Just returned from Primary care doc...

[michelleric]

Ok, my doc came in and I told him I was there for my horrible face pain. He knows I have had that in the past, because I thought I had an ear infection at times in the past with this pain. I just never had it this painful. He had a student with him, so gave me a thorough exam. (not that he doesn't always, but was showing him how to do a basic neuro exam). He said my eyes aren't tracking and my feet go down? when doing some type of test on the bottom of them, and they should go up? My relflexes are way too quick, (although he said that could still be from my neck). I told him I am not seeing well, limping, numbness, pain etc. Basically the exam was very abnormal. I told him my surgeon (2 herniated discs in cervical spine were operated on Jan 09), doesn't think any of these symptoms have to do with my neck. My neurologist thinks they do, and are left over from my cervical myalopathy. My primary care doc agrees with the surgeon, and is certain I have MS. He says the MRI notes says MS is a possibility, and all my exam and history point to MS. He asked me what the neuros plan is. I told him she wants me to get another MRI in May. He wants to know what she is waiting until May for. I told him that is 6 months since that last MRI. He was angry, saying this is ridiculous. I should not go back to that neuro and he set me up for an MRI this Monday. He says it is time to get more aggresive, and get to the bottom of this. I agree wholeheartedly. He has been my doc for almost 10 years, so can "see" me and "sees" what is happening with my body.

So that is the latest, guess it is good that it is moving forward. The thought of starting all over with a new neurologist is just frustrating to me, but I need to do that. Hopefully he will send me to a good one if needed. He also told me to take it easier, and see about cutting back at work. Lulu was right with this...

Thanks for listening,
Michelle

[Quixotic1]

Your are correct.  Newborns have several reflexes that disappear after a few months and then are considered abnormal if they show up again.   The Babinksi is one of these.

[Heather3418]

Just wanted to ask a question about the Babinski sign in a newborn.  Don't their toes go upwward, because of an immature nervous system?  I thought I heard this somewhere, but wanted to check with you....just for my information....

Thanks,
Heather

[Quixotic1]

If the Trileptal is not working now on the face pain, then I would recommend that you be on the "drug of first choice for TN."  That is carbamazepine (brand name Tegretol).

The Babinski Test is a test wher they apply a "noxious stimulus" - often a sharp instrument - and drag it along the lateral edge of the bottom of the foot.  They often alos pull it under/behind the ball of the foot over toward the great toe.

They watch the great toe for the sign.  The normal response is a movement downward.  No movement is also considered negative.  The abnormal or positive Babinski will have the great toe move upward.  The critical thing is the first movement of the great toe.  If it first flickers down, and then comes up, it is considered a normal test.  The doc also must distinguish a "withdrawal" of the foot from the pain or obnoxiousness of the test.

The fanning outward of the other toes can be either part of a positive test or part of a withdrawal, so it is usually ignored.

FYI - the Babinski is properly done on the bare foot.  It can not be done reliably through socks, because the fabric softens the noxiousness and can render a false negative.  Also, if the doc pushes hard enough thru the sock he can destroy the sock - poor form.  Any doc that does this test thru a sock is either lazy or uneducated.

As for where the pain is in TN, it can be quite variable.  The nerve brings sensation from the skin of the face, the gums, the lips.  But the pain can be so intense as to make exact localization impossible.  It make be felt deeply at the front of the ear - which is the same place that TMJ is felt, because that is where the Trigeminal nerve emerges from the deeper brainstem.  It can cause the muscles of the side of the face spasm and contort - giving this disorder it's classic name "tic doloreaux" (painful twitch)  It can be felt so surely to be dental pain that people have ordered their dentists to extract all of their teeth or have actually pulled all of their own teeth.

Quix

[michelleric]

You don't need to be sorry. I would love if I have a blocked salivary gland, although I am thinking that is not the case. I will ask my doc next week when I see him though...always good to hear others ideas.

Jensequitur, thanks for the lesson on the toes. I actually have no idea how my toes moved, I was too focused on how my feet looked. If I knew I was going to have to go sockless, I would have had a pedicure or something! They are very ugly winter feet these days...I have had a sinus infection in the past, and this face pain is not anything like that. Tonight it is pretty painful again, as always, I hope tomorrow brings a better day. (for all of us).

Thanks,
Michelle

[truelove47]

hi again

I am very sorry if somehow i misformed you about a blocked salivary gland

It is kind of wierd and not all docs pick it up  Just trying to help you

Pain and suffering is no fun   be well                 Linda

[jensequitur]

With Babinski sign, the big toe will go up, and the little toes will go down.  I think they look more at the little toes than the big one, but I don't know.

I've had trigeminal neuralgia on and off, but not very intense - I think this must be what you're experiencing, Michelle.  I've never had a blocked saliva gland, but I think that pain would be in the jaw, rather than on the cheekbone.  I have had sinusitis, which causes pain under the cheekbone, and makes the sinuses feel stiff and sore - but it's more a throbbing pain than a shooting one.  (feels like when a cut gets infected.)

[biowham]

What a great PCP you've got. Hold onto him.

Yes, the Babinskis (I think you might remember it backwards--down is normal, up is the sign) means something besides your now-operated cspine. I do think you need a new neuro--with everyone else, including your good PCP on that one.

Good luck,
Bio

[truelove47]

It has been so long, ago, i can't remember.

All I can remember was the pain was horrible and shot up to my ear and side
of the face  I thought I would go nuts.   The dentist ordered a full mouth x ray even though
there was nothing wrong with my teeth.

It broke the day before I had the full mouth x-rayt     I felt a pop. a few pieces on sand came out from under my tongue and all this clear fluid released   The pain left instantly

I had ever in my life heard og a blocked salivary gland  Hope this helps  Linda

[michelleric]

Where in your face did it hurt? Mine is between my upper cheek bone and goes towards my ear and nose, and then it hurts above that going towards my eye. It primarily is the "skin" that hurts, doesn't feel deep, just like the surface is on fire.and it shoots at times...that might sound strange, but that is the feeling of it.  Even the air can "hurt" it. Does that sound like what you had?
Thanks,
Michelle

[truelove47]

Hi,

I may be way off base with this one.  I suffered with face pain, got the run around between my family doc and ENT,  My dentist dx'ed me with a blocked salivary gland
and he was correct.  Fluid backs up.  This pain was nasty

He explained to me that a dentist gets a lot more education about the face and head then some docs Go figure ,  Just a shot in the dark,  sometimes something sour will release the plug

Hope this may help                             Linda

[michelleric]

Ladies, you are the best...I didn't even think to ask about the meds. I just called and asked the office that question. To continue with the Trileptal or get a different one. They will get back to me today.

I will also mention to my husband about going with me to the doc. My MRI is Monday and I am seeing my doc the following week. (he is on vacation next week). I will ask my husband to come with me to the PCP at that visit. Good idea.

I don't know what I would do without this board at the moment. It is truly a life-saver for me.

Thanks so much,
Michelle

[essdipity]

I'm so glad your primary doc is great. Hang on to him!

Yes, it's frustrating to start over with a new neuro, but you do have to. Your current one is ridiculous. To save time in this process, make sure you have records of all your test results, and have all your actual MRI images. Take these to your new neuro, along with a brief timeline of your symptoms. I'm sure your PCP will help with the information-gathering if need be.

Whatever is wrong with you, you seem just too ill to work at your current pace. Maybe you can't work at all. Of course, try to go part-time and see how that works out.

If at all possible, have your husband go with you to see the new neuro, and he should at least talk to your PCP soon. It's too much for you to have to try to function normally when you just can't, and your husband needs to understand this. Please work on this aspect of things because it's clearly a major stressor and only makes things worse.

ess

[Lulu54]

Wow! That was a great visit - but was he able to do anything for the facial pain?  Pain first, dx you can keep working on.  

It only makes sense to work part time right now - see if you can broker a deal with your employer.  

I'm glad to read you are on top of this with your excellent PCP.

all ears,
Lulu