Dentistry, St. George and Salvation

Dr. Doug Lovely extracted my molar on an emergency basis. He’s a kind and caring man, a gifted dentist and my personal Mensch.  He commented about the suddenness of the white van jihadi attack in Toronto this week, “Life is fragile. I doubt any of those people who got up that morning thought they’d be mowed down and killed on the street.”

As he was extracting my tooth he commented on the copious pus escaping.  “It must be 200 cc. No wonder your jaw and cheek were all swollen. Most people respond to antibiotics but you didn’t."
He went on to say, "Before antibiotics people died all the time from these abscesses.  When I read history I'm always  amazed at how many people died of infections, consumption, TB, pneumonia.  Then there were the flu epidemics. We take it for granted but antibiotics changed the course of history.” 

I listened as the suction took the pus. Then there was intense tugging and a cracking sound.  “It’s a boy!” Doug laughingly exclaimed.  His bright and beautiful assistant laughed too. There was obvious relief.  Anyone who lives in the real world, especially that of surgery, knows things can take very scary turns.  That moment though it was as if the war had paused.  The  words ‘cease fire’ were being shouted down the battlefield.

I laughed too, a little, as best one can, in a dental chair, another's fists in your mouth. My eyes teared with the relief.  God , the relief.  In the night I'd felt I couldn't go on.    I am so ashamed at how weak I am alone. I so don't like to be dependent, to ask for help, to need help.
The evil was now gone.  The thought of the pus though left me feeling dirty. The sickly smell of anaerobes in the room. The scent of contagion.  The shame. I'd been defiled and not even known it. I felt apologetic for kissing her days before.  I felt betrayed by my body. Smaller. Human.
The nightmare was all but over now.  I felt I was no longer on the down elevator, not moving up yet, but no longer descending.
There followed  a tense moment as Doug moved along to get out the back root. He heaved and pulled, a muscular activity, with steady gentle persuasion.  

 “You don’t want to break the root off in the socket.” He said.
I thought of thousands of years and millions of toothaches.  The sheer misery in the world untold, before the advent of modern dentistry, precision tools, anitibiotics,  anesthesia, guild and professional training.   A toothache can be so humbling.   We are an ungrateful species. I'm the worst, so utterly self absorbed till life literally slaps me in the face. 

When that second root came out it was a bit of an aftermath.  A last tug and more relief.  Both Doug and his assistant relaxed. The tension left the room. Almost immediately it was like the Post Modern Jukebox began playing a coccabana song.   Tropical breezes wafted through the room.  Water lapping on beach in the distance.  Sunrise over sand.  Sweet relief.
The offending tooth and all it’s parts were gone. The whole body strained.  Doug had been asking me how I was doing through out the procedure.  I'd only grunted.  Now I felt good. It's  been a long time since  I felt good.  

I’d not been breathing there for a bit. My chest  felt heavy. Bacteremia. Septicemia.  The whole process was a work out, a physical ordeal.  I’m not as young and athletic as I once was. I felt tired,  worn, battered.  The Travelling Willbury Song, “Handle me with care.”comes to mind too often these days.

The briefest exquisite pain occurred then, like an electric shock.   Doug pulled out the last of the abscess sack.   A tiny price to pay.  “I added more freezing but it leaks out so quickly at the end when everything is so inflamed.” he said.   It gave me a glimpse of what dental and surgical care had been like before the advent of anaesthesia.   What else do we take for granted, I thought. 

 Every second that passed from the removal of that offending tooth,  gospel band Third Day's song, "There's a Light at the End the Tunnel" now  played in my mind. Hillsong, Mercy,  Grace and Salvation all came to mind. Timeless themes.

I’d been crying in the night in pain and despair, waiting till 6 am to email Doug that morning. Sleeplessness makes everything worse. I remember  being alone at sea, at night, at the end of a hurricane , waiting for either my boat to break up, pitchpole in the high seas, or dawn to come. Dawn had come with all it's glory that day.  Dawn came this day.  Again.  "Ye of little faith."
I'd just read that Kate Middleton, Duchess of Cambridge, gave birth to her royal baby boy, serendipitously, on St. George's Day.   A great time of celebration.
I had a fleeting thought of  Dr. Doug Lovely as St. George, white shining dental armour, great dental lance,  the evil dragon tooth putrid tooth stabbed dead through the middle.  

I don’t know how long the pustulence had been there.  Abscesses are sneaky that way.  Like liars and false allegations. I’ve not felt well for some time.  Low grade fever. Lethargy. Disappointment with putrid politics.  Negativity.  I just couldn’t shake the foreboding. Too many family and friends dying. Patients dying.  Another great one died last week. He'd turned his life around and was a veritable success story in so many ways before his cirrhotic liver dragged him home.  Maybe only the good die young. I'm around for a long time.
My own mortality has been ever present. It’s been a  bad winter of sad blues tinged with poor rockabilly. The tooth flaring last week moved the whole universe symphonically.  It became a regular Tchaikovsky then crescendoed seriously Richard Straus at the end.  Now there’s hope again. I'd loved a little Bach, maybe some Handel's, Water Music.  I’d give anything for Strauss but that’s reaching in these shallow godless bureaucratic times.

I slept last night. I’m still on antibiotics. My mind is clearer. I woke to  sunshine and spring. I feel like Steven Segal punched me in the jaw in my sleep.  Otherwise the swelling is down.  I actually feel hope.  I’d lost it there. I'm pretty much a wimp.
Hope's like peace of mind.  And faith. They’re so utterly precious.  They colour the universe. Without them life would be just black and white and grey. I didn't  quite see them slip away.  Somewhere in the night. That 19th version of Dark Night of the Soul,the comic strip despair.
We'd  watched Monty Python last week,  the  Crucifixion Scene,  the men hanging from nails,  whistling and singing, "Always look on the bright side of life."  It's hard not to be cynical.
All those people who survived the jihadi van attack.  A new born baby boy..  A Royal couple pleased as any commoner.  The cycles of life. The blessing of spring.
There's a certain absurdity to a molar abscess. The dentist as St. George. I take life too much for granted these days.  I need to be more thankful for small mercies. The cracks that Leonard Cohen  described are the places where the Light shone in.  The gentle touch of the sacred can still be felt beneath the burden of the mundane.  
I heard the  bird songs today.  The scent of cherry blossoms was in the breeze.   Salvation  and Modern Dentistry.  Hooray for St. George.

Acute and Chronic Sinusitis

Symptons and signs:
Upper Respiratory Infections (ie cough, nasal discharge, passibly fever and chills - ie 'a cold) that are accompanied by "fascial pain  (Degown & Degown' Diagnosistic Examination, Richard L. DeGowin, McGraw Hill Inc 1994)  suggests 'acute suppurative (draining) sinusitis'). If it is the maxillary sinus then the fascial pain is dull and throbbing in the cheek and several of the upper teeth on that side.  Thumb pressure tenderness may be noted over the sinus invoved. Frontal sinus involvement is noted with pain in the forehead and along the eye brow ridge.  Ethmoid sinus is medial (next to) the eye and deep feeling. Sphenoid Sinusitis generates pain behind the eye.  Chronic or subacute sinusitis is sinusitis that lasts more than 3 weeks.  Xray or CT scan may help with the diagnosis at this time.  12 week is the figure used by Mayo Clinic for diagnosis of 'chronic'.
Treatment:
Home remedies for acute sinusitis are warm compresses on the face, avoid alcohol, sleep with head up to increase drainage, antiinflamatories ie aspirin, ibuprofen, lots of liquids, antihistaminines, juices especially.
Antibiotics for empiric treatment, ie treatment where it's based on symptons and signs rather than an actual culture of the pus, include amoxil 500mg tid (three times a day) for 10 to 14 days, trimethoprim/sulfamethoxazole 1 DS tab bid (twice a day) for 10-14 days, cefuroxime 250 mg po q 12 h for 10 to 14 days, clarithromycin 250 to 500 mg twice a day for 10 to 14 days, azithromycin 500 mg for 1 day then 250 mg per day for 4 days......(Epocrates)
For Chronic Sinusitis Empiric Antibiotic Treatment changes to include Clindamycin 450 mg 4x a day for 4 to 6 weeks and metronidazole 500 mg twice a day for 4 to 6 weeks followed by a macrolide treatment for 4 to 6 weeks or amoxicillin/clavulanate 875/125 mg twice a day for 4 to 6 weeks. The last one, Amoxicillin/clavulanate may interestingly be used for acute sinusitis as well and is the only one which could be recommended for both.  (Epocrates).
Always with antibiotics avoid where person is allergic.  Note each antibioltic has side effects and those side effects will often make one better than another for an individual patient.
For this reason it's obvious that seeing a physician is the best medicine.  Ear Nose and Throat surgeons are the people who are the specialists and authorities on this condition.  They have little cameras on probes which they can use to enter and look in sinuses and extract fluid for culture and sensitivity assessment of antibiotic optimization.
Sinusitis can be caused by fungus.  It can be caused by allergies. It can represent an underlying autoimmune disorders. All infections can be made worse or arise in depression and stress. People who are over stressed or experiencing anxiety and depression have reduced immunity and risk for infections and risk for persisting infection is increased.  Rest is therefore beneficial at first.
Psychosomatic medicine suggests that people who are healthy are best able to fight illness however those who are chronically stressed, threatened, abused, neglected, over tired have less 'fight' in them. They are more at risk for having a mild illness become more major or extended. Why if a 'bug' is equal, do only certain people in contact with that 'bug' get infected.  That's what immunity is about. Some people are more immunity. Immunity is affected by stress.  Mind and heart affect immunity.
Environmental factors such as cold and damp are not conducive to sinus healing.
Sleep disorders increase risk of infections because sleep is a time of self healing. Pain disorders beget sleep disorders and sleep disorders beget reduced immunity to psychiatric and physical illness.  Too often we treat connected matters as disconnected when in fact they aren't.  Today most things are recognised as multifactorial.
However, often a 'cure' can result from a change in a specific or focal area: resolve the pain or improve the sleep, and the immune system can take care of the sinusitis.  Sinusitis affects sleep by affecting breathing and thereby can cause depression and pain is worse with depression.  So there are these inherrent cycles that can work against one unless recognised. Then the very cycles can be used to benefit the individual.
Using an antihistamine to improve breathing and drainage from sinuses can improve sleep and thereby improve healing.  Advil sinus is one of many over the counter preparations which can be used early.  While it is considered messy, the old fashioned sinus washing process is actually still considered beneficial and recommended by some ENT specialists.

MayoClinic.com is a good safe mainstream resource.