Dear doctors: I travel a great deal and am thus unable to read your column regularly. If you have not covered this subject, please tell your readers about trigeminal neurology. I suffered for three years with severe jaw pain before my dentist diagnosed me and sent me to a neurologist.
P.K.
I'm pretty sure, P.K., that you mean trigeminal neuralgia. The trigeminal nerve relays to the brain all the sensations arising on the face. It also controls the chewing muscles. Trigeminal neuralgia consists of sudden attacks of unbearable facial pain centred on a cheek, the chin, the jaw or part of the lip or gums. The pain is brief, lasting seconds to minutes.
A person with this disorder is in constant fear of another attack arising unexpectedly. A breeze blowing on the face, chewing, talking or brushing the teeth can provoke an attack. Sometimes it happens without a recognizable cause.
This nerve problem most often arises in middle ages or older.
One underlying cause of trigeminal neuralgia has to do with an artery that encircles the nerve. Pulsations of the artery often are the root cause of the painful attacks. The pulsations irritate the trigeminal nerve.
A neurologist is the right doctor to see about this problem.
Treatment with medicines often can control attacks. Carbamazepine, lamotrigine and baclofen are the names of some of the medicines used for treatment. The doctor gradually increases the dose of medicine until success is achieved.
If medicines are unable to control attacks, then a number of other ways of dealing with the trigeminal nerve are available.
One way is to protect the nerve from the encircling artery. A neurosurgeon is the doctor equipped to perform this operation.
If you're on medicine now, how are you doing? I'm interested in knowing what has happened to you.
Dear doctors: I finished chemo and radiation therapy in September of 2008. In December of 2010, I started bringing up yellow and green phlegm. After seeing many doctors, one finally suggested a culture of a sputum sample. The germ involved was Pseudomonas. I was given 21 daily infusions of tobramycin, and after the infusion used a nebulizer containing tobramycin. The doctor says Pseudomonas never goes away, but it can be controlled. Is this so?
M.S.
Pseudomonas (SUE-duh-MOAN-iss) is a bacterium found in waters, soil, plants, hot tubs and many hospital sites. It is difficult to eradicate. Only a few antibiotics are effective against it. Most often, infections with this germ are seen in people who have other illnesses.
In some instances, it can be eradicated. I don't know if you're under treatment right now. I imagine your doctor will stop treatment eventually and see how you do on your own. If need be, antibiotic therapy can be restarted if Pseudomonas raises its ugly head again.
Dear doctors: My son is 14. Our neighbour was a professional boxer for a few years. He still trains boxers in his garage and yard. He thinks my son would be a natural for boxing. My son is eager to start. I'm not so eager.
I'm concerned about head blows and the damage they cause later in life. What's your opinion?
J.K.
I don't believe that any sport compares with boxing when it comes to exhausting work. A three-minute round drains more energy than most other sports burn in an hour. Continuous upper-body action demands greater energy than does pure leg action.
Head injuries with the potential for brain damage at a later date are a big concern. I would give the boy permission only if head blows were eliminated completely in his training.
Drs. Donohue and Roach are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write them at P.O. Box 536475, Orlando, FL 32853-6475.
