Trigeminal Neuralgia 2016 5 & 6

I'm including number 5 just to keep the string going, because pain levels in the 4 to 5 range hardly count any more.

It was interesting because it was followed by two entirely pain-free days. What a cheat that experience can be! It's a treat like low gas prices; you think it will last, you hope it will last, but part of you realises that it won't.

It didn't. With my triggers, running a snow blower is a roll of the dice, even the Dead Bunny bomber hat and three layers of hoods. The warning shot was kind enough to wait until I was done and inside. Then I waited to get a grip on how bad this episode was going to be. When it became clear that this was going to generate sensations above average, I popped a Clonazepam and went to bed.

Blessed be Clonazepam. Before it kicked in (tablets take about 20 minutes to dissolve and enter the bloodstream) The zaps were Mankoski 7, some up to 8, or McGill 9. This is the start of the "Holy Shit" range, if your brain could spare the energy to get your mouth to speak. The drug did what it was supposed to do, bringing the pain down to an manageable level before it got out of control.

I don't know how it is for others, but without Clonazepam, my breakthroughs can spiral up to levels that are near unconsciousness. The scariest episode I had like this hit me when I was driving, some years back. I knew the road, and I knew as the Beast rampaged, that there was a place I could pull off not far away and ride it out. I just made it. One of my oaths with all this is no matter what happens to me, I don't want to harm anyone else before I regain control. I'll put up with a great deal of pain to prevent that.

Everyone who lives with this knows that it is rare, and consequently few clinicians know how to treat it or how, exactly, it manifests. I was just reading a well-meant but hilarious piece by a neurosurgeon on the fine distinctions between idiopathic and atypical TN. Atypical, he says, is likely to point to a physical cause. Then, he said that any pain ("zaps" to the cognoscenti) lasting longer than five minutes should be investigated for that cause.

Ayah well. In breakthroughs, my zaps last from one to five seconds. But they are spaced only a few seconds apart, and one's grey matter is reeling from the assault during the time between zaps, so much so that one could be forgiven for thinking the TN pain is constant for the 30 minutes to several hours of the episode. One neurosurgeon I was sent to had heard of this manifestation, and called it the trip hammer effect.

All this is much better than it used to be, before we got the regimen that helps. Then, the zaps flashed in every half-second or so, at increasing intensity. Just leave it at that and be grateful for small blessings.

Late news. Had another breakthrough of similar intensity in the evening. This was self-inflicted: I forgot to take my meds with supper (a danger of getting wrapped up in sports). All the same, I don't know why I'm cruising on the edge. Carbamazepine is lipid-soluble and I should be building up a reserve. Going without even one dose right now is like driving with the gas gauge warning light on.