I hate to put this challenge so close to the top of our list, but it has to be done. I know there are some absolutely wonderful doctors out there – with some effort, persistence, and TN Mama networking, we found one we will always be thankful for. Due to the rarity of Trigeminal Neuralgia, many adult patients have a very tough time finding a qualified team of doctors to work with. Pediatric cases of Trigeminal Neuralgia are < 1% of the diagnosed cases of TN, so you can do the math on how much harder it is for the kids.
Is the very, very, VERY rare pediatric doctor who knows much beyond a quick mention in medical school about Trigeminal Neuralgia. So, what they know is often restricted to a text book or mention in a lecture. And who knows how long ago that happened and how dated that information may be.
Let me clarify – I am not saying this to be overly critical of these doctors. The overwhelming majority of pediatric doctors will never see a case of Trigeminal Neuralgia, so we really can’t have the expectation that they are going to know the most complete and up to date information on symptoms, diagnosis, imaging, and treatment options.
However, there are several areas where this causes real problems:
One, if you have a pediatric doctor that is not working to come up to speed on the current medical information with you. Some doctors know what they know, will treat based on that, and aren’t going to invest the time to look for other alternatives or better information for you. Each of us TN Mamas tends to be forced into the position of educating ourselves and coming to the doctor with specific medication questions, options of treatment, etc. (Which is one reason we started this site! Check out www.facepain.org.) If your doctor consistently does not know information you need and isn’t willing to help you find it, or has no interest in research you have done and your questions – find a new doctor.
Two, many of the non-pediatric doctors – who actually know this condition and have experience working with it – just won’t take a pediatric patient on. This is true for neurosurgery, other specialties, and especially when it comes to neurology. I’m not sure of the reasons for this, but my guess is it has something to do with medications working differently in pediatric cases than adults, and dosage adjustment concerns. However, when you are dealing with TN, your neurologist is your partner in keeping your child’s pain managed, which often becomes the center of life. The frustration level of working with a neuro who isn’t up on the latest medications and medication combinations – which become increasingly important and complicated – is immense. And it is worse when you know there are doctors who understand this better, but they will not see your child. While I want a doctor to be honest with me if they do not feel comfortable treating my child, it can be infuriating.
Three, even doctors who have treated a good number of TN patients, may not have treated enough pediatric patients to know about some of the issues specific to them. Really, finding a medical professional who has treated enough TN patients to be considered somewhat of an expert, and who has treated enough pediatric TN patients to know the issues specific to them is an extremely difficult thing. They are the magical unicorns of the pediatric TN world. It is a combination that is nearly impossible to find.
Finally, unfortunately many times now, insurance companies decide whether you can see a certain doctor or not. So, even if you have found a non-pediatric doctor who is willing to take your child on as a patient, and who has treated enough pediatric cases – the approval process with the insurance company just may not come through. Yes, this makes you want to hit someone, scream until you are blue in the face, and basically throw a temper tantrum until someone listens to you.
Our best advice on this issue, is persistence. Remember to be someone the doctor you are pursuing would want to work with. Polite, but firm and persistant. Tug the heart strings. Explain your situation. Call. Call again. See if you can get an appointment for a consult or a discussion “to learn more about TN” if they are hesitant to take on your child as a patient. Enlist your pediatrician or whatever doctor will consider it, to write a letter/email or make a call on your behalf. If it is the insurance company refusing, see if the doctor who is willing to see you and your pediatrician or primary care physician would write letters on your behalf to the insurance company. Write a letter/email yourself explaining why you want to see a specific doctor and why it is important for your child to have treatment from a medical professional with sufficient knowledge and experience, regardless of the “pediatric” title. Call whoever says no at the insurance company, and ask (politely but firmly!) who their supervisor is. Repeat this to the boss. Never Give Up is the motto of so many of us.
It’s really exhausting, I know. It seems overwhelming, and sometime, yeah, it is. When you hit your wall, it’s ok to fall apart, get mad, cry, throw something, nap. Then get up and keep going.
We’re sorry about this, and we are hoping it starts to change. But we know you are the best asset your child has right now, and you will leverage that to give them all they need. You will get there.
Love, Hugs, & Hope, from us to you.
This photo is of 6 of our TNKids, with our personal favorite team: neurosurgeon Dr. Mark Linskey, and his PA Wendy, of UCI Medical Center. All 6 kids are post MVD and doing well.