DEAR DR. DONOHUE: I am a facial pain sufferer. I suffer from trigeminal neuralgia. The slightest breeze on my face triggers excruciating pain. I had been on carbamazepine, but I had to stop taking it because it altered my thoughts and dreams. Now I take Tylenol. The pain is indescribable. What specialty doctor should I see? Please send any information you may have. — M.S.

ANSWER: The trigeminal nerve is the nerve that relays facial sensations to the brain. Trigeminal neuralgia is attacks of indescribable pain due to misfiring of that nerve. It also goes by the name tic douloureux, French for “painful spasm.” As you describe, a light breeze blowing on the face, chewing food, talking or brushing the teeth can be a switch that turns on a violent jolt of horrible pain, like being stabbed in the face with an ice pick. The attack lasts but a short time. However, a series of attacks can take place. Between spasms, a person is left in a state of panic, not knowing when the next assault will take place.

Carbamazepine (Tegretol) is one of the initial medicines prescribed to control attacks. There are many others. You might want to try oxcarbazepine (Trileptal). It has worked for many.

A surgical procedure — microvascular decompression — is potentially a way to end the attacks. A neurosurgeon frees the trigeminal from an encircling artery. Pulsations from that artery irritate the nerve and trigger attacks of pain. A shock absorbing material — Teflon, for example — is placed between the nerve and artery to prevent the chances of future compression by the artery.

Other procedures include inactivating the nerve via the gamma knife. It’s not a knife. It’s a focused application of gamma rays on the nerve. Doctors also can inject the nerve with a variety of substances. The specialists to see are a neurologist and neurosurgeon.

DEAR DR. DONOHUE: I am a 70-year-old man diagnosed with osteopenia seven years ago, and I am taking Fosamax for it. I also have had kidney stones. I have a dilemma. My primary physician says I should take foods containing calcium. My urologist told me to stop taking additional calcium. He fears I will have more stones. Do I take in more or less calcium-rich foods? — C.C.

ANSWER: The most common kind of kidney stone is a calcium oxalate stone. Not so long ago, standard treatment for these stones was a low-calcium diet. However, studies showed that a low-calcium diet not only did not prevent stone recurrence, but it encouraged it.

The most important aspect in averting new stones is an increase in fluid intake. Drink 2 to 2.5 liters (approximately 2 to 2.5 quarts) of fluid a day. You’ll know you’re getting enough fluid if your urine is colorless or pale yellow.

Lowering your salt intake is another way to decrease urinary calcium.

DEAR DR. DONOHUE: Please help me make some sense of my beloved husband’s death. He passed away very suddenly in February of this year. He was diagnosed with diabetes in 1999 and promptly lost 40 pounds. In 2006 he had a stroke, which left him with a weakness on one side. Does stress cause a stroke?

He was 75 when he passed away. Two days before, he had driven himself to the doctor with a minor respiratory infection. The doctor noticed nothing else wrong. — P.P.

ANSWER: Without an autopsy, determining the cause of death is, at best, a reasonable guess. Even though your husband did all he could to control his diabetes, that illness still can take its toll on arteries. It encourages artery clogging. With such suddenness to his death, it suggests he had either another stroke or a heart attack. Your husband’s attention to his diabetes extended his life to 75 years. I know that is too short a life for you, but it could have been even shorter had he not been so resolute in caring for his illness. Stress can be a factor in heart attacks and strokes.

You have my sincerest sympathy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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