For the past week, I have been trying to get my peculiar jaw-ear-head pain diagnosed. At the end of this process, having dealt with eight doctors in as many days, I sit and write a few thoughts on the importance of diagnosis - not to relate in tremendous detail my medical troubles but just to emphasize how important it is not to rush into any kind of treatment without giving it due thought.
Initially I thought I needed a root canal and went hurriedly to my dentist who stood his ground and said my teeth were perfectly fine. I must have been the only patient there longing for a root canal that day, to put an end to the pain! However, he said it was likely to be a joint pain and gave some muscle relaxants and asked me to return in a week if things did not change. He is quiet, steady and very skilled and unwilling to rush into intervention. I went back home and tried the medicines but did not feel much change. Decided to visit a general physician as I wasn't able to sleep; I was told I had neuralgia and asked to stop the previous medication, was given some medicine for nerves which completely knocked me out - I began sleeping half the day and all the night and still I felt that things were not what they should be.
Went back to some doctors I had been seeing for other ailments to check if the medicines they prescribed could have side effects - but they all (youngest to oldest in hierarchical fashion) shook their heads.
My next trip was to the ENT specialist, a very gentle competent man, but who had a line up of patients for the next two weeks. I explained to his secretary that this was an emergency and he said they would see me after the regular patients; the doctor was expected at 6 p.m. But the doctor was delayed at surgery and when I reached his residence cum clinic, they were cancelling all appointments. I said I could return later at night in case the doctor got back and was seeing patients and when I called later, they asked me to come. I finally saw the doctor at 10.30 that night and I was the second last patient. He looked worn out and I felt tremendous sympathy for these doctors who see masses of people from morning to night in endless succession. Is there enough time or energy for them? Perhaps not, but there are certainly not enough good doctors though almost every second person in the country wants to pursue medicine.
The doctor said I had trigeminal neuralgia and prescribed some medicines for a week. He said the general physician's medicine was to be stopped as it was normally a long course, and prescribed something else, with the cautionary note that if I had trouble opening and closing my eyes, I should contact him. As it was late at night I did not want to begin a new medicine and decided to start in the morning. When I awoke and checked details on the net, I found unbearably horrible descriptions of trigeminal neuralgic conditions and realized that I had been given the standard line of treatment - anti epileptic drugs.
I did nothing for a couple of days except re-visit the bevy of old doctors for other conditions and check with them. As they were treating other parts of me, they were uninterested in this new twist. Fortunately, my family thought of an old, experienced neurologist and I trundled off to him, hoping I wouldn't be sent off for CAT scans or other scary sounding things! He was old and low key with a completely unhurried and relaxed air, appearing interested in everything I said without dismissing any of it. We went over descriptions of the pain again and again - the location, the feeling, the intensity and finally he said gently that he did not agree with the previous diagnosis. He asked me to stand and pressed a few points, flashed some lights and finally, settling back in his chair, said he thought my temporomandibular joint (TMJ, located somewhere between the ear and the teeth) was the cause. He said the dentist would confirm (or reject) this and meanwhile no medication was to be taken if I could tolerate the pain.
As I learnt more about this condition and about why he ruled out the other (there is often some confusion as there are different types of trigeminal nerve pains, but the treatment is drastic enough to warrant further testing before a conclusive diagnosis, I feel) various things began falling into place, including my previous medication and small twinges I have been feeling over the past several months.
Back to the dentist, who immediately called in my father and gave both of us a lecture on how this was not trigemninal neuralgia and indeed a TMJ condition, the seriousness of taking anti-epileptic medication, how ENT specialists are not trained to tackle this, how his own strategy was to relax the muscles (and the mind as well) which generally worked and how this condition was painful but not alarming and would subside in due course. He also agreed that it could be triggered by some of my previous medication given by the bevy of doctors in denial (and indeed when I scanned published medical literature I found many such reports). So of course I have stopped my earlier medicines and will visit the doctors to inform them just for their records, but they will probably not be interested (it's not jaw dropping enough!)
Anyway, the bottomline is just mental relief, not finger pointing. But the consequences of doctors being in too much of a hurry, too confident of areas that they may not know enough about, of dismissing data that does not fit in with a model and also of patients feeling compelled, through frustration or alarm, to do things in a hurry - can be grave. The internet brings a lot of information as does each doctor, and for unusual complaints (not emergencies obviously), one should begin a course of treatment only after thoughtful consideration. The body, mind and spirit send us signals of all kinds and it's often hard to unravel them, but when the right solution comes along, several things click into place and not just the stray observation or symptom. This is the beauty of medicine and physiology - the science of the subject and the art of diagnosis are equally important.
As I write this, I think of my old, trusty doctor, who I wanted to visit to get an input into what other medicines I could try without developing strange pains. I have known him for over ten years and each time we have a leisurely consultation session followed by many stories of other cases (keeping identities confidential but discussing the medicine and science) - these have helped me manage my own medication, even if I disagreed with other doctors on issues, and also helped me save my own life once. As I write this, he lies critically ill in hospital and I may never see him again. But all the sessions of unhurried, thoughtful and path breaking diagnoses and treatments that he prescribed will stay with me forever.
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