A professor spent 7 years trying to get treatment for facial pain

Within minutes, the pain was gone and Wies’ December 2015 final leg back home to California was uneventful. But in the next few months, the feeling was repeated in the same place. At first the unexpected pain was mild and easily disturbing; Later it became a painful daily torture.

Years after the onset of the illness, Weiss, who consulted dentists, otolaryngologists and an otolaryngologist, was given the correct diagnosis. But his complicated medical history, one important discovery, and a cryptic warning from one of his doctors, a failed radiology report delayed effective treatment for another three years.

“It was completely confusing,” Weiss said. In June 2023, he underwent surgery that greatly reduced his pain and improved his quality of life.

N. Nicole MoyerA Santa Barbara, California, neurosurgeon who operated on Weiss, it is not unusual for people suffering from Weiss’s unusual pain to seek long-term diagnosis and treatment.

“I see a lot of people who have had a lot of dental work done over the years,” Moyer said. It is shocking to me that so many people suffer from this for so long.

After three months of constant pain after the flight, Weiss consulted an internist. For unclear reasons, the doctor told Weiss that the cause was probably psychological, not physical, and that it wasn’t serious.

He sent Weiss to an ear, nose and throat specialist whom he saw in March 2016. She did an examination and ordered a CT scan A deviated septumUsually a painless condition It is estimated to be up to 80 percent. The bone or cartilage that divides the nostrils from the center of the population. A moderate or severe disorder contributes to the development of sinus infections, headaches and breathing problems. But Weiss was having none of that. And a deviated septum doesn’t explain the pain.

Weiss then consulted the dentist. He found nothing and referred Weiss to a colleague who specialized in treating mouth ulcers. The specialist advised Weiss to repeatedly open and close his mouth while spraying the problem area with cold water.

“The idea was to train my mind not to track my pain,” Weiss said. He was also appointed nortriptyline, antidepressants are also used to treat facial pain. Both treatments were ineffective.

A few months later, Weiss consulted a second orthodontist Trigger point injections, anesthetic injections intended to relieve muscle knots. Weiss said he received these injections every two weeks for the next few years. He also tried acupuncture.

It is shocking to me that so many people suffer from this problem.

– Doctor N. Nicole Moyer

The reasons for injections and acupuncture, which both seemed to work only for a short time, were unclear. “I wasn’t asking questions,” said Weiss, 73 at the time. “I was just listening to my doctors — they’re some of the best in LA.”

But in the year By the end of 2019, the price of the biweekly trigger point injection was “getting out of hand,” Weiss said. His health insurance will only cover a portion of the cost. He decided to consult a neurologist.

In the year The neurologist who examined him in January 2020 focused on the area where the pain was concentrated on his face. He did an investigation Trigeminal neuralgia (TN), a rare neurological disorder that affects the trigeminal nerve, a cranial nerve that sends signals from the brain to the front. The degree of pain caused by TN varies, but it can be physically and mentally debilitating, so it is nicknamed.“Suicide Disease.”

TN, which usually affects only one face, is more common in women and people over 50 and is often thought to be a dental or jaw problem. Supposedly 10,000 to 15,000 cases They are examined every year. TN can be caused by a blood vessel pressing on a nerve or sinus surgery or dental trauma. In some cases, no reason was found. Sometimes people with multiple sclerosis get TN because the disease destroys the myelin sheath that protects the nerves.

Primary treatment includes medications. Surgery is the only treatment for cases where drugs fail to relieve pain.

The neurologist ordered a new series of injections and sent Weiss to a second neurologist who performed an electromyography (EMG); The test can rule out neuromuscular diseases, including MS. Weiss advised the neurologist to “try every possible pain medication” before considering any surgery for TN; Why didn’t Weiss ask?

In early 2021, Weiss retired and moved north to Santa Barbara.

He practiced and taught daily until his pain worsened and he was no longer able to meditate. “It was very frustrating. This was a central part of my life,” he said.

Weiss had stopped practicing dentistry at the time of the outbreak, so he made an appointment with a dentist in Santa Barbara. As a dentist, Novocaine required many shots and confirmed that the experience was very painful He replaced the crown. “I’m having the worst night of my life,” Weiss said as he tried to sleep with an ice pack on his face to numb the pain.

He started seeing new specialists in Santa Barbara. Some have suggested that the problem may come from the sinuses, thinking that the cause of the pain is TN. There have been other brain surgeries — the next step if drugs fail — because of his medical history.

In the year In 1997, Weiss underwent surgery to remove one Pituitary adenoma, a healthy brain tumor can cause hormonal imbalance. A year later radiation was done to eliminate the remaining diseases. Many doctors seem reluctant to recommend another brain surgery.

In June 2021, a neurologist consulted a third new drug to treat nerve pain. She also ordered tests, including an MRI, to determine if there was an abnormality. Cranial nervesespecially the trigeminal nerves. She told Weiss that TN pain was usually triggered by drinking cold water, eating, talking, or brushing his teeth, which didn’t seem to bother him at all. Weiss’s pain was getting worse when he slept.

In the year An MRI in July 2021 found no abnormalities in Weiss’ trigeminal nerves. A CT scan revealed a possible blockage. sphenoid sinuses, It is located at the back of the nose.

In the year In early 2023, Weiss saw a new ENT who told him he wasn’t sure what was wrong.

Not even close to relief for more than seven years, Weiss said he felt hopeless and depressed.

“I decided I had to take control of the situation,” he recalled. He made an appointment with another otolaryngologist and obtained the records of the pituitary surgery and follow-up examinations. He hopes doctors can help if he finds out that he has a sinus problem or that the results of a CT scan in 2021 reflect scar tissue from a 1997 surgery.

After another false start — the new ENT noticed a dental problem, prompting another visit to the dentist that found nothing — Weiss was referred to Moyer, the medical director of neurosurgical oncology at Nest Health.

as if At their first meeting in May, the neurosurgeon said Weiss’ previous pituitary surgery and focus on his sinuses had “led him down the wrong path for a while … he went around seeing a lot of doctors.”

She goes back to the TN investigation and tells Weiss that she needs to review the investigation. Moayeri also changed his medication to an anti-seizure medication that was more effective in treating TN, which relieved some of his daily pain.

I wish I had gone online earlier and started reading about facial pain.

– Alan M. Weiss

When the neurosurgeon examined the 2021 MRI images, she was shocked by what she saw. of Superior petrosal veinShe said, Weiss was compressing the left trigeminal nerve.

“There is too much variation among medical professionals,” Mowairi said of the disagreement.

Moyeri suspected that the compressed nerve was the cause of TN. Delicate brain surgery a Microvascular degeneration Taking the pressure off the nerve from the vein or veins by compressing or irritating it and protecting the nerve with a small Teflon pad.

Moyeri told Weiss that he was a candidate for breech surgery, but the unusual approach to TN had lowered his success rate — perhaps as low as 30 percent. And she listed risks including stroke, permanent facial numbness, worsening pain and infection.

Surprisingly, Weiss did not hesitate: he wanted surgery.

“Nothing else helped,” he said. “I was in pain every day and I thought I would be in more pain for the rest of my life. I thought it was my only choice.

During the June 28 procedure, Moieri discovered that the veins leading to the petrosal vein were pinched and scraped by nerves, making the tedious surgery difficult. Many years have passed since the first attack, the neurosurgeon told Weiss that while the severe pain may have subsided, the long delay may not have completely disappeared.

Her prediction proved to be correct. Weiss said the pain has subsided a lot, but now he feels intermittent pressure around his ear. Doctors told him that this was the result of nerve scarring and that it could be permanent.

“I’m glad I had the surgery, but I wish I’d gone online and started reading about facial pain,” he said. Weiss added that he believes they trust doctors “too much” and “don’t understand how narrow” their skills are.

He says he regrets the years he spent doing it, especially the expensive trigger point injection. “If I had found a doctor years ago who ordered an MRI and sent me to a neurosurgeon, the pinched nerve might have been caught earlier,” Weiss said. And I may have avoided some nerve damage and pain.

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