Kind of… And how better technical SEO could have helped me sooner.
Backstory
Chronic pain is a real thing, and I had it. Many moons ago while playing water polo in college, I dislocated my right temporomandibular joint — my jaw. I won’t go into the gorier details, but it was painful. While I recovered from that relatively quickly I was (mis)diagnosed with Temporomandibular Joint Syndrome (TMJ). And I would occasionally have flareups. Eventually, they would become bad enough that I’d spend a few days down with pain. My pain presented as pressure and tension on the right side of my face, neck, and ear. Typically I felt like I was slowly having a pencil pushed into my ear.
It was distracting. It made me irritable. I spent an inordinate amount of energy I could’ve spent on my productivity or my relationships tamping down the pain. Over time it got worse. And even worse. I saw doctors with the hope that I could get some relief but had little luck. They would schedule an MRI and then tell me the MRI showed nothing wrong with me. The flareup would subside and I’d go back to work if I hadn’t lost the job, and wait for it to return. And it always would. Over time the frequency, intensity, and duration of the flareups would increase, and I’d learn to just deal with the pain as best as I could. On the classic “What’s your pain level on a scale of 1–10?” I would answer “baseline it’s a 3 with occasional flareups to a 7 or 8.”
In 2021 I stumbled accidentally upon the concept of Trigeminal Neuralgia while I was having a flareup. I did that thing all doctors tell you NOT to do and I Googled it. The Wikipedia entry led me to believe I might have TN Type II, or Atypical Trigeminal Neuralgia. My then practitioner at the time agreed. The MRI — as usual — did not. I went home again with no hope that anything would change. But I googled and I googled, and I read the Trigeminal Neuralgia Subreddit.
It’s a pretty bleak landscape. Bleak enough that I’m now going to provide a trigger warning that the following content discusses suicide. That’s right, I’m going to talk about suicide in relation to SEO. Crazy talk, right?
TN is frequently referred to as the “suicide disease” because of its difficulty of diagnosis, poor treatment options and prognoses, and its intensity. If you read the subreddit, there are clear rules posted prohibiting discussion of suicide.
The typical course of action is to prescribe medication, which is usually Carbamazepine or Gabapentin. Some folks have success with these, but I didn’t. First, on Gabapentin I would experience serious fatigue and when I wasn’t sleeping my memory was like Swiss cheese. I would have a conversation that I remembered having but wouldn’t remember important details. For example, I remembered conversing with a friend by phone but had no memory that we’d scheduled lunch for the following day. He called me when I failed to arrive and I drew a blank. I knew we’d talked but the lunch in question just didn’t exist in my memory. As you can imagine, this doesn’t serve someone who does what I do for a living. I need to be sharp and on my game and most of all to remember important details. So I stopped taking the Gabapentin and dealt with the pain.
On Carbamazepine I was just a zombie. I like to say I was like Rex, the male Border Collie in the movie Babe — just non-functional. And I quit taking that and dealt with the pain.
I was at my wit’s end, and what I heard from the Neurologist I was finally able to see after six months didn’t make me feel much better. He was a nice enough fellow, but he was in a health system that didn’t have a specialty in Neurosurgery. The suggestion was radio ablation therapy, which means they use what they refer to as a gamma knife to burn out the offending trigeminal nerve. This has a relatively low success rate; worst of all, it’s not a permanent solution. Even worse, the more often you do the procedure, the more likely that you develop a condition called Anesthesia dolorosa. I’ll let you read about that if you want, but let’s just say it’s bad. Very bad.
I left my initial appointment with the neurologist for Medstar at Union Memorial upset that he’d told me I needed to see a neurosurgeon (which was another 3-month wait) after I’d waited 4 months to see him, and that the neurosurgeon would decide about gamma knife surgery while I continued to try ignoring the pain.
When I got home, I had what I’d call a bit of a breakdown. I called a dear friend who lives in Denver and laid out all of the info I’d been given in tears. While we were on the phone she asked me what my condition was called again, and she googled it. And then something odd happened.
The SEO Issue
She texted me a link to Johns Hopkins Medicine’s Trigeminal Neuralgia department. I’m going to remind you that I live in Baltimore. Hopkins is located in Baltimore. I have Googled trigeminal Neuralgia hundreds of times since my initial diagnosis in the autumn of 2021. I am almost always signed into my Google account via Chrome when I do this or I’m using my phone which by its very nature knows I’m in Baltimore.
I never once received a result for the Johns Hopkins Trigeminal Neuralgia Center.
So first things first, I visited the website and did some very shocking reading about how one of the best TN clinics in the country is in the city where I live. Secondly, I thought long and hard about why I might not have been served that result when I live in Baltimore.
No Technical SEO
Over my two-plus decades of doing digital marketing, I’ve developed a very basic, very quick audit process. It’s the following:
- Search the branded term for the organization in question
- Review the search engine results page. Where does the organization appear in terms of ranking? Are they “above the fold” — do I have to scroll to find them? If you’re looking on your phone or — worse yet — you’ve used a voice assistant for this search, you won’t likely see it.
- Are there rich results for the search in question? On a desktop or tablet, that’s on the right-hand side. On your phone it’s at the top of the result.
- I navigate to the website in question and use Google’s (now deprecated, but still working) tag assistant chrome extension.
- What are the results? If they’re doing things remotely right I expect to see at least a Global Site Tag result, Tag Manager, and Google Analytics.
- I’ll copy the URL and paste it into whatcms.org, and do the same at builtwith.com.
- This gives me an idea why things may not be working wonderfully from an SEO and general functionality perspective.
- I also learn a plethora of things about how they built the site and potentially what their marketing priorities are.
- Next, I use Google’s Rich Results tool, and Schema.org’s schema test to see if they’re doing anything in terms of technical SEO.
This takes less than 10 minutes to perform, and all of the tools I use to do this are free, and don’t require logins or credentials. In that ten minutes, I know enough to have an intelligent conversation with the site’s marketing lead about what they’re doing, and how I can help them improve. It’s not uncommon that I do this even when I’m visiting a site and find it interesting. I want to see what makes the site tick, and I gain a bit of a business intelligence understanding based solely on this quick, easy, and free audit.
In the case of Hopkins Medicine’s TN site, I found this:
- They ARE the first result on the search page for “Johns Hopkins Trigeminal Neuralgia,” and the result has sitelinks. However, there are no rich results. This means Google doesn’t know WHICH city the TN clinic is in, which is why I wasn’t immediately served a result for the clinic by searching for “Trigeminal Neuralgia.”
- There are no results shown from Tag Assistant’s Chrome extension. This means the site doesn’t use Google Analytics, Tag Manager or any other Google tools. This means Hopkins isn’t tracking user traffic with Google. I also didn’t see code for Adobe Analytics within the page’s source code.
- I can see that they’re using Sitecore as their CMS, and that they don’t have a particularly developed back end for technical SEO. Having used Sitecore in the past, I know there are out-of-the-box tools within Sitecore that could improve rankings and searchability significantly.
- Using the structured data testing tools in number 4 above, I can see that there are no rich results, and no schema is detected either. A fairly simple application of properly formed JSON-LD schema code implemented with tools as easy to use as Google Tag Manager can show Google where the clinic is, what they treat, who their doctors are, what the phone number is, operating hours, social links, etc. All of which would make finding the clinic easier for someone like myself.
Searching for “Trigeminal Neuralgia” used to show the Wikipedia article as the first result. Now, a year later it shows a Hopkins Medicine Trigeminal Neuralgia page. This page can’t even be parsed by the structured data testing tools, and the rich results for the search term itself don’t point to the clinic page. There are no obvious links within the above page that take you to the clinic page, and no easy-to-identify calls to action that take you to the TN-specific clinic.
All of this is to say that when I googled “Trigeminal Neuralgia” on the August of 2023 day in question above, I did not get the same result my friend did.
So what happened to me?
I followed the instructions on the clinic page to request an appointment. The representative I spoke with asked me to fill out their intake questionnaire, and I settled in, prepared to wait the week for a response. It was a Friday, They were faster than that, and I got a call asking if I could be seen in their Timonium office the following Thursday.
I lucked out. I saw a great doctor, Judy Huang, who said she thought I was a good candidate for Microvascular Decompression surgery. The basics are that they make an incision behind your ear, open your skull, and then create space between your trigeminal nerve and nearby blood vessels which can create impingements that cause the TN in the first place. Basically, they’re cutting the pain off at the pass. Then they re-seal your skull, stitch you up, and you spend several days in the Neurosurgery ICU, and two months minimum in recovery.
But first, the dreaded MRI. Initially, the radiologist said they saw no impingements, but Dr. Huang said she could see them, and we scheduled surgery for a Tuesday at the end of October.
I woke up from surgery a different person. No more pain and the happy side-benefit of lifelong tinnitus being gone. By the morning after my surgery, I was able to walk around and was discharged Thursday morning.
I was — and continue to be ecstatic about my outcome. In the 8 months since my surgery, I haven’t had any facial pain. No more flareups, no more anxiety about those flareups, and no worries about eventual, inevitable pain.
My only complaint is that it took me so long to find Dr. Huang and the clinic in my own hometown that would get me the relief I needed. If the Hopkins site was using simple schema, I expect I would’ve found them at least 2 years before my friend did. Meaning I would have been seen and gotten the surgery I eventually did that much faster. I would likely have held onto work I lost, and money I didn’t earn because I was laid up in a dark room in pain. I would’ve better-maintained relationships I simply couldn’t because I didn’t have the energy to get past my pain.
While I’m largely joking about it being the fault of poor SEO, I know that finding the Hopkins TN clinic faster would have helped me immeasurably.
I also know that relatively simple improvements to the SEO for the Hopkins Medicine sites would help others get desperately needed relief from TN. I’d do that work for free just to ensure I could help others find these great doctors and suffer less.