COQUILLE - For months, Kay Heikkila dreaded brushing her teeth. She would clean the molars and incisors on the right side of her face, then pause, take a deep breath and reluctantly address the other half.

“I couldn't brush my teeth without pain,” the 59-year-old Heikkila said recently from her home in Coquille. “It was not a fun experience.”

The root cause for this discomfort was an uncommon medical condition known as trigeminal neuralgia. Patients diagnosed with the disorder, which occurs in men and women, suffer jolts of pain radiating from the principle nerve along the jawbone.

For Heikkila, the pain could be triggered by physical manipulation, such as with a toothbrush. But at other times, it would strike without warning. And in those instances, the pain was far worse.

Heikkila describes the sensation as a mix between really strong labor pains and an electrical shock, coursing up her face. At its worse, the pain was so great, Heikkila said it would have registered 25 on a scale of one to 10.

“When you get in that much pain, it's hard to quantify,” she recalled.

An ominous sensation

One morning in November 2005, Heikkila was headed to her job at Heritage Place in Bandon when she noticed something unusual in her mouth.

“At first I thought, ‘This is weird,'” she said. “I thought it was a tooth going wrong.”

When the pain persisted, she went to see a doctor, who diagnosed trigeminal neuralgia. He recommended a medication to address the problem. By the following March, her symptoms were subsiding, so Heikkila stopped taking the drug.

Four months later, Heikkila was sitting on a deck, enjoying a summer evening with some of her friends, when the pain returned in a significant way. Previously, she had experienced attacks that would last as long as two minutes and then fade away. This time, the sensation lasted for nearly half an hour.

Her doctor put her back on the drug regimen, but this time it was less effective.

The pain became so great that her daughter insisted she go to Coquille Valley Hospital for treatment.

“I was really scared what would happen to me,” Heikkila recalled.

She remained in the hospital for three days, though physicians were eventually able to get the pain under control. The experience was so traumatic, Heikkila has no recollection of the time spent there.

“Later, I was told I talked and I ate food but I couldn't remember any of it,” she said.

Surgical options

After her stay at Coquille Valley Hospital, her doctor recommended she see a specialist at Sacred Heart Medical Center in Eugene. It was there that she met Dr. Andrew Kokkino.

The neurosurgeon explained to Heikkila she had three medical options to choose from. The first involved making a hole in the back of her skull through which doctors would push her cerebellum to the side and manually reposition the nerve.

“The problem with that method is there is the risk of bleeding, infection and stroke,” Kokkino said. “Bad things can happen, but they generally don't.”

The second option, which Heikkila found equally unappealing, involved inserting a needle through her check and irritating the nerve until it stopped generating the painful reaction.

The final alternative was a “Gamma Knife” treatment. Performed in a chamber not unlike an MRI machine, the procedure involves focusing about 200 cobalt beams on a specific point on the back of the head, where the facial nerve originates.

Although a relatively new option at Sacred Heart - the equipment was installed in November 2006 - the base cost of the Gamma Knife procedure is $35,000, but $10,000 less than an average hospital charge for open brain surgery.

(Andrea Ash, a media relations specialist at Sacred Heart, said an individual's bill could fluctuate based upon the need for additional procedures, the health status of the patient and whether complications arise.)

Dr. Kokkino did not rush a decision, but after several more months of ineffective drug treatment, Heikkila was ready to try it.

“I found (Gamma Knife) less frightening than the invasive procedure and more reassuring than depending on the pills all my life,” she said. “One time, I forgot a pill and that sent terror through my heart because you never know what will happen.”

On Feb. 1, Heikkila arrived at the Eugene facility at 6 a.m. After watching a film explaining what would happen to her, Heikkila received a sedative and then a helmet and brace were placed on her head.

“After putting on the helmet, the patient lies down and then basically just soaks up the rays,” Kokkino said.

For just under a half hour, Heikkila received the treatment.

“It was very quiet. They zap that nerve and then you come out,” she said. “Because of the medication they give you, you don't notice anything really.”

After receiving some lunch, Heikkila was able to leave the hospital less than six hours after entering.

Since the operation, Heikkila has not had any problems.

She has a touch of numbness on the inside of her mouth as a result of the procedure, but it has not dampened her enthusiasm for the operation.

“There was no question I wanted it done,” she said. “If I have to live with (numbness), hey, this is OK.”

According to Kokkino, patients receiving the Gamma Knife treatment can expect a decrease in pain in 80 to 85 percent of cases. About 15 percent experience a return of pain within a five-year period. As of Friday, 29 patients had received treatment at Sacred Heart's Gamma Knife Center.

Even if the pain returns and she needs another procedure, which she would pay for, Heikkila has no regrets. Now, she doesn't worry about having medication with her in case of a surprise attack. And because she takes less medication, she has more energy.

But best of all, she no longer dreads the sight of a tube of Crest.

“That first day, I got home and I put the toothbrush in my mouth and said, ‘Wow!'” she said. “Now, I get so into brushing my teeth.”