Pam left for Canada early yesterday morning, starting the long trek that is our annual pilgrimage to see family and friends at the end of the school year. I will remain in Kuala Lumpur for another five weeks, which means that some of these posts, like this one, will originate from Malaysia, and those that Pam writes will originate from Canada.

Regular readers of this web log will know that Pam’s Dad has not been well. He suffers – and that is the proper word in his case – from a condition known as tic douloureux, a severe, stabbing pain to one side of the face. It stems from a branch of the nerve that supplies sensation to the face, the trigeminal nerve. The pain usually lasts from a few seconds to a few minutes. It may be so intense that you wince involuntarily, hence the term tic. There is usually no pain or numbness between attacks and no dysfunction of the muscles of the face.

Most people feel the pain in their jaw, cheek, or lip on one side of the face only. Pain is usually triggered by a light touch of the face or mouth on the same side as the pain. The pain is so severe that people can become afraid to talk, eat, or move during periods of attacks. It is considered one of the most painful conditions to affect people.

The cause of tic douloureux is unknown. There are a number of theories as to why the trigeminal nerve is affected. The most commonly accepted theory is compression of the trigeminal nerve, usually by a blood vessel, causing it to become irritated. This irritation causes the outer covering of the nerve, the myelin sheath, to erode over time. The irritated nerve then becomes more excitable and erratically fires pain impulses. Tumours and bony abnormalities of the skull may also press on and irritate the trigeminal nerve. Trauma, infections, and multiple sclerosis can also cause damage to this nerve.

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. They live in fear of unpredictable painful attacks, which leads to sleep deprivation and undereating. The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition. Suicidal depression is not uncommon.

Her Dad has been taking Tegertol, an anticonvulsant that keeps the pain impulses from firing. It also causes her Dad such shortness of breath that he feels like he is suffocating. As the myelin sheath surrounding the nerve continues to erode, the Tegertol has become less and less effective, requiring the use of morphine to control the pain. For the last three weeks her Dad has been hospitalized in an effort to stabilize his medication and the pain.

There is a new surgery that promises relief in about 85% of cases. The operating procedure requires part of the skull cap to be lifted back and the nerve exposed and cauterized. It is a six hour operation and not without risk for someone who is 86 years old. But medication is no longer an option, and surgery has been scheduled for May 27. Pam has gone home to assist her family in the preparation for her Dad’s surgery. She would appreciate your prayers.

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