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[QUOTE=Jeepmanjk14;5432158]Hello everyone I have been diagnosed with small fiber neuropathy from the skin plug test. This is where they take a small skin plug from the top of my foot and side of my upper ankle then it's collected in a test tube frozen and shipped to New York, well it has came back and these jerk doctors can't tell me how bad it is.The test results say: Epidermal nerve fiber density test.
Left calf. 0.55. <3.5. 3.5-4.4
Left foot. 0.33. <3.0 3.0-4.8

Ok so I'm a kind of 1-10 how bad is it guy and none of these idiot dr.s can tell me that they even said oh those numbers don't mean nothing! What why would this test cost my insurance co. 10,500.00 dollars yes you read that right 10,500 and the numbers don't mean anything? Are you freaking kidding me...
Now these idiot Drs. Are only pain specialist nothing more I'm only going as I work 60 hours a week and I have it the same in both ankles and feet and by the middle of the day I can hardly take it anymore.They now have me on tramadol hcl50mg. Every 6 hours......and lyrica 50 mg twice a day........and cymbalta 60 mg so I don't punch some one in the throat at my work.(wife likes me on it says I'm not a *****)...... Now I have a appointment with my family dr. Just so he can get his office call money and then refer me to a neurologist who is where I think I need to be instead of these so called pain specialist. But I'm just on here to see if someone else had a test like this and can give me the 1-10 how bad I am...The test was from Therapath Neuropathology in New ANYONE Please help.....Thankyou jeepmanjk14[/QUOTE]

Hi Jeepman,
I was diagnosed with SFN about 3 years ago with the punch skin test. It was the final and last test that was given me when all the others failed (read: negative) to dx my problem. Let me first say I HEAR your frustration. I was there.

I hope what I say can help you in some way. First, and MOST IMPORTANTLY, it's not "how bad" you are, but how well your pain meds work. I never asked my dr. how bad I am. My pain tells me. Since there is no cure for SFN, there are only a few things you can try that may help you as they have helped me.

But let me back up. Therapath is the recognized lab in the country that measured your skin and gave the results to your pain dr. I would trust their outcome. I will say that you DO need to see a neurologist to get better answers. Pain drs. are just for that....pain. They don't usually care where it came from or how you got it and I would also guess they have no idea what SFN is. However, when you make an neurologist appointment, make sure that particular dr. is familiar with SFN. The office manager may know or can get the answer for you when you call. Many....most drs....are not familiar. My Primary didn't know what it was either. It's pretty rare, so you may have to search a bit.

Do your research. Go online and read everything you can about it so you can speak knowledgeably and have good questions for your new dr. WRITE them down. I kept a record, just written on my calendar, of how I felt each day until my appointment. I rewrote it out before my appointment. My dr. loved that I captured how I felt so that he could get a better idea about me and the pain I was experiencing.

Since SFN starts in the feet, I found I had to wear good shoes. I'm a lady who likes style, but I had to wear shoes with fairly thick, rubber soles that gave me a lot of support and cushioning for my feet. I found a company, Easy Spirit, that makes good quality shoes that feel good on me. Since you're a man, you may have to get some referrals from friends or your dr. Please, don't wear ill fitting shoes, sneakers or especially flip-flops. They will only make your feet feel worse.

I found a lotion that helps the pain in my feet when they ache a lot. It is called Morton's Epsom Lotion and is found where the epsom salt is sold. I bought mine in Walmart and put it on lavishly at night. I do think it helps a bit. It contains Magnesium which is a good pain inhibitor. DO NOT take magnesium by mouth, or be careful when you do, or you will get the runs. The lotion is absorbed through the skin so it is perfectly safe. No side-affects.

I also found that getting A LOT of sleep was one of the best things I could do. Now I understand that we are all busy and getting to bed earlier than usual is tough sometimes, but try it. Even an extra hour will help. The next thing is exercise. I purposely got a dog so that I would be required to walk him and get me off my butt! There are mornings (and mornings are the worst!!!) when I don't want to take another step. But once I am out the door and walking, I really, truly begin to feel better. My legs hurt less and my feet are ok (I wear the ugliest walking shoes; don't tell anyone). I know I need more exercise, but for me, it was a starting point. Plus, I have a pup we got from a shelter now who is the love or our dogs go. That is a bonus.

Meds are different for everyone. I take Lyrica 75's, three times a day....for now. I tried Cymbalta but it made me neauseous. My dr. was hoping it would work better than Lyrica but that's not going to happen now. He also gave me Flexaril, a muscle relaxer to use ONLY at night to help me sleep. And it does work in conjunction with the Lyrica so I usually sleep pretty well.I don't know much about tramadol and (2) 50's of Lyrica is a small dose. But it tells me that perhaps your symptoms are not very bad as bad can go. I hate to say you'll get worse. Maybe not. I think I have gotten better since I first got SFN. My first terrible pains are almost non-existant now, but not gone for good. I don't believe they ever will be, so I am resigned to do the best with what I have and deal with it.

I hope I've given you some things to work with. Again, don't worry about what all those test numbers mean; worry about what your pain numbers mean. Then learn how to make the meds work for you.
Hi Jeepman,
Mel52 is right. Once you get a neurologist, you may have more testing. Don't get upset at this. Neuropathy is a disease of elimination. You have to be negative for many things before there is a certainty of the diagnosis. I had every one imaginable: xrays, MRI's of the brain and spine, EMG's (god awful! and wont show SFN), Tilt-table test, One I can't remember the name of, Diabetes, etc. It wasn't until after ALL of these tests that my neurologist said, "let's try the skin punch test. That's the only one left" Bingo! You are fortunate that you had this test before having to take more.

If there is any possibility of you having diabetes, Mel is right about that, too. It is the first thing drs. suspect, so don't get aggravated about this test. Neuropathy in the feet is the most common symptom with diabetes. And, you may have it and not know it. That is very common. My dr. wants to test me again for it and I won't complain. I see that he has my best interests in mind.

As for your meds, I don't know about tramadol but I know that most other medicines like Norco don't and will not help nerve pain, nor do over-the-counter NSAIDS. I have taken both and only got a buzz from the Norco and sleepyness from the NSAIDS. My feet still hurt. Only meds made specifically for nerve pain help with a few exceptions: those that have been found to help a disease that it wasn't meant for, like Cymbalta and Savella. These are for depression but for some reason, in combination with Lyrica, help the pain even more. If your feet hurt that much, you need to have a stronger dose of Gabapentin or Lyrica. I started on 100 Gabapentin a day which my Primary gave me. Once I got to a neurologist, he told me that was like taking a baby aspirin. No wonder I had so much pain! A neurologist will understand your pain once he has seen the pathologist report from your skin punch test (make sure he has that before you go to your first appointment and results from any other tests you've had). Once he he sees the results of those testes, he will begin to give you meds he thinks will help. But, and this is important, if the meds don't begin to work in the time they are supposed to, don't wait! Call your neurologist and tell him/her. She may be willing to adjust your meds. This is how it works. But I'm hoping you will get the right med and dose right away. Mel is also right. You MUST advocate for yourself. When all this started with me about 4 years ago, I asked for and got every report for every test given to me. Don't let them tell you you can't have a report. You have a RIGHT to them. That was so I had a record of everything and could easily make copies and present it to the next doctor if I had to see another. I am fortunate to live near Philadelphia where there are several terrific hospitals and doctors, although it took me 5 months to see the specialist who is treating me. (My primary neurologist near my home suggested I see a specialist once the dx was given. He was smart to do this since he admitted he didn't know much about SFN. I appreciated his honesty)

Don't give up, Jeepman. You will feel much better emotionally and mentally once you find a doctor who understands where you are coming from. Most neurologists are very familiar with neuropathy of the feet.

I hope you get some relief from the lotion. Warm foot baths and keeping your feet up at night might help, too.

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