12 April 2010

And it’s only Monday!

This morning I took A to the dentist for the first of several visits to have a tedious 'root canal' job ("...a dental procedure that replaces a tooth’s damaged or infected pulp with a filling. The pulp consists of specialised dental cells, blood vessels, tissue fibres and some nerve fibres located in the hollow space in the central part of the tooth..." – that’s a quote from the Better Health Channel, a useful Victorian government website providing health and medical information).

Background: We have just finished dinner last Tuesday in front of TV – A in his Superman chair, so called because it flies him up into the air at the push of a button. (Since I bought him a great little adjustable tilt-table on lockable wheels to use with this chair, the electrically operated recliner has functioned as sometimes-desk chair, hobby chair and dining chair, as well as TV chair and frequent site of daytime naps.) I forget what was on the menu on this night – lamb chops, I think.

As I am clearing away the plates in a bit of a rush, keen to be ready for Foreign Correspondent, A pipes up with: "I think I lost a tooth". I immediately think to myself: "Oh no, one must have fallen off his partial plate. Did he swallow it?" But he removes his plate (bottom jaw) and smiles at me. And no, it's not a bottom tooth that's missing; it's one of the two front teeth in the upper jaw! If I remember correctly, that not really HIS tooth either, but an expensive 'cap' attached to a tooth fragment. So where is the cap? And can it be re-attached?

After a frantic search through table scraps, I finally locate the gleaming little metal-backed porcelain curio. On closer inspection, I see that the cap must have been attached to the tiniest fragment of original tooth, which has now completely snapped off. Not surprising, really, given all the pushing, tugging and tubing that A's jaws were exposed to last year before the decision was made to do a tracheotomy at the end of his first week in hospital.

First thing last Wednesday morning, I ring the dentist’s office. They kindly agree to fit us in at about midday, to see what can be done. But there’s a hitch: we have long ago scheduled A’s Extended Primary Care review with the specialist nurse at our doctor’s office for this Wednesday morning. She only takes these appointments on Wednesdays, and this is our only available Wednesday. Every other Wednesday, we travel to Brisbane for A’s speech therapy clinic at the university. But this Wednesday there’s no Brisbane clinic due to uni holidays. So we can’t reschedule the EPC review. We will just have to rush from there to the dentist – about half an hour’s drive away.

And there's another complication. Wednesday is also the last day of grandson Sam’s one-week stay, and we have promised to take him to a movie in the afternoon. Never mind. The dentist should fit in between the EPC appointment and the movie, with enough time before the movie to grab some lunch somewhere. (Wise old grandma knows better than to go to the cinema with a hungry 12-year-old. The $12 we gave Sam for his movie-time ‘snacks’ would never be enough to fill him up without some lunch beforehand.) The three locations (doctor’s and dentist’s offices and cinema) are all in different towns spread out like points on a ribbon here in the Sunshine Coast hinterland. We will have to move quickly all day (not something A is very good at!)

Fortunately, it all goes like clockwork – greatly helped by Grandson Sam’s good nature and patience, even though the book he’s currently devouring got left at home during our hurried departure on Wednesday morning. But his Nintendo DS Lite made it into my bag, so he spends the waiting time at the doctor’s office happily enough, training his pet Nintendo dog to obey and do tricks. (See any transferable skills there? Oh well, it is school holidays.) Then the dentist’s receptionist lets him choose which TV station to watch in her waiting room.

The dentist manages to ‘bond’ A’s cap back in place with some kind of (we assume) non-poisonous cement! But she isn’t too optimistic about the chances of success. She warns me to watch carefully to make sure A doesn’t swallow the cap if it detaches again. At first I think she is concerned for the damage this might do to A's gastro-intestinal tract. Then I realise she is only suggesting that a swallowed cap will make a very expensive meal, because if this bonding doesn’t work, then a ‘root canal’ procedure, to dig out the remains of the tooth and replace it with a ‘post’, will be the only option. And that will all go much easier (and cheaper!) if we haven’t lost the cap, which can be re-jigged to fit over the post. (Is she suggesting I might somehow want to retrieve a swallowed cap a day or so later?????? Really, there are limits to a carer’s devotion!)

After a quick lunch at our favourite noodle bar (Sam bringing in a sausage roll from next door), we arrive at the cinema just in time to get priority seating before the doors actually open to the public – thanks to Granpa’s tottering status when surrounded by ankle-biters. Sam is very impressed by this, as we get to choose whatever seats we want. By the end of the day, though, we have been going non-stop for seven hours. Even allowing for the time A slept during the movie, we are all pretty tired by the time we get home.

Next day, Thursday, is Blue Care day, in which one of several different angels comes and spends four hours with A while I go off and ‘do my thing’, whatever that may be. In the first months after A’s hospitalisation, I would have to run around doing all the week’s errands, including groceries, as this was my only time away from home. But now A happily accompanies me on all such errands, provided I slow to a snail’s pace or, sometimes, ‘borrow’ one of the shopping centre’s disability go-karts (which he loves). So now during A's carer visit, I am free to entertain myself however I see fit for these four hours each week. At first, without a plan and unused to this freedom, I would drive around aimlessly, unable to decide how best to spend these sacred few hours. Now that I’m better organised, I usually go to a favourite nursery and browse the plants, maybe buying, maybe not – it doesn’t really matter. Very occasionally, I have lunch with a friend. Other times, I just walk by the river or in the National Park. It’s all good medicine.

On this Thursday, though, I am supposed to meet Sam’s ‘real’ paternal grandma (he has quite a few step-grandmas like me!) a half hour down the highway, where we will effect the grandson handover and have a quick coffee! That doesn’t quite go to plan, however, since my Blue Care angel doesn’t arrive until 15 minutes after the time scheduled for my highway rendezvous with Sam's other grandma. Thank god for mobile phones (how did we ever manage get-togethers without them?) The meeting place is quickly changed, with Grandma Grace (GG, as she’s known) offering to drive further in my direction. So I finally hand over the red-headed package safely, GG treats Sam and me to some lunch, and I head off with enough time remaining for me to call into my favourite nursery, Fairhill Native Plants, on the way home. (You can see one outcome of that day's purchases in another recent post.)

Arriving back home on Thursday after my time-off-for-good-behaviour, I walk in the door to A’s big smile, a gap showing where the top front tooth should be! Luckily, our Blue Care angel has retrieved the cap, which hadn’t survived the chicken sandwich, let alone the apple that followed. Obviously the repair was doomed. The next morning, after a couple of phone conversations with the dentist’s receptionist and A’s assurances that he is OK to manage the long sessions in the chair that will be required, we get two appointments this week for the invasive drilling and fitting that, we hope, will re-anchor that salvaged cap into the top jaw 'till death do us (or it) part'.

And the result today: Here we are this morning at the dentist's again. A is just settling into the chair when the dentist asks: “Is he on any blood pressure tablets?” My god, I realise, I don’t really know what two of his five daily tablets are for. (Caregiver-guilt strikes again!) I ring our doctor. The dentist holds the needle in her hand, poised to inject, but our doctor is on the phone to someone else. Minutes (it seems longer) go by. Finally I get the doctor's answer: Yes, one of those tablets is a blood pressure tablet. No problem, says the dentist, as she quickly changes to a different drug, one without adrenaline, which is OK to use with someone taking blood pressure tablets. But then the doctor, still on the phone, asks to speak to the dentist. ‘Has A had his antibiotics first?’ It seems that after mitral valve repairs, anyone undergoing an invasive dental procedure should begin a course of antibiotics at least an hour beforehand to minimise the likelihood of an infection which could make its way to the heart.

I should know this from my experience years ago taking my elderly mother to the dentist. She had the same problem but hated taking pills so much, she eventually stopped going to the dentist just so she wouldn't need to take antibiotics! I had even thought of phoning the doctor early this morning to check that very thing. But I rationalised that surely someone would have told us this at the time of the operation, or at the time of dismissal from the hospital. Did we ever get a list of do’s and don’ts after heart surgery? I guess we probably did. But A's massive post-operative complications overshadowed all the usual cardiac-related warnings we might have paid more attention to otherwise. Anyway, his supervising doctor in hospital never expected A to be able to come home, let alone undergo major dental work.

Well A got his antibiotics (probably not quite an hour before, but fingers crossed!) and I’ve added another no-no to the growing list of warnings in my caregiver’s survival manual. At the end of the week, we go back to the dentist for the rest of the procedure. Here’s hoping it goes too smoothly to warrant another post, except for before and after pictures.


Stafford Ray said...

Root canal therapy is the pits! I think I'd rather have a baby! No, I will not say the line my cryptic trained subconscious brain threw at me, it's too naughty! Anyway, he has my sympathy!

Anonymous said...

I'm exhausted just reading this.

Chartreuse said...

SR: I agree re 'the pits' and also re the rhyme you didn't print! If it weren't one of the two front teeth, we might have gone without any fix -- though how they would have managed to extract the below-gum-level remains remains(!) a mystery. One thing we knew for sure after A's reaction to general anaesthetics last year: we would do just about anything to avoid subjecting his poor ole brain to those drugs again. So a root canal with local injections was the lesser of two evils.
GB: My daily routines often remind me of bygone years chasing around with a toddler, except that then I could still run!

About me

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I started this blog in 2009 when I became a full-time caregiver. My husband had been diagnosed a few years earlier with primary progressive aphasia. Over the next four years until his death in 2013, we went on a journey of discovery about this rare condition. My blog is about what I learned, how we both coped and how the journey deepened our love and appreciation of each other. Allen’s journey is over, but mine goes on.