The Scary One With That Power Tool Might Be an Angel

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It’s like a little horror story that reveals a deep underlying niceness, I think drowsily. I slept little the night before and now I am looking up at a golden orb of light seen darkly through goggles, my body very still, lips stretched into the sort of grotesque shape a mime would create to depict a scream. I cannot make a sound. I’ve been this way a long time, or maybe a little; it’s difficult to discern actual minutes. Industrious hums and grinding noises intrude on my consciousness. I think of the chair I am pressed into–it’s a cool, smooth Granny Smith apple green. A shadow falls on my face and water droplets trickle across my neck and chest. My jaw may crack apart at some point but my tongue already fell asleep long ago in the dry gulch that is my mouth. I want desperately to swallow, so do.

“Doing alright, yes?” Dr. K. asks sweetly.

I nod, then she bears down upon the front tooth again.

There have been occasions when such an innocuous question was my cue to consider putting a halt to business and bolting from the tiny room. But, no, I’ve made a long drive from my home. I will stay the duration. I am willing to put myself into her hands despite the costs of being plied with treatments that often can bring pain. Dr. K., my dentist, was found again after I endured a few months with her old team. They gave me enough trouble.

Saved, I think, despite discomfort. It’s not as big a deal as it could be. In fact, it’s downright pleasant when I consider the alternatives. No one is thrilled to see the dentist but if we can any way afford to have even routine care, we go and endure, sometimes with the aid of drugs to prep us. I have experienced dentist appointments in many ways; my history is chock full of them. But fear of dentists was not natural to me as a child.

Dr. Smith was the first to take care of my teeth. That was back when they were still whiter, neat little gems that encouraged my wide smile to grow wider. His office was on the corner of our street, a small brick square overhung with maple trees. From the patient chair I could watch branches sway in the breeze, see birds hopping about, the weather change; the window was large.

He always greeted people with a glamorous grin (Was it really white back then, before whitening was a requirement? No, likely just charming). His black hair was shiny, wavy, precise. He shook my hand, asked me about my family, then school and activities, then how my teeth had been behaving, as if they were unruly things that he would set right. He didn’t have puppets about or cartoon characters on the walls. Dr. Smith was just friendly in a quiet way. Simply hearing his voice made me feel like I was a member of an appreciated group. Comfortable. He was a handsome man, and I imagined he was a potential movie star who decided to take on dentistry at the last minute.

I was glad to be there, no matter possibility of pain. That was a good thing, as I visited him often enough that his waiting room started to feel like another living room. Despite fluoride in our water in my hometown, good insurance, diligent parents, decent habits and healthy meals, my teeth were trouble. He never once indicated he thought so.

“I’ll take care of this,” he’d say. “I’ll fix you right up in a jiffy.”

He’d tell me, “If it hurts, raise your finger and point right at me. But it shouldn’t hurt; I’ve tried to take care of that for you. We’ll be done in no time.”

He had given me a shot? I had barely felt the prick of the needle because he was talking to me about his garden and kids. Afterwards, because I had managed to sit still and let him do good work, I got to pick a small toy from his reward box.

The years passed; I began to grow up some but still visited Dr. Smith often. Between the two of us, I was managing to keep complete ruin of my perilous teeth at bay. In fact they looked and felt pretty good so far.

A few years later when my mother told me Dr. Smith had drowned on a boating trip I burst into tears. Terrible way to die. Horrible that he would never be there again, that he wouldn’t smile at me and pat my shoulder, shape up my defiant teeth and send me home with a greeting for my folks. I couldn’t imagine how things would be managed and knew his family was heartbroken.

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You can see why I was shocked when I got older and visited other dentists. They were too silent or brusque. Many seemed less than happy about their work (many are, I later learned, enough for the profession to have a high suicide rate). Their offices smelled stringent and were a little frightening with their chic colored walls and accoutrements. Who were they kidding? And I hated paying a fortune for the big or small miseries I suspected awaited me. Because my teeth had not stuck to a good course. They had surprises for me like decay, fractures, moving about and coming out. Sometimes they made me ill. I had not inherited good dental genes and worse, I had health issues that added challenges. And my insurance was sometimes not very good. Or it was gone.  Who can afford the cost of surgery, crowns and root canals when you have five children and their teeth are more critically important?

By the time I was in my late-thirties I was aware that my smile was not so lovely. I was a smoker and a coffee and tea drinker. Toss in some rum and whiskey instead of food at times. Chronic illness. I knew my history was apparent.

One time a quirky new employer, my manager, told me she remembered people by their teeth; she was studying mine as she spoke. I was so embarrassed that I talked very carefully with her and smiled infrequently. After that I learned to smile in public with mouth closed, lips curling up at the edges. If you knew me, you would have seen it as fake from the start. I am a laugh-out-loud person, a gabber, someone who likes to say hello with a big smile when taking walks or shopping. In fact, I love to laugh and smile so it was tough to not do so more readily.

But I didn’t have much success finding competent–never mind excellent–dentists. One let a dental tool slip down into my throat, and I had a death-defying moment of gagging until he managed to grasp and remove the item. Another gave me a local injection for a procedure that had epinephrine in it, which I cannot take due to bouts of tachycardia, that is, sudden onset of rapid heartbeat (120-140+ beats per minute). It was coded in red on my chart. Sure enough, in seconds my heart nearly thumped out of my chest. It took 45 minutes for it to settle down. I left shaken up and exhausted. The dentist was appalled by the error, yes, but I was done at that office.

There was the dentist who told terrible jokes, even off-color and sexist. I was captive in the patient chair, unable to even protest as he worked merrily away on my teeth. I complained to the office manager but he was still there the next time so that was that for me.

A life changer occurred when a practitioner didn’t take my emergency phone call seriously enough, instructing me to wait over a week-end. An abscess worsened, causing me to become systemically ill. In bed with severe dental pain and high fever, I finally recovered in two weeks after family intervention and a more potent antibiotic. Following this, I started to have strange heart palpitations with dizziness. I dismissed it as a left over from the infection. Years later I would be informed the infection may have caused my early onset coronary artery disease.

Dentistry! I often told dentists that they should save me the misery and pull them all out. Dentures would look great, too.

All this due to those less conscientious than Dr. Smith, I thought. So when I first met Dr. K. I tried to be hopeful once more. I had just left another dental office due to billing issues that lingered for over a year. There were no more expectations of a satisfactory visit but there was yet another crisis. Dr. K. entered the cubicle, small, quick-moving, soft of voice with an Indian accent so thick I tried hard to figure out what she was saying. She repeated herself. I attuned my ear shortly. Dr. K. explained everything before she did it, answered each question as if it mattered, not as if I was demanding too much. Then I received the best dental care I’ve had in decades. In a couple more visits, we chatted easily.

I apologized for my teeth–occasionally dentists look in my mouth and sigh–but she reassured me.

“No, not such a problem. Don’t say take them out. Good to keep them very long. Many are still quite strong. You are beautiful lady. So good you give counseling to people. I enjoy music and art, too. But really, you must smile more, okay?”

She left after six months to develop her fledgling practice. It was forty-five minutes from my neighborhood. I thought that too far to drive. That was before I experienced “dry socket” effect ( a first; may you never get this) following an extraction done by another dentist in the office. I got on the internet and found her office number.

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So here I am in one of her green chairs; it is a favorite color of hers. The orange color used to upholster a few others is her son’s chosen color. I know this because she is telling me, that musical lilt to sentences that are clearer to me now, her voice confident, gentle.

“Do you like my new place? Had to do it, Cynthia. It is so close to my home and I have a family, you know. How are your grandchildren doing? Tell me when I am done.”

She works away, explaining what is necessary now and later. She is conservative in her approach, cares to do her very best for each patient, she explains. I know this. I have no fear here.

Afterwards, she tells me this:

“Cynthia, I was just thinking of you right before you called. I had made a small mistake one time, remember? It so upset me. I still wake up at night, think of those things. I wondered how you are doing. I miss my old patients. I now tell you this, how I did think of you. Then you just called my office and I happen to answer. How wonderful you find me again. I will do good work. I hope you come back though it is far.”

I can barely recall the incidenty she referred to but I wanted to hug her. I felt one within her as well. She’d spontaneously embraced me the last time I’d an appointment at the old office. It was right before Christmas; we wished each other happy holidays.

She had said, “You are a beautiful lady, a lovely person, God go with you.” My old teeth demanded I give her a big smile.

But now she had other patients waiting. It was clear she was doing well.

“It’s very good to see you again,” I said. “Thank you.”

Dr. K. stood with hands clasped in front of her as usual when her hands aren’t maneuvering drills and sharp things. She nodded, then attended to the next person.

You can see this isn’t so much a story about teeth or dentists as it is about human nature. How we do better with kindness. How I admit I worry about things like how teeth look even as the world has so much suffering going on. The little horror story part is that I have had a time of it with dentists but the nice surprise is it depends on the actual dentist. Dr. K. seemed so familiar to me that as I wrote this it struck me: she is very like Dr. Smith. Thorough and accomplished. Someone who cares first about people, second about an impressive career. I have been a very fortunate recipient of both their talents.

And I’m still working on this, but expect a full-on smile if our paths ever cross. This one is for the incomparable Dr. Smith, may you rest in peace. I will always be thankful for such careful assistance.

Heart Chronicles #18: Risking Our Lives, Part 2

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( Map engraved by Daniel Stoopendaal, 1730)

Each body is a map of a universe, a living, breathing cartography. We carry the routes of our life travels within our flesh and bones, and our powerful feelings and thoughts can detour or bolster health. Just ask any heart patient how the most responsive and crucial organ in the body must be cared for: just like a beloved. Most of the time we can count on microscopic cells and complex systems to respond heroically and rejuvenate what is necessary.

But on the stairway that day, perched between safety and peril, it seemed all my body’s wisdom was failing. It was clear I had to start the brainstorming phase. But how to explain to anyone else what I didn’t understand?

By early March 2013 an old problem with low-level dizziness worsened. It hit me before I opened my eyes in the morning, unmoored my day, then haunted my nights. Between my vertiginous head and trying to stay upright on increasingly unsteady feet, life certainly lacked buoyancy. I ended up in physical therapy for the inner ear issue and it resulted in excellent results. Of course! I thought. It was that old beast, first diagnosed as labyrinthitis in 1999. Relief replaced dread. I could handle this one. Six weeks later my head quit its surprise spinning.

Still, if I was honest, my gait wasn’t yet quite right. I couldn’t perform basic balance exercises well. D., my physical therapist, noted my legs were far weaker than they should be for someone my age and activity level. I was still trying to stay active daily by walking two miles, and would hike on week-ends.
I took a breath and started to enumerate the odd symptoms. It had been gradual, cumulative. I had ignored most things, like little spasms and ticks or the day-long cottony brain. The drugged feeling like I hadn’t gotten sleep enough although I usually did. I had not been alarmed a long time. The last six months? A bit frightening.

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( Da Vinci’s Study of Arms and Hands, 1474)

It was the first time I stated it all aloud and fear grabbed me, made my innards quiver.

“Poor muscle control, weakness in legs, arms with a weakening grasp–have a very hard time opening jars or holding onto pens or really anything. Cursive is terrible when it used to be nice. I have burned myself badly with a curling iron many times because my hands and arms are so weak they just lose their grasp. I can’t seem to routinely control where I want to place my feet or hands. I drop way too many other things. I even just…fall over. I lose strength as my feet hit the ground. I have deep random leg pain and cramps that wake me up at night. In fact, I have little muscle spasms all over, at times. I can’t calculate what to do with my body like I should. I mean, we usually don’t even think about it, do we? It’s like it belongs to someone else…I reach out a foot or arm…and nothing works right. I feel… spongy, unstable even sitting, tired out. I get funny nerve shocks. My mind is pushing through a cloud and sometimes I feel like I lost a minute… Each day takes all I have, especially the last six months.”

There. Done. I had lowered the last barrier to finding out the truth. I wanted to laugh and say “I feel like an alien sometimes–body snatchers got me..” but it wasn’t humorous now that I had spoken of it. Speaking dragged me out of denial, that age-old coping skill I had taught my addiction and mental health clients about. It works well, until it doesn’t.
Still, I worried D. would find it strange, extraordinarily so. I waited as she put a finger to her lips and thought a minute.

“Well, I have to tell you I have some other heart patients I have treated. Some of them take statins like you do. They at times report symptoms like you describe. I’m going to get you some research I found and then you might consider calling your cardiologist.”

My mouth dropped open. Statins? The now-common cholesterol medication that also supposedly decreases arterial inflammation? I didn’t have high cholesterol but with heart disease “high” means another thing altogether. I did have inflammation issues. I had taken a statin since the first stent implant in 2001, a second in 2003. It was deemed necessary. What would Dr. P., trusted cardiologist, think?

I took home the research and studied it. There were my symptoms and more on pages of paper. “Statin myopathy”, translation: muscular weakness. “Statin muscle toxicity”. Muscle pain, fatigue, heaviness, stiffness, cramps, balance problems with attendant coordination issues. The papers went on to describe much of what I experienced but not all. The most startling note was that physically active patients experienced more symptoms due to intolerance of lipid-lowering therapy. I read one study that stated around 10% of those who took Pravastatin at 40 mg, like myself, suffered from muscle-related symptoms. Many patients didn’t note the symptoms as they were gradually induced and often dismissed at first. (Note: taken from Cleveland Clinic Journal of Medicine June 2001 vol. 78). No less than fifteen other diseases could be confused for statin muscle toxicity. I read the other indicators of those most at risk of myopathy but they did not ring a bell. It could be just my luck of the draw. I made an appointment to talk with Dr. P. for whom I hold much regard.

As always, he opened the door with a warm smile, shook my hand and got down to business. I had expected that he might take it all in and say, sure, there is some reason to think the statin might be the issue, and then remind me that I had aggressive coronary artery disease and required this treatment for as long as I lived. The end.

“Get off it at once, ” he said. “You look ill, you’re having a terrible quality of life and I wish you had complained before. One to two percent of my patients can’t tolerate statins and have similar negative effects.”

“It’s been subtle over the years; I didn’t realize it could be anything serious until recently. But it has been bad…”

His green surgical scrubs and rubber clogs were still on and for a second I wondered if the person he had operated on was recovering well. His eyes held mine. “I want to make sure it’s the statin. If it isn’t, there are some sinister diseases like MS and ALS that we need to investigate…”

Dr. P. always tells me the truth. It is what I like to hear and part of his skill. He noted it was a risk to take but my cholesterol was quite low at least on the statin, blood pressure was very good and I had taken excellent care of my overall health. I was to return in six weeks. I would either feel better or I would not. After he listened to my heart–“sounds good”–he put his hand on my shoulder and gave it a small squeeze. I knew that gesture. It meant he was hoping for the best, cared that I get better.

What does a person do with information that is affirming while not necessarily reassuring? I did nothing. I stopped taking the statin and went on with my life. I prayed for Divine guidance and compassion and got both. I wrote and walked every day and enjoyed the outdoors as always. After a week, I felt something change, a little less fatigue, a few less twinges and spasms. I said nothing to my husband but waited for him to remark on my gait and energy. Within ten days Marc told me what he saw.

“You seem different. It’s hard to explain, but you’re thinking and moving faster and better. You’re stumbling less, I think.”

“Yes,” I breathed and went on with my life.

And so it went. Each day I felt more awake in the morning. My feet hit the floor solidly. I could get to the bathroom without tilting and grazing the walls. I reached and grasped onto things. My feet recovered quickly if they stumbled; they rarely got hung up. Walking felt so good and I felt so strong that I wanted to walk another ten blocks, crest another hill in the forest. My mind cleared so that words clicked along without hesitancy and words rose out of a sunny place, not a gray, misty one. My typing could almost keep up with my thoughts so writing was a sweeter release.

The experience that told me I was on the road to health was how my feet wanted to dance. I am not a dancer now but I love to be in a lot of motion (unless writing) and adore music. One morning I felt acutely attuned to vast energy moving through my limbs, down to my toes, throughout my whole body. My feet felt strong, steady on the floor. I began turning and dancing. It felt like being set free. It was a perfect combination of lightness and gravity. I knew then I was going to be alright. In fact, I feel better than I have in years, long before I fell gasping to the dirt in the Columbia Gorge years ago, on the precipice of death.

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When I saw Dr. P. in six weeks he said upon entering the room, “You are so much better! I can see how you sit, like you are ready to get going. You LDL went up forty points, so we do need to watch that. You owe it to yourself to stay alive in the best way possible, which means having a good time being here. You’re tough–most people wouldn’t put up with those symptoms so long.” He laughed softly. “So since you’re so tough, get out there and get to work! You must increase your exercise so it is more vigorous and eat even better. Call me if you have any problems, and don’t wait to call. I’m very glad you’re better.”

Can we celebrate? Is there a truly happy ending here? I don’t yet know. It’s much more than I had hoped. I thanked D., my physical therapist, for her knowledgeable response. Medicines can help or harm; this one is no good for me, at least right now. I have relied on it a long time so getting off it is risky in a way. I will research alternative aids. I will eat more fish and take fish oil, ramp up my exercise until I can’t do any more, get my lab work and meet Dr. P. in six months to re-evaluate. I was never told coronary artery disease would be easy to treat or I would live a long time. I agreed from the start of this business to do whatever I must in order to be able to keep diving into this treasure hunt called life. I want to keep this body in the known world. We all take risks, some even unknown, but in the end we exit anyway. I just want to make the most of it.

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