Nerve biopsy test: Is it done by a neurologist or rheumatologist?

Hi there @sunnyflower. I received a copy of my skin biopsy report today. What would you like to know?
Rachel

Hi Rachel, well, I worked in patient care for over 20 years. I also loved my microbiology class in college. So whatever you feel comfortable sharing. I would probably research the info as I'm sure you already are! I'm pretty cerebral and awestruck by how God created the human body and it's function and/or, malfunction! Your results may give myself and others some perspective/relativity to their/our own path and neuro reports when/if we get them. Hope you will get a better understanding of what you learn. Do you have an appointment in place to go over the results w/ the doc who ordered the Bx's? I would have a paper and pen handy to take notes. At least I KNOW I need that. Research shows that patients forget up to 80% of what doctors tell them as soon as they leave the office. There are other studies that speak to the specific amount of time patients are able to absorb what the doctor tells them. Like they can only receive the first few minutes. I can't find that now. Nothing is simple!!!!!!!!!!!!!! Be well, Sunnyflower

@sunnyflower Ohhhhh, this is nothing new my friend. My results are from January 2019. I just never knew at that time patients were entitled to every office visit note, reports, labs, etc... I was quite deep in pain, frustration and anxiety when my results came back and so overwhelmed that I never considered obtaining for myself, only making sure my disability company and Social Security Admin received their copies for long term disability. Always having to prove my case.

It was ironic you asked recently about skin punch biopsy labs because I had already been scheduled for a routine consult with my neurologist and had planned to dissect the report, all this time later, out of curiosity. When visiting my Dr and asking him to clarify a deeper meaning of my lab, like the percentage of neuropathy revealed which I've researched can be detected, he disagreed.

Part 1 of my biopsy was epidermal nerve fiber density. Both left calf and left thigh were normal.

Part 2 was sweat gland nerve fiber density. It revealed my left calf sweat gland nerve fiber density was 31.6, verifying Small Fiber Neuropathy diagnosis. Abnormal range is <36.5 and low normal is 36.5 - 38.5 which proves early stages of SFN. I could have told ya that one based upon my temperature irregularities!

One interesting find on the sweat gland nerve fiber density was that my left thigh biopsy had no identifiable sweat glands. Basically, it's a crap shoot where the Dr scoops from and can be hit or miss. No biggie, I wasn't charged due to no findings!

So, that's about it....Therapath Neuropathology reports indicate the result value (numbers) and provide interpretation of results which state the percentile. My percentile was defined as the 5th percentile with significantly reduced sweat gland nerve fiber density. It states it cant indicate cause for SFN or predict a response to therapy. The diagnosis and treatment of any medical condition depends on the patient's presentation and results of all laboratory investigations as interpreted by the treating physician.

If you'd like to see my actual report, I have no problem sending it by private message to you. Hope this helps satisfy your curiosity. 😊

Be well,
Rachel

@rwinney HIiRachal. I asked my rheumatologist today about my neuropathy in my thighs and she told me Medicine doesn't have any answers. I found out for myself when the burn starts I apply a cold washcloth that really helps and stays that way for quite a while . I was told by my foot Dr to put my feet on ice when this happens . Have you ever tried this?

@lioness Yes ma'am I have and still do. I'm big on heat and ice. It works best for me.

@sunnyflower Ohhhhh, this is nothing new my friend. My results are from January 2019. I just never knew at that time patients were entitled to every office visit note, reports, labs, etc... I was quite deep in pain, frustration and anxiety when my results came back and so overwhelmed that I never considered obtaining for myself, only making sure my disability company and Social Security Admin received their copies for long term disability. Always having to prove my case.

It was ironic you asked recently about skin punch biopsy labs because I had already been scheduled for a routine consult with my neurologist and had planned to dissect the report, all this time later, out of curiosity. When visiting my Dr and asking him to clarify a deeper meaning of my lab, like the percentage of neuropathy revealed which I've researched can be detected, he disagreed.

Part 1 of my biopsy was epidermal nerve fiber density. Both left calf and left thigh were normal.

Part 2 was sweat gland nerve fiber density. It revealed my left calf sweat gland nerve fiber density was 31.6, verifying Small Fiber Neuropathy diagnosis. Abnormal range is <36.5 and low normal is 36.5 - 38.5 which proves early stages of SFN. I could have told ya that one based upon my temperature irregularities!

One interesting find on the sweat gland nerve fiber density was that my left thigh biopsy had no identifiable sweat glands. Basically, it's a crap shoot where the Dr scoops from and can be hit or miss. No biggie, I wasn't charged due to no findings!

So, that's about it....Therapath Neuropathology reports indicate the result value (numbers) and provide interpretation of results which state the percentile. My percentile was defined as the 5th percentile with significantly reduced sweat gland nerve fiber density. It states it cant indicate cause for SFN or predict a response to therapy. The diagnosis and treatment of any medical condition depends on the patient's presentation and results of all laboratory investigations as interpreted by the treating physician.

If you'd like to see my actual report, I have no problem sending it by private message to you. Hope this helps satisfy your curiosity. 😊

Be well,
Rachel

@rwinney HIiRachal. I asked my rheumatologist today about my neuropathy in my thighs and she told me Medicine doesn't have any answers. I found out for myself when the burn starts I apply a cold washcloth that really helps and stays that way for quite a while . I was told by my foot Dr to put my feet on ice when this happens . Have you ever tried this?

Hello. I'm Sunnyflower. I'm sitting under my down comforter with heat on my feet, ice gels (heavy but the best) and my hands in a rolled up heatopad. My norm. My knees are the most painful neuropathy/arthritis and cold works. The comforter keeps the icegels cold for over 2 hours, And the microwaveable heat thingy warm for hours too.
I have Raynaud's Dz goo so my feet./toes and hands/fingers get so cold they hurt! My bones ache! At the same time, my toes feel hot from the neuropathy. Like liquid nitrogen gets so cold it burns.
I hate having to be in bed so much, but to get relief, I have to. Also bc ysm so weak.
I hope this helps in some way.
Many blessings, Sunnyflower. 🙏💕

Hello. I'm Sunnyflower. I'm sitting under my down comforter with heat on my feet, ice gels (heavy but the best) and my hands in a rolled up heatopad. My norm. My knees are the most painful neuropathy/arthritis and cold works. The comforter keeps the icegels cold for over 2 hours, And the microwaveable heat thingy warm for hours too.
I have Raynaud's Dz goo so my feet./toes and hands/fingers get so cold they hurt! My bones ache! At the same time, my toes feel hot from the neuropathy. Like liquid nitrogen gets so cold it burns.
I hate having to be in bed so much, but to get relief, I have to. Also bc ysm so weak.
I hope this helps in some way.
Many blessings, Sunnyflower. 🙏💕

Very good info Rachel. So often I have found results to be not straight forward. I would hang onto these reports, if for anything, as a baseline for you to compare with future tests of the same, and/or, as a significant piece of the puzzle to help a doc put it all together. Also, to have at hand when you see different providers who don't have a access to your records.

I've had so many diagnostics over the years that I have results in my hanging file catagorized mostly by body part or area of the body. So there can be X-rays, MRI, CT and even ultrasound of one body part like a neck for example. Bone density is labeled as a diagnostic. It's exhausting. I have a Physical Therapy file too, that I keep all my exercises for different body parts.
Whatever is most user-friendly for you is best. Let me know if you have any tips or ideas on that.
If you want to send me your results privately, then sure, please do. I am only in the early learning stage of neuropathy. I 've had it and fibro along with a myriad of other afflictions for 40+ years.

I'm learning so much from this blog thanks to the very special people here devoting their time to myself and others from the goodness of your /their hearts. I am deeply grateful! Many, many thanks! ♥️