Hi Dr. Graf. I am a disabled orthopedic surgeon with a 25 year history of peripheral neuropathy involving feet, hands and face. I had skin biopsies a year ago which showed severe loss of nerve fibers at the ankle (.3/mm). I was told it was due to diabetes which I have had 8 years and is under strict control (HgA1c 5.5) the last 3 years and less then 7 before that. I went through a pregnancy 21 years ago and showed no signs of diabetes at any time although I weighed 40 lbs more. Diabetes does not run in the family and neither does peripheral neuropathy. I try to exercise a minimum of 3 times a week and usually manage 4-5 times of heavy aerobic activity for 50 - 75 minutes a session. I rarely drink alcohol as it is neurotoxic and keeps me awake. I went to the Mayo clinic 10 months ago and their labs showed slightly elevated arsenic (organic) and nothing else. I have no renal disease and my retinas are clean as a whicstle. My cholesterol is low. I do not take statins. My triglycerides are elevated for which I take fenofibrate. I got several conflicting explanations from the docs at Mayo and was told more then once that I should be glad I wasn t in a wheel chair. The numbess has progressed since then. Medications that aggravated the pain include dexilant, ace inhibitors and an OTC antioxidant, the name of which eludes me, but it starts with a B. Review of the abstracts indicate either a subclinical nonsystemic vasculitis involving the blood supply to the peripheral nerves or a dorsal ganglionic problem. I ve had bigeminy and trigeminy that started at the same time and that gets worse with exercise. Exercise makes me so tired I have to have a nap. All EMGs and nerve conduction tests are normal. Imaging studies, except for a spinal cord ependymoma at L1-2 (removed in 2006) and degenerative disc disease are normal. I have a C5-6 spinal stenosis of 7 mm which my neuro surgeon didn t think was significant. The University of Kansas neurology dept. who did the biopsy lst year decided it was all diabetic, ignoring my history and the pattern which is why I ended up at Mayo. I had cardiovascular autonomic tests which were slightly abnormal and they attributed this to the atenolol. I couldn t stay in Rochester long enough for the sudomotor sweat tests. Question? Where can I go to get listened to with respect, a definitive diagnosis, and treatment that emphasizes reversal rather then symptomatic treatment with medications that make me groggy, unable to remember anything from one second to the next, or stay on task.