We thoroughly enjoyed our week in Florida.
I always thought it was sort of corny that every Canadian on the east coast dreams of wintering there, but now it all makes sense.
I never tired of this view (which never looked the same twice as the light changed):
I have a lot to report on the health front.
I'm providing this mostly to help others, so don't feel compelled to read all this if you are not a headache sufferer!
(tall enough for ships to pass under and sorta scary to drive across)
If you recall, I went to see the famous Dr. Mark A. Piper, a world-renowned oral/maxillofacial surgeon who specializes in TMJ surgery. He trained at Harvard as a dentist and Vanderbilt as a surgeon. If you have any jaw problems (or bite issues or bruxism) and related head pain/discomfort, he is your man.
The session with Dr. Piper cost $1800 and the CT/MRI was $955. I was in his office from 7:15 am to 3:30 pm and had a whole range of analyses done, as well as a long meeting with Dr. Piper and his assistant Julie to discuss my issues.
Several other patients were in the clinic at the same time, so Dr. Piper and his assistants were in and out all day. I had to leave the clinic for my CT and MRI, which took about an hour. After that I was given 1/2 hour for lunch.
Palm trees outside Dr. Piper's office in downtown Saint Petersburg on a balmy February day.
Dr. Piper was thorough, kind, and patient (he took time to read my entire 4-page health history very carefully and asked me many questions). He did not jump to conclusions and took a lot of time to listen, evaluate, and gather all the information he needed to help me understand what might be causing my headaches and in particular if it could be related to my jaw.
Palm trees at The Pier downtown. This is Tampa Bay!
He took about an hour to review my MRI and CT scans and sat with David and I to review them. He found that:
1. I have some TMJ disease but not enough to warrant surgery. My TMJ disks are not in perfect shape but they are both pretty good. I was level 3a on his Piper TMJ classification system, which goes up to 5b.
2. My TMJ disk may still be contributing to headaches, so he did some nerve blocks (marcaine injections) to see if they helped. More on this later.
3. I don't have a normal cervical spine! C1 and C2 have anomalies which may be contributing to headache (cervicogenic origin). He said I could see a specialized chiropractor who addresses this area but was not sure it would help as I have a bone spur on C2 that is really limiting my neck mobility.
4. I don't have any other head pathology (e.g bone) and my sinuses are perfect (i.e. not sinus headache).
5. I do, however, have an enlarged pituitary, which needs to be addressed immediately (I am seeing my GP on Wednesday). He said this may or may not be a pituitary tumor, and it can be contributing to the headache.
Since I'm not experiencing really unusual non-headache symptoms, this may be a non-secreting tumor (doesn't affect hormones) but can cause serious issues if it continues to grow. It can press on the optic nerve and cause blindness or can bleed out and cause sudden very serious issues (like inability to maintain your blood pressure). It needs to be evaluated and watched.
(I will let you know. As you can imagine, I'm a bit worried!)
6. To deal with the bruxing (grinding/clenching), he prescribed a new medication Trazodone (which affects serotonin). I'm supposed to take this in lieu of my current headache med (which is very sedating). However, I took it the past two nights and laid awake until 4am the first night and 2am the second night before getting up and taking my usual med (which helps me sleep). I will have to call Dr. Piper to see how to proceed as I can't take this and not sleep. Sleep is a problem for me after being on sedating meds for many years.
7. I need a thicker bite guard (splint) to wear at night. The thicker-than-normal splint prevents the jaw muscles from getting a good grinding position. I will just look like a hockey player at bedtime.
Our amazing beach (that's David). There was no public access so it was lovely and peaceful!
Lastly, Dr. Piper did some nerve blocks in my head and neck.
Nerve blocks are injections of analgesic into nerves (and are a bit unpleasant as the needle goes in pretty far and can ZAP the nerve (oww!) and the needle stays in there and wiggles around). AAHHH!
The first day he did 4 nerve blocks on the right side. The first was in my neck, the second and third behind my ear, and the fourth in my right TMJ. The reduction in my headache on the right side was about 30%, so not very significant. That means the nerves and muscles in that area are not creating all the pain in my brain but are contributing some.
I came back the second day for one more nerve block, this time in the left TMJ. He did two injections (very painful but brief!) and instantly my headache improved maybe 75%. This suggests much of my headache is coming from the TMJ on that side. I was shocked and amazed.
Unfortunately, I had an adverse reaction to the injection (which can happen) and the left side of my face became totally paralyzed for 8h. It looked like I had a stroke.
My left eye would not close for 2h (really...it was WIDE open) as the motor muscles were paralyzed, so I had to either close both eyes (it would only stay shut if the other eye was also closed) or hold it manually shut when the other eye was open. So we came straight back to the apartment and I went to bed until the motor function came back. Ugh!
But it was not too hard to lay in a quiet room with the ocean waves crashing on the beach outside.
The good news is that the nerve block worked! Although it has worn off, my headache has been a lot better since, maybe 4's and 5's instead of the usual daily grind of 8's and 9's and 10's. He said that the nerve block can help to re-set the nerve and some people get relief for a long period of time. I pray this is me!
I will repeat the various nerve blocks with my neurologist (I think a surgeon has to do them) to see if they work again.
This may give me a tool for controlling pain.
So the bad news is that there is no magic bullet to totally cure my headaches (like jaw surgery, as I was hoping), but I have more understanding of my head issues and the nerve blocks helped.
Now, there is just this pituitary thing to fret about...
Critters sunning themselves...
Have a nice week and thanks for reading.
I will resume my regular posts soon.