1 What will you do? |
I have gum recession that resulted (-ing) from bone loss from bruxism/grinding and other factors. Tissue grafts are apparently the way to go, and I had one done some years ago. It used the "harvest tissue from the palate" method, which was one of the most uncomfortable things I've gone through, worse psychologically than walking on my broken leg to the hospital (with the attendent bone crunching).
However, I need more, and I've decided now's the time to do it. I have many, many concerns (is this the right procedure? is the periodontist good?, will it take? ...), and the procedure is not guaranteed to be successful (i.e., whether the graft ultimately "takes" or not), so I categorize it as an experiment. As with any TTL effort, I find that tracking it here helps with the fear. I'll put decisions below as observations, even though it's a few weeks off.
This time I've decided to go with "Alloderm" for the work, which is collagen taken from - get ready for it - cadavers. There is some controversy re how well it lasts over the years, but this periodontist was convincing, so there. The procedure is hideously expensive, but the plus is that the recovery is much faster due to not scraping skin from the palate. However, because of the situation he won't know until he gets started whether the Alloderm will be enough. If not, he'll do the palate business. Wah.
Timeline: There are two separate surgeries necessary (he can do two grafts at once, and I need four total), with three months between them minimum. The first is now scheduled for 4/12 (!) |
2 How will you test your idea and measure success? |
Good question. Since the outcome is not guaranteed, I'll say that getting the procedure done is a success. In TTL fashion, success is working with what I can control, which I'm now thinking of as focusing on becomming an expert discoverer. This includes learning about myself, managing my anxiety, learning, having a health sense of detachment, being curious, working to stay positive and enjoy it, and generally staying open and treating it as an experiment. That said, I will acknowlege that there is strong desire for a couple of things that I cannot control. I put them here to objectify them: The harvesting won't be needed (Alloderm only); the recovery time will be short; the graft will "take" and last for years; I will not feel too much anxiety. |
4 How will you enjoy the journey? |
Ahh. This is really scary for me - a big deal given my dental anxiety, so enjoying it is a challenge. Here are some ideas:
o I'll be taking Xanax for the first time (instead of general anesthesia), which, while a little scary, might be fun. Certainly it'll be interesting.
o I'll appreciate that I'm able to get the procedure done; it's a gift.
o I'll work to come up with some black humor. The cadaver angle is rich.
o I'll be curious about the overall experience, how it compares with expectations and desires, to the previous time I had it done, etc.
o I'll appreciate my increasing resilience that comes from medical procedure experience.
o I'll appreciate my courage.
o I'll bring my iPhone for listening to music or books, maybe.
o I'll appreciate support I'm given from friends and family.
o I'll tell myself "This is exactly what I want and where I want to be."
Any suggestions? |
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Comments & Observations
Matthew Cornell It's scheduled, I've coordinated with my wife, so now the challenge is not obsessing about it. I do not have good mental tools for controlling this kind of thinking. Suggestions welcome!
Mar 18, 2010
Matthew Cornell I found this site, which has many experiences from people who've had it done: http://www.rousselle.com/allan/archives/000256.html It's both scary (they share complications and problems) and a bit reassuring: I am not alone!
Also: I'm reminded of something I was told about dental work: "It's not cancer." Even with no teeth (my ultimate worry) I can survive and - with money - not look like a monster.
Mar 18, 2010
Matthew Cornell Just for fun I've pushed back on the price. The secretary indicated there's apparently a precedent for it. Also, I've called a few periodontists in the Boston area to see if they'll give me their rates for the service codes. YNK!
Mar 18, 2010
Brock Tice There's a precedent for the price, or negotiation of the price? Interesting approach. I really should work in the negotiation angle more. It's so common outside the States (and it can be tiring to have to negotiate every purchase).
Mar 19, 2010
Matthew Cornell It never hurts to ask. I forget almost no one has 100% fixed prices, and, with competition, there should be a little leverage. In this case he's in the realm of the Boston area docs.
Mar 20, 2010
Matthew Cornell Gonna' have to ping the doc re: anesthetic, discount $. As usual, I'm trying to be happy with the uncertainty. Feeling anxious = data.
Mar 27, 2010
Matthew Cornell When following up re: discount, receptionist asked about actual "greenbacks." Feels a little weird, like some under-the-radar deal. It's unsettling.
This is still stressful, and I'm anxious. So many decisions and scary unknowns! I'm trying my mouth-as-machine spin - it's hard not to take it personally.
Mar 29, 2010
Matthew Cornell Decided to forgo anesthesia due to high cost. Instead I'll do a sub-experiment of a tranquilizer like Xanax. I'll beta-test it in the middle of the week when nothing is happening, then test it on the cleaning the week before, then (hopefully) use it the day of the surgery. This is an unknown.
Mar 30, 2010
Matthew Cornell Alloderm black humor: Certificate of authenticity, visiting adopted gum family, what were his gums like like when he was alive. Dreams from the donor.
Mar 30, 2010
Matthew Cornell I'm concerned about my new-ish habit of sucking air through my teeth to dislodge food, which collects more readily these days, because sucking is contra-indicated for the gum surgery - might dislodge the new skin. So a sub-experiment: I'll use the Motivaider every 5 minutes to remind myself to relax my mouth and >not suck< :-). Been doing it for a day and seems to be working!
Mar 30, 2010
Matthew Cornell Surprisingly, the Motivaider seems to have worked! I'll stick with it for a few more days. Doubly surprising, I think it's helping with overall anxiety about the project. Maybe it's because I'm regularly reminding myself to relax my mouth.
Mar 31, 2010
Matthew Cornell Hey, look what I found by accident: "Lessons from 1st graft" from 2006:
o allow at *least* 2 weeks to recover
o take Moxicillin, not straight Penicillin
o walk 30 minutes *every* day
o be prepared for depression afterwards
o don't schedule much for 2-3 weeks after (e.g., no trips)
o ~4 1/2 weeks to get relatively back to normal
This makes me curious: How will this compare to what happens after Monday? We'll see!
Apr 06, 2010
Matthew Cornell The Xanax RX is coming, and I have post-op instructions. Monday is show-time. Surprisingly relaxed about it (relatively speaking). Maybe there's something to this Think, Try, Learn stuff after all ;-) BTW, he gave me a 10% "professional discount" for cash. I'll handcuff the money bag to my wrist, and I'll have to bring Serge The Enforcer.
Apr 07, 2010
Matthew Cornell I thought of another way to enjoy the ride. Until now I've been a little saddened that I won't be able to mountain bike for a week or two (hopefully no longer), and that's manifested as a kind of urgent "get it while you can" feeling. So I've been out on my bike daily. Last night it hit me that a) this urgency is getting in the way of being happy (no riding = lost a precious opportunity), and b) being off the bike has some /advantages/, reduced pain in particular. (Intense biking hurts my back, which I've worked to normally be relatively pain free.) So there - a welcome shift in thinking.
Apr 08, 2010
Matthew Cornell Tomorrow is a regular cleaning, and I'll alpha test the tranquilizer then. I'll freak myself out if I think too much about the drug (ironic, no?) so I'll put on my TTL hat and be curious. Hell, people pay good money for illegal drugs, so why not enjoy it? No matter what, I'm sure I can handle it. I'm curious.
Apr 08, 2010
Matthew Cornell Surprisingly little effect from the tranq. RN wife says probably helped, but not noticed. A surprise. Preparing drug/care chart for next week - seems to help calm a bit.
Apr 10, 2010
Matthew Cornell Pretty much ready for tomorrow. Tonight taking the prescribed double dose of Xanax, which I'm not afraid of. Yesterday I prepared the drug schedule, and it's a doozy (http://www.flickr.com/photos/matthewcornell/4510907321/). I'll suggest that they provide this to others in the future :-)
Apr 11, 2010
Matthew Cornell On my way to the appt. Curious how the larger Xanax dose will work. Got my bag of cash. Reviewing my notes above helps.
Apr 12, 2010
Matthew Cornell Did well during the procedure, which took over three hours. Xanax dose helped, I think, but I *was* present and receiving lots of data from my body, including scraping and pain sensations ;-) Face hurt like a mother until I got home, took high doses of rx painkiller, and konked out for a few hours. The good news is that he didn't need to do "scrapies" on the palette. Watching THe IT Crowd and eating ice cream. Glad *that's* over. Now the subject will test the results.
Apr 12, 2010
Matthew Cornell A surprise: More swelling than expected. Feels like I've been bashed about with a rubber bag. It's like getting pregnant without having sex.
Apr 13, 2010
Matthew Cornell more Surprises:
o not missing the daily drinking chocolate much. My sugar needs are probably being met my the ice cream diet. Additionally, my taste for it has desensitized.
o I didn't expect to miss regular food this much, though it's not surprising - I love to eat!
o swelling still a lot
o not much pain, though my wife thinks I have a relatively high threshold. Maybe , but my /fear/ of pain is up there
o REALLY missing my night guard. I can feel the effects of not wearing it. Might try it tomorrow
o getting much more comfortable with trying rx meds. Part of enjoying the ride?
o The decrease in back pain from not mountain biking is dramatic. Maybe I should take longer breaks between rides.
Apr 15, 2010
Matthew Cornell One of my challenges is, unsurprisingly, not worrying about the healing. My default is to get wrapped up in the minute changes, basically like a tea leaf reader of the body. Ain't helpful. So I'll step up a level up and notice the noticing.
Apr 15, 2010
Matthew Cornell Per usual crazy Matt, it's natural to worry about each and every little spot in the area. Very hard to acknowledge no control, let it go, and trust the outcome!
[After further thought] OK, so here's TTL in action: I'm anxious about one particular area up front where a part of the graft seems to be doing poorly. I noticed that I'm assuming the worst - that it shouldn't be going this way, that it will die, and feeling loss over that. However, all this is unfounded speculation. I can't know for certain what actually will happen, so I activate my curiosity and question each assumption, such as how this particular area will change, how fast it will change, and whether it actually sloughs off or regrows. I can't turn off my desire for a particular outcome - 100% perfect results (unrealistic) - but I /can/ use it to learn about myself, esp. comparing What Is to What Ought To Be."
Apr 16, 2010
Matthew Cornell Swelling peaked Thu eve, so on the mend in that regard. Still working on not "pre-worrying" (anticipating problems with no evidence). My wife points out that I'm probably underestimating the impact of all the drugs I'm taking, esp. mentally. I don't think she's just being mean ;-)
Apr 17, 2010
Matthew Cornell Seemed to have reached a turning point this morning - feeling better, swelling down, now just some residual bruising. Relatively successful at ignoring the area of concern.
Apr 18, 2010
Matthew Cornell Skipped the Ibuprofen yesterday to see its effects, and discovered there's still some achiness. Starting my seventh day.
Apr 19, 2010
Matthew Cornell It's been one week. I still feel a bit doped, and my energy flags ea afternoon. Able to get some work done, but must manage ambition. Great info for next time.
Apr 20, 2010
Matthew Cornell For someone who struggles with anxiety, making observations with detachment is hard. I'm attached to my vision of a perfect result, which means no dead tissue. It ain't so.
Apr 21, 2010
Matthew Cornell day 9: the subject is experiencing mild-to-moderate signs of depression
while going through the gum surgery, I realize the diary will be helpful when I get it done in the future (!) because I can look back, be comforted by having a better sense of what to expect (decreases unknowns), and might make me more curious by wondering how the second time might compare - valuable data!
Apr 21, 2010
Matthew Cornell Last two days my mouth's been feeling a little less Frankenstein-ish. Turned a corner? Helps that I finished off the last of the Rx meds yesterday. (My RN wife *really* dislikes Prednisone, BTW.)
When I get anxious about results I remind myself that the outcome is an experiment, over which I've exerted as much control as humanly possible - I've followed the instructions like a saint. That plus trust in the perio. Tue is the 2 week appointment, which will generate lots of data.
Eating on one side of the mouth has pretty much become a habit. That said, I look forward to being able to use my whole mouth. Very importantly, using the Alloderm and not having to harvest from the palette has been a huge factor in being more comfortable than last time I got it done. Eating then was a lot less pleasant. Enjoying the ride surprise: Conscious eating is /necessary/ :-)
Looking forward to thoroughly brushing and flossing, too.
Apr 23, 2010
Matthew Cornell Mood has positively tanked starting yesterday, and is taking some of the fun out of gum surgery.
Apr 24, 2010
Matthew Cornell Really imagining the worst re: results, which I'll learn in f/u appointment Tuesday. But who knows - what look bad to me might be OK. Hard.
Apr 25, 2010
Matthew Cornell Capturing my attitude and assumptions going into tomorrow's meeting with the periodontist. Attitude: Curious, respectful, trusting, realistic, and anxious but trying to stay positive anyway. Assumptions: There's a strong part of me that assumes the results aren't great - areas where the graft doesn't cover very much tooth. In fact, these might even be *worse* than when I started. You can see why these thoughts lead to anxiety! I'll know for sure tomorrow. Another assumption: That the results are final - nothing will change or can be done.
Apr 26, 2010
Matthew Cornell Here at the 2w 2d point I'm feeling pretty good. The perio says it's still "very active," which I was able to take in. He things things look good, possibly better than he was expecting. He described what a "disaster" would look like, which was helpful and vivid. Interestingly, he's directed me to massage the area firmly as often as I can think about it. I'm doing this lovingly. It continues...
Apr 28, 2010
Matthew Cornell Psychiatrist confirms Prednisone causes mood swings. Also, my research indicates it might be causing the fatigue I'm feeling. Another case of expectations != reality - I expected to be feeling 100% by this time (~3 weeks). My wife says 6 weeks to be at that point. I am not good at letting myself recover; too much to do!
May 02, 2010
Matthew Cornell Something I did *not* do, but which I was sorely tempted, was to try to "clear out" the three or four white spots (i.e., dead-looking skin), say by rinsing or touching. Leaving them alone is important because - get this - they can fill in with pink tissue. Very cool.
Related: When rinsing with salt water I notice a few spots that are like flaps hanging down. Kinda' gross, but I'm having some success "letting sleeping dogs lie." This is hard for me, but I simply have to trust that it's OK and not create a problem that doesn't exist. There's no pain, and it's not bothering me. Applying TTL, I'm curious what the perio will say/do about it. Let it go? Cut it out? What will flossing be like?
May 04, 2010
Matthew Cornell Mild mountain bike rides yesterday and today were a piece of cake. Some trail riding, mostly on the road, though. I'm not sure what I should be cautious about. Falling? Too much blood flow?
May 04, 2010
Matthew Cornell Took a peek inside my mouth (something I intentionally do infrequently and briefly :-) and noticed staining from the Chlorhexidine (
http://en.wikipedia.org/wiki/Chlorhexidine#Dental). Also noticed a little alteration of taste sensation, but not major. I continue to gently swab a few times a day, which shows a little "dirt" from the teeth. As someone with excellent oral hygiene, this is discomforting. However, I will not put energy into it, and will wait for my appointment in a couple of weeks.
May 06, 2010
Matthew Cornell Spoke with the perio office today re: two things. First was when is it OK to do strenuous exercise, in my case, mountain biking. Doc said if I feel good, go for it. A measure: Is there any throbbing in the surgical area when exercising. I went out for a moderate ride today (about 1 hour of which ~45 minutes was spent riding; max heart rate ~160 BPM) with absolutely no throbbing at all. Yay! I feel like I'm finally coming back on-line. I'll bump it up a notch tomorrow or the weekend. I do love to mountain bike, and I suspect part of the mood destabilization was due to my body's missing the exercise.
The second issue I asked the office about was - this gets a little gross - a thin-ish string of tissue that's hanging down so that I notice it when chewing (still on the left). Surprisingly, I didn't freak too much when I discovered it. They said not to worry unless it is painful or bleeds - generally good advice. I decided to trim it, washing the scissors fairly well beforehand. "Bathroom surgery" my RN wife calls it. I was pretty conservative about it.
Continuing regular rinsing and massage.
May 06, 2010
Brock Tice Good to hear things are coming along. I would have trimmed that string too -- that kind of thing drives me crazy. Luckily the mouth is pretty well 'designed' for losing tissue all of the time, hence the ease of collecting cheek cells for science class, etc.
May 07, 2010
Matthew Cornell On Fri I went for a more strenuous bike ride where my heart was up to ~175, and where we were barreling down hill - bumpy, fast, etc. First, I felt *very* tired - a continuing side-effect of the Prednisone (and possibly of surgery in general). Second, and probably as a result of the former, I noticed a mild sensation in the surgical area akin to throbbing, but something new. A tinging, say. In my usual fashion I freaked a bit. Decided to cut the ride short. It ended up going away after a few hours. But clearly I had pushed my return to exercise too quickly.
May 08, 2010
Matthew Cornell Did some research on the Prednisone to guage how likely I'm experiencing side-effects. Anecotal results:
o even a small dose can cause weaning problems, including headaches like the ones I had at night for about a week after going off it
o how long it takes to clear your system depends on the dosage and how long you took it. some said it takes 1 to 2 times that length to get out. in my case I was on a weaning schedule that was in multiples of 4 mg tablets, from six the first day (24 mg total) down to one (4 mg) on the last. So I've been off it a little over 2 weeks, or 2x. Maybe it's over!
o the exhaustion and mood destabilization are common: "the hardest part of weaning is getting my own adrenal glands to start up again. That's the cause of mood swings, nausea, rash, exhaution, etc. that I get when I stop taking steroids."
o Also "God, but the headaches and fatigue are killing me."
May 08, 2010
Matthew Cornell If I don't end up with any cavities from not brushing and flossing for six weeks, I'll be flipping amazed.
May 08, 2010
Brock Tice Are you using mouthwash or something?
May 09, 2010
Matthew Cornell Definitely, Brock - see Chlorhexidine above. I'm flossing and brushing on the left, but the on the surgical side I can only gently brush the biting surface. Trust!
May 09, 2010
Matthew Cornell Sleep is better the last few nights, which makes me think the Predisone is wearing off. Mood might be better too. MTB the last two days too, but took it easy (1hr, more breaks). Good news!
May 12, 2010
Matthew Cornell At the five week point, and getting better, but still more tired than usual, and moodier in the late afternoon. Prednisone? Looks like my wife was right about six weeks.
May 17, 2010
Matthew Cornell Had my final follow-up with my periodontist this morning, and everything looks great. There are two places in the mouth where I would have liked the gum to cover more of the root, but his explanation makes sense. Plus, going in I acknowledged that the procedure can never have perfect results. Over time I'll be curious to see how it changes. For example, he said it's possible that the graft will "creep" over more tooth, which would be cool.
Conclusion: I'm very happy with the results, and I'm glad I got it done. It was *far* better than getting the "free graft" that required harvesting the palette. I'm checking off this experiment as completed (yay!) and I'll welcome any celebratory emails or comments you might give. (I would love to have Edison "badges" in the future, including "Job Well Done" or such. Check out http://stackoverflow.com/badges). I'll put off the other side for the end of the year.
May 18, 2010
Brock Tice w00t! Interesting that I can comment here, but not when I followed the link from Facebook. Maybe I wasn't logged in?
May 18, 2010
Matthew Cornell Brock, not sure what you tried re: Facebook. I noticed that my comments from here get published but without a link to the original comment. Is it related to that?
May 19, 2010
Matthew Cornell My dental anxiety is almost nil, which is surprising. I'm putting this observation here and in "adopt a new oral care regime" (http://edison.thinktrylearn.com/experiments/show/149) because I'm not sure which contributed more. Probably the surgery, but either way, it's a relief.
Jun 20, 2010
Matthew Cornell Update: I had an evaluation by the periodontist, and the attachment numbers were clearly improved compared to pre-surgery. Also, they're a lot better than the other (non-done) side. I'll definitely be getting the second half done, maybe this fall. Good news, though: He said the Prednisone is not necessary, which will help make it go smoother, I think.
May 15, 2011
Matthew Cornell Finally getting the second half done tomorrow: Edison - gum surgery part 2/2: http://edison.thinktrylearn.com/experiments/show/495
Dec 11, 2011