Dean's New Implant!

I got a new tooth implant a couple weeks ago. The exact need and timing is sort of lost in the blur of time, but I believe the cause was that I had a cavity under a crown (this more than 2 years ago!). Dr. Chang cleaned out the cavity, but there wasn't enough of a stump to fasten a new crown, so the root was extracted and bone graft installed (by oral surgeon). I vaguely recall that because there was a bleeding issue (since I'm on blood thinners), and had to go in for assistance to stop it. Eventually it took, and a few months later, the titanium threaded insert was installed - all was well. I sort of forgot about it, but a couple months ago, Dr. Chang reminded me we had it hanging over me, so after a session with a mouth full of modeling putty, a couple months later I had a new tooth! That is my always-smiling Dr. Chang at left, and at right is an x-ray of the titanium threaded insert and bolt that was in place for something over a year and a half!



The mouth of modeling clay was new (to me), but he took an impression of the top and bottom row of teeth (one at a time) to get a near-perfect model of my teeth. From that, a new replacement was evidently machined or cast and fired in a kiln with a hole to take advantage of the threaded insert. Shown at left is one of the molds with the implant to go at right. The new (pricey)tooth is shown at right before installation - note the hole the bolt goes through to clamp it down.





The modeling clay was used to make a complete cast of my mouth, and was used to create the new tooth. My upper bite is shown at left with the new tooth in place to check for fit.

The implant is fastened in with a titanium bolt, not to different from what you would find in a hardware store - your standard Allen head bolt, but not quite! The sterile one to be used is still in its bag at right.




After the snug check in the plaster cast above, he tried it in the real gap in my mouth. It went in, but interesting he couldn't get it back out! He didn't really panic, but had wanted to remove it to polish it up some, perhaps take a little off where it was binding. Not wanting to damage any neighboring teeth or the implant, he eventually left it in place and placed the bolt in place - yes, using an official torque wrench at left! It really is a little Allen head hex bolt! After proper torque was applied, he filled the drive hole in the bolt with a little UV-curing cement, scraped it off level and it was done! He took one more x-ray of the finished product for the historical record, shown at right... Eventually the gaps will likely distribute more evenly, but I still can't get floss down both sides of the new one. I have an unrelated cleaning scheduled Thursday, so they will likely take another look at it then... For now, all paid for and all the ivories are "in the pink"!

A Final Detour?

In our last post from a week ago, Melinda had been released to a "skilled nursing facility" for some physical rehab to get back her strength and stamina. She didn't really care for the place, so we got out as soon as she passed the PT goals after about a week there. That was this last Monday - 8 August, about noon.

So it was with some concern that about 8 hours later, she was complaining of weakness and lack of energy - generic complaints, but was it worth another trip to the ER? Her blood pressure wasn't particularly low, and her heart rate has been higher than normal since her last round of tachycardia - nothing unusual there. We called the on-call oncologist at the cancer center for his opinion and he supported the decision to go, so called 911 for the second time in 18 days...

So another trip to the ER - more blood tests than last time, but not as much excitement as her BP and HR weren't too unusual. But the preliminary tests showed her hemoglobin was a third of normal, as if her blood volume was way down - no wonder she was so tired! After some quick tests to look for internal bleeding (sonograms and CT scan) they gave her a transfusion of packed red blood cells - eventually giving a second unit by Tuesday morning. A day and night of observation and the emergency seems to have passed... The official diagnosis is "pernicious anemia", a shortage of red blood cells from a lack of vitamin B12. Whether there were some complications from her radiation treatments just ending a week ago remains to be seen, but today before releasing her she got a B12 shot and off to home she goes.

So she is again resting at home, glad to be feeling better and be around the cats. We'll be getting home health care nurses checking up on us and also continuing to get physical therapy at home till she is stronger. For now, with a little assistance, she is going down the hall to the bathroom using her walker. Sister Maj is here helping out and is shown at left with Melinda. Hopefully that last trip was the final detour to staying home - seems like forever we've been camping out at medical facilities - 2 days short of 3 weeks!

Latest Melinda News!

Time for another update for Melinda for those who are not on her Facebook circle!  She was able to finish off her radiation treatments for her cancer while an inpatient at Banner University Medical Center on Monday.  That night they discharged her to a "skilled  nursing facility" to continue her medical treatments and more importantly, provide physical therapy to get her up and around to function normally around the house. 

But when activities started the next day, she was ill-prepared... Banner hadn't really gone to any effort to get her out of bed, and between the conclusion of her radiation, and moving around for the first time in over 10 days, she was exhausted just in standing.  On top of all that, she was feeling poorly and by Tuesday, really wanted to go back to the hospital...  Fortunately a good night's sleep works wonders and the next morning put in a good effort to get up and around.  The days since then have shown good improvement, and she is sitting upright in a chair for well over 30 minutes at a time without her heart rate shooting skyward or blood pressure diving.  The edema in her legs and feet are gone, and amazingly, the back pain is much less too, likely both from the radiation treatments.  Look into her face at left - much more than a hint of a smile in a photo taken by visiting Erica this morning - or maybe my beard was tickling her ear...

Her sister Maj arrives this weekend and she'll spell me in assisting and keeping her company at the facility.  Hopefully in a week or so she'll be discharged for home in time to start her next chemo cycle.   I'm sure being home will make her feel even better, and no doubt is looking forward to continuing her treatments.

Melinda Update

It has been a week already, so time for an update on Melinda! Seems like a bad remake of "Groundhog Day" with an endless repetition of the day before... Our last post gives a good synopsis of the events - turns out her infection caused her to go into septic shock, due to the pasteurella and her lowered immunity from cancer treatments and radiation therapy. Fortunately she was only in the ICU for 48 hours, and has remained since then in a normal hospital room in the oncology ward. Starting Wednesday she has been able to continue her radiation therapy, and after today's session, only has one left on Monday. With the proper antibiotics she has responded well, and the 20cm (8") red blotch marking the infection in her leg has all but disappeared. The original plan was for her to be released today, but several scenarios has caused a rethinking of these plans...

For Melinda, the highest priority has always been to follow the course of treatments outlined by her oncologist. In her mind, nothing should stand in the way of that battle that has raged for nearly 3 full years! The plan was to discharge her to an in-patient facility for rehab, since she has effectively been bedridden for a week now. There has been no attempt to administer rehab or occupational therapy while in the hospital. Unfortunately, all the rehab places do not have the mechanism in place to allow transportation to her radiation or chemotherapy treatments. As a result, Melinda turned down that offer and then the plan was to discharge her to home, with home health-care nursing visiting every day. Of course, since she has not been up, I'm reluctant to take on the responsibility of assisting in her mobility around the house to use the bathroom and other activities. We got to the point that the home health team brought her meds over to us and in the image at left, Danielle is instructing Melinda in giving herself the antibiotic and flushing her port afterwards...

But Melinda hasn't been feeling well the last few days and really didn't want to come home either.  So her doctor approved her staying until Monday.  She will get her last radiation treatment Monday morning, then be released to a rehab facility, and hopefully recover in the week she has off treatments until her chemo starts up.

So that is the plan - a couple more nights at Banner University Medical Center, and some more in a rehab place.  We both feel better with that plan.  Note she has been getting near-endless interruptions to her rest from calls and visitors, so I've taken to carrying her phone with me so as to not wake her while she is napping.  So if you try calling, don't be surprised if I answer!  You are officially up to date!

Our Weekend in the ICU...

Well we've had an interesting weekend - Melinda spent 2 days in the Intensive Care Unit at Banner University Medical Center (BUMC)! Saturday started normally enough - we were sitting around relaxing, mostly controlling Min's back pain w/her Vicodin and my taking care of her needs. She took a dose and laid down for a nap about 4pm, while similarly, I laid down back in the bedroom dozing in front of the Tour de France replay on TV.

When I returned to the living room nearing 6 to do the cat-feeding chores, she was lying funny, as if about to roll off onto the floor. She was sort of "out-of-it" and only partially responsive. Her extremities also had Parkinson's-type tremors. She said she was cold, so I put another blanket on her, turned up the AC a degree and warmed her up some food, which she didn't want once done... After feeding the cats, I queried if she needed anything and she wanted help to go to the bathroom. All this is normal, I've been assisting with most of her bathroom trips the last couple weeks. But she couldn't get up on her own, and once I hoisted her up, she couldn't stand... My first priority was to get her to the bathroom so I fetched the wheelchair we've rented to get her around the hospital, hoisted her up, rotated her and set her down in the chair, and did the same in reverse in the bathroom for her to go. She continued to be only partially responsive and had difficulty holding herself upright, even keeping her head up seemed difficult. I figured there was certainly something going on, so called 911 to get them on their way. After some confusion about our address and how to get there, they arrived in about 15 minutes. Six buffed-out EMTs and firemen hoisted her out of the bathroom onto the cart and rolled her into the ambulance and hauled her to BUMC.

Once there, her heart rate (HR) was 220 with a very low blood pressure (BP). When she saw me, she asked for me to be near her head and I was positioned with a good view of the action. At one time I counted 14 people in, or trying to get into ER room 19 to assist. On two occasions they injected a drug to slow her heart, but both times after the initial drop to near normal, it sped back up over 200. Finally the third time it stayed down. Had it taken a 4th time, they were going to shock her to reset her heart rhythm! She ended up getting 3 liters of fluid, and giving about a gazillion blood samples, many of which were contaminated somewhat with all the saline she was getting.

By about Midnight they moved her up to the ICU, where they took very good care of her. After she got settled in I headed home about 1:30am, and was back about 10. We saw a slew of doctors, and I recounted the above story every time, since Melinda didn't remember anything before getting to the ICU... Tests showed an elevated white blood count and even the preliminary blood culture indicated an infection. So while that is what they were zeroing in on, they took a CT scan, x-rays, ultrasounds, and likely other auxiliary tests I've forgotten. We had a few friends stop by - at left our buddy Erica is shown chatting it up with the patient. Coming back from the CT, the nurses rearranged the bed and equipment so she could enjoy the view out the window from the 3rd floor room.

Today (Monday) we also talked to doctors from infectious diseases and our radiation oncology doctors. Melinda had been getting daily radiation treatments last week, and I called their offices this morning to make sure they knew she was an in-patient, in case the treatments were contributing to her condition, or affect her receiving treatments this week. She got put off for today, but will likely start up again soon. The infectious disease docs came in and talked to us about the likely diagnosis - that her infection was identified as Pasteurella - likely given to her by one of our cats! The bacteria is part of the normal flora in the saliva of cats and can get into humans through a scratch or bite, where a serious infection can result. Once brought to our attention, Melinda had developed a red blotch about 8cm (3") in diameter early on Saturday, which had grown to about 20cm (8") by Sunday before fading today from the antibiotics. While we typically don't get bites from the cats, since they lick themselves, if they were to sit on our laps, get startled and jump down, their claws can break the skin and pass the bacteria. Since Melinda's immune system is diminished from cancer and treatments, she is ultra-susceptible! Sure enough, near the center of her red blotch was a little puncture...

As of 10pm tonight, she was moved out of the ICU do the oncology ward 3NW, where she will likely stay for a day or two before possible discharge to a rehab facility. Well that is the latest - I didn't think life could get much stranger than taking care of her and getting her to her daily radiation treatments, which tend to stretch into 5-hour long affairs. But a trip to the ER and ICU is a kick in the pants that life is easy to shake up even more!

The Seven-Week Ordeal

Don't you just hate it when the littlest things in life misbehave and just kick you in the butt?! The latest case-in-point just came to a conclusion today, but began 7 weeks ago! I was flossing before bed one night in January, and one of my crowns popped off. I was thinking that my dentist could just glue it back in, but Dr Chang pointed out that the little stump it was glued to came off with it, so that couldn't happen... I needed to go to an oral surgeon for a "crown lengthening", trim away the gum line and remove some underlying bone to expose more of the tooth to hold a new crown securely. Sounds fun, eh? At left is shown the offending crown that broke off. No response from the tooth fairy - I guess she's not responsive to fake teeth (crowns)!

So I make an appointment to the recommended oral surgeon - of course, 2 weeks away. In the meantime, no chewing on my right side. Finally the day comes - consultation only, it turns out. It also turns out that I've been there before - a good sign as I recall none of it! Evidently I was there 10 years ago for the same procedure on the tooth in back of the one he is working on this time! He said the job was no problem, appointment was 2 weeks away.

Turns out those 2 weeks were needed. Since I'm on blood thinners (artificial heart valve), I need to be off them for the minor surgery. The gold standard is to go on Lovenox for a few days before to bridge my being off Coumadin. While my drug store stocked it, insurance wouldn't pay it unless it came from Walgreen's Specialty drugs from somewhere in Texas. But to get it, the script from the surgeon that went to CVS somehow had to go through the clearinghouse in Columbus, Ohio to the distribution in Texas. It came the day before I needed to start taking it! Close call!

Surgery day came, my INR (measure of blood clotting) was right where the doctor wanted, and the procedure went fine. He used Versed for the anesthetic - same as used for colonoscopies too. So I was awake, but mostly out of it. Melinda came along to drive me home later - all was well. Until the next day... I had started my Coumadin back up, and sometime on Thursday, the tooth, which was well-packed under gauze and tape, started bleeding and wouldn't stop. Not gushing, but steady enough to have big clots of blood in your mouth every 10 minutes. Hard to sleep through the night that way, but showed no signs of abating, so back to the surgeon, where his assistants worked on me (he was out at some insurance meetings). She got it to slow down if we packed rolls of gauze and I bit down hard, so left it at that - after she supplied me with what seemed a case of gauze! Still bled into Friday, when I involved the INR clinic at the hospital. She had me stop taking the Lovenox after my Friday morning dose and that is what did it - full bleeding stop on Saturday - no more issues. Saw the surgeon a week later - I was fine and he okayed 3 weeks to a new crown.

So today was new crown day! For a fan of technology like me, getting a crown is kind of fun these days. A decade ago when I had my first one, it was the 3-week wait for the permanent crown to come back from the lab. These days, there is a new computer-driven system called CEREC that maps out the tooth with a 3D camera, the dentist designs the tooth on a computer CAD (Computer Aided Design) program. And a little diamond milling machine cuts it out of a block of ceramic in the room next door. After a test fit it is baked in a high-temperature oven and it will be harder than your original teeth! And it usually takes about an hour for the entire process! At left is shown the screen where the dentist designs the tooth to fit the stump below, and at left is the typical fit into place.

New Crown in the Middle

The last one Dr. Chang did for me took 57 minutes! This time we started without anesthesia, but I had some twinges, and he saw another patient for 15 minutes while the novacane took effect. As a result it took about 90 minutes, but better than a 3 week wait.  Oh, and the best part as he said goodbye - since the crown that came off was put on just 3 years ago, he didn't charge me the normal $500! What a guy!  And his last words - don't chew on your right side for 24 hours! Can't wait for tomorrow!

Those Times I nearly Died...

Labor day is one of those holidays that don't hold a lot of meaning for most. But for me, 10 years ago, it was important as I nearly died. Well, on more than one occasion - twice, actually...  But it is a long story, seemingly a lifetime ago. But now, 10 years later, let me tell it.

It starts in 2003.  It was not a good year for me. That was the year I turned 50. My wife Vicki died of pancreatic cancer the end of October, and on MY ACTUAL 50TH BIRTHDAY, 16 December, one of my best friends Ed Vega died of brain cancer. Well, at least 2004 had to be better! A couple weeks into the year and I came down with the flu or something similar... Whether purely physical or if there were emotional aspects to it, I can't say, but I was admitted to UMC in February. Blood cultures indicated an infection, but hydrated and started on antibiotics, I felt better and was discharged a couple days later. Initially feeling ok, I went downhill fast to the point where my friend Roger likely saved my life by driving me to the ER. I finally had a diagnosis - endocarditis with pneumonia. The infection had eaten a hole in my aortic valve - time for some open-heart surgery! The surgery to implant a pig valve was uneventful, and I woke up in intensive care with a 10" chest scar and orders to cough out the phlegm in my lungs - NOT what you want to hear with a new scar!  But sister Linda came out to Tucson to nurse me back to health with some good Iowa cookin' and I recovered quickly.  I was a maniac in cardiac rehab - a shining poster boy on the treadmill for most of the patients nearly a generation older, and back to work in 6 weeks, as I recall... So that was the first time I was near death, but came out of it fine.

Fast forward to 2005, 10 years ago. I had done RAGBRAI, the bike ride across Iowa as a rider - biking the 500+ miles in 7 days the end of July with 15,000 of my friends. It plum wore me out, though, and I didn't have any zip on the hills - but completed it! 10 days later I was back in Tucson and biking in to work on a warm morning (most August mornings are warm in Tucson!). About halfway there, a sledgehammer hit me in the chest - it felt like boiling fluid was flushed down the interior of my chest top-to-bottom. I did not know what it was - I didn't stop, though slowed down a lot. I made it to work, but felt an unusual pain in my stomach, so biked home (good call, huh?) to get horizontal. Couldn't really get comfortable, so went to see my Primary Care Physician the next day. Externally, I seemed fine - he was concerned about my abdominal pain, thinking gall bladder attack, but sent me to a cardiologist. A couple days later I saw the PA of the doc who did my first heart surgery, and she prescribed an MRI, so about a week later went to NW hospital for that. By that time I was feeling fine, was back to work (biking, of course). I'd never had an MRI, but spent seemingly a LONG time in the tube. When I came out the tech wouldn't make eye contact, made me sit down, and literally pushed me the 200 yards in a wheelchair to the ER at Northwest Hospital. I finally found I'd suffered an aortic dissection 10 days before! It had started at my 18-month-old pig valve, and continued up the arch of the aorta, down the entire length to where my femoral arteries branch off. Evidently no one survives that, so they were sort of at a loss of what to do...

The doctors at NW all insisted I'd be operated on that day, then that night, then they transported me to University Medical Center (waiting till evening rush hour so I could add to the traffic congestion). There I was told they had to clear the surgeon's schedule for what was to be a long operation - it was put off till tomorrow, then a couple days - this all while I was NPO (no food) and under observation. After 2 days, I could finally eat, while they continued me under observation. Finally my ER doctor friend Chuck helped them make the decision by sneaking in a cake and 6-pack of beer from a party he left. We drank beers, hiding them under the bed from the nurses, and of course I had some cake too. It was about the next day they sent me home with orders to come back in a week, the day after Labor Day for my marathon surgery. Noted heart surgeon Jack Copeland was on hand to assist, with Raj Bose doing the heavy lifting. It went over 12 hours start to finish, replacing my pig valve with an artificial one (I click now if you listen to my chest!), and rebuilding my aortic arch with a Dacron graft. While the length of my abdominal aorta was unrepaired, I've had annual CT scans to monitor it, and it has been stable to date. There was always talk of reinforcing it with stents, but hasn't been needed. Coming out of surgery I did so much better in recovery than the first surgery as I didn't have the pneumonia to deal with. Vicki's mother Betty came to Tucson for a couple weeks to help nurse me back to health. Shown at left back in those days when she was a mere 80 (we celebrated her birthday while she was with us then), we're headed to South Carolina next month to help her celebrate her 90th. Again, without the pneumonia, recovery was swift and I was back to work in 5 weeks.  It was my 3rd Family Medical Leave in 3 years (Vicki's illness, my first, then second surgeries), and while I was out of sick leave to get paid, thankfully volunteers at Steward Observatory donated vacation hours so I'd get paid! And of course, my friend Valerie Goff (gone now for 4.5 years) made sure everyone was informed of my status and that I had everything I needed, even finding me a new PCP, Dr. Mackstaller who specializes in cardiac issues.  She just retired this month, so I'm not looking forward to replacing her!

The recovery was complete. When it was apparent I was going to survive, I bought my first DSLR camera to take these pictures - among my earliest digital! Physically, I'm on too many blood pressure meds to think about biking across Iowa any more, but I do spend time on the recumbent bike in Illinois. An interesting read about aortic dissections came from the NewYork Times, when noted heart surgeon Michael DeBakey, who developed surgery to repair dissections, suffered one at 97 years old. His description of his symptoms as he suffered them was interesting to read, at least to one who suffered a similar affliction. As I gained strength, I was finally able to travel and carry Vicki's ashes back to South Carolina, where they were scattered off Charleston harbor. Besides Roger and Valerie, sisters Linda and Sheri accompanied us as well, shown at dinner afterwards at left.

Since then, I've had a most excellent life. While I had first met Melinda a couple weeks after Vicki died, we re-met a few months into 2006, married and started this little blog in 2008. So I've cheated death twice now, and finally got to write a little about it, now that the 10th anniversary has come.  Congrats to me!

More Medical Stuff...

Way back last fall (the day after Labor Day), Melinda blacked out and fell, hurting her back. After waiting a long time to see an evidently popular orthopedic doctor, he recommended a Balloon Kyphoplasty, which supposedly gives near-immediate relief to her chronic back pain. Subsequent head CT scans showed a subdural hematoma, which needed to go down on its own before the orthopedic surgeon would do any procedure, which it has. So finally today we had a follow-up appointment with him, and now we're proceeding at the speed of light! She has a new MRI of the injured spine area (T-12) tomorrow, another appointment with the surgeon Friday, and surgery on Monday! Oh yea, and she has to be off her blood thinners, so is transitioning to Lovenox tonight to relieve her clotting issues... She'll likely get a general anesthetic, recover for an hour or two, and get sent home with no pain, according to the doctor. She is a little nervous, but looking forward to some relief from the chronic pain she has had for 7 months!