Dr. Chenitz

Or alternately, “how I leapt out of his chair”

He did not mean to cause me immense pain.

Let me go back to the beginning.

In Dec and Jan the gp and ENT doc had both said “find a dentist to rule out TMJ because we do not what you mean when you say you feel you were kicked in the side of the head by a horse. Well, we know what you mean but we have no idea why.”

I am years overdue for normal things like dental appointments and female exams because my emergency and pain issues have kept all my energy and time and money tied up. So I was driving in Red Bank NJ a few weeks ago wondering who I would see for my head pain level 11 and there in glowing gold letters was a doctor who specialized in tmj and oral/facial pain. I called and had a nice chat with Susan his assistant and she sent me paperwork. I told her I didn’t really think I had tmj but I had severe right sided head pain.

My thinking was that we would rule in/or out tmj and meanwhile he must be an expert in the anatomy of the head and maybe he would help me.

Desperation. Let’s call 2011 the Year of Desperation. (Really it started in the Fall 2010, the supremely desperate part. Ok, maybe before that. It’s like those Homeland Security color charts they have just retired. Hard to tell what shades of red, orange, yellow really mean.)

So she sent the paperwork and it was lengthy and detailed and gave me hope, such interesting and precise questions. I also see his insane number of credentials and his $500 price tag and I think he is either a genius or a quack. What have I got to lose? I mean besides the obvious.

Well, Dr. Chenitz was wonderful. And might I add charming and sort of old fashioned. He teaches at two hospitals and I felt I was having the privileged attention of a Dr. House but with kindness added.

(And regarding the money, he is actually $500 per hour, and they should have charged me $750 for the hour and a half he spent focused on my troubles but they didn’t. And he was worth every penny. Let me say that.)

He sorted out my story the best he could.

He said I was the only person in all the years of his practice who had self referred.

And that he couldn’t believe anyone else had even ever seen his small sign. (He practices here only one day, subletting in someone else’s office. His practice is in South Orange.)

I would go on to astound him in another way.

He did the thorough history. He began the physical exam. All was well. Poking, prodding, measuring, open your mouth, close it, do this, do that. No problems.
Until he began to put pressure on the upper right side of my head above my ear. (That place that landed me in ER in the Fall). He pushed and I got the most overwhelming electrical shock crushing deep and horrible pain move through the right side of my head and down my right side and into my gut and I almost instantly vomited.

He released quickly as I grimaced and said “Oh my God, that was awful.”

He went to find it again, found it too well and applied pressure~ and I almost died.
I nearly vomited and passed out from the pain, and instantly began crying and hyperventilating so badly I couldn’t even catch my breath.

They got me water and a Kleenex and I got up from chair and stood crying, trying to catch my breath and to not black out or throw up. I was dizzy and nauseous. And I had felt my bp spike up and my heart was pounding racehorse style.

After about five solid minutes I was ok.

Dr. Chenitz and Susan said in all their years of practice they had never seen someone have that extreme of a reaction to that spot.

And with all respect to Dr. Chenitz, he is a bit old.

So we resumed the exam and everything else was fine and normal though there was some more pain in right side cheek/jaw and also right back/shoulder which he called the rhomboid and which is the spot that sent me to the ER in 2007.

So here was his finding:

I do not have tmj the way people think about it.
He does say I have some muscle pain with trigger points associated with the temporomandibular system and that his pushing there may also trigger my migraine reaction. Everything overlaps.

He also says a diagnosis of POMP, persistent oral facial pain is possible but he is not sure yet.

1. He would recommend a deep temporal nerve block (injection into my temple)
2. If that wasn’t helpful then he would try a trigger point injection into that muscle
3. If those didn’t work he would try a masseteric nerve block

Relief could come within a week after the injection. There is the risk of headache at the sight of the injection.

He was glad the myofascial release treatments worked and thought I should continue as long as it was helping. He wanted me to see Dr. Raab and to talk to her about starting nortriptyline at bedtime. He says my inadequate sleep is not good and that the medicine could put me into Stage 3 sleep. He says it used to be used for depression and what they learned is that it is very helpful for chronic pain, and that also it can help reduce migraines. “A prize package” he called it.

Some people have cardiac problems so he wants me to have a baseline EKG and then follow up EKGs a month after starting and then again.

He wants to see the migraines get under control and hopes that nortriptyline would help, or he recommends topomax or a triptan, possible frova.

After the migraines are under control he would reevaluate me after that to check on my muscle pain. And he wants me to see a psychologist named Karen to talk about stress management, since my life is now so changed by this condition.

I left his office in pain and yet calmed on some level by the thorough attention he paid, and the fact that he talked to me with great care and kindness. I don’t know what that means that he hurt me so badly. I cannot push there and induce that (or maybe I would not dare) and thankfully Olympia has not done that (or I would not return to her due to fear.)

But what did the pain there mean? That is the central puzzle.

I think I have moved into the dread area of trigeminal neuralgia, which the doctor in January had hoped was not true.

Meanwhile, in other news, I am starting to really believe I have porphyria and that I have had it my whole life and it has been disabling me with attacks since I was 14. That was when they began testing me for lupus and other diseases but couldn’t find anything.
Last night I found two blogs of young women with porphyria.
There is part of me that is so desperate and envious of these girls who figured it out in their twenties. And there is part of me that is just relieved and hopeful that I might have an answer soon, before it’s too late to reclaim a life, and then there is part of me so very sad for my mother and grandmother who suffered so much of their lives with no diagnosis.

But maybe all these tests will again show nothing.

And in other news, the violets are coming up. I love violets.