RSD Puzzle #042

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #42
"CRANIAL FACIAL RSD AND ROOT CANAL PROCEDURES"

The summary of your problem is that to begin with you had RSD starting from a knee injury and then this was followed by traumatic nerve blocks in the form of multiple epidural nerve blocks with leakage of spinal fluid as well as traumatic sympathetic ganglion blocks.

The problem would not have been so complicated if you did not have such an aggressive dentist. By the time the first root canal was done and you noticed a spread of RSD to the oral facial region, the dentist should have stopped right there and then.

Once the RSD spreads to the oral facial region, it causes necrosis (death of cells) of the maxillary and mandibular bones in the areas of the root canals. This is mistaken for surgical problems from root canals. Then the dentists and oral surgeons try to explore the area only to find disturbance of circulation as your dentist has found on numerous occasions. At the present time what you have is a vicious circle of RSD causing bone degeneration in the face aggravated by unnecessary root canal explorations.

You have got to put an end to this vicious circle. You are the only one who can do it. Just refuse to have operation for root canal. You have brought up a question, "what if you have an abscess in the area of previous root canal surgical procedures". There are newer antibiotics such as Zithromax which early in the developmental phase of abscess can eradicate the infection.

Apparently in one year you have had a dozen root canal operations because of the imaginary fear of development of abscess if you would have refused the surgical procedure. This logic does not make any sense. At least 3-4 times a year, I see patients from different parts of the country and Canada that go through the same torture that you are going through. The answer to all of them has been the same.

2. Systemic nerve blocks in the form of Clonidine Patch, or Hytrin, or Clonidine or Dibenzyline by mouth, the use of newer antidepressants for prevention and treatment of chronic pain, and proper oral hygiene. Gargling the oral cavity with warm water and epsom salt can be quite helpful. In the more severe cases, in the hands of an experienced oral surgeon, sphenopalatine ganglion block is quite helpful in management of the RSD involving the oral cavity.

The second question that you have brought up is the fact that when they do the root canal exploration, they find unusual things such as a dead and scared up nerve or necrotized (dead and liquid black tissue) bone structure. These are nothing but the side effects of RSD causing inflammation, lack of circulation, and death of the nerve and bone tissues. It is best not to keep digging into the area surgically because it only aggravates the condition.

The third question that you have is in regard to the fact that already your immune system has fallen apart. You are reporting abnormal killer T-cells, IGG deficiency (Immunoglobulin deficiency), and other defects of your immune system. The disturbance of the immune system in stage IV (this is the stage you are in) is quite common. The abnormalities that they have found in regard to your immune system is because of the fact that dozens of times the multiple surgical procedures have challenged your immune system and eventually have made it exhausted and deficient.

The sympathetic nervous system has three major functions:

2. Control of internal environment (temperature control and control of other function of internal environment.

With the repetitive unnecessary and destructive operations that you have had in your oral cavity, your immune system has already become deficient and paralyzed.

There are only two things that can be done to enhance the function of the immune system:

1. I.V. Immunoglobulin treatment, a minimum of 10 gram in 1,000cc D5&W to be given as IV drip once a month for a minimum of 12 months. This should be done after they check your urine function and after they make sure that you have no problem in excreting protein through the urine.

2. The second method of improving the function of the immune system is what I have described in my book, "Chronic Pain, Reflex Sympathetic Dystrophy: Prevention and Management" (CRC Press, Boca Raton, Florida). In this method, ACTH in conservative doses is given to the patient not to simply stimulate the patient's own cortisone, but more importantly to increase the formation of endorphine and to enforce the function of the immune system.

Finally, the way your case has been handled is the glaring example of how RSD is being mishandled. The treatment has consisted of doing nothing but giving the patient repeated sympathetic ganglion nerve blocks which usually (as was in your case) are complicated by technical traumatic side effects.

You need a comprehensive multi-disciplinary treatment in the form of proper oral hygiene, enhancement of your immune system function, treatment with newer antidepressants, discontinuation of addictive narcotics and benzodiazepines, keeping the surgeon away, and doing other types of block other than the traumatic blocks that you have had.

A patient like you with craniofacial RSD, invariably suffers from headache, dizziness, neck pain, and tinnitus (buzzing in the ear). Such patients benefit tremendously from paravertebral nerve blocks in the cervical spine region, and occipital nerve blocks.

You should not forget to keep working on treating the original source of your RSD which was the knee injury.

There is a strong denial and nihilism among care givers who believe that "RSD doesn't spread". I am enclosing a dozen references that prove that RSD does spread.

Also, in the volume one of my "RSD Puzzles" books I have described the nature of development of RSD and especially its relationship to craniocervical RSD.

Please do not forget. It is your decision, it is your life, it is your mouth, it is your head, it is your RSD, and do not let anybody approach you with a knife again.

H.Hooshmand, M.D.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.