Tiffany Smith … A Lawyer’s Story
By Pamela Unverzart
If track shoes were made personalized for those that plan to change the world at breakneck speed, 26-year-old Tiffany Smith’s name would be emblazoned in bright fluorescent colors across the finest pair made. Born with a passionate disposition concerning the racial and socioeconomic disparities in the world, Tiffany remembers being interested as early as elementary school in using the law as a means to help bring balance back to these injustices. Having skipped the fourth grade, Tiffany often found herself debating with older students. Her unique ability to win those debates blossomed in middle school, further cementing Tiffany’s desire to do her part in changing the world by becoming a top-notch litigator.
This extremely intelligent young woman dreamed of pursuing a career in dispute resolution and graduated from high school at the tender age of 16, a year of college credits already tucked securely under her belt. After receiving her undergraduate degree cum laude at 19 from American University, Tiffany took a two-year hiatus from her studies to work full time for a prestigious law firm in Washington D.C. before heading to The Ohio State University to earn her Juris Doctorate degree. Then with the first year of law school successfully behind her and the smell of victory wafting in the air around her, Tiffany’s thoroughly mapped out course for success was suddenly road blocked with a sudden on-set of severe facial pain. As is the case with most facial pain sufferers, Tiffany recalls the date and time the first pain struck, and that date – May 17th, 2007, while she was getting ready to attend a surprise birthday party for her then-boyfriend – changed her life forever. The pain lanced through her head like lightning, and each time it happened it was so intense she thought she was going to die.
Frequent visits to the emergency room for pain relief dotted her summer calendar, yet no one could find anything wrong with her. Added to her already full research curriculum at her summer job was the new challenge of researching symptoms and specialists in an attempt to find a reason for her increasing pain. Desperate to find the cause – and treatment – for her pain, Tiffany tracked down doctors in many specialties. Surprisingly, a well-trained allergist who “was the first doctor to think to look up my nose,” recognized what appeared to be large polyps and immediately sent Tiffany to an Ear, Nose and Throat specialist who confirmed the existence of sinus polyps. Bilateral sinus surgery excised the benign polyps, but they quickly returned, and follow-up surgery was done within six months.
The pain in Tiffany’s sinus cavity was eradicated with the second surgery, but left behind was debilitating right-sided facial pain that defied any treatment. Never a quitter, Tiffany pulled back on her running shoes and relied on her stores of drive to continue through the grueling law courses while she searched for answers. Because of the rivalry typical of students reaching for elite careers, showing weakness in law school was not an option, so Tiffany kept to herself, letting only the Dean of Student Affairs, a handful of professors, and very few friends know about the pain she was suffering. Although the university worked to accommodate her schedule, her grades suffered. As she recalls, “I felt like I spent more time in the hospital than in class… and my doctors would always joke that they had never seen a patient hooked up to IV pain medication studying 1100 page thick law books sprawled open across the hospital bed.” Worse even than the decline of her grade point average was the loss of her social sphere as understanding friends eventually fell by the way side. Tiffany explains, “The first time someone finds out you’re in the hospital they send flowers. By the third time all they can do is tell you they’re sorry. By the fifth or sixth time they only respond with, ‘Oh, no, not again.’ It’s the nature of humans to pull away from what they can’t understand,” she adds with more than a hint of sadness in her voice.
Doctor after doctor returned with no clear cut answer. Though her doctors tried numerous combinations of anticonvulsants, antidepressants, muscle relaxers and pain-relieving opiates - nothing worked. Being eventually diagnosed with atypical facial pain came as no great surprise to Tiffany who, by that time, had researched everything she could concerning her symptoms and possible causes. Getting few answers and limited assistance from the myriad of doctors she’d dealt with, Tiffany turned to the Mayo Clinic for help. So the day after taking her Bar Exam to cement her career as a full-fledged attorney, Tiffany flew to the Mayo Clinic to begin another grueling exam, this time one consisting of medical tests, numerous doctors’ consultations, and committee meetings. Consensus from the Mayo doctors confirmed the diagnosis of atypical trigeminal neuralgia (now referred to as TN type 2a), and because of the atypical nature of her face pain – a constant, deep, boring pain in the upper two pathways of her trigeminal nerve interrupted with intermittent zaps of sharp, lance-like electric shocks – the doctors were doubtful the usual course of therapies such as Gamma Knife, rhizotomy, balloon decompression, or microvascular decompression surgery would work. Greater still was the concern these procedures could exacerbate her condition. After a battery of studies and discussions, motor cortex stimulation (MCS) was chosen as the best option for controlling her pain, but because of the experimental nature of its use for trigeminal neuralgia patients, Tiffany first underwent Mayo’s four-week pain rehabilitation clinic to ensure she had pursued every natural course of pain control possible.
Preceding surgery, Tiffany returned to D.C. to begin her career in the field of international white collar crime with the prestigious law firm she had worked with prior to law school. Facing challenges head on and winning was not strange territory for this new attorney, but overcoming the challenge she was facing with her health was taking its toll. After undergoing the four-week pain rehabilitation clinic, her pain management anesthesiologist in Washington D.C. suggested a sphenopalatine ganglion block, a procedure that uses topical anesthetic applied by means of a long, thin needle with a hollow handle saturated in a solution of 4% Lidocaine and other anesthetizing medications. The needle is inserted through the jaw and maneuvered up until it meets the appropriate nerve bundle, where the local anesthetic is topically applied and left in place for approximately 45-60 minutes, which results in the desired nerve block. Two procedures later Tiffany was left with little pain relief, and worse, unexplained pain that had temporarily taken up residence on the left side of her face as well. Although Tiffany was sure the new condition of left-sided face pain was only temporary, its existence put a halt on the Mayo Clinic’s agreement to perform the motor cortex stimulation.
Desperate for relief, Tiffany sought a second opinion from a renowned Cleveland Clinic neurosurgeon who had recently moved to The Ohio State University Medical Center. Although he agreed that MCS was her best – if not only – option, he suggested they first try peripheral nerve stimulation (PNS), as it carried significantly lower risks. Tiffany underwent this procedure in May of 2010.
PNS is a neuromodulation technique in which electrical current is applied to the peripheral nerves in an effort to ameliorate chronic pain. A trial period with temporary electrodes generally lasts about a week. If sufficient pain relief occurs, then a permanent system is implanted. For superficial peripheral nerves such as the trigeminal, individual leads are placed just under the skin, overlying the nerve. In Tiffany’s case, pain relief was again minimal, so the Ohio State surgical committee approved her neurosurgeon’s request to perform MCS surgery. Ohio State struggled to get Tiffany’s insurance to cover this costly (and as yet, “experimental”) surgery, so Tiffany, with her typical drive and initiative, attended TNA’s 20th Anniversary conference in an attempt to find answers from other patients who had endured insurance battles over coverage for MCS. There, she found a renowned neurosurgeon from Michigan who could perform the surgery for substantially less money and who had better success rates.
Due to the increasing and debilitating nature of Tiffany’s pain, she decided to take leave from work in mid-July 2010. In September of 2010, Tiffany flew to Michigan to undergo the grueling MCS process. The procedure, usually only employed when all other pharmaceutical and surgical treatments have failed, involves brain surgery with all its risks, including infection and surgical complications. During the MCS operation, electrodes were attached to the cover of Tiffany’s brain, and after a four-day trial period, the electrodes were attached to wires run under her scalp, down her neck, to a programmable neurostimulator device that doctors implanted in her chest. The goal of MCS is to interfere with the chronic pain signals by sending electrical pulses to the brain. Tiffany had now suffered such severe facial pain for over three years that she considered the surgical risks that lay before her incidental to the possibility of pain relief. Even so, recovering from MCS surgery was the worst experience in Tiffany’s life. Only one thing made it worth it: the surgical procedure was wildly successful in reducing her pain. Describing the outcome as a “miracle,” Tiffany’s pain that on a good day seldom fell below a five and bad days tipped the scale at several notches above 10 had been reduced by 80 to 90%.
Tiffany’s journey through torturous facial pain appeared to be at an end, but her joy was short-lived and bittersweet. Just when she thought she was “finally going to get her life back,” disaster struck. Although extensive pain relief was achieved through the procedure, physical healing was unfortunately nonexistent, and within weeks Tiffany flew back to Michigan weakened and sick, puss oozing from the surgical site. Although rare, there is a risk of the body rejecting the foreign material implanted in the brain, and Tiffany’s neurosurgeon believed that was the case in her situation, so she was put on medication and sent back to D.C. to recover. But recovery did not happen. Growing weaker each day, Tiffany sought a second opinion from an infectious disease doctor in Maryland. One look at the now raging infected wound spurred the doctor to have Tiffany immediately hospitalized. Three days of mega doses of antibiotics failed to control the infection that had now overtaken Tiffany’s immune system. Despite her pleas and much to Tiffany’s dismay, doctors insisted that her life-line to pain relief had to be removed or the infection would kill her. With no other options, Tiffany cried as she consented to have the neurostimulator removed. Within 24 hours after removing the MCS device, Tiffany’s excruciating facial pain had returned. Tiffany’s immune system took a major blow from the infection that had raged through her body, and she suffered a secondary infection as a result of the battery of antibiotics used to treat her. The pathway back to physical health was long and slow, but it was the emotional wound suffered from the return of her facial pain that left this born optimist feeling lost and defeated. Short term disability from the law firm where she had just started her career allowed Tiffany the time to stay at home to heal physically, but it was with the help of a caring therapist, loving family, a few steadfast friends and Tiffany’s own resilient nature that eventually allowed her to see a future beyond her sick bed.
Like the tattoo she had engraved on her wrist in ancient script, “perseverance” is the word Tiffany uses to describe making her way through the last four years. Selflessness would also best describe this young woman. Downplaying her own suffering, she decided to turn her talents toward helping start a young person’s initiative within TNA – The Facial Pain Association in order to bring support to the younger generation suffering this devastating disease. TN is most likely to occur in people over 50 and no matter the age of the person, dealing with its painful symptoms can be devastating. However, younger sufferers bring to the table their own unique set of issues. Building relationships (and families), establishing careers, finding insurance, the lack of financial resources, and simply finding the wherewithal to keep living while dealing with the possibility of a long lifetime of unrelenting pain are monumental tasks for the young to overcome. Tiffany will be chairing the committee, working to strategize with others in an effort to discover different ways of helping those who find themselves in similar circumstances. You can hear the excitement take over this young woman’s voice as she discusses the possibilities.
Resiliency and perseverance are understatements when used to characterize Tiffany. Despite the return of her pain, she is ecstatic to return to practicing law and find a way to have a successful career. Determined to beat the odds in dealing with her disease, she is already researching the next possibility of pain relief by studying transcranial magnetic stimulation. When asked what got her through the past few years, hope is the word Tiffany finds first, but she is quick to add that “hope is a luxury and something that you’re not always able to rely on. It is easily crushed. So when hope lets me down, faith pulls me through.” And in times of most need, she turns to her favorite scripture, Romans Chapter 5 verses 3 and 4, “And not only so, but we rejoice in our suffering; for suffering produces perseverance; perseverance, character; and character, hope.” These inspirational words encompass the very soul of this hard working, driven, young woman. Tiffany’s hope and excitement for the future have been heightened with the news that the Facial Pain Research Foundation has initiated research in an effort to find an actual cure for those suffering with neuropathic facial pain, not just a band aid for its symptoms -and a timeline of no more than 10 years to find that cure promised by the Foundations’ founding fathers. This hope keeps her moving toward a brighter future, advocating for others in similar circumstances will help her find peace through her own tribulations, and love and faith will overcome all. Tiffany will succeed, her running shoes once again readied for the race, and in her success, others will follow to find their own hope.