ArcaMax

DEAR DR. ROACH: I am a 73-year-old female who is in above average health. I have recently been diagnosed with trigeminal neuralgia after many trips to the dentist and finding out that my pain wasn't dental-related. I experienced electrical shock pains in my lower left jaw when I talked, when I ate, and sometimes when I brushed my teeth.

I am on 300 mg of gabapentin, and after a month, I can say that I'm about 95% better. I still feel some sharp sensations for a few seconds when starting to eat. In the previous year, I was on Fosamax for osteoporosis for one year. Since this didn't show an improvement, I was given one infusion of Reclast. I will be due for another in June.

I mentioned this diagnosis to my ophthalmologist recently, and she mentioned that these drugs for osteoporosis could possibly narrow the openings that the trigeminal nerves run through, therefore rubbing on the nerves themselves. Do I need to stop taking the osteoporosis treatment to stop the nerve pain? Your thoughts on this would be appreciated. -- D.K.V.

ANSWER: Trigeminal neuralgia is a neuropathy (a disease of the nerve) that, in this case, causes face pain. The pain is often described as an electric shock, but it can vary in different people. It is often misdiagnosed as a dental condition. Gabapentin (Neurontin) is often tried, and a 95% reduction is a very good outcome in this disease, which can sometimes be frustrating to treat.

Bisphosphonate drugs like alendronate (Fosamax) or zoledronic acid (Reclast) do not directly cause trigeminal neuralgia. Most cases are thought to be caused by the compression of the nerve root that is deep inside the brain by an artery. Microdecompression of the nerve is sometimes used to treat trigeminal neuralgia, although the success rate is not perfect and the pain relief is not always permanent.

Bisphosphonates can occasionally cause a condition called osteonecrosis of the jaw. This condition can press on the trigeminal nerve, causing a facial pain syndrome. Your endocrinologist or primary care doctor who is prescribing the osteoporosis treatment should be aware of your facial pain and ensure that you do not have this complication.

DEAR DR. ROACH: I am writing to seek advice regarding medical privacy for someone I know. Due to significant distress caused by social media, this individual is hesitant to seek medical care for fear of being recognized and is looking for a highly private or discreet health care option.

Could you please provide information on which steps one should take if they require a high level of anonymity when seeing a doctor? Are there specific resources or types of practices that specialize in this level of privacy? -- D.H.

ANSWER: I daresay that there are physicians who have many famous patients. Certainly, a physician who has a smaller practice and a private entrance would make sense for a person who doesn't want to be seen in public. I suspect that the best way to find out is by asking other famous people who live in the same area. I have known doctors who were "physicians to the stars."

On the rare occasions when I have a similar situation, I come in early (my practice is a busy academic group) before anyone else has arrived so that the patient can be seen with as much privacy as possible.

I would also argue that privacy should be respected for all patients, but anonymity is probably unwise (and may be impossible for someone who is very well-known) as having a patient's correct medical history is important.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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