Third Time's The Charm

This morning I had my third eye surgery since July, and hopefully the last.  I have been anxious about this because my right eye has been filled with silicon oil since my last eye surgery in August, necessitated by the failure of the first surgery for a detached retina, which was the most painful surgery I have ever endured or would ever want to endure.

I was totally out for the second surgery, at my insistence, intubated and of course I didn't feel a thing.  But for this morning's surgery my doctor insisted that I was to have only a local anesthesia, just like the first surgery, because he might need me to move my head or eye upon command as he worked inside the orb with his tiny instruments and magnification gadgetry, in case the retina started rolling up off its platform of cones and rods as my eye was being flushed of the oil.

I greatly feared another agonizing moment as the scalpel cut into my eye, and I fixated upon that possibility, already once realized, as the weeks approaching surgery drearily went by.  I had a long talk with the anesthesiologist this morning pre-op, who was very sympathetic to my experience during the first surgery as I described it, and she said she had never had any other patient complain about eye pain during eye surgery but every case, and every head, is different and sometimes the nerves leading into the eye alongside the temple or maybe the cheekbone ridge aren't in exactly the same place as normal when the doctor put in the local pain-numbing or blocking cocktail of drugs.

I tried to be a big boy and I forced, or willed, myself to lie as still as possible if the incision hurt again, because that too would pass, as I lay on the gurney in the cold OR and everyone in scrubs bustled about me and spoke in clipped, precise sentences or issued crisp commands.  The next thing I knew I became aware of being wheeled out of the OR with only a trace of memory of people moving about or above me and I hadn't felt a thing, and I was so euphoric about not experiencing any pain during the procedure that an hour later I was dressed and having breakfast with the friend who picked me up (all surgery is ambulatory these days) at a nearby diner.

Surgery

Tomorrow's the big day. Report at 6:30 am to pre-op to save your sight.

Anxious?  Yeah.

Didn't get your bloodwork done this week?  Oops, I forgot, I'm old and can't remember things.

Maybe they'll send me home because I didn't get it and push the eye surgery further down the road.  Couldn't be worse than obviating the October 30th surgery because the dock broke his arm right before that date, necessitating a delay because of him.

I'm O+ anyway so any old blood will do, I think. At least they keep calling me to donate because they love my blood.

The first (of three, counting tomorrow) eye surgery didn't go so well, it hurt a lot and failed to boot so I am leery, to say the least.  They won't tell me exactly what went wrong but I think they blame me for both aspects of the botched surgery.

Me, I blame the first anesthesiologist, because I never felt such shocking pain, in my eye no less. I wasn't expecting it, having had several surgeries before, including where I've been aware of my surroundings, where I never felt a thing.

But this was different, and I never willingly want to experience that again.  Unless I was forewarned, so I could be forearmed.

Perhaps I am wrong, and every so often surgery hurts so much that you'll never forget that first cut for the rest of your life.  Luck of the draw maybe, or perhaps I pushed my so-many-times-painfree quota past its limit.

Or perhaps I got someone who went to Western Florida State instead of Harvard and skipped most of her classes.  I certainly never saw her after the surgery (the surgeon called me as I was being driven home) and although I have voiced my suspicions about the reason for my difficulty in lying still for the surgery, no one has confirmed or disputed my stated inklings.

I can safely say that I never want to get operated on again.  But I'll show up tomorrow and hope (trust) that I won't suddenly feel crushing pain.

It hurt

By Tuesday morning I already knew I had retinal detachment, as I had consulted Dr. Google. But it was worse, I had three tears in the superior region of the retina which was ruining my vision, probably permanently. There's no telling why it occurred.

I was scheduled for surgery that very afternoon and whisked off to the pre-surgery ward and given that famous surgical open-in-the-back garb in the doctor's hope that a surgical window would open sooner. "Who's going to come pick you up after surgery," I was asked.

I frantically made calls and imposed myself upon a good friend, who left work, stayed with me and took me home afterwards. She is a true friend and if my sight in that eye is saved, she will be responsible for that. I spent a restless night as my eye was taped shut and it hurt.

My recovery instructions were to keep my head parallel to the floor 12-14 hours a day for two weeks, then very sedate physical activity for six weeks, and no strenuous physical activity for four months in the hope the repair would take permanently upon the delicate structure of the eye. Try keeping your head very parallel to the floor for 12-14 hours, then extend that for 13 more straight days.

The final dental visit

The third and final trip to the dentist this year, to get the new permanent crown put in, came two weeks after the temporary crown was put in.  Again, it capped a tooth which had had a root canal done so I declined the offer of novocaine before the dentist went to the drill to clean off the stump, remove the temporary cement from the site and clear out or enlarge the pinhole the post in the crown was going to fit into.

The dentist remarked that the crown with a short wire rod jutting out below it, much like the old crown which had been unusable, was a thing of the past and he hadn't even trained in dental school last decade on its use.  Cements were so much better now, he indicated.

But he dropped it in, worked on tamping it down into the hole (I suggested at one point that he just use a rubber mallet) and got it seated perfectly.  Two months later I haven't had a hint of a problem with it.

I was pleased that the 40 minutes or so had not produced the dreaded jolt.  The bill for the three hours of work came to over $2,000, my insurance costing about $40 a month paid about $40 of it, and the good dentist charged off most of it as a courtesy.  I paid the rest.  I'll see my new dentist again when I have my next dental emergency, hopefully not for years.

Dental, day two

The second day of dental work after a crown come out on July 4th was uneventful although protracted.  The first attempt at a permanent mold wasn't successful because I couldn't keep my jaw bite still enough for the entire five minute setting period, so evidently it got some bubbles in it.  Another five minute period was ordered up, which evidently was satisfactory this time around.

I remember a lot of drooling, due to all the stuff I had in my mouth for minutes at a time.  I wondered where the tiny swing-away porcelain sink was which my former dentist had.  Nowadays they do a lot of vacuuming up of saliva, give you tissues to wipe your chin with and if necessary to get grit out of your mouth, a dixie cup half full of water with which you can drink, swish and swirl, spit back into and give back to the tech.

Then I sat through a couple of sittings for settings for the temporary crown (I must have moved my jaw again and introduced bubbles on the first time), it was cemented in and I was done for two weeks while the mold was sent away to the lab so a permanent crown could be made.  There was no drilling this time, except for some rasping and buzzing with a dull bit to remove the excess cement or clay or play-dough or whatever they used in the oral cavity.

I once used a temporary crown for fourteen months while I gathered enough money to come in to sit for a mold for a permanent crown.  There isn't any dental insurance in this country that is worthwhile so dental work tends to be on a pay-as-you go basis, if you do it at all.  My last dentist told me just before she retired that she knew me as an emergency-basis-only client, a challenge overtime I walked through the door.  She was the best, but I was liking Nick already because of his dedication, care and solicitous nature.

More dental, day one.

The twenty-six year old crown with a post that had been wrenched out by chewing on a cold snickers bar was formerly over a ground-down tooth that had my first root canal in it.  Back in the eighties, that procedure turned into a gruesome two-week process for me.  I think it was that dentist's first root canal and several times as I was deep in the chair hearing the electric whine of the drill and smelling the smoke of pulverizing bone, I drew back as an electric shock raced through my jaw.

This always annoyed that dentist and after the obligatory, "Did you feel that?" he'd jab some more novocaine into the back of my mouth.  If the jolt happened again during that session, he'd always dismiss me for a day or two and have me come back later.  This went on for two weeks before the root canal was finished, a time I'll always remember, and I had so many novocaine shots in my mouth that my mouth hurt like, well, the living pincushion it was.

Back in the present, the dental tech lightly placed the old crown into place, saw that it fit, took it out and went to get the dentist.  He repeated that process, saw that it fit perfectly and tightly, and tried to get it back out.  That turned into a struggle that ended with the porcelain bullet finally popping out of the confined space and the suddenness of its release caused him to drop it by accident into my mouth with my face facing upwards and my jaws stretched wide open.

I have always feared something dropping down my throat during a dental procedure but I deftly swept the crown into my cheek with my tongue, where the dentist fished it out.  After the vacant place was filled with cement, there followed a long series of unsuccessful attempts to get the crown back  into place so that it seated correctly.  The fit was too tight and eventually the dentist told me that we would have to create a new crown.  He then ground the tooth stump down a little to clean it off, after asking me if I wanted novocaine although assuring me that I shouldn't feel anything because of the root canal.  I declined the shot and waited nervously as he worked with the drill in my mouth but he was right and I didn't feel any jolts.

So that was the end of day one and I was scheduled to come in to create a mould the next day, as my visit had already consumed 90 minutes.  The doctor asked me if I wanted a prescription for valium to allay my discomfort and anxiety but I turned that down by joking that a staff shot of bourbon would do just fine.  He laughed and said, "Well, we shouldn't be celebrating just yet because we still have work to do."

Brzzz

I've had dental work done lately. Check out my 2015 posts, late in the year, for my recounting of having thousands of dollars of dental work done, based upon emergency conditions.

The fact that then I paid for it entirely out of my pocket (and didn't ever go to the dentist except when something bad happened) reflects upon the American health insurance for-profit industry, which is genuflecting at the altar of profiting obscenely from people's misfortune.  Dental insurance is known to be practically useless, which matters because the condition of your mouth can presage your body's general overall condition or imminent decline, as any dentist of reputable status knows.

This most recent time I had dental insurance, from GEHA, and it paid $77 in amelioration of over $2K worth of dental work.  Dental insurance did I say?  I pay about $39 per month for this, ahem, insurance.

My dentist retired in 2015, and then, before she left her practice, we took on the condition of my mouth and fixed all those cracked teeth which were apparently ready to shatter.  I had for years been going to her (on an emergency basis) because she was good and she was also was one of the few dentists in my life who had never hurt me.

That is, until my last last 2 visits, when she minimized my pain to, I suppose, an acceptable level as she fit the last last crown on an uncooperative tooth resisting the influence of novocain as it was being shaved to accommodate the fitting.  (Brzzz!)  I admired Dr. Rye because she was only thinking of my welfare and didn't run up the score and do unneccessary procedures or charge me excessively.  We also sometimes talked about our kids, who played soccer together way back when.

Yeow!

I'm stuck in mid-winter doldrums and I'm only doing short runs of one or two miles, even though the weather has been temperate.  Right now, early in the morning before sunup, it's above 60 degrees.  I still run five times each week though, that is my discipline.  I'm not in any kind of shape though and my conditioning has fallen through the floor.

I was into my first quarter mile on the W&OD Trail yesterday when, on a foot plant, I felt a nail dig into the bottom of my foot even though I was wearing running shoes and the blacktop path was clear of obstacles.  I immediately stopped, removed my shoe and felt the inside of it to see if there was a burr or a nail in there.  There was nothing in there, nor in my sock, so I inspected the bottom of the shoe.  What I found was shocking, something that hadn't happened to me before in almost two decades of running.

Upon close inspection, it looked like there were two nails driven into the bottom of the shoe, one where I had felt the prick and one further back towards the heel.  My other shoe had no seeming nails driven into its bottom.  I couldn't go on with a nail poking through the bottom of my shoe so I worked at removing the nail by pulling it back through the bottom of the shoe using my fingernails.  I got the two offending projectiles out after some effort and was stunned.

What had pierced my shoes were two hard-as-rocks, pointy-tipped, half-inch thorns, driven straight into the sole of the shoe from the bottom up as though a cobbler had hammered them home.  The back one hadn't pierced the sole of my foot yet but it was waiting to do so at any foot strike; the forward thorn had worked through the bottom of the shoe and its sharp point had stung the sole of my foot, thankfully I stopped immediately.  I was bewildered as to how these offending missiles had gotten into my shoe but later I realized I had cut through my neighbor's back yard to get to the trail on the path's right of way (he has no fence), walking through the vegetative stubble there and I must have walked on a long dead thorny branch lying under the surface of the weeds or tall grass that had imparted its lethal tendrils into my shoe at perfect right angles.  My neighbor would be glad to know I won't cut across the back fringe of his yard along the untended trail's ROW anymore, I'll be using the sidewalk out front to get to the W&OD from now on, but now I'm paranoid and inspect the bottoms of my running shoes every time I put them on.  (These spearlike thorns hurt!)

 

Still Running

Last week I logged 21 miles, with a long run of 10K (6.2 miles).  On that run I went on a big loop that took me past some quiet, reflective spots, reminding me why I like the serenity of running.

The next two days I ran 4.5 miles each day, slowly trying to pick up the pace a little.  I ran by the nearby party store which is already ramping up for Halloween, it's biggest season.  Fall has arrived.

My sister who lives in the midwest visited and we went out to dinner in the district, followed by an evening walk on the Mall.  We traversed the Tidal Basin and enjoyed the quiet, reflective beauty of the Jefferson Memorial with the moon hanging over it.

I finished out my running week with two runs of 3 miles on consecutive days, giving me 21 miles for the week.  One month after surgery, I'm happy with my progress in coming back, although I still have some discomfort as I heal fully.  I was able to spend a day with my sister before she returned home and we walked around DC for awhile, saw the USAF Missing Man Memorial by the Pentagon, had lunch in Falls Church and went out to the Air and Space Museum at Dulles for the afternoon.

More miles

I finished up last week with five lumbering runs totaling 12 miles.  My "long" run was 3 miles, three weeks after surgery.  (Out at the crack of dawn.)

I took three days off and then started off the running week with a "long" run of 4 miles.  There followed a procession of four 3-milers to cap the week at five runs totaling 16 miles.  (In the heat of the day.)

Two runs were nice and easy lopes along the W&OD, and another run took me past the school up the hill, my first foray on a hill, where I saw all the excited schoolchildren piling off their school buses for the first day of being back at school.  (Running by pastoral settings.)

Four weeks after my procedure I am back to running, sort of.  The incisions are healed, although the  abdominal cut still bothers me sometimes but slowly and surely I'm coming back.  (This beautiful cat came out to greet me when I ran by her.)

Final Dental Visit, Part Five.

Two of the three teeth waiting for permanent crowns had been anesthetized now, and the dentist and her technician turned to the third, non-deadened tooth to cement its crown into place.  The dentist placed the molded porcelain cusp onto the tooth, pushed it down and seemed to be pleased with the fit.  Then she pulled it off so the bonding cement could be applied to it.

ZING!  I practically leapt out of the chair and the dentist, two of her gloved fingers deep in my mouth holding the little nub of a faux tooth, struggled not to lose her grip on it while it was still in my mouth.

That was the worst jolt yet because the onset of the pain was so sudden, unexpected and intense.  She took her fingers, clutching the crown, from my mouth and said, "It's the metal on its base that creates that shock effect on the tooth, but we'll deaden that tooth too before we place it in permanently."

As yet another long needle appeared before my face, I croaked, very earnestly, "I can't wait for my ten-mile run back to my house as soon as I leave here."  "In the rain?" she asked.

Final Dental Visit, Part Four.

The dentist came back in and after looking at the fit of the new crown on the top side, she pulled it off so it could be emplaced permanently.  Zing!

"Sensitive, huh?" she remarked, seeing me wince.  "We'll just shoot that up with a mild sedative before we go further with it."

The long needle loomed in front of my face, carrying with it the prospect of needle holes in both sides of my mouth, again.  I sat there glumly, mouth closed tight, for fifteen or twenty seconds composing myself while both women waited patiently before I opened my mouth to accept the shot.

It had been a long three months at the dental office and my pain tolerance was definitely weakening.  While the Novocain took effect on the second tooth, they started in on the lower tooth on that side, the only non-deadened tooth left of the three being worked on that day.

Final Dental Visit, Part Two

The first thing that happened as I settled into the dentist's chair on my final visit, to get three permanent crowns cemented in, on three of the four far-back teeth in my mouth, two lower and one upper, was the dentist shot the particularly sensitive tooth up with Novocain.  She left so the sedation could take effect, and the technician hooked her metal prongee-thing under the temporary crown on one of the other teeth, the one on my upper left side, and jerked it off.

Zing!  "Did that hurt?" she asked.

I nodded miserably.  It was going to be one of those mornings at the dentist's office.

She wrapped the metal point of her prongee in cotton linen and gently rubbed off the residual cement from the tooth surface.  No further pain was provoked, yet.

Running From The Dentist

Because my dentist is retiring this month, I decided to take care of all of my dental problems before she leaves.  She's excellent, and how could I trust anyone else?

Got an extra six grand this year?  Send it to me.

There's a reason that I don't go to the dentist, unbidden by an actual problem.   My dentist wryly commented that my pattern of dental health was emergency management.

Well, yeah.  It hurts and it's expensive.

Final Dental Visit

In my imagination, I'm in Dr. Lipscome's dental office alone on Staten Island as a 10-year old boy over half a century ago, getting seven cavities filled without Novocaine or a parent present; this is not so uncommon back then, either the shocking lack of sedation as teeth are drilled or the lack of a parent accompaniment, as confirmed by friends my age from the same region.  It manifested itself in my psyche when I became an adult as a refusal to go to a dentist unless it was absolutely necessary.

But stuff happens with your teeth.  It's even promoted these days that you should go get your teeth cleaned twice a year (!) by persons who scrape sharp-pointed metal prongs around your teeth.

Ever felt that metal pronger touch somewhere on a naked tooth that produces the Jolt even if you are sedated?  The sudden pain is enough to catapult you out of your seat.

Now well into the next century, no dentist would go any further when he or she sees you jerk in pain without stopping and shooting you up with more with Novocain, and then waiting for it to take effect.  Today I went to the dentist to have three permanent crowns emplaced.

Dental Work

By enduring a few pure-rush-of-pain jabs from my dentist's drill as she ground down a troublesome tooth which couldn't be totally deadened at the point of the crack in the tooth, the tooth was shaped enough to be molded for a permanent crown.  The product to cap the cracked tooth came back from the lab two weeks later and I returned for its insertion and to have, gulp, two more cracked teeth shaped for crowns.

On that day, as I wormed my way into the back of the dental chair and the sweat started to collect on my brow, the tech yanked off the temporary crown over the sensitive tooth and used her prong tool to clear cement off the tooth.  I jerked when she touched the point of the crack in the tooth with her wicked implement.

That hurt.  She didn't touch the spot again.

The dentist came in and tried to place the lab product on the troublesome tooth.  It didn't, wouldn't, fit.

Another Dentist Visit

I came back a week later for another round with the dentist after a painful session the week before.  My posture in the chair was anticipatory, my body was rigid, my mind was focused on the event at hand, more drilling of the bad tooth.

I had taken an Advil the night before and the morning of, and I had eschewed any coffee that morning. The drilling went, well, okay.

Round and round the drill went on the deadened tooth until it actually touched on the point of the crack.  Jolt!

"Hmm," she said.  My dentist now had the lay of the land.  "Your sensitive spot is right on top of the crack in the tooth."

Round and round the drill went on the deadened tooth and again it touched on the point of the crack.  Jolt!

I was far back in the chair now, my knuckles white.  I hadn't started sweating yet, though.

Round and round the drill went on the deadened tooth until it touched on the point of the crack.  Jolt!

Round and round the drill went on the deadened tooth but this time it didn't touch on the point of the crack.  "All done," my dentist said.

I happily paid a large part of my mounting bill, which now was well over $3,000 for the year to date, with at least two more procedures to come within the next 45 days.  But we weren't done yet with that troublesome tooth.

Trembling.

Having yanked out the old fillings on two teeth on my left side, which disclosed the need for crowns on both, my dentist refilled them temporarily and set to work shaping the badly cracked last tooth on my lower right side. We presumed it was deadened, trusting in the power and magic of Novocain.

Whiir!  I was hit with a jolt and reacted noticeably.

"That's really sensitive," she said. "Every time I touch near the point of the crack, you move.  The vibration of the drill sometimes travels down the crack and upsets the nerve, even with local anesthesia.  I hope the crack doesn't run into the nerve, which would require a root canal before we can proceed further."

Always the specter of a root canal.  Suffice to say, two more ampules of Novocain, which is about all the fluid a jaw can take in one sitting, did nothing more that was noticeable to me.  The dentist drilled around one side of the tooth shaping it for the crown but couldn't touch the other side in any way without me reacting.

I was pressed as far back in the chair as far as I could go, my forehead wet with sweat.  The jolts were strong.  I was, well, trembling.

"That's enough for today," she finally said.  "I've gotten about three quarters of it done but you'll have to come back next week for me to finish it.  Sometimes a tooth is just different on another day.  Take an Advil the night before your appointment next week, and that morning also.  And no coffee on the morning you come."

She looked at me intently and asked, "You will come back, won't you, Peter?"  I didn't answer my friend and neighbor.

The anticipation.  I spent a miserable week.

A Dentist

So I came in for some major dental work before my trusted dentist retired, and she deadened my mouth so she could shave down the tooth in the lower right corner of my mouth.  Meanwhile she jabbed the other side of my mouth with novocain as well so she could drill out those two old fillings and refill them.

I could tell things were not progressing nicely when she muttered, "Oh, God," when the first filling was removed.  She was silent when the second filling was drilled out but amidst the smell of scorching teeth and the suction required to keep me from drooling as the second filling came out, I noticed the lack of any encouraging salutation when she finished on that side.

Cha-ching!  She took photos, which she showed me, disclosing cracks in both teeth, hidden for decades under the old fillings, running across the floor of the two teeth and which were bad.

She told me that both of those teeth also needed crowns before one or the other shattered under some awkward bite.  And then she set to work on shaving down the tooth she was going to fit for a crown that day, and that's when the real trouble started.

Dentist

A loose crown put back in and a cavity filled.  Now my dental bill for the year was around $700.

Since my dentist is retiring and I think she is very good, I let her at my cavity-filling session talk me into a teeth cleaning and an oral exam.  Apparently these are basic necessities and neither had been done for years.

So I came in for a teeth cleaning, and now my bill for the year was over a thousand dollars.  The dental examination, which was very thorough with some spectacular pictures of breaking and decaying teeth for my viewing pleasure, sent my bill for the year to date rocketing towards two thousand dollars.

From the examination, my dentist identified a tooth that was badly cracked and needed a crown before it broke into pieces in the not-too-distant future.  She also wanted to pull out two old fillings and, if there were no surprises under them, refill them.

What's the old saw?  If it ain't broke, don't fix it?

Against my better judgment I made not one, not two, but three more dentist appointments, to shave one tooth and fit it for a crown, drill out two old fillings and refill them, and insert the permanent crown when it came back from the lab.  After several years of seeing my dentist two or three times every three or four years, I was going to be seeing a lot more of her in the not-too-distant future.