faris1877 View Post
Hi All,
I was recently referred to a neurologist for a tingling/stinging in my heels and buzzing in the front of my heels/back of the arch of my feet. These sensations almost always come up before going to bed or after exercise. I never really have any discomfort while walking, running, or biking and go several days without discomfort at a time. Occasionally (maybe a couple times a month) after excercise and sometimes as i'm trying to sleep, the top of my feet, close to the toes begin to feel hot making me either take my shoes of or walk around on cold tiles.
The neurologist did a full physical exam and did EMG and nerve conductance tests and said all was normal except I had diminished reflexes in my lower extremities (something I believe has been noticed by other doctors before). I asked him explicitly and he said there is no evidence that I have any neuropathy. He put me on a trial of medication for restless leg syndrome. Regardless, I'm going in for a full blood workup tomorrow (B12, thyroid, ferretin, RPR).
My question is, with all his assurances, could this still be a type of neurapathy? I've read online the the small fiber type does not show up in an EMG or NCS. Do my symptoms suggest that type of neuropathy? Any help or advice would be greatly appreciated!
Thanks and good luck to everyone.
Hi, the small fibre nerves are the ones that responsible for sense of feeling
[heat,cold & pain] you would need Quanitive Sensory testing or a skin punch biopsy to confirm small fibre damage, QS testing also tests the large nerve endings as they are responsible for sensing vibration, your right, a NCtest or an EMG test for large nerve function only.
In the early days of my neuropathy i had an idiot professor of neurology do a nerve conduction test on me and he wrote back to my doctor saying that i showed no signs of peripheral neuropathy, luckily the next neuro knew what he was doing and laughed at the others report, i hope you find a good neuro.
good luck anyway,
Aussie

 
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Old 03-13-2008, 06:49 AM   #3
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Re: Other Neuropathy types

thank you for your response, aussie.
I'm wondering if he ruled out small fiber neuropathy because of my symptoms? Can anyone tell me what the symptoms feel like and how often you feel them? Is it a pain,cold,or hot feeling all the time or is it an inability to recognize temperature and pain?

 
Old 03-13-2008, 07:33 AM   #4
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Re: Other Neuropathy types

hi faris. I was dx with small fiber neuropathy thru a epidermal biopsy after 2 long years of trying to find an answer. My symptoms began to appear over 4 years ago. At first I only had problems after exercising(walking 2 miles). My feet would get really red, burn, and the veins would pop up. Other symptoms that I had were; muscle twitches, cramps, numbness(stocking-glove distribution) in arms and legs,numbness in face,tingling,and electrical shock sensations, sensitivity to touch. I think what really got me to the diagnosis was a realization that I could not differentiate b/w hot and cold below my knees. I saw 4 neurologist before i found one who finally got it. I hope you find an answer soon.

 
Old 03-13-2008, 07:58 AM   #5
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Re: Other Neuropathy types

thank you anwise. Although my symptoms come up after exercise, they sound a bit different than what you've experienced. Are those typical of SFN? I do feel the tingling and occasionally stinging but never really pain. Only on rare occasions i feel something like burning. From experience, I can tell the difference between cold and hot. I've never had any numbness though. Are these symptoms you've described "defining" SFN symptoms? Did you ever find out what caused you SFN?

Last edited by faris1877; 03-13-2008 at 08:35 AM.

 
Old 03-13-2008, 12:11 PM   #6
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Re: Other Neuropathy types

My SFN is a result of occupational exposure to chemicals. i think in the beginning of the disease my main issue was the burning feet after exercise, some balance problems, and muscle twitches. I really didn't have pain and numbness until the disease had progressed. To check your temperature perception you can use a piece of metal and see if it feels different on your feet as opposed to your legs. That is how the 4th neurologist did it. The other 3 never checked for lack of temperature sensation. It is easy enough to do. When I read an article called "answering the burning question", I new I had SFN b/c I had every symptom that they discussed. In the article it also states how SFN goes undiagnosed for so many people. They say that the burning is the key symptom. Hope this helps. I'll try to find a linc for the article if you are interested.
ali

 
Old 03-25-2008, 02:13 PM   #7
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Re: Other Neuropathy types

Thanks for all the help anwise. So i went back to my doctor a few days ago. He did a blood workup for Fe, TIBC, Transferrin saturation, TSH, T4, ferritin, B12, and RPR. He said all was normal. But I still have the tingling/stinging in my heels after excercise and before going to bed...with the occasional burning before going to bed. he seems to still think its restless leg syndrome.
I can't help but think that it cant be RLS because its coming on after excercise. i specifically asked again about neuropathy and he again told me that nothing in my EMG/NCV and now blood tests indicate any neuropathy.
I guess my question is, based on all these tests can it still be neuropathy? I feel like i shouldn't be second guessing my doctor as he's the neurologist and i'm just a guy learning about this on the internet. Are there other conditions completely unrelated to nerves that could cause this, like problems with the blood vessels or muscles? Any thoughts on this from people that have gone through a similar experience?

Thanks again for everyones help and good luck.

 
Old 03-26-2008, 11:08 AM   #8
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Re: Other Neuropathy types

Hi Faris. Did you have a glucose tolerance test? Does diabetes run in your family? I know how hard this is. Knowing something has changed but not being able to pinpoint what that is. In my experience with neurologist, I have found that once they rule out anything immediately life threatening they are content to take the sit back and wait approach. Did he give you something for RLS? There are many things that can cause neuropathy and I guess your doctor ruled out the most common.
ali

 
Old 03-27-2008, 08:22 AM   #9
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Re: Other Neuropathy types

Hi faris, after all the test my neurologist had recommended for PN did not show up a skin biopsy was positive. Did you have this test?

 
Old 03-28-2008, 06:30 PM   #10
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Re: Other Neuropathy types

Hi again,
Thanks for all the advice everyone. You all have proved more informative than my doctors!
I did have a glucose test a few months ago as part of a physical came back normal. The doctor put me on mirapex for RLS to see if thats the issue, but I can't imagine it is.
He didn't mention a skin biopsy, only told me he doesn't believe its neuropathy. Maybe he's done all the test for causes of neuropathy and came up with nothing so he assumes it cant be it? Based on my research, even if it is neuropathy, all thats left (if it isn't RLS) is idiopathic neuropathy, so i will likely just have to just learn to live with it?

Thanks again for all your help!

 
Old 03-28-2008, 10:22 PM   #11
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Re: Other Neuropathy types

Quote:
Originally Posted by faris1877 View Post
Hi again,
Thanks for all the advice everyone. You all have proved more informative than my doctors!
I did have a glucose test a few months ago as part of a physical came back normal. The doctor put me on mirapex for RLS to see if thats the issue, but I can't imagine it is.He didn't mention a skin biopsy, only told me he doesn't believe its neuropathy. Maybe he's done all the test for causes of neuropathy and came up with nothing so he assumes it cant be it? Based on my research, even if it is neuropathy, all thats left (if it isn't RLS) is idiopathic neuropathy, so i will likely just have to just learn to live with it?

Thanks again for all your help!
Hi again, typical signs of small fibre damage are burning, tingling, sharp *****ly jabbing sensations and numbness can follow.
It sure makes me wonder why your neuro hasn't done a skin punch biopsy or at the very least Quanitive Sensory testing as it is normal procedure for detecting symptoms you describe.

I am curious to if you have actually have had a 2 or up to 5 hour glucose tolerance test or just a fasting glucose test ? as the fasting glucose test is pretty useless for detecting early stages of diabetes [prediabetes] which in some people can cause the exact same nerve damage as full blown diabetes can, it is good test to at least eliminate insulin resistance, even a normal general practioner can order this test, thats if you haven't had it yet, of course.

Gluten sensitivity is another that can cause neurological problems, toxins, lack of B1, B6, B12, with b12 a score of below 500 is very suss by Japaneses standards, i keep my b12 level well over 1,000 by supplementing 1 mg daily of b12 methylcobalamin on a empty stomache, combined with a multi B as the b12 needs the other B's vitamins to work properly. B1 taken in divided dosages during the day can help the burning in some, but b6 can be toxic in large doses and must be limited as it can actually cause PN, " P5P " the active form of B6 is a better choice, i wonder if your neuro has tested for these other vitamin deficiencies.

I hope you haven't got PN, but i wouldn't leave any stone unturned if it persists or gets any worse.
good luck with it anyway.

Last edited by Aussie100; 03-28-2008 at 10:25 PM.

 
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