Here we go again, chapter 2.

Apr 29, 2015

This is a follow-up to the tale of woe that is my last trip to the dentist after a diagnosis of an abscessed molar on the bottom left. I kept the following bits under wraps mostly for the past week or so, save to a small number of people, and then I'll wrap things up with the events of today. To save your stomachs and appetites, the rest of the this post is under the cut. If you read the known side effects of the antibiotic clindamycin carefully you will note the following: Chills, confusion, diarrhea with blood in it, nausea and vomiting.

Guess which ones I had?

The chills and confusion weren't terribly surprising, those are a relatively normal for me when I'm fighting off a bacterial infection but were bad enough that I worked from home for practically all of last week (and even then it was kind of touch and go). I did the best I could with what I had to work with but it wasn't easy. Nausea and vomiting were an unpleasant surprise, to say the least. I spent late Tuesday night and much of Wednesday afternoon purging violently following a couple of "Gangway!" moments sprinting down the hall at home. I wasn't able to keep much of anything down, not even the traditional saltines and water that are supposedly ideal for calming one's stomach. When you can't keep water down, you know something is very wrong, doubly so when you're hurling so hard you're getting splashback. Insult, meet injury. Please don't hurt dignity, she hasn't done anything to you but ask you nicely to cease and desist.

Then the bleeding started.

Seeing as how this post ventured into "too much information" territory almost immediately, I may as well go all-in and say it: I was passing blood along with diarrhea for most of last week. All of the food I managed to keep down checked out the other end rapidly, with a couple gouts of bright red blood in hot persuit. As the EMT's mantra goes, air goes in and out, blood goes 'round and 'round, and any deviation is a bad thing indeed. The very first day it happened was Wednesday, and in point of fact a hasty trip was made to the hospital to get checked out. As near as could be told I wasn't bleeding continually, which meant that nothing was ulcerated or perforated, and really the only thing I could do was keep an eye on things, and if they got worse or if anything else went sideways to call in immediately. In addition, the nausea and vomiting were so bad I had to get my prescription changed to amoxicillin, an old standby from when I was a kid who got four or five ear infections every year. The vomiting and nausea stopped almost immediately (it took one more supplication at the porcelain altar for the clindamycin to fully leave my system) and the internal bleeding was a scary memory by Saturday morning. You have no idea how much of a relief that was to note; or maybe you do, bleeding being a generally bad thing all around. Moving on.

I went back in the chair for the root canal this afternoon to clean up the mess beneath tooth #19. The artist this time was Dr. Anna Ratiner of Union Square Endodontics in downtown San Francisco (490 Post Street, Suite 1516, 94102, within easy walking distance of BART). Really the only bright light in this whole clusterfuck is the fact that I'd already had RCT done on this particular tooth so much of the prep work was already done, it was just a matter of boring through the crown and post to access the pulp cavity, extract the old filling, clean out the root canals themselves, and then fill everything back in with new materials. While unpleasant, the RCT process went as smoothly as could be expected. She shot me up with an awesome combination of anaesthetics that has the entire left side of my face still numb as I write this post a couple of hours after getting out of the chair and set to work carrying out the procedure outlined above.

The bad news was this: When I first visited Dr. Ratiner after being referred by Dr. Freeman, she noted that the molar in question was pushed nearly halfway out of its socket by the inflammation at the tips of the root canals and beneath the neck of the tooth. This was due in part to the fact that the infection had chewed away a nontrivial amount of the mandibular bone in which that tooth is socketed, thus compromising the structural support of the molar. She's not quite sure how much bone is gone yet, it won't be clear on the x-rays until the residual trauma of the RCT procedure is resolved in a week or so. What we do know is that something happened to break the seal beneath the crown on that tooth and give bacteria access to the base of that molar and jawbone, whereupon they set to work making my life difficult in subtle ways for a couple of weeks to a couple of months(!) until the party started in earnest. Hopefully in six to twelve months, we'll have a better idea of how bad things are or are not by the amount of bone regeneration that shows up on a new set of x-rays. I'll also need to get a new crown and a little more reconstructive work done to ensure a better seal next time.

The accessory enervation? She spotted it almost immediately and took it in stride. Yay.

As for the nerve block? I wrote this entry on Tuesday night but timed it to post automatically the next day. One full quarter of my face is insensate and mobility is severely impaired as I finish editing this post. I can't help but sound like I'm really pissed off when in fact I have to enunciate very carefully so as to not accidentally injure anything else inside my mouth. Dinner tonight is a couple of different soft and spoonable foods. I have no idea how I'm going to eat dinner tonight; possibly in my office with a bib because I feel kind of embarassed. It's also really weird only being able to taste on one side of your mouth, kind of like feeling pain when watching someone hit a mannequin with a hammer.

And, lest some people immediately begin crying that clindamycin is a dangerous compound that needs to be banned, please don't do that because you won't do anyone any favors. Every drug on the market has known side effects, that's why there are warning labels on them. Not everybody experiences those side effects but the responsible thing to do is make the warnings known so that physicians and patients can make informed choices about whether or not the risk is acceptible or not, and if you do happen to spot something weird happening with your body you can look at the label and have some idea of why it's happening (and possibly seek medical consultation, as I did). Some of the drugs I need to take every day have side effects that range from euphoria to mood swings to cardiac arrythmia; I experience none of these things but it was helpful to know that I might and know to look out for them. Every body is different, meaning that every person metabolizes things a little differently. For many drugs you pretty much have to roll a botch (warning: TV Tropes link) as it were to get an abreaction. For some drugs side effects are common but the benefit they give is considered more than enough to warrant putting up with them; many drugs used in chemotherapy fall into this category. Sometimes knowing what the side effects are and how likely they are to occur can help one plan around them, such as adapting to insomnia or a sensitivity to sunlight. In my case, I happened to roll at least a two-dice botch on the clindamycin and had to fall back on plan B. Sure, it sucked but it all worked out in the end after seeing a physician.