Pheealzabraces: PAOO 2, or an Asia song for a prognosis

The second round of PAOO surgery happened yesterday. I was coming out of the Anesthesia as Dr. Brownfield was finishing up, and since the doses are in 45 minute cycles, I woke up a little quicker than I would if the procedure had lined up with the cycles. This was due to the procedure taking a little longer than anticipated, since some unexpected discoveries were made. It was also not the most pleasant way to wake up from the surgery.

The Resorption has continued and ramped up, evidently. As Dr. B feared when she initially diagnosed it, it has been affecting the bone between the two dead teeth as well as the teeth themselves, and has caused an active infection. She cleaned the infection out as best she could and did a gum graft between the two teeth. She doubled the course of antibiotics for me from 1 to 2 weeks, and the elestics are back on as I type this. Obviously this is a less than ideal development, but it is not a complete surprise. I’m not sure if the resorption had been occurring all along and we just hadn’t seen it until now or it restarted when the damaged teeth got to a certain point in the extrusion process (pulling them down with the elastics).

I spoke with her on the phone this morning and she filled me in on all these developments (I was still out of it enough that any discussion we had right after the surgery is long gone from my memory). I’m going to see her again on Wednesday and going to see Dr. Hall in approximately 2 weeks. 

When I asked her how this might impact the rough timeline that we had been working under she inadvertently quoted one of Asia’s hits, answering “Only Time Will Tell”, which didn’t really come as a great surprise to me.

The pain isn’t too bad right now, but I’m pretty tired and punchy. I took some Tylenol 3’s yesterday spaced apart properly and got some sound sleep, but woke at about 3:30 and never really got back to sleep (the fact that the paper was already delivered by then (shocking) was no help - I read the whole thing hoping it would wear me out but to no avail) mainly for fear of dropping into another deep slumber and turning onto my side, thus inviting another black eye. I went to the store and then had some pancakes and eggs at Teotihucan, so I’m going to see if that was enough to knock me out after I finish this and get it posted.

Many thanks to my friend Rebecca for transport to and from the office (Clint is out of town) and for bringing some delicious water ice from Rita’s later in the evening and hanging out for a bit. Sometimes the fact that I’m going through all this with out a constant companion (human - Bolt is always here for me) is the toughest part about it. But, I soldier on, with plenty of friends I know I can count on available and willing here in town and family a phone call away. I just have this stiff necked aversion to calling on them sometimes, thinking that I’d just be an imposition. Every time I voice that sentiment I get admonished for it, but it still persists, from where I have no idea. 

More as it develops. Thanks for following the saga this far.  

Pheealzabraces: Frozen

So things have been going pretty well along the tooth front until the last checkup I went in for at Dr. Hal’s office yesterday. He confirmed a suspicion that I had about the dead teeth and the two on either side of them, which was that they had stopped moving. He changed the configuration of the elastics on that side and asked me to see Dr. Brownfield to get her opinion. 

She determined that the teeth were ankylosed and that we would have to do another PAOO surgery. Dr. Hall had eluded to this, but it was still not the most welcome news. So, I’ll be going under the knife and drill in about two weeks. Hopefully Dr. Brownfield will be able to coax them to move as much as she and Dr. Hall want them to on schedule so that we can start looking at the extraction of the dead teeth and the installation of the implant(s) and appliance(s). 

Pheealzabraces: Photo Gallery, weeks 1, 2, 3

July 11: The hot mess on the morning of the initial installation.

July 13: Two days after installation.

 July 17: Up close and personal.

July 25: Two weeks out, First rewire and banding. They added a second wire to the top brackets to help with spreading out the upper palate. The banding was initially what they called a box. A SINGLE elastic between the two upper eye teeth down to the two lower eye teeth and across. I was never able to re install the single elastic and actually ended up ripping the bracket off the upper left eye tooth trying Monday night. When I went back Tuesday afternoon to have it re attached, Dr. Hall went ahead and told me to do individual elastics from upper to lower eye tooth on either side.   

A much easier endeavor. The second wire should be coming out on the 8th, a decision on the elastics will depend on how much the teeth have moved.

Pheealzabraces: Bracket Installation: 3 days out

I just finished browsing Lingual Braces (the trade name for the Incognito type) blogs to see if what I have been and continue to experience was in the norm, which evidently it is. I am referring to an unexpected and extremely intense "world of pain", in the immortal words of Walter Sobchak.

After about three and a half hours in the chair at Dr. Hall's office which encompassed the cleaning and prep of the teeth, the application of the brackets (two #12 & #21 (I think) came off with the trays and had to be re applied), and the wiring of the brackets I expected there to be a degree of aching pain in my jaws and teeth, since the basic work of the brackets and wires is to move teeth around in existing bone. What I didn't foresee was the difficulty in speaking immediately after the installation of the brackets and the development of painful ulcers on the underside of the side of my tongue near the back from rubbing against the brackets.

The speaking issues (which still haven't gone away) were evident immediately, and were not all that surprising. It's primarily in the from of a lisp, but there is also a good deal of extra salivation that goes on, resulting in having to pause fairly frequently when speaking to deal with (swallow) the aforementioned saliva. The tongue ulcers were a bit more surprising and definitely more annoying. Brace wax and Benzocaine based oral topicals have become my new best friend. There's nothing like having a band of sharp brackets with wire running between them on the inside of your teeth to remind you of how much your tongue moves around in your mouth when eating, coughing, clearing your throat, and hacking.

I bring up hacking because on top of the PAOO surgery and the braces I seem to have caught a dose of a flu of one sort or another. My chest was getting that lovely tightening sensation when I woke up Monday morning for the appointment at Dr. Hall's office and my throat had progressed to the classic hot scratchy state by that evening. The fever (such as it was) has since broken and I'm at the achy, tired, expectorating stage.

The blogs (none more recent than 2012, and the majority being from across the pond in GB) are a bit reassuring, speaking of the tongue pain and the speech issues and stating that, while the first week or two are a bit Hellish, things do settle down and one will get accustomed to the braces.  I've never been the most patient of people, but have learned the prudence of it in the past few years, so reading these entries has helped.

So has the Ninja. I think I'm drinking as many smoothies as I was immediately following the surgery. Soft food isn't too painful, but the (disgusting but inevitable) feeling of food of any type getting caught in the brackets is something that I tend to avoid right now. It's easily rectified with a thorough brushing immediately following the meal, but the smoothies and shakes make satisfying hunger a quicker (depending on the prep time for the smoothie) and cleaner (to an extent - I still brush afterwards) proposition.

Based on the blogs the eighth day is a milestone in terms of adjusting to the brackets and wire, so I'll plan on posting on this topic again then if there are no pressing developments before then. With what's going on in the world over the past ten days (not to discount the entirety of 2016) there may be additional posts on the general state of things once I'm over this lovely crud that is making its way slowly out of my system.

Pheealzabraces: PAOO surgery, 5 days out

Those of you who have been following this saga via social media are aware of the latest step in this long and arduous process, the PAOO surgery. Dr. Brownfield performed it this past Monday (6/27) and I saw her again on Thursday (6/30) for a follow up. Everything is progressing well, although its been a little more intense than the Wisdom Tooth extractions.

In addition to the PAOO procedure, she also did some gum grafting to address the Gingival recession on the lower front as well as the removal of some compound filling put in by Dr. Hung to address distal fractures on my upper molars a couple years ago. All in all it added up to a long day in the chair, though I was, again, blissfully unaware of the proceedings save for another nose scratching episode. This time I was more insistent, and was actually obliged by Dr. Brownfield and her assistant until the spot was scratched.

Once again, faithful friend and responsible party Clint got me to the office and back home and settled in. Monday afternoon and evening are pretty spotty (there was some soccer viewing in there somewhere, and a lot of spit that looked suspiciously like pure blood), not surprising considering I probably had a good bit of sedative and painkiller still in my system. It wasn’t until Tuesday and really Wednesday that the full brunt of what had been done started to hit home.

Apparently I have harder bone than most folks, necessitating the shaving down of it in order for the PAOO cuts to be properly made. My face is going to ache for quite a while, I think. I finally broke down and took a Tylenol 3 (Tylenol w/Codeine) Tuesday night and turned onto my side at some point, which I was advised against due to the fact that not keeping my head elevated might result in one or both eyes blackening. Viola, instant left eye black. It’s not tender or anything, but it sure looks serious. Dr. Brownfield was duly impressed Thursday. I think the bigger pain in all this is the swelling that is stubborn in not going down (my nose feels like it’s stuffed up all the time, but blowing it is an exercise in pain (and futility, most of the time)) and the stitches all over my mouth, especially the ones on the outside of my gums poking into the inside of my lips.

The other tough part about the recovery this go round is how much longer it’s going to take and the necessity for me to take it easy for an extended period of time. I’m lucky I was able to take the entire week off, and glad that I did so. Still, I went out to run errands on the past few days and to band practice last night, which plumb wore me out. It’s frustrating, because the recovery from the extractions was relatively short and easy. I’m not the most patient person in the world, and laying around the house doesn’t feel right, even when I know it’s the best thing for me.

The ‘no solid food for two weeks’ thing is also proving to be interesting, mainly in the sense that it has all but reduced my meat consumption to zero. I’m learning quickly about what I like and don’t like in the smoothie world.

So the next week or so will be an exercise in patience and self control. The stitches come out on Friday (7/8) and the braces go on on the following Monday (7/11) Then the long road to the eventuality that will be the implants to replace the dead teeth that started all this will be underway.

Pheealzabraces: Stage 2, 2 days out

So all four Wisdom teeth are gone, almost thirty years after appearing without incident (aside from confusing and causing slight pain to their owner as they erupted). The second extraction and the recovery are going as smoothly as the first (although the gum flap over the upper socket on the left side (the one worked on yesterday) has already dropped out, almost 24 hours earlier than the right side did), but I'm not too worried. Dr. Brownfield called last night to check on me and said that it was actually a little easier than the right side. I know what to do and not do to avoid complications (he says, knocking on wood). Next up (after the follow up in two weeks) will be coordinating the ordering of the braces and subsequent scheduling of the PAOO surgery.

At Clint's (and my once I was appraised in greater detail of the annoying and hilarious details of my state immediately after the first surgery) request I was given more time to wake up before they called him to come whisk me back to the house. I don't remember coming to in any capacity during the procedure (see the infamous 'trying to scratch his nose" incident during the first surgery), but definitely was lucid afterwards while I was still in the room both in the dental chair and the wheelchair (I imagine they need to have me in one until I'm in the vehicle out front) having conversation with both Dr. Brownfield and the DA who assisted her. I was sharp enough to notice that the ice packs and headwrap that I brought with me to reuse (apparently I was their first patient to ever do that, serial recycler that I am) and remember the entire ride home as well as to wait for Clint to stop the truck, help me out, and help me to the front door. None of which I did the first time, apparently.

Now for some surreal and befuddling communication between the surgeries:

After the first surgery, Dr. Brownfield sent a treatment letter (SOP) to my regular dentist, Dr. Tim Hung. I have been seeing him for about 4 years, and he had put some fillings in on both the top and sides of some of my teeth as well as cutting one of the dead teeth down and placing a crown on it (the tooth in question (6) had darkened over many years mainly due to (voracious) coffee and tea consumption in my younger years. He had also asked me about whether I wanted to explore the possibility of braces, and I told him that I didn't, thinking that he was asking with cosmetic considerations in mind and not the issues that Drs Brownfield and Hall highlighted.

When his office received the letter, they were, shall we say, less than thrilled, called Dr. Brownfield's office and proceeded to espouse in a passionate and a little less than diplomatic manner on how THEY did extractions, and THEY did braces and had spoken to me about them (Dr. Brownfield's office manager Kelly actually fielded the call, which is a normal part of her gig, albeit a pretty crappy one). Dr. Hung then called me to "answer any questions that I might have" about everything that was going on. I spoke with him for a bit and wasn't really sure where things stood with he and I even after the conversation. I spent a couple days before the follow up after the first surgery (about two weeks ago) wondering if I had done something wrong in not going back to him after the visits with Drs Brownfield and Hall (this being my first real experience with a referral). Once I had the follow up with Dr. Brownfield we talked at length about it (she had called Dr. Hung back since he called me) she gave me her take on things which boiled down to the fact that Dr. Hung was trying to offer as many services as possible out of a single facility and that his office was encouraged to try to keep as much as possible procedure wise with established patients in house. While this is certainly the way things are moving in the world that we live in today (think big box home improvement stores and grocery store size sections in Targets and Wal Marts) it doesn't sit too well with me when it comes to the medical industry. Specialists are called that for a reason. Dr. Brownfield tried to assuage Dr. Hung's apparent confusion about why I followed her and Dr. Hall's counsel concerning the braces when he had mentioned it to me earlier by explaining that sometimes it takes a person being told more than once that a certain course of action is preferable. I was also a little confused about Dr. Hung and/or his office's angst over my electing to follow the treatment regimen that Drs Brownfield and Hall had proposed since he had referred me to Dr. Brownfield and she had referred me to Dr. Hall (which she agreed with). Dr. Brownfield also said that she had told Dr. Hung that he wasn't qualified to do the Orthodontic treatment on me due to the lateral cross bite, the over bite, the crowding in the lower front, all of which he ended up agreeing with. It seemed that Dr. Hung's major concern is the two teeth in the front from the accident and how they were going to be addressed. He expressed a desire to try to save the lateral incisor (7), which Dr. Brownfield expressed doubt about, and she felt the conversation ended on a good note.

[This is probably as good a place as any to point out that Dr. Hung has a pretty thick accent and his tone is pretty consistently flat and neutral, making it hard to read him when he speaks to me about issues and procedures outside the scope of day to day tooth care. I outlined this to Dr. Brownfield during my first appointment, which she heard and agreed with after their first conversation.]

So Dr. Brownfield and I decided to do the other two Wisdom teeth next and the PAOO surgery after that (the two together would be a pretty long day in the chair, which I am happy to forego) and Kelly and I scheduled the appointment for Tuesday the 3rd. Then last week (Thursday, I think it was) who should call but Dr. Hung's office asking me to come in so that he could walk me through my options for the next several stages of treatment. I was getting ready for a call at the Opera and was getting close to my limit with him. I asked the woman on the phone (who I'm pretty sure is his wife) what exactly he wanted to talk about since I was already on a set course of treatments that I had discussed with Drs Brownfield and Hall. He came to the phone and eventually made it known that he wanted to walk me through the different replacement options for the two dead teeth in the front. After further conversation with him mainly getting across that I in fact did not have any questions and that (according to my understanding gleaned from discussion with Drs Brownfield and Hall) the replacement of the two front teeth was something we were going to consider after the PAOO and Ortho treatment I got him off the phone (not without him getting his stock way of ending a call out; "If you have any questions don't hesitate to call") and decided not to bother Dr. Brownfield with it and see if he was going to call her office.

Which is indeed what happened. She came into the room before I went under from the oral sedatives (it seems like it took a little longer than the last time) and told me she spoke to him again (I asked resignedly "when did he call you?", to which she replied with a knowing and slightly weary smile: "after he called you." She was more firm with him this time, again attempting to explain that it sometimes takes a person more than once to hear something before deciding on going forward with it. She ended the conversation on a slightly firmer note, stating that she and Dr. Hung didn't need to speak again until after the Ortho treatment at the earliest (I mentioned that it seemed to me Dr. Hung was asking me to make decisions pertaining to "step 7" of this process when I was mere days away from "step 2", which she agreed with). She did mention to me that one of the things he said to her during the conversation was that he "just wanted me to be happy" with the end result, which apparently is something that she'd never heard from a Dentist before. I greeted all of this with a bit of relief (not at the fact that she had heard from him again) but at the fact that it seemed as though he was going to back off a bit (one of the other things he kept mentioning was "coordination between the three offices of our efforts").

I mentioned a couple possibilities that had crossed my mind during the course of the phone calls between Dr. Hung and Dr. Brownfield and I to Dr. Brownfield:

He was fearful of losing control of the overall course of treatment (which I felt he had relinquished with the referral, but this being my first referral experience I am not so sure of now) and potentially me as a patient.

He was concerned about the fate of the two front teeth that prompted the referral in the first place (one of which he had done significant work on with the crown). I don't know, concern over the legacy of that work or the potential that I or Dr. Brownfield or Hall or both would consider that work a failure or at best a stopgap measure?

(A third that I didn't mention to her was the possibility that he didn't appreciate being told that he "wasn't qualified" to do the Ortho on my teeth, especially by a woman. It's another aspect of Dr. Brownfield that I admire pretty highly: establishing an independent practice in a specialized area of a field that is (to my limited observation) still rife with patriarchal attitudes while raising a pair of 2 year old twin boys).

She didn't agree with either of them outright but didn't disagree either, so I have a feeling that it's a combination of the two. Maybe this post should have been subtitled "Ego and Politics in Dentistry"

One of the other things that Dr. Brownfield has mentioned to me more than once is that my case is refreshing in that the history of the two teeth that are eventually going to have to be removed and replaced is a known one and that I'm at peace with that fact. She has told me of patients who, upon hearing such news, have refused to acknowledge that as a possibility, not understanding or being able to remember an incident that might be the underlying cause of the current need for the removal of the tooth and have burst into tears in the chair, left the office and weren't seen again by her for two years. At one point during one of our conversations when this came up I asked if there were one or more Psychology or Communications courses that were a part of the Dental School course load. She answered that there weren't, but that her Undergraduate degree was in Humanities, and that she finds herself using it every day, contrary to what many people say to her ("it's too bad that that degree is going to waste") when they find out that she has the degree and yet is a Dental Specialist.

I'll close this out before I think of another tangent to start rambling about. More after the follow up and potential additional scans/models.

Pheealzabraces: 8 days out

So here we are, a week and a day out from the first leg of this long arduous trek. The surgery went well, and I seem to be healing well and on schedule. There was a little bit of a scare on my part about a potential dry socket on Monday and Tuesday, but it appears to be some tenderness and bacteria build up due to the medicated rinse not getting to all the places it needs to, mainly due to my paranoia about swishing too hard and flushing a graft out of one of the sockets. Slightly more vigorous rinsing and local application of the rinse to the extraction areas seems to be doing the trick.

    I have to extend my appreciation to my buddy Clint who took me to the Dentist and got me home safely in my completely zonked out state, the details of which I remember absolutely nothing until we were back at the house. My only memory after falling asleep is one of waking up (I use the term very loosely, it was at most a state of 50% consciousness) and trying to scratch my nose while feeling a tugging on my lower right jaw. After about five or six attempts, each of which was gently deterred, I gave up with a weary sigh (probably only in my head) and fell back under.

    Clint got me settled in and fed me some Cottage Cheese and a chopped up hard boiled egg (he vetoed my request for some Bacon pieces), and once I was on the couch and not bouncing up every 30 seconds, left me to my own dozing, ice pack changing and baseball/Masters watching devices. Once I got my phone unlocked (Clint texted me asking for my phone pass code after he left the office and I told him that I had the fingerprint reader set up on it for both thumbs and index fingers, then promptly turned it off once I got into the operating room – it only unlocks with the passcode on restart – try that coming out of anesthesia) I added semi coherent postings to the mix between long cat naps. I’m sure my cat Bolt was a little unsure as to what exactly was going on. Time was a rather difficult concept for me to comprehend for the rest of the day. I’d close my eyes and open them after five seconds and it would be two hours later, but getting up to get a banana and come back to sit down and eat it seemed to take 45 minutes when in actuality only 10 passed at the most. I’m also pretty sure I stood in front of the freezer touching either side of my tongue with an ice cube because I could still feel absolutely nothing on the right side at 6 PM and was getting paranoid that a nerve had gotten severed. Yay drugs.

A couple other notable milestones directly related to these current events:

I had my last beer 11 days ago.
I had my last drink 8 days ago. (I’m not inclined to interfere with the Steroids and antibiotics that I’m on if they’ll help me heal faster and not get an infection)

The beard is back. I started growing it about a week before the extraction because I figured shaving would be an unpleasant prospect. The pain never got to that level, and it’s come in about as salt and peppery as I expected (although much slower than I remember it growing in the past), but it’s also garnered a couple compliments so I’m going to let it stay for a while.

My pain threshold seems to be unusually high (just been taking 400 mg of Ibuprofen four times a day, haven’t touched the Acetaminophen that was prescribed for pain), likely as a result of the experience of the wreck and my chest surgery when I was 12.

    I was back at work Friday afternoon and several people were pretty amazed that I was up, moving, and not swollen up like Rocky Balboa after his bout with Apollo Creed. My response was a simple shrug.

I go back to see Dr. Brownfield next Friday to see how I’m healing and to hopefully determine whether the next Surgery will be the left side alone or with the prep and to schedule it.