Yahoo! Sees the (Fluorescent) Light - BusinessWeek

13 Aug 2008 at 7:59pm  I must admit that like many people, I?m not a fan of fluorescent lights, much as I know how much energy they save, because they always seemed to give me a headache. Apparently, I?m behind the times on this, and Yahoo!?s helping shed some light ...

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Hope for multiple sclerosis sufferers - Health 24

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New hope for MS sufferers - Health 24

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How to Keep Your Heart Healthy - Center for Food Safety and Applied Nutrition

5 Jul 2008 at 7:31am  Sixty-two-year-old Jack Andre says having a heart attack in March 2003 was like getting hit in the head with a baseball bat. "It brought a lot of things to my attention that I never thought about before," he says. He was overweight, didn't exercise ...

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www.moldytoaster.com

27 Jun 2008 at 10:38pm  www.moldytoaster.com

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hall two members of the House be sent to Yanina? Speak!' Morcerf did not reply. Then all the members looked at each other with terror. They knew the count's energetic and violent temper; it must be, indeed, a dreadful blow which would deprive him of courage to defend himself. They expected that his stupefied silence would be followed by a fiery outburst. `Well,' asked the president, `what is your decision?' "`I have no reply to make,' said the count in a low tone. "`Has the daughter of Ali Tepelini spoken the truth?' said the president. `Is she, then, the terrible witness to whose charge you dare not plead "Not guilty"? Have you really committed the crimes of which you are accused?' The count looked around him with an expression which might have softened tigers, but which could not disarm his judges. Then he raised his eyes towards the ceiling, but withdrew then, immediately, as if he feared the roof would open and reveal to his distressed view that second tribunal called heaven, and that other judge named God. Then, with a hasty movement, he tore open his coat, which seemed to stifle him, and flew from the room like a madman; his footstep was heard one moment in the corridor, then the rattling of his carriage-wheels as he was driven rapidly away. `Gentlemen,' said the president, when silence was restored, `is the Count of Morcerf convicted of felony, treason, and conduct unbecoming a member of this House?' -- `Yes,' replied all the members of the committee of inquiry with a unanimous voice. "Haidee had remained until the close of the meeting. She heard the count's sentence pronounced without betraying an expression of joy or pity; then drawing her veil over her face she bowed majestically to the councillors, and left with that dignified step which Virgil attributes to his goddesses." Chapter 87 The Challenge. "Then," continued Beauchamp, "I took advantage of the silence and the darkness to leave the house without being seen. The usher who had introduced me was waiting for me at the door, and he conducted me through the corridors to a private entrance opening into the Rue de Vaugirard. I left with mingled feelings of sorrow and delight. Excuse me, Albert, -- sorrow on your account, and delight with that noble girl, thus pursuing paternal vengeance. Yes, Albert, from whatever source the blow may have proceeded -- it may be from an enemy, but that enemy is only the agent of providence." Albert held his head between his hands; he raised his face, red with shame and bathed in tears, and seizing Beauchamp's arm, "My friend," said he, "my life is ended. I cannot calmly say with you, `Providence has struck the blow;' but I must discover who pursues me with this hatred, and when I have found him I shall kill him, or he will kill me. I rely on your friendship to assist me, Beauchamp, if contempt has not banished it from your heart." "Contempt, my friend? How does this misfortune affect you? No, happily that unjust prejudice is forgotten which made the son responsible for the father's actions. Review your life, Albert; although it is only just beginning, did a lovely summer's day ever dawn with greater purity than has marked the commencement of your career? No, Albert, take my advice. You are young and rich -- leave Paris -- all is soon forgotten in this great Babylon of excitement and changing tastes. You will return after three or four years with a Russian princess for a bride, and no one will think more of what occurred yesterday than if it had happened sixteen years ago." "Thank you, my dear Beauchamp, thank you for the excellent feeling which prompts your advice; but it cannot be. I have told you my wish, or rather my determination. You understand that, interested as I am in this affair, I cannot see it in the same light as you do. What appears to you to emanate from a celestial source, seems to me to proceed from one far less pure. Providence appears to me to have no share in this affair; and happily so, for instead of the invisible, impalpable agent of celestial rewards and punishments, I shall find one both palpable and visible, on whom I shall revenge myself, I assure you, for all I have suffered during the last month. Now, I repeat, Beauchamp, I wish to return to human and material existence, and if you are still the friend you profess to be, help me to discover the hand that struck the blow." "Be it so," said Beauchamp; "if you must have me descend to earth, I submit; and if you will seek your enemy, I will assist you, and I will engage to find him, my honor being almost as deeply interested as yours." "Well, then, you understand, Beauchamp, that we begin our search immediately. Each moment's delay is an eternity for me. The calumniator is not yet punished, and he may hope that he will not be; but, on my honor, it he thinks so, he deceives himself." "Well, listen, Morcerf." "Ah, Beauchamp, I see you know something already; you will restore me to life." "I do not say there is any truth in what I am going to tell you, but it is, at least, a ray of light in a dark night; by following it we may, perhaps, discover something more certain." "Tell me; satisfy my impatience." "Well, I will tell you what I did not like to mention on my return from Yanina." "Say on." "I went, of course, to the chief banker of the town to make inquiries. At the first word, before I had even mentioned your father's name" -- "`Ah,' said he. `I guess what brings you here.' "`How, and why?' "`Because a fortnight since I was questioned on the same subject.' "`By whom?' -- `By a Paris banker, my correspondent.' "`Whose name is' -- "`Danglars.'" "He!" cried Albert; "yes, it is indeed he who has so long pursued my father with jealous hatred. He, the man who would be popular, cannot forgive the Count of Morcerf for being created a peer; and this marriage broken off without a reason being assigned -- yes, it is all from the same cause." "Make inquiries, Albert, but do not be angry without reason; make inquiries, and if it be true" -- "Oh, yes, if it be true," cried the young man, "he shall pay me all I have suffered." "Beware, Morcerf, he is already an old man." "I will respect his age as he has respected the honor of my family; if my father had offended him, why did he not attack him personally? Oh, no, he was afraid to encounter him face to face." "I do not condemn you, Albert; I only restrain you. Act prudently." "Oh, do not fear; besides, you will accompany me. Beauchamp, solemn transactions should be sanctioned by a witness. Before this day closes, if M. Danglars is guilty, he shall cease to live, or I shall die. Pardieu, Beauchamp, mine shall be a splendid funeral!" "When such resolutions are made, Albert, they should be promptly executed. Do you wish to go to M. Danglars? Let us go immediately." They sent for a cabriolet. On entering the banker's mansion, they perceived the phaeton and servant of M. Andrea Cavalcanti. "Ah, parbleu, that's good," said Albert, with a gloomy tone. "If M. Danglars will not fight with me, I will kill his son-in-law; Cavalcanti will certainly fight." The servant announced the young man; but the banker, recollecting what had transpired the day before, did not wish him admitted. It was, however, too late; Albert had followed the footman, and, hearing the order given, forced the door open, and followed by Beauchamp found himself in the banker's study. "Sir," cried the latter, "am I no longer at liberty to receive whom I choose in my house? You appear to forget yourself sadly." "No, sir," said Albert, coldly; "there are circumstances in which one cannot, except through cowardice, -- I offer you that refuge, -- refuse to admit certain persons at least." "What is your errand, then, with me, sir?" "I mean," said Albert, drawing near, and without apparently noticing Cavalcanti, who stood with his back towards the fireplace -- "I mean to propose a meeting in some retired corner where no one will interrupt us for ten minutes; that will be sufficient -- where two men having met, one of them will remain on the ground." Danglars turned pale; Cavalcanti moved a step forward, and Albert turned towards him. "And you, too," said he, "come, if you like, monsieur; you have a claim, being almost one of the family, and I will give as many rendezvous of that kind as I can find persons willing to accept them." Cavalcanti looked at Danglars with a stupefied air, and the latter, making an effort, arose and stepped between the two young men. Albert's attack on Andrea had placed him on a different footing, and he hoped this visit had another cause than that he had at first supposed. "Indeed, sir," said he to Albert, "if you are come to quarrel with this gentleman because I have preferred him to you, I shall resign the case to the king's attorney." "You mistake, sir," said Morcerf with a gloomy smile; "I am not referring in the least to matrimony, and I only addressed myself to M. Cavalcanti because he appeared disposed to interfere between us. In one respect you are right, for I am ready to quarrel with every one to-day; but you have the first claim, M. Danglars." "Sir," replied Danglars, pale with anger and fear, "I warn you, when I have the misfortune to meet with a mad dog, I kill it; and far from thinking myself guilty of a crime, I believe I do society a kindness. Now, if you are mad and try to bite me, I will kill you without pity. Is it my fault that your father has dishonored himself?" "Yes, miserable wretch!" cried Morcerf, "it is your fault." Danglars retreated a few steps. "My fault?" said he; "you must be mad! What do I know of the Grecian affair? Have I travelled in that country? Did I advise your father to sell the castle of Yanina -- to betray" -- "Silence!" said Albert, with a thundering voice. "No; it is not you who have directly made this exposure and brought this sorrow on us, but you hypocritically provoked it." "I?" "Yes; you! How came it known?" "I suppose you read it in the paper in the account from Yanina?" "Who wrote to Yanina?" "To Yanina?" "Yes. Who wrote for particulars concerning my father?" "I imagine any one may write to Yanina." "But one person only wrote!" "One only?" "Yes; and that was you!" "I, doubtless, wrote. It appears to me that when about to marry your daughter to a young man, it is right to make some inquiries respecting his family; it is not only a right, but a duty." "You wrote, sir, knowing what answer you would receive." "I, indeed? I assure you," cried Danglars, with a confidence and security proceeding less from fear than from the interest he really felt for the young man, "I solemnly declare to you, that I should never have thought of writing to Yanina, did I know anything of Ali Pasha's misfortunes." "Who, then, urged you to write? Tell me." "Pardieu, it was the most simple thing in the world. I was speaking of your father's past history. I said the origin of his fortune remained obscure. The person to whom I addressed my scruples asked me where your father had acquired his property? I answered, `In Greece.' -- `Then,' said he, `write to Yanina.'" "And who thus advised you?" "No other than your friend, Monte Cristo." "The Count of Monte Cristo told you to write to Yanina?" "Yes; and I wrote, and will show you my correspondence, if you like." Albert and Beauchamp looked at each other. "Sir," said Beauchamp, who had not yet spoken, "you appear to accuse the count, who is absent from Paris at this moment, and cannot justify himself." "I accuse no one, sir," said Danglars; "I relate, and I will repeat before the count what I have said to you." "Does the count know what answer you received?" "Yes; I showed it to him." "Did he know my father's Christian name was Fernand, and his family name Mondego?" "Yes, I had told him that long since, and I did only what any other would have done in my circumstances, and perhaps less. When, the day after the arrival of this answer, your father came by the advice of Monte Cristo to ask my daughter's hand for you, I decidedly refused him, but without any explanation or exposure. In short, why should I have any more to do with the affair? How did the honor or disgrace of M. de Morcerf affect me? It neither increased nor decreased my income." Albert felt the blood mounting to his brow; there was no doubt upon the subject. Danglars defended himself with the baseness, but at the same time with the assurance, of a man who speaks the truth, at least in part, if not wholly -- not for conscience' sake, but through fear. Besides, what was Morcerf seeking? It was not whether Danglars or Monte Cristo was more or less guilty; it was a man who would answer for the offence, whether trifling or serious; it was a man who would fight, and it was evident Danglars would not fight. And, in addition to this, everything forgotten or unperceived before presented itself now to his recollection. Monte Cristo knew everything, as he had bought the daughter of Ali Pasha; and, knowing everything, he had advised Danglars to write to Yanina. The answer known, he had yielded to Albert's wish to be introduced to Haidee, and allowed the conversation to turn on the death of Ali, and had not opposed Haidee's recital (but having, doubtless, warned the young girl, in the few Romaic words he spoke to her, not to implicate Morcerf's father). Besides, had he not begged of Morcerf not to mention his father's name before Haidee? Lastly, he had taken Albert to Normandy when he knew the final blow was near. There could be no doubt that all had been calculated and previously arranged; Monte Cristo then was in league with his father's enemies. Albert took Beauchamp aside, and communicated these ideas to him. "You are right," said the latter; "M. Danglars has only been a secondary agent in this sad affair, and it is of M. de Monte Cristo that you must demand an explanation." Albert turned. "Sir," said he to Danglars, "understand that I do not take a final leave of you; I must ascertain if your insinuations are just, and am going now to inquire of the Count of Monte Cristo." He bowed to the banker, and went out with Beauchamp, without appearing to notice Cavalcanti. Danglars accompanied him to the door, where he again assured Albert that no motive of personal hatred had influenced him against the Count of Morcerf. Chapter 88 The Insult. At the banker's door Beauchamp stopped Morcerf. "Listen," said he; "just now I told you it was of M. de Monte Cristo you must demand an explanation." "Yes; and we are going to his house." "Reflect, Morcerf, one moment before you go." "On what shall I reflect?" "On the importance of the step you are taking." "Is it more serious than going to M. Danglars?" "Yes; M. Danglars is a money-lover, and those who love money, you know, think too much of what they risk to be easily induced to fight a duel. The other is, on the contrary, to all appearance a true nobleman; but do you not fear to find him a bully?" "I only fear one thing; namely, to find a man who will not fight." "Do not be alarmed," said Beauchamp; "he will meet you. My only fear is that he will be too strong for you." "My friend," said Morcerf, with a sweet smile, "that is what I wish. The happiest thing that could occur to me, would be to die in my father's stead; that would save us all." "Your mother would die of grief." "My poor mother!" said Albert, passing his hand across his eyes, "I know she would; but better so than die of shame." "Are you quite decided, Albert?" "Yes; let us go." "But do you think we shall find the count at home?" "He intended returning some hours after me, and doubtless he is now at home." They ordered the driver to take them to No. 30 Champs-Elysees. Beauchamp wished to go in alone, but Albert observed that as this was an unusual circumstance he might be allowed to deviate from the usual etiquette in affairs of honor. The cause which the young man espoused was one so sacred that Beauchamp had only to comply with all his wishes; he yielded and contented himself with following Morcerf. Albert sprang from the porter's lodge to the steps. He was received by Baptistin. The count had, indeed, just arrived, but he was in his bath, and had forbidden that any one should be admitted. "But after his bath?" asked Morcerf. "My master will go to dinner." "And after dinner?" "He will sleep an hour." "Then?" "He is going to the opera." "Are you sure of it?" asked Albert. "Quite, sir; my master has ordered his horses at eight o'clock precisely." "Very good," replied Albert; "that is all I wished to know." Then, turning towards Beauchamp, "If you have anything to attend to, Beauchamp, do it directly; if you have any appointment for this evening, defer it till tomorrow. I depend on you to accompany me to the opera; and if you can, bring Chateau-Renaud with you." Beauchamp availed himself of Albert's permission, and left him, promising to call for him at a quarter before eight. On his return home, Albert expressed his wish to Franz Debray, and Morrel, to see them at the opera that evening. Then he went to see his mother, who since the events of the day before had refused to see any one, and had kept her room. He found her in bed, overwhelmed with grief at this public humiliation. The sight of Albert produced the effect which might naturally be expected on Mercedes; she pressed her son's hand and sobbed aloud, but her tears relieved her. Albert stood one moment speechless by the side of his mother's bed. It was evident from his pale face and knit brows that his resolution to revenge himself was growing weaker. "My dear mother," said he, "do you know if M. de Morcerf has any enemy?" Mercedes started; she noticed that the young man did not say "my father." "My son," she said, "persons in the count's situation have many secret enemies. Those who are known are not the most dangerous." "I know it, and appeal to your penetration. You are of so superior a mind, nothing escapes you." "Why do you say so?" "Because, for instance, you noticed on the evening of the ball we gave, that M. de Monte Cristo would eat nothing in our house." Mercedes raised herself on her feverish arm. "M. de Monte Cristo!" she exclaimed; "and how is he connected with the question you asked me?" "You know, mother, M. de Monte Cristo is almost an Oriental, and it is customary with the Orientals to secure full liberty for revenge by not eating or drinking in the houses of their enemies." "Do you say M. de Monte Cristo is our enemy?" replied Mercedes, becoming paler than the sheet which covered her. "Who told you so? Why, you are mad, Albert! M. de Monte Cristo has only shown us kindness. M. de Monte Cristo saved your life; you yourself presented him to us. Oh, I entreat you, my son, if you had entertained such an idea, dispel it; and my counsel to you -- nay, my prayer -- is to retain his friendship." "Mother," replied the young man, "you have especial reasons for telling me to conciliate that man." "I?" said Mercedes, blushing as rapidly as she had turned pale, and again becoming paler than ever. "Yes, doubtless; and is it not that he may never do us any harm?" Mercedes shuddered, and, fixing on her son a scrutinizing gaze, "You speak strangely," said she to Albert, "and you appear to have some singular prejudices. What has the count done? Three days since you were with him in Normandy; only three days since we looked on him as our best friend." An ironical smile passed over Albert's lips. Mercedes saw it and with the double instinct of woman and mother guessed all; but as she was prudent and strong-minded she concealed both her sorrows and her fears. Albert was silent; an instant after, the countess resumed: "You came to inquire after my health; I will candidly acknowledge that I am not well. You should install yourself here, and cheer my solitude. I do not wish to be left alone." "Mother," said the young man, "you know how gladly I would obey your wish, but an urgent and important affair obliges me to leave you for the whole evening." "Well," replied Mercedes, sighing, "go, Albert; I will not make you a slave to your filial piety." Albert pretended he did not hear, bowed to his mother, and quitted her. Scarcely had he shut her door, when Mercedes called a confidential servant, and ordered him to follow Albert wherever he should go that evening, and to come and tell her immediately what he observed. Then she rang for her lady's maid, and, weak as she was, she dressed, in order to be ready for whatever might happen. The footman's mission was an easy one. Albert went to his room, and dressed with unusual care. At ten minutes to eight Beauchamp arrived; he had seen Chateau-Renaud, who had promised to be in the orchestra before the curtain was raised. Both got into Albert's coupe; and, as the young man had no reason to conceal where he was going, he called aloud, "To the opera." In his impatience he arrived before the beginning of the performance. Chateau-Renaud was at his post; apprised by Beauchamp of the circumstances, he required no explanation from Albert. The conduct of the son in seeking to avenge his father was so natural that Chateau-Renaud did not seek to dissuade him, and was content with renewing his assurances of devotion. Debray was not yet come, but Albert knew that he seldom lost a scene at the opera. Albert wandered about the theatre until the curtain was drawn up. He hoped to meet with M. de Monte Cristo either in the lobby or on the stairs. The bell summoned him to his seat, and he entered the orchestra with Chateau-Renaud and Beauchamp. But his eyes scarcely quitted the box between the columns, which remained obstinately closed during the whole of the first act. At last, as Albert was looking at his watch for about the hundredth time, at the beginning of the second act the door opened, and Monte Cristo entered, dressed in black, and, leaning over the front of the box, looked around the pit. Morrel followed him, and looked also for his sister and brother in-law; he soon discovered them in another box, and kissed his hand to them. The count, in his survey of the pit, encountered a pale face and threatening eyes, which evidently sought to gain his attention. He recognized Albert, but thought it better not to notice him, as he looked so angry and discomposed. Without communicating his thoughts to his companion, he sat down, drew out his opera-glass, and looked another way. Although apparently not noticing Albert, he did not, however, lose sight of him, and when the curtain fell at the end of the second act, he saw him leave the orchestra with his two friends. Then his head was seen passing at the back of the boxes, and the count knew that the approaching storm was intended to fall on him. He was at the moment conversing cheerfully with Morrel, but he was well prepared for what might happen. The door opened, and Monte Cristo, turning round, saw Albert, pale and trembling, followed by Beauchamp and Chateau-Renaud. "Well," cried he, with that benevolent politeness which distinguished his salutation from the common civilities of the world, "my cavalier has attained his object. Good-evening, M. de Morcerf." The countenance of this man, who possessed such extraordinary control over his feelings, expressed the most perfect cordiality. Morrel only then recollected the letter he had received from the viscount, in which, without assigning any reason, he begged him to go to the opera, but he understood that something terrible was brooding. "We are not come here, sir, to exchange hypocritical expressions of politeness, or false professions of friendship," said Albert, "but to demand an explanation." The young man's trembling voice was scarcely audible. "An explanation at the opera?" said the count, with that calm tone and penetrating eye which characterize the man who knows his cause is good. "Little acquainted as I am with the habits of Parisians, I should not have thought this the place for such a demand." "Still, if people will shut themselves up," said Albert, "and cannot be seen because they are bathing, dining, or asleep, we must avail ourselves of the opportunity whenever they are to be seen." "I am not difficult of access, sir; for yesterday, if my memory does not deceive me, you were at my house." "Yesterday I was at your house, sir," said the young man; "because then I knew not who you were." In pronouncing these words Albert had raised his voice so as to be heard by those in the adjoining boxes and in the lobby. Thus the attention of many was attracted by this altercation. "Where are you come from, sir? You do not appear to be in the possession of your senses." "Provided I understand your perfidy, sir, and succeed in making you understand that I will be revenged, I shall be reasonable enough," said Albert furiously. "I do not understand you, sir," replied Monte Cristo; "and if I did, your tone is too high. I am at home here, and I alone have a right to raise my voice above another's. Leave the box, sir!" Monte Cristo pointed towards the door with the most commanding dignity. "Ah, I shall know how to make you leave your home!" replied Albert, clasping in his convulsed grasp the glove, which Monte Cristo did not lose sight of. "Well, well," said Monte Cristo quietly, "I see you wish to quarrel with me; but I would give you one piece of advice, which you will do well to keep in mind. It is in poor taste to make a display of a challenge. Display is not becoming to every one, M. de Morcerf." At this name a murmur of astonishment passed around the group of spectators of this scene. They had talked of no one but Morcerf the whole day. Albert understood the allusion in a moment, and was about to throw his glove at the count, when Morrel seized his hand, while Beauchamp and Chateau-Renaud, fearing the scene would surpass the limits of a challenge, held him back. But Monte Cristo, without rising, and leaning forward in his chair, merely stretched out his arm and, taking the damp, crushed glove from the clinched hand of the young man, "Sir," said he in a solemn tone, "I consider your glove thrown, and will return it to you wrapped around a bullet. Now leave me or I will summon my servants to throw you out at the door." Wild, almost unconscious, and with eyes inflamed, Albert stepped back, and Morrel closed the door. Monte Cristo took up his glass again as if nothing had happened; his face was like marble, and his heart was like bronze. Morrel whispered, "What have you done to him?" "I? Nothing -- at least personally," said Monte Cristo. "But there must be some cause for this strange scene." "The Count of Morcerf's adventure exasperates the young man." "Have you anything to do with it?" "It was through Haidee that the Chamber was informed of his father's treason." "Indeed?" said Morrel. "I had been told, but would not credit it, that the Grecian slave I have seen with you here in this very box was the daughter of Ali Pasha." "It is true, nevertheless." "Then," said Morrel, "I understand it all, and this scene was premeditated." "How so?" "Yes. Albert wrote to request me to come to the opera, doubtless that I might be a witness to the insult he meant to offer you." "Probably," said Monte Cristo with his imperturbable tranquillity. "But what shall you do with him?" "With whom?" "With Albert." "What shall I do with Albert? As certainly, Maximilian, as I now press your hand, I shall kill him before ten o'clock to-morrow morning." Morrel, in his turn, took Monte Cristo's hand in both of his, and he shuddered to feel how cold and steady it was. "Ah, Count," said he, "his father loves him so much!" "Do not speak to me of that," said Monte Cristo, with the first movement of anger he had betrayed; "I will make him suffer." Morrel, amazed, let fall Monte Cristo's hand. "Count, count!" said he. "Dear Maximilian," interrupted the count, "listen how adorably Duprez is singing that line, -- `O Mathilde! idole de mon ame!' "I was the first to discover Duprez at Naples, and the first to applaud him. Bravo, bravo!" Morrel saw it was useless to say more, and refrained. The curtain, which had risen at the close of the scene with Albert, again fell, and a rap was heard at the door. "Come in," said Monte Cristo with a voice that betrayed not the least emotion; and immediately Beauchamp appeared. "Good-evening, M. Beauchamp," said Monte Cristo, as if this was the first time he had seen the journalist that evening; "be seated." Beauchamp bowed, and, sitting down, "Sir," said he, "I just now accompanied M. de Morcerf, as you saw." "And that means," replied Monte Cristo, laughing, "that you had, probably, just dined together. I am happy to see, M. Beauchamp, that you are more sober than he was." "Sir," said M. Beauchamp, "Albert was wrong, I acknowledge, to betray so much anger, and I come, on my own account, to apologize for him. And having done so, entirely on my own account, be it understood, I would add that I believe you too gentlemanly to refuse giving him some explanation concerning your connection with Yanina. Then I will add two words about the young Greek girl." Monte Cristo motioned him to be silent. "Come," said he, laughing, "there are all my hopes about to be destroyed." "How so?" asked Beauchamp. "Doubtless you wish to make me appear a very eccentric character. I am, in your opinion, a Lara, a Manfred, a Lord Ruthven; then, just as I am arriving at the climax, you defeat your own end, and seek to make an ordinary man of me. You bring me down to your own level, and demand explanations! Indeed, M. Beauchamp, it is quite laughable." "Yet," replied Beauchamp haughtily, "there are occasions when probity commands" -- "M. Beauchamp," interposed this strange man, "the Count of Monte Cristo bows to none but the Count of Monte Cristo himself. Say no more, I entreat you. I do what I please, M. Beauchamp, and it is always well done." "Sir," replied the young man, "honest men are not to be paid with such coin. I require honorable guaranties." "I am, sir, a living guaranty," replied Monte Cristo, motionless, but with a threatening look; "we have both blood in our veins which we wish to shed -- that is our mutual guaranty. Tell the viscount so, and that to-morrow, before ten o'clock, I shall see what color his is." "Then I have only to make arrangements for the duel," said Beauchamp. "It is quite immaterial to me," said Monte Cristo, "and it was very unnecessary to disturb me at the opera for such a trifle. In France people fight with the sword or pistol, in the colonies with the carbine, in Arabia with the dagger. Tell your client that, although I am the insulted party, in order to carry out my eccentricity, I leave him the choice of arms, and will accept without discussion, without dispute, anything, even combat by drawing lots, which is always stupid, but with me different from other people, as I am sure to gain." "Sure to gain!" repeated Beauchamp, looking with amazement at the count. "Certainly," said Monte Cristo, slightly shrugging his shoulders; "otherwise I would not fight with M. de Morcerf. I shall kill him -- I cannot help it. Only by a single line this evening at my house let me know the arms and the hour; I do not like to be kept waiting." "Pistols, then, at eight o'clock, in the Bois de Vincennes," said Beauchamp, quite disconcerted, not knowing if he was dealing with an arrogant braggadocio or a supernatural being. "Very well, sir," said Monte Cristo. "Now all that is settled, do let me see the performance, and tell your friend Albert not to come any more this evening; he will hurt himself with all his ill-chosen barbarisms: let him go home and go to sleep." Beauchamp left the box, perfectly amazed. "Now," said Monte Cristo, turning towards Morrel, "I may depend upon you, may I not?" "Certainly," said Morrel, "I am at your service, count; still" -- "What?" "It is desirable I should know the real cause." "That is to say, you would rather not?" "No." "The young man himself is acting blindfolded, and knows not the true cause, which is known only to God and to me; but I give you my word, Morrel, that God, who does know it, will be on our side." "Enough," said Morrel; "who is your second witness?" "I know no one in Paris, Morrel, on whom I could confer that honor besides you and your brother Emmanuel. Do you think Emmanuel would oblige me?" "I will answer for him, count." "Well? that is all I require. To-morrow morning, at seven o'clock, you will be with me, will you not?" "We will." "Hush, the curtain is rising. Listen! I never lose a note of this opera if I can avoid it; the music of William Tell is so sweet." Chapter 89 A Nocturnal Interview. Monte Cristo waited, according to his usual custom, until Duprez had sung his famous "Suivez-moi;" then he rose and went out. Morrel took leave of him at the door, renewing his promise to be with him the next morning at seven o'clock, and to bring Emmanuel. Then he stepped into his coupe, calm and smiling, and was at home in five minutes. No one who knew the count could mistake his expression when, on entering, he said, "Ali, bring me my pistols with the ivory cross." Ali brought the box to his master, who examined the weapons with a solicitude very natural to a man who is about to intrust his life to a little powder and shot. These were pistols of an especial pattern, which Monte Cristo had had made for target practice in his own room. A cap was sufficient to drive out the bullet, and from the adjoining room no one would have suspected that the count was, as sportsmen would say, keeping his hand in. He was just taking one up and looking for the point to aim at on a little iron plate which served him as a target, when his study door opened, and Baptistin entered. Before he had spoken a word, the count saw in the next room a veiled woman, who had followed closely after Baptistin, and now, seeing the count with a pistol in his hand and swords on the table, rushed in. Baptistin looked at his master, who made a sign to him, and he went out, closing the door after him. "Who are you, madame?" said the count to the veiled woman. The stranger cast one look around her, to be certain that they were quite alone; then bending as if she would have knelt, and joining her hands, she said with an accent of despair, "Edmond, you will not kill my son?" The count retreated a step, uttered a slight exclamation, and let fall the pistol he held. "What name did you pronounce then, Madame de Morcerf?" said he. "Yours!" cried she, throwing back her veil, -- "yours, which I alone, perhaps, have not forgotten. Edmond, it is not Madame de Morcerf who is come to you, it is Mercedes." "Mercedes is dead, madame," said Monte Cristo; "I know no one now of that name." "Mercedes lives, sir, and she remembers, for she alone recognized you when she saw you, and even before she saw you, by your voice, Edmond, -- by the simple sound of your voice; and from that moment she has followed your steps, watched you, feared you, and she needs not to inquire what hand has dealt the blow which now strikes M. de Morcerf." "Fernand, do you mean?" replied Monte Cristo, with bitter irony; "since we are recalling names, let us remember them all." Monte Cristo had pronounced the name of Fernand with such an expression of hatred that Mercedes felt a thrill of horror run through every vein. "You see, Edmond, I am not mistaken, and have cause to say, `Spare my son!'" "And who told you, madame, that I have any hostile intentions against your son?" "No one, in truth; but a mother has twofold sight. I guessed all; I followed him this evening to the opera, and, concealed in a parquet box, have seen all." "If you have seen all, madame, you know that the son of Fernand has publicly insulted me," said Monte Cristo with awful calmness. "Oh, for pity's sake!" "You have seen that he would have thrown his glove in my face if Morrel, one of my friends, had not stopped him." "Listen to me, my son has also guessed who you are, -- he attributes his father's misfortunes to you." "Madame, you are mistaken, they are not misfortunes, -- it is a punishment. It is not I who strike M. de Morcerf; it is providence which punishes him." "And why do you represent providence?" cried Mercedes. "Why do you remember when it forgets? What are Yanina and its vizier to you, Edmond? What injury his Fernand Mondego done you in betraying Ali Tepelini?" "Ah, madame," replied Monte Cristo, "all this is an affair between the French captain and the daughter of Vasiliki. It does not concern me, you are right; and if I have sworn to revenge myself, it is not on the French captain, or the Count of Morcerf, but on the fisherman Fernand, the husband of Mercedes the Catalane." "Ah, sir!" cried the countess, "how terrible a vengeance for a fault which fatality made me commit! -- for I am the only culprit, Edmond, and if you owe revenge to any one, it is to me, who had not fortitude to bear your absence and my solitude." "But," exclaimed Monte Cristo, "why was I absent? And why were you alone?" "Because you had been arrested, Edmond, and were a prisoner." "And why was I arrested? Why was I a prisoner?" "I do not know," said Mercedes. "You do not, madame; at least, I hope not. But I will tell you. I was arrested and became a prisoner because, under the arbor of La Reserve, the day before I was to marry you, a man named Danglars wrote this letter, which the fisherman Fernand himself posted." Monte Cristo went to a secretary, opened a drawer by a spring, from which he took a paper which had lost its original color, and the ink of which had become of a rusty hue -- this he placed in the hands of Mercedes. It was Danglars' letter to the king's attorney, which the Count of Monte Cristo, disguised as a clerk from the house of Thomson & French, had taken from the file against Edmond Dantes, on the day he had paid the two hundred thousand francs to M. de Boville. Mercedes read with terror the following lines: -- "The king's attorney is informed by a friend to the throne and religion that one Edmond Dantes, second in command on board the Pharaon, this day arrived from Smyrna, after having touched at Naples and Porto-Ferrajo, is the bearer of a letter from Murat to the usurper, and of another letter from the usurper to the Bonapartist club in Paris. Ample corroboration of this statement may be obtained by arresting the above-mentioned Edmond Dantes, who either carries the letter for Paris about with him, or has it at his father's abode. Should it not be found in possession of either father or son, then it will assuredly be discovered in the cabin belonging to the said Dantes on board the Pharaon." "How dreadful!" said Mercedes, passing her hand across her brow, moist with perspiration; "and that letter" -- "I bought it for two hundred thousand francs, madame," said Monte Cristo; "but that is a trifle, since it enables me to justify myself to you." "And the result of that letter" -- "You well know, madame, was my arrest; but you do not know how long that arrest lasted. You do not know that I remained for fourteen years within a quarter of a league of you, in a dungeon in the Chateau d'If. You do not know that every day of those fourteen years I renewed the vow of vengeance which I had made the first day; and yet I was not aware that you had married Fernand, my calumniator, and that my father had died of hunger!" "Can it be?" cried Mercedes, shuddering. "That is what I heard on leaving my prison fourteen years after I had entered it; and that is why, on account of the living Mercedes and my deceased father, I have sworn to revenge myself on Fernand, and -- I have revenged myself." "And you are sure the unhappy Fernand did that?" "I am satisfied, madame, that he did what I have told you; besides, that is not much more odious than that a Frenchman by adoption should pass over to the English; that a Spaniard by birth should have fought against the Spaniards; that a stipendiary of Ali should have betrayed and murdered Ali. Compared with such things, what is the letter you have just read? -- a lover's deception, which the woman who has married that man ought certainly to forgive; but not so the lover who was to have married her. Well, the French did not avenge themselves on the traitor, the Spaniards did not shoot the traitor, Ali in his tomb left the traitor unpunished; but I, betrayed, sacrificed, buried, have risen from my tomb, by the grace of God, to punish that man. He sends me for that purpose, and here I am." The poor woman's head and arms fell; her legs bent under her, and she fell on her knees. "Forgive, Edmond, forgive for my sake, who love you still!" The dignity of the wife checked the fervor of the lover and the mother. Her forehead almost touched the carpet, when the count sprang forward and raised her. Then seated on a chair, she looked at the manly countenance of Monte Cristo, on which grief and hatred still impressed a threatening expression. "Not crush that accursed race?" murmured he; "abandon my purpose at the moment of its accomplishment? Impossible, madame, impossible!" "Edmond," said the poor mother, who tried every means, "when I call you Edmond, why do you not call me Mercedes?" "Mercedes!" repeated Monte Cristo; "Mercedes! Well yes, you are right; that name has still its charms, and this is the first time for a long period that I have pronounced it so distinctly. Oh, Mercedes, I have uttered your name with the sigh of melancholy, with the groan of sorrow, with the last effort of despair; I have uttered it when frozen with cold, crouched on the straw in my dungeon; I have uttered it, consumed with heat, rolling on the stone floor of my prison. Mercedes, I must revenge myself, for I suffered fourteen years, -- fourteen years I wept, I cursed; now I tell you, Mercedes, I must revenge myself." The count, fearing to yield to the entreaties of her he had so ardently loved, called his sufferings to the assistance of his hatred. "Revenge yourself, then, Edmond," cried the poor mother; "but let your vengeance fall on the culprits, -- on him, on me, but not on my son!" "It is written in the good book," said Monte Cristo, "that the sins of the fathers shall fall upon their children to the third and fourth generation. Since God himself dictated those words to his prophet, why should I seek to make myself better than God?" "Edmond," continued Mercedes, with her arms extended towards the count, "since I first knew you, I have adored your name, have respected your memory. Edmond, my friend, do not compel me to tarnish that noble and pure image reflected incessantly on the mirror of my heart. Edmond, if you knew all the prayers I have addressed to God for you while I thought you were living and since I have thought you must be dead! Yes, dead, alas! I imagined your dead body buried at the foot of some gloomy tower, or cast to the bottom of a pit by hateful jailers, and I wept! What could I do for you, Edmond, besides pray and weep? Listen; for ten years I dreamed each night the same dream. I had been told that you had endeavored to escape; that you had taken the place of another prisoner; that you had slipped into the winding sheet of a dead body; that you had been thrown alive from the top of the Chateau d'If, and that the cry you uttered as you dashed upon the rocks first revealed to your jailers that they were your murderers. Well, Edmond, I swear to you, by the head of that son for whom I entreat your pity, -- Edmond, for ten years I saw every night every detail of that frightful tragedy, and for ten years I heard every night the cry which awoke me, shuddering and cold. And I, too, Edmond -- oh! believe me -- guilty as I was -- oh, yes, I, too, have suffered much!" "Have you known what it is to have your father starve to death in your absence?" cried Monte Cristo, thrusting his hands into his hair; "have you seen the woman you loved giving her hand to your rival, while you were perishing at the bottom of a dungeon?" "No," interrupted Mercedes, "but I have seen him whom I loved on the point of murdering my son." Mercedes uttered these words with such deep anguish, with an accent of such intense despair, that Monte Cristo could not restrain a sob. The lion was daunted; the avenger was conquered. "What do you ask of me?" said he, -- "your son's life? Well, he shall live!" Mercedes uttered a cry which made the tears start from Monte Cristo's eyes; but these tears disappeared almost instantaneously, for, doubtless, God had sent some angel to collect them -- far more precious were they in his eyes than the richest pearls of Guzerat and Ophir. "Oh," said she, seizing the count's hand and raising it to her lips; "oh, thank you, thank you, Edmond! Now you are exactly what I dreamt you were, -- the man I always loved. Oh, now I may say so!" "So much the better," replied Monte Cristo; "as that poor Edmond will not have long to be loved by you. Death is about to return to the tomb, the phantom to retire in darkness." "What do you say, Edmond?" "I say, since you command me, Mercedes, I must die." "Die? and why so? Who talks of dying? Whence have you these ideas of death?" "You do not suppose that, publicly outraged in the face of a whole theatre, in the presence of your friends and those of your son -- challenged by a boy who will glory in my forgiveness as if it were a victory -- you do not suppose that I can for one moment wish to live. What I most loved after you, Mercedes, was myself, my dignity, and that strength which rendered me superior to other men; that strength was my life. With one word you have crushed it, and I die." "But the duel will not take place, Edmond, since you forgive?" "It will take place," said Monte Cristo, in a most solemn tone; "but instead of your son's blood to stain the ground, mine will flow." Mercedes shrieked, and sprang towards Monte Cristo, but, suddenly stopping, "Edmond," said she, "there is a God above us, since you live and since I have seen you again; I trust to him from my heart. While waiting his assistance I trust to your word; you have said that my son should live, have you not?" "Yes, madame, he shall live," said Monte Cristo, surprised that without more emotion Mercedes had accepted the heroic sacrifice he made for her. Mercedes extended her hand to the count. "Edmond," said she, and her eyes were wet with tears while looking at him to whom she spoke, "how noble it is of you, how great the action you have just performed, how sublime to have taken pity on a poor woman who appealed to you with every chance against her, Alas, I am grown old with grief more than with years, and cannot now remind my Edmond by a smile, or by a look, of that Mercedes whom he once spent so many hours in contemplating. Ah, believe me, Edmond, as I told you, I too have suffered much; I repeat, it is melancholy to pass one's life without having one joy to recall, without preserving a single hope; but that proves that all is not yet over. No, it is not finished; I feel it by what remains in my heart. Oh, I repeat it, Edmond; what you have just done is beautiful -- it is grand; it is sublime." "Do you say so now, Mercedes? -- then what would you say if you knew the extent of the sacrifice I make to you? Suppose that the Supreme Being, after having created the world and fertilized chaos, had paused in the work to spare an angel the tears that might one day flow for mortal sins from her immortal eyes; suppose that when everything was in readiness and the moment had come for God to look upon his work and see that it was good -- suppose he had snuffed out the sun and tossed the world back into eternal night -- then -- even then, Mercedes, you could not imagine what I lose in sacrificing my life at this moment." Mercedes looked at the count in a way which expressed at the same time her astonishment, her admiration, and her gratitude. Monte Cristo pressed his forehead on his burning hands, as if his brain could no longer bear alone the weight of its thoughts. "Edmond," said Mercedes, "I have but one word more to say to you." The count smiled bitterly. "Edmond," continued she, "you will see that if my face is pale, if my eyes are dull, if my beauty is gone; if Mercedes, in short, no longer resembles her former self in her features, you will see that her heart is still the same. Adieu, then, Edmond; I have nothing more to ask of heaven -- I have seen you again, and have found you as noble and as great as formerly you were. Adieu, Edmond, adieu, and thank you." But the count did not answer. Mercedes opened the door of the study and had disappeared before he had recovered from the painful and profound revery into which his thwarted vengeance had plunged him. The clock of the Invalides struck one when the carriage which conveyed Madame de Morcerf away rolled on the pavement of the Champs-Elysees, and made Monte Cristo raise his head. "What a fool I was," said he, "not to tear my heart out on the day when I resolved to avenge myself!" Chapter 90 The Meeting. After Mercedes had left Monte Cristo, he fell into profound gloom. Around him and within him the flight of thought seemed to have stopped; his energetic mind slumbered, as the body does after extreme fatigue. "What?" said he to himself, while the lamp and the wax lights were nearly burnt out, and the servants were waiting impatiently in the anteroom; "what? this edifice which I have been so long preparing, which I have reared with so much care and toil, is to be crushed by a single touch, a word, a breath! Yes, this self, of whom I thought so much, of whom I was so proud, who had appeared so worthless in the dungeons of the Chateau d'If, and whom I had succeeded in making so great, will be but a lump of clay to-morrow. Alas, it is not the death of the body I regret; for is not the destruction of the vital principle, the repose to which everything is tending, to which every unhappy being aspires, -- is not this the repose of matter after which I so long sighed, and which I was seeking to attain by the painful process of starvation when Faria appeared in my dungeon? What is death for me? One step farther into rest, -- two, perhaps, into silence. "No, it is not existence, then, that I regret, but the ruin of projects so slowly carried out, so laboriously framed. Providence is now opposed to them, when I most thought it would be propitious. It is not God's will that they should be accomplished. This burden, almost as heavy as a world, which I had raised, and I had thought to bear to the end, was too great for my strength, and I was compelled to lay it down in the middle of my career. Oh, shall I then, again become a fatalist, whom fourteen years of despair and ten of hope had rendered a believer in providence? And all this -- all this, because my heart, which I thought dead, was only sleeping; because it has awakened and has begun to beat again, because I have yielded to the pain of the emotion excited in my breast by a woman's voice. Yet," continued the count, becoming each moment more absorbed in the anticipation of the dreadful sacrifice for the morrow, which Mercedes had accepted, "yet, it is impossible that so noble-minded a woman should thus through selfishness consent to my death when I am in the prime of life and strength; it is impossible that she can carry to such a point maternal love, or rather delirium. There are virtues which become crimes by exaggeration. No, she must have conceived some pathetic scene; she will come and throw herself between us; and what would be sublime here will there appear ridiculous." The blush of pride mounted to the count's forehead as this thought passed through his mind. "Ridiculous?" repeated he; "and the ridicule will fall on me. I ridiculous? No, I would rather die." By thus exaggerating to his own mind the anticipated ill-fortune of the next day, to which he had condemned himself by promising Mercedes to spare her son, the count at last exclaimed, "Folly, folly, folly! -- to carry generosity so far as to put myself up as a mark for that young man to aim at. He will never believe that my death was suicide; and yet it is important for the honor of my memory, -- and this surely is not vanity, but a justifiable pride, -- it is important the world should know that I have consented, by my free will, to stop my arm, already raised to strike, and that with the arm which has been so powerful against others I have struck myself. It must be; it shall be." Seizing a pen, he drew a paper from a secret drawer in his desk, and wrote at the bottom of the document (which was no other than his will, made since his arrival in Paris) a sort of codicil, clearly explaining the nature of his death. "I do this, O my God," said he, with his eyes raised to heaven, "as much for thy honor as for mine. I have during ten years considered myself the agent of thy vengeance, and other wretches, like Morcerf, Danglars, Villefort, even Morcerf himself, must not imagine that chance has freed them from their enemy. Let them know, on the contrary, that their punishment, which had been decreed by providence, is only delayed by my present determination, and although they escape it in this world, it awaits them in another, and that they are only exchanging time for eternity." While he was thus agitated by gloomy uncertainties, -- wretched waking dreams of grief, -- the first rays of morning pierced his windows, and shone upon the pale blue paper on which he had just inscribed his justification of providence. It was just five o'clock in the morning when a slight noise like a stifled sigh reached his ear. He turned his head, looked around him, and saw no one; but the sound was repeated distinctly enough to convince him of its reality. He arose, and quietly opening the door of the drawing-room, saw Haidee, who had fallen on a chair, with her arms hanging down and her beautiful head thrown back. She had been standing at the door, to prevent his going out without seeing her, until sleep, which the young cannot resist, had overpowered her frame, wearied as she was with watching. The noise of the door did not awaken her, and Monte Cristo gazed at her with affectionate regret. "She remembered that she had a son," said he; "and I forgot I had a daughter." Then, shaking his head sorrowfully, "Poor Haidee," said he; "she wished to see me, to speak to me; she has feared or guessed something. Oh, I cannot go without taking leave of her; I cannot die without confiding her to some one." He quietly regained his seat, and wrote under the other lines: -- "I bequeath to Maximilian Morrel, captain of Spahis, -- and son of my former patron, Pierre Morrel, shipowner at Marseilles, -- the sum of twenty millions, a part of which may be offered to his sister Julia and brother-in-law Emmanuel, if he does not fear this increase of fortune may mar their happiness. These twenty millions are concealed in my grotto at Monte Cristo, of which Bertuccio knows the secret. If his heart is free, and he will marry Haidee, the daughter of Ali Pasha of Yanina, whom I have brought up with the love of a father, and who has shown the love and tenderness of a daughter for me, he

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3-6 Microvascular Decompression MVD Dr. Parrish Neurosurgeon

7 Aug 2007 at 6:05am  3-6 Microvascular Decompression MVD Dr. Parrish Neurosurgeon
BrianNelson123
6 min - Aug 7, 2007

Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: ? Avoid years of medication and intermittent pain ? Avoid facing surgery when old or infirm ? If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain ? how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and ? if it appears that you have trigeminal neuralgia ? which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. ? Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com

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5-6 Microvascular Decompression MVD Dr. Parrish Neurosurgeon

7 Aug 2007 at 6:02am  5-6 Microvascular Decompression MVD Dr. Parrish Neurosurgeon
BrianNelson123
5 min - Aug 7, 2007

Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: ? Avoid years of medication and intermittent pain ? Avoid facing surgery when old or infirm ? If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain ? how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and ? if it appears that you have trigeminal neuralgia ? which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. ? Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find