“I have a sharp shooting pain in my throat when I swallow,” Freny aunty told me as she came in with her daughter. “It’s like a fish bone stuck in my throat for over a year now!” she exclaimed. She was in her early eighties and wore a nice floral dress, quintessential of one worn by Parsi ladies of yesteryear as a tribute to the queen of England. She had the perfect amount of lipstick and makeup to pass off as ‘propah’. The ENT surgeon they had gone to had performed an endoscopy and declared that all was clear. “Do you have pain at the bottom of your tongue?” I asked a ninja question, one that allows you to clinch the diagnosis swiftly. She nodded in the affirmative, opening her mouth and pointing to the exact spot on the left side.
“You have glossopharyngeal neuralgia,” I declared, acknowledging the irony of diagnosing her issue with two tongue-twisting words. “Dikra, jara aapri language ma please explain!” she requested for a dumbed-down understanding. I elucidated that the glosso (tongue) pharyngeal (pharynx) nerve, the ninth cranial nerve, was being disturbed by something going on in the brain. Neuralgia meant nerve pain. “An MRI will give us the answer,” I stated, insisting she get one done. When they returned with the result, sure enough, there was an abnormal loop of an artery pressing against the nerve. On occasion, in some patients, there could be an elongated bony spicule that could do the same, but in her case, it was the former. “Since you’ve tried medication for over 6 months and nothing has worked, I suggest surgery to separate the vessel from the nerve.” “What?” she gasped, shocked. “Surgery at 82?” “At least that way you’ll be able to eat whatever you want for the next two decades,” I smiled, making light of the situation. She couldn’t help but giggle, knowing that longevity runs in the race. A few weeks later and after a lot of thought, she agreed; she wasn’t able to even drink water anymore without pain.
In the operating room, the anaesthetist put her to sleep. The electrophysiologist connected all the muscles of her face and body to a computer for them to monitor in real time if any damage was being done. We positioned her on her side and strapped her frail body firmly against bolsters, then cleaning and draping her in the usual fashion. I made an incision behind the ear and entered the brain like we usually do. The ninth nerve is not a single nerve but several white rivulets that join together with the topography of an Alaskan glacier. A large abnormal loop of the vertebral artery was pressing against its main trunk. I meticulously mobilized it, seeing the blood flow through it with every heartbeat. I don’t think such an immersive experience is possible in any metaverse. Tiny red blood cells, millions of them, summersaulted within the artery as if enjoying their own water slide at an amusement park. A little padding of Teflon helped keep the artery away from the nerve.
The next morning, she drank a cup of hot tea for the first time without pain and requested that I get some mint leaves by evening to make the experience even more magical. She indulged in a nice warm South Indian breakfast and thanked me with folded hands for insisting that she do the operation. She was no longer worried about the fish bone being lodged in her throat; all she wanted was patra ni machhi.
A lot of people still fear brain surgery, especially the elderly. While it may be a reasonable emotion to entertain because complications occasionally do occur, one must know that they are the exception. Modern neurosurgery is able to successfully restore quality of life in a majority of patients, and if they are otherwise in great shape, we want our patients to live to a hundred. Especially the Parsis; there are so few of us left now. The queen must have smiled from above on the day Freny aunty went home: a fan of hers had been restored to good health.
19 thoughts on “The ninth nerve”
Brilliant write up as always 👏👏
What a blessing to live pain free n that too a 100!!!!
Long live doc!
Saras Dikra!
Hats off for a quick action!
I know where to come if I need help🤓
Dearest Dr Mazda sir …….
It’s an amazing piece on solving the problems of older patients’s problems through brain surgery……
Sir you will get Super blessings from older patients too whose suffering you are resolving especially Parsees 🌹
May AHURA MAZDA Bless you and your magical fingers to do surgery & for your writing 🥰
Great going Mazda. Just love the column and how light heartedly you are doing such a Noble cause. ! ♥️👌🙌
Getting pain relief after clinching to the right diagnosis is a night mare for a lot of pts who keep going to various consultants for years .A perfect clinical diagnosis and good postop out come is only possible with the right knowledge and approach and skill.
I admire your work and Your writeups are very informative. Thanks ❤️
Terrific Dr Mazda.
Nicely written Dr. 👌
The talented surgeon that you are, it’s the last line of your article that lances through with humour and intent!
What talent!
Bless you for spreading good health, happiness and cheer
Brilliant as always
Excellent Mazda there is always a way and to live healthy until you are 100 what a blessing 😀😀
Right decision by the right person(doctor),to extend the longevity of her happy life.excellent.
Sir hats off to your soothing way to developing confidence in patient of that age. Impressed as a student of medicine the language of explanation of the pathology in the article. Sir you are ideal teacher for me. Learned something new. Thanks.
“With the topography of an Alaskan glacier”👏👌
Just imagine if you were really a travel writer!
A master with the pen you are! God bless!!
Since the last couple of articles i hv observed that your turn of phrase has reached the highest level and the description of the surgery goes into the background.Maz u r doing a super job my boy and making all your fans hv great Sundays.
U truly are a miracle worker. So glad that all was well and had her cup of Choi with out any pain. Bless her
As always, excellently written Doc. I stop to ponder as to how beautifully you pen all these thoughts and continue to educate your readers in a subtle way. The comments of each of your articles speak for themselves so I have nothing more to add but say that you are blessed.
Amazing sir
The way you describe the medical issue in plain descriptive way is too good