Progress update

Just an update on my TN journey, which I'm finding more confusing than ever now. I had my second vitamin B12 injection on Tuesday last week.

I went to see my neurologist for the second time the following day (Wednesday) and was pretty worried about what he might tell me from the MRI results as I have been having a rough time of it lately (as I'm sure you all can relate to!) with the medications all seemingly doing their best to turn me into a zombie I've been feeling really down about it, as I've had constant searing headaches from the medications and had to take paracetamol so frequently to try and get rid of them that I lost count almost. It felt like my head was trapped in a vice. My GP has been great, she's spoken on the phone to the neuro for advice about meds and has adjusted them accordingly, but still I haven't been able to function. Plus, I was convinced that the MRI would not show what the problem was and I'd be stuck on these meds unable to do anything for ever.

So I go and see the neurologist (Dr Johnson based at Leeds General Infirmary) who is the loveliest consultant I've ever met. He totally understands this crazy condition and is very attentive and doesn't make you feel like you're being rushed at all. I took my pain diary again which he always looks at and makes notes from. I also took a list of questions I needed answering. He commented because I've been experiencing numb fingers in my left hand and sometimes my right (which he says he's never come across before as a side effect of these meds). However he took a blood test to check sodium levels as this can cause tingling apparently in fingers if you have low sodium levels, which Oxcarb can cause apparently). I'd been taking Oxcarbazepine 300 mg x 3 daily and was completely unable to function, so he suggested reducing to 150mg Oxcarb plus 50 mg Pregabalin (morning) which I was on previously, but in higher doses gave me vertigo and increasing to 300 Oxcarb just at night.

Then he told me that they can see quite clearly on the MRI scan what the problem is, and that the TN is due to a blood vessel in direct contact with the trigeminal nerve. He says the vessel is normal but slightly more "knobbly" than usual and this is what's pressing on it.

So, of course that now makes me a candidate for surgery for MVD. He mentioned 2 surgeons in Leeds, one in particular who specialises in TN and has done an urgent referral for me that same day. My GP is also doing an urgent referral to back things up.

I came out of the consultation (with my husband there) and burst into tears in the corridor (relief I think that they can see it and do something about it) although at the same time I will be scared about what's to come. He says I shouldn't be waiting too long to be seen (weeks probably) so all this was good news and hope for the future.

On the day i saw him I chose to reduce my meds to 150 mg Oxcarb instead of the 300 so I could concentrate on what he told me, and I had a feeling the 300 was far too strong for me anyway. I seem to be really sensitive to any of these drugs, even in small doses!

The following day (Thursday) I reduced my meds according to what he said - 150 Oxcarb plus 50 Pregabalin in the morning and I was comfortable all day. Less headaches too. Saw my GP and explained everying to her. In the evening I took the same dose as I didn't feel I needed 300. I slept reasonably. On Friday when I woke up the pain seemed improved, so I decided only to take 150 mg Oxcarb. Pain level was pretty good and I even managed a walk out (unsteadily!) By night time the pain level was still good and i didn't feel I needed another dose of anything, so I took a chance and didn't take any. I stayed up till midnight to see what would happen. I slept badly (probably because I had no TN meds in me by this time!) but pain was OK. I was up early Saturday morning writing my pain diary to try and keep track of things. When I got up I had no pain to touch (light or otherwise EXCEPT in and around my nose on right side, which has always been there, so again i didn't take any TN medication! The only problem I had was if I sneezed or had to blow my nose (then it was AGONY as usual) but otherwise - nothing! This is a dramatic improvement for me, as usually my forehead/eye and cheek area are all really bad). So, the upshot of it is that I have not had any TN medications in me since the low dose on Friday morning (a whole 2 days ago as it's now 9 am Sunday morning!) The pain is the same - OK unless I touch near my nose/lip or have to blow my nose, then it's really intense as before, but otherwise I'm comfortable. I'm so confused!!! I daren't get my hopes up, I'll just have to wait and see as I'm sure it's waiting in the background somewhere but it feels amazing not be having to take those awful medications and be able to think and see clearly again!

My husband did point out to me that last month after I had the vitamin B12 injection I had a relatively good day the following day (but it was short lived and only lasted for the day). Now I'm wondering could it be connected to the B12 injection I had last Tuesday? I'll certainly discuss it with my GP next week. I know some people have reported dramatic improvements with B12, but this is just incredible to me if it is connected.

Well, we'll see what today brings - hopefully more of the same, but you never know where the TN pain devil may spring from I guess!!

Any thoughts or comments from you all would be appreciated, as I am completely baffled! Wishing you all a comfortable day too.

Suzy

Several thoughts, Suzy, as you requested.
(1) There are no consistent research results or controlled randomized trials (that I know of) which demonstrate a positive role for Vitamin B12 in managing TN pain. Some patients have speculated that various forms of B12 may have a positive overall effect on the health of the nervous system. But apart from the reality that Vitamin B deficiency an HARM the nervous system, it really hasn’t been established that elevated levels of the vitamin can heal it.

(2) Your response to Oxcarbazepine seems to suggest that you are highly sensitive to it. But your reactions to light touch suggest also that you probably need to have a consistent low to moderate level of one of the anti-convulsant drugs in your blood stream, pending a future MVD surgery. I know that many patients hate the side effects of this class of meds. But they are truly necessary in this disorder. There are other alternatives, of course. Neurontin is one of them and I suggest that you talk with your consultant about that med as an alternative to Oxcarbamazepine that you might tolerate better.

Feel free to friend me and follow up as needed.

Go in Peace and Power
Red

Thanks for your reply Red. I see what you’re saying about vitamin B12. I was found after blood tests to be deficient in it fairly early on, and initially took the tablets I was advised by my GP to buy. However, when the consultant saw me he said I would not be able to get my levels up sufficiently by mouth, therefore needed monthly injections for 3 months, thereafter injections once every 3 months. Perhaps the improvement is linked because I was so deficient in the first place?
Does Neurontin have another name - it’s not one I’m familiar with? I am also finding the pain is a little stronger each day I’m not taking any TN medication, so maybe you’re right. It is still manageable though, at the moment. Thanks

Neurontin is Gabapentin (the generic name). One online resource that I recommend to members here, can help you track such matters down: see http://www.rxlist.com. The site provides some of the most authoritative information available on a wide variety of medications – including non-US and non-brand names, as well as extensive trials data and directions for use.

If you have a B12 deficiency established by blood tests, then it is appropriate to treat that deficiency quite apart from any expectation of improving your TN pain.

Regards, Red

I had in and out brief remissions in the months before my MVD - I was glad I did it : )

Hi KC, thanks for your reply. I guess that's what I've been having briefly (remission), as the beast is well and truly alive and kicking today! I suppose I was clutching at straws really, but it was nice to have a few days respite from the dreaded anti-convulsants and brain-fog anyway! The pains have been increasing slowly each day, but i guess I'm pretty much back to square one now - except that I'm quite good now at concealing the pain unless the zaps are really really intense and make me shout out sometimes! I'm afraid I did that in the pharmacy this morning, as I still haven't taken any medication for it yet, and someone did give me a funny look - quite embarassing!

Well I've seen my GP again today to discuss possibly going back to work (I wish!). So, I've decided to give Amitriptyline a go and see if that will help with the pain as the anticonvulsants (even in low doses) really incapacitate me. I have had this drug before when I had really bad inflammatory arthritis and it did help with that pain, so hopefully it might do something for this particular beast as well. We'll see! If I can't manage on that alone I'll have to start adding in the Oxcarb again and get used to being brain-fogged again. Anyway, GP says I can't go back to work tomorrow, we have to see how I am on this new medication and then see her again next week, but she did offer and rang to speak to my employer while I was there to spell out the situation clearly to them, and they seemed to be OK when she spoke to them. However I will have been off for 11 weeks by next Tuesday. I suppose there's more to life than one particular job, but i do enjoy it and would like to be able to go back eventually.

How long is it since your MVD and has it made a big difference to your symptoms KC? Hope you're having a good day.

Suzy

Kc Dancer Kc said:

I had in and out brief remissions in the months before my MVD - I was glad I did it : )

Hi Red and thanks for the info about the website. Unfortunately I have already tried Gabapentin and it really didn't suit me at all. It appears I'm extremely sensitive to all these types of medications even in low doses, so I've agreed with my GP that I'll try Amitriptyline instead to see if that will take the edge of the pain (which has more or less gone back to full strength now unfortunately).I'm now waiting for my neurosurgery appointment to come through. Best wishes, Suzy


Richard A. "Red" Lawhern said:

Neurontin is Gabapentin (the generic name). One online resource that I recommend to members here, can help you track such matters down: see http://www.rxlist.com. The site provides some of the most authoritative information available on a wide variety of medications -- including non-US and non-brand names, as well as extensive trials data and directions for use.

If you have a B12 deficiency established by blood tests, then it is appropriate to treat that deficiency quite apart from any expectation of improving your TN pain.

Regards, Red