You Be the Doctor: Mystery Solved

Sept. 19, 2007 — -- Tony Horwitz was a travel writer in his 40s and except for some long-ago kidney stones, was very healthy, until he started to experience strange pains.

"I just noticed one day that I had a sore throat in a certain spot on the right side of my throat," he said. "I thought, 'Well, maybe I'm getting a cold.'"

Horwitz 's friend, Dr. Alice Flaherty, remembers that Horwitz told her his wife and son both had viruses around the same time, and he thought he'd caught the same thing.

"I had traveled down to Washington to visit my father who had just come out of the hospital after open-heart surgery," Horwitz said. "My father is a doctor and I asked him if I should take some antibiotics."

"He took some antibiotics, which didn't help at all, and then it started spreading into his teeth, so when he ate or swallowed, his teeth would hurt," said Flaherty.

Horwitz says that he had been to the dentist a few weeks prior, and "thought maybe the dentist poked a nerve or something, because I had a pain [in] a really very specific spot between two teeth."

Tale of the Tuna

Horwitz went to see a doctor in a small Virginia town near where he was staying and the doctor performed a standard check-up, including a strep test, which was negative. The doctor agreed that Horwitz , who didn't have a fever and didn't have allergies, probably had a virus. Horwitz recalls that, "[The doctor] said keep taking aspirin and drink water and hopefully it will go away."

But 10 days later, everything changed when Horwitz opened the refrigerator, found a tuna fish sandwich, and, he says "took a big bite of it."

"When I swallowed, I felt like a bomb had gone off in my throat and it sort of exploded up into my face and in my ear," he said. "And it was really so painful that I sort of … fell to the floor of the kitchen on my knees, sort of clutching my face. And I don't know exactly how long it lasted. It seemed like forever."

Horwitz says he became desperate to do something to make the pain go away, because he couldn't function. He went to the phone book and found ear, nose and throat specialist Douglas Mann.

Mann says that "Tony was an athletic, young-looking middle-aged person. … He was having some excruciating pain, so he had to get some relief. We discussed his problem. … I was concerned that it might be a canker sore, that is, lesions of the throat that can cause pain that also radiates to the ear."

"One question might be, 'Could this be throat cancer that's causing Tony's pain?' It was a little atypical for that, but it's still something we would want to consider," said Flaherty.

Mann did a complete examination of Horwitz 's upper air passages, and also noted that a brain tumor could also cause similar symptoms.

"Dr. Mann said that I should get an MRI to make sure that there wasn't something very serious," said Horwitz. "Then he sprayed some anesthetic in my nose and brought out this rather alarming looking skinny, very skinny hose. … I wasn't really alarmed by this procedure. I just … I was sure he would see something.

The Real Diagnosis

When Mann examined Horwitz's throat, "Everything looked just as it should be."

"To my surprise … he didn't see anything," said Horwitz. "He left the room for a moment and came back. I had told him that my father was a neurosurgeon."

"I said to Tony, 'I think your father is really going to appreciate this diagnosis,'" said Mann. "You have tic douloureux." Horwitz's first reaction?

"I said, what the heck's that?" he said.

Flaherty explains that "Tic douloureux is what doctors would call Trigeminal Neuralgia, and it's a horrible, painful, brief, jabbing sensation in your face that's caused by a pinched nerve, the trigeminal nerve. It looks now that what happens is a blood vessel or something else [that] is pressing on the nerve causes the nerve to lose its protective coating … and then [it] starts malfunctioning." (CLICK HERE for more information about Tic Douloureux.)

Trigeminal neuralgia is often mistaken for a dental problem and Flaherty says that she's "had patients who had several teeth pulled out. Usually when it spreads to the other part of the jaw, that's when people realize this is not dental."

Mann prescribed an anti-convulsant, a medication for seizures.

"That might sound weird," said Flaherty, "because seizure medicines should treat seizures, except that they also dampen all types of nerve impulses and that helps … stop the spread of this nasty pain."

"Really within about a day I started to feel, you know, much less pain," said Horwitz. "All in all I feel really lucky. Not only did I receive very good medical treatment, but I'm responding to the medication."

"I called my father and he said, 'Oh, yes, of course. You have tic douloureux.'"

So if you chose option A, a blood vessel problem, you were right. A blood vessel in Horwitz's head was pressing on a facial nerve to give him the condition called tic douloureux.