Sandra Novekosky felt like she had run out of options. The 71-year-old had suffered excruciating facial pain for years that made it extremely difficult to talk, eat or drink. None of the treatments she tried offered any relief.
It was very much on a whim that Novekosky, 71, went to Tidelands Health Family Medicine at The Market Common on a day when her pain was particularly intense.
“The office is within walking distance of my house. I was in such pain one day, I just walked in. The receptionist was able to find me time with Dr. Sean Nguyen, and it was God’s miracle that I got to see him,” she says.
Within 15 minutes of seeing her, Dr. Nguyen had diagnosed the cause of Novekosky’s pain: trigeminal neuralgia.
“She had seen oral surgeons, dentists, emergency room physicians and several other primary care providers,” says Dr. Nguyen, who first met Novekosky during his residency at Tidelands Health MUSC Family Medicine Residency Program. “I reviewed treatment options with her, and we elected to start her on a medication. Within the night, she had symptom relief, which helped me diagnose her condition.
“I think the key to diagnosis at the time was spending enough time to hear her symptoms and review her previous work ups.”
Eating, drinking nearly impossible
Trigeminal neuralgia occurs when the trigeminal nerve that supplies sensation to the face becomes compressed, usually by an artery. The beating of the heart causes the artery to pulse on the nerve, resulting in pain patients compare to being stabbed with a knife. It occurs primarily in older adults, especially women.
Novekosky says the pain on the left side of her face started gradually in 2019 and became so intense she was almost entirely debilitated. She couldn’t touch her face, talking was difficult, and eating or drinking was next to impossible.
“I lost 60 pounds, and I have kidney damage now because I went so long without being able to swallow,” she says.
A path forward
The new medication prescribed by Dr. Nguyen provided Novekosky with some relief for several months, she says. When the pain returned, she saw Dr. Michael McCaffrey, a neurologist at Tidelands Health Neurosciences, who explored other potential medication options with her before ultimately referring her to Tidelands Health neurosurgeon Dr. Oluwaseun Omofoye to examine surgical options. Drs. McCaffrey and Omofoye are part of a new level of care now being offered through the Tidelands Health neurosciences program.
Dr. Omofoye performed a microvascular decompression at Tidelands Waccamaw Community Hospital in the spring of 2022. The surgical procedure involved drilling a small hole at the base of the skull, finding the trigeminal nerve and using a piece of synthetic felt to cushion the nerve from the compressing blood vessel.
“It is the only treatment that does not involve damaging the nerve. Most of my patients have been able to go home the next day after surgery, and they usually wake up from surgery with the facial pain completely gone,” he says.
That’s exactly what happened with Novekosky. She woke up from surgery, and the pain had disappeared. She returned to her Horry County home the next day.
“There was immediate relief. From the surgery to now, nothing. It has been wonderful,” she says.
Dr. Omofoye says the difficulty Novekosky experienced trying to identify the cause of her pain isn’t unique.
“It is not a commonly known diagnosis, so a lot of patients tend to get diagnosed months to years after the pain starts,” he says. “Some patients who see a dentist and have teeth pulled think it is dental-related pain before they get diagnosed with trigeminal neuralgia by either an astute primary care physician or a neurologist.”
While trigeminal neuralgia can return, Dr. Omofoye says 75 percent of patients who have surgery remain pain-free a decade later. If the pain comes back, surgery or stereotactic radiosurgery are options for relief, he says.
Novekosky says she hopes the pain doesn’t return, but if it does, she won’t hesitate to seek help from her Tidelands Health team.
She and her husband were so thankful for the care she received they subsequently gave Dr. Omofoye and his team a bag of Lifesavers candy along with a touching note of appreciation.
“Thanks to them, I’ve got my life back. I’m so grateful,” she says.