Because I have seen very anxious people before anaesthetic (and it is not pretty), I was determined to keep a calm manner for my wisdom teeth removal with conscious sedation.
To get to this day, I had consulted two dentists and two maxillofacial surgeons over some months. It would be correct to say that I was running out of cash!
One dentist looked at my teeth for less than 30 seconds before declaring that she could not do it. I was referred to a max fac surgeon who was kindly and gave me mouthwash and insurance tips. However he was too busy to operate on me during this one and only two week break of my university year.
As I was pondering this, I got the biggest oral abscess I have seen in my life (after exaggeration). It was bulging and round and encroached onto my other molars and the pressure of it on my lingual nerve started to make my tongue lose sensation…
Driven by the loss of sensation of a vital part, I visited another dentist who gave me antibiotics and had a look at my OPG scan and confirmed once more that ‘nay it is a surgical extraction’.
Thus with this and many episodes of sore gums and pericoronitis I decided to find another maxfac surgeon. He had a nice but brisk manner – and I don’t think he ever said much to me really. If he did, it was in a very rushed sort of way. He had a warm voice but a funny nervous type of snort at the end of every sentence which was odd! He just handed out some info sheets regarding the procedure and aftercare and I would wait until my holidays.
I came in suitably fasted and I had gotten up early so I could have my legitimate fluid intake before the surgery. The lovely nurse with a bedside manner (which made up for the surgeon’s lack of) took my obs and later the surgeon came in and placed an IV line.
I was not looking but I knew he made me bleed in the process. “Good back pressure you have there” he commented and looked sheepish… This did not bother me as I do this to my patients on a regular basis!!
I was given sunnies to wear which annoyingly rode up on my face as I kept smiling nervously- my good old cheeks kept pushing them up. IV sedation went through and we were ready to start.
The local anaesthetic was rather uncomfortable but much more bearable as I was at the beginnings of a sedated state.
At one point there seemed to be chips of something in the back of my throat and I started gagging and coughing. I am unsure how it was resolved but it was not an issue after my initial complaining and coughing. I have a hazy idea of it being fished out possibly? Or that could have been imagined.
During the procedure, I did not feel much going on in my right side at all. I had a vague recollection of my upper right molar being done but none whatsoever of my right lower one. When the surgeon went to my left side – I started to be able to follow what was happening- this side hurt a lot more.
I also recall how annoying it was for me at the time to hear them chat away to each other (surgeon and the dental assistant) and not talk to me. Lol, I know this was absurd but I still bristled inside while they yarned on about seemingly useless things.
For some reason I kept tensing up my muscles and voluntarily relaxing them. I am not sure if this was my anxiety or a drug effect. Another thing I laughed about later was the fact I kept tilting my head back as far as I can (I had practiced this the night before in mentally preparing for this operation) to be told to put it to neutral!
When he announced that he was done I was surprised and alarmed as I was ‘sure’ that the right lower one had not been done… it had been a comfortable ‘15mins’ (which was more like over an hour).
So while he dictated something, I asked how much midazolam I had been given. This was the med student getting the better of me as well as the curiosity coming from just having done the anaesthetics attachment. He said ‘oh, 6mg of Midaz and 50 micrograms of Fentanyl’. I was a bit miffed as I was never informed about Fentanyl. It would not have really mattered as I would have probably agreed to Fentanyl anyway but it was the principal of having only been mentally ready for midazolam. Oh well- I am sure I benefited from this intraoperative pain relief.
Thus it was my first experience of an opiod and a benzo. I can’t pinpoint the exact effect of the fentanyl but the effect of midaz was interesting.
After the procedure, while I was waiting on the dental chair and gazing at the paintings and the windows I was bathed in this weird sense of clinical happiness. The textbooks would probably call it euphoria. For me I would not qualify it as euphoria but it was a strange sense of wellbeing without any reason to feel so well. I was quite warm and happy and surmised that this must one of the reasons that people get addicted to opiates.
Later, I was thinking of this feeling at home, whereby my feelings about this state had changed to one of eeriness. It was such a bland happiness – so artificial – it scared me in hindsight.
Many hours passed for the local anaesthetic to wear off. It was quite amusing to see the progression of this. The whole of my two cheeks were numb and it was so strange. And despite my efforts to slather my lips with vaseline pre-op to protect them – they had been bruised and particularly my bottom lip started to swell up.
You have this certain helplessness as your bottom lip starts to swell of its own accord and you cannot eat in a coordinated manner. Because I had not had any food for the last 13 hours I was rather hungry. Thus it was funny for me to realise after I finished my soup that some of it had trailed off and had made its way down my chin… ‘An introduction to being elderly’ I thought grimly but not without humour. Luckily the lip began to behave soon after this and I started regaining my feeling in my upper cheeks.
I am glad I did not have facial palsy from the local anaesthetics like my friend did after her teeth extraction. After the sensation returned to my cheeks and my lips recovered, I did not feel bad at all. No swelling, not much pain – I thought ‘wow it’s no big deal!’
But after I regained feeling in my chin – the pain started to come on. I guess the analgesia had worn off. I controlled it with ice and my friends came over with soft foods (the yoghurt without pips was extra thoughtful) and we watched 3 movies in a row :)
Post op day 1
The regular drug intake is such a lie. How can you take a drug every 6 hours a day even when you sleep – you are hardly like to get up, eat food with your drugs in the middle of the night! I guess you would if it was life and death – but then you would have nurses who administer it for you in that situation in hospital. Even with witnessing the annoyance of doctors for patient’s non compliance – it is ironic that I can’t comply either. Same goes for salt water rinses for two minutes, 5 times a day. I think my best effort is three times a day.
Anyway because I was not diligent or mildly negligent in this aspect, I woke up at 7am with pain!! Aaargh. So I was forced to get up after 4 hours of sleep and make myself something to eat with the drugs… I guess this was the payback for getting off lightly on the first day. After a few hours I fell back into sleep.
I employed the use of ice throughout the day as well as paracetamol with codeine for that breakthrough pain in between the non steriodal dosing. Despite all this I gloated in my mind that this pain – bad enough as it was – was nowhere in comparison to my 10/10 pains of dysmenorrhoea.
I actually cannot recall much of this day! It passed by with reading and a movie I think. I was quite tired by my recollection.
Post op day 2
Waking up at 11am with pain, pain, pain wasn’t pleasant. I think the running out of analgesia overnight is terrible as it means half the day is spent playing catchup to control that pain. And that was exactly what I did.
I realised the pain I had on this day was the worst ever. I could feel all the swelling inside my mouth… arrrgh… not on par with my worst ever pain but close to unbearable at certain times.
It was noticed that the capacity of my stomach had shrunk. Even in this short period of a change in diet! I get full from not much by ‘real food’ standards. I mean eating a few fruits would hardly count as a meal for me normally but now making those fruits into a smoothy would have me quite satisfied in terms of satiety.
Then in the evening I had the unfortunate incident of loose motions… and very painful lower abdominal pain. Could this be a karmic follow up of my insolence or disregard yesterday on the forces/deity of pain? This incident was followed by 3 more episodes… I am very grateful to my hot water bottle. I wonder who invented the blissful invention?
I was first suspecting the food I ate – gastroenteritis… then a better differential came along à drug effects. The most likely one being diarrhoea as a side effect of the Diclofenac. Perhaps pseudomembraneous colitis could be a feature. After all I had the risk factors of being female and having been on antibiotics – metronidazole. I looked it up in my favourite online reference – emedicine. The treatment itself was metronidazole or vancomycin – so I hope I will recover.
Although the colicky abdominal pains were bad at the time, in hindsight not my worst pains ever. I am not gloating however – superstition can play a part in the human psyche however laughable it can be. Even though the thought of my 10/10 pains makes me shudder – in effect it has given me a higher pain threshold? I suppose from the ‘training’.
Then a different worry floated across my mind. I know one patient – my age that got gastroenteritis with vomiting and diarrhoea after her wisdom teeth extractions. She was on her non steriodal drugs but got very dehydrated and this culminated towards renal necrosis and her being on dialysis.
This is a worst case scenario, but I could not help think about this and thus I tried my hardest to keep rehydrated. I also want to stock my cupboards with pedialyte…
Post op day 3
After I finally could ignore by abdominal troubles, I fell asleep at 12am – I woke up with pain in my mouth at 2am. This was the exact time I should be having my next dose of NSAID… What a nightmare – if I ate more food I could trigger more diarrhoea but at the same time I did not particularly want to just tolerate the pain and be sleepless nor did I want to get a peptic ulcer by not taking food with the NSAID…
So in a rather irritated mood I went to the kitchen and decided I had enough of this soft food shite! I ate a piece of bread with hummus and an icecream cone like a trumpet with nuts and hard chocolate. It hurt but it made me feel better and rebellious in an absurd way! I read in bed afterwards and slept again.
As I was leaving the throes of a dream which included a swimming pool, a lovely house within it and seeing a friend who recently went to Japan and exploring the grocery stores of Japan I was slowly waking up and thought – why does ice reduce swelling?
I cannot believe I had never really thought about this before! I guess my mouth is swelling from tissue death from the operation. All sorts of channels would be destroyed – lymph, arteries and veins and general tissue rupturing.
How can ice help… it could constrict the mass the water takes up to reduce swelling (marginal probably!) it could constrict the arteries which pump out blood therefore fluid. This can help reduce the increasing swelling. But what about the other aspect of vessel constriction? If the veins constrict – they cannot take away the fluid. However I just realised that the veins are probably wrecked anyway so maybe it stops the backflow of ooze to reduce swelling.
Once swelling is reduced perhaps it allows healing to occur in a timely fashion which would mean swelling can be further gotten rid of. I will look this up – as well as the invention of hot water bottles.
It’s a funny diet I have been subjected to for 4 days. It consists mainly of fruits made into a smoothy, yoghurts, pumpkin soup, rice congee, potato and gravy from KFC. To be honest I am getting quite sick of them actually.
I did eat a banana this morning in an attempt to replenish my low potassium from my unfortunate bowel activities of last night.
Tonight I am looking forward to a potluck party where I am unsure whether they are joking but they have promised me 18 different icecream flavours! I hope like mad it will be true :D
Post op day 4
I held true to my research and instruction. I stayed up last night until 2.30am to take my drugs on time so the falling half lives rule works to my advantage… this aspect was well done – however I did not foresee me getting some very new reflux while trying to sleep… Win some lose some…
My searches have lead to the information that the ‘hot water device’ was used in the 16th century and the first patented rubber hot water bottle was by Mr Penkala.
It is of note that going to the medical library yesterday to pick up some gorgeous books I ordered– The map that changed the world, One hundred years of solitude and Tom Jones – I had come across this distasteful idea across my mindscape once again. The medical school building, for me, somehow came to symbolise oppression of individuality and darkness… It had come across my attention that I currently did not enjoy internal medicine or surgery… what is left for me? I do appreciate the beauty of being a surgical specialist but after being near the end of my medical degree… I just feel that general medicine stifles my feelings of ‘creativity’ (that is if I had any!) or my persona…
Medicine can be so narrow minded – or am I to blame to allow myself to be sheltered or hide within this narrow focus on life? It was a bit disheartening to play a game of Cranium with my friends – some of which had dropped out of university/ was on the dole/ never went to university…
I know – it is dumb to judge people by whether they went to university or not – it is merely an arbitrary measure of their ‘intelligence’ – it probably reflects more about whether that person is a conformist or not.
Anyway what bothered me was the fact my friend who is on the dole sits at home and watches TV and movies all day. I thought secretly of this as ‘wasting precious time’. But they seemed to know so much more about general knowledge and the world than I did…
I mean I cannot really even feel good about my ‘knowledge of medicine’ as they seem to know quite a bit from TV anyway! However laughable this may sound. And besides I am no world expert on medicine despite studying it for 6 years… sigh. I mean some may consider 6 years of study as rather short in some respects!
My superficial judgements are coming into the fore and it shows how easily my meager confidence in anything can be affected.
However I digress – as this is a blog on the journey of my wissies! My defence is that I got 4 wisdom teeth removed – thus I am allowed to fall 4 points in wisdom?
So I woke up with the pain improving into an ache – the throbbing on the left worse than the right.
A nice image from last night was gargling the opening of the right cavity (the stitches seem to be way too tight on the left – perhaps that’s the cause of the pain) when out came a tiny individual browned twig of a broccoli– it had been there for at least over a day! It was very cute.
At the post-op check up, the staff had marvelled over the fact I was not in one bit swollen or bruised. I am quite thankful for that. Unfortunately I am intimately acquainted with the dirty word of the day – Alvogyl- it serves to plug the hole where my teeth used to reside – and presumably soak up the inflammation of the area.
It is quite foul – I describe it as a strong type of antiseptic mouthwash/ strong toothpaste taste continually leeching from my gums into the saliva. Such a horrid taste… yuk yuk yuk
I had no idea I needed two follow up appointments – that’s the poor communication skills of that surgeon for you. My second visit cannot be done as my holiday finishes and I have to go on attachment to another town. This he had never considered or known! Thus I have to track down a buddy of his to flush out the rest of that horrid Alvogyl stuff.
I am continually sucking on lollies to drown out the taste. No wonder it tastes so foul – it has local anaesthetics (lignocaine and eugenol), other chemicals and ofcourse that ‘natural’ mint flavour! Eww
Post op day 5
Although the Alvogyl has totally intensified my already established dislike of spearmint flavours, I realised to my surprise that it at some point during the night gave me NO pain whatsoever! Wow that was great! While my NSAID tablets remain, I have finished my course of Metronidazole. I am now the proud person to go totally off any more analgesia.
You see, although I like the effects of Diclofenac, I was constantly worried about the side effects of renal and gastric damage! Now I can be a free person that is finally good at swallowing pills :p this was a skill that used to evade my sensibilities.
I have left now one last follow up appointment to get rid of the Alvogel traces. Hopefully I will remember to mention that there is still one last stitch remaining (or hopefully he will spot it).
It is confirmed that I have 2 small retained roots in my left molar space – and I will wish they will not cause any troubles in the future.
Thanks for reading my Wissie teeth diaries!
Ps- There are many names for wissies over the world:
Holland – ‘Far back tooth’
Indonesia- ‘Younger tooth’
Japan- ‘Tooth unknown to parents’
Korea – ‘Love tooth’
Thailand- ‘Huddling tooth’
Turkey – ‘20th year tooth’