Wednesday, January 06, 2010

Lotsa Docs

On Monday, as advertised, I went to see my primary-care doc. His partner was filling out some paperwork in the hallway, so I introduced myself to her and explained that I'm not a drug seeker. She looked absolutely blank; she had no memory of the incident. When I reminded her what had happened, she looked chagrined and said, "I'm really sorry. I should have spoken to you on the phone myself."

Meanwhile, my doc's putting a note in my file to say that it's okay to give me muscle relaxants when I have spasms. With any luck, it will be another few years -- or, better yet, never -- before I need them again.

I also asked him how I'd go about getting more than fifteen minutes with him were it ever necessary. Could I pay for two visits and get half an hour? He looked slightly baffled and said, "If you need longer, just tell us, and we'll schedule you for half an hour."

I told him that the oversleeping problem has improved greatly since I reduced my antidepressant meds. Yay! Nonetheless, given my two previous wonky stress-echo results (EKG positive for ischemia but normal echo), I wondered if it would be appropriate to test further to make sure I don't have microvascular disease. So on Friday, I'll be having a thallium stress test, which measures perfusion throughout the heart rather than just testing for major blockages. This is probably excessive -- and it's going to be mondo-expensive, even with insurance -- but it's the test that the PA who did the second stress-echo (the one who was using words like "profound" and "globalized" to describe the ischemia, and who thought the docs might send me immediately upstairs for catheterization) said I should press for if I were concerned. I'm sure the results will be normal and that my nagging chest pain will turn out to be nothing. I just want to know. I did check with my doc, though, to make sure that if anything shows up, there will be something we can do about it. Yes: medication.

My previous primary-care doc, when I raised this issue with her, told me briskly that there was no way to test for microvascular and nothing to be done about it anyway. My current primary-care doc dismissed my concerns equally briskly a few years ago, but gave in this time, probably just to get me to let go of this particular bone. (Can you say, "Over-educated medical consumer with too much time to do internet research?" Can you say, "Squeaky wheel gets grease?" Can you say, "Poor folks with much more serious health concerns probably never even get access to this kind of testing?")

The worst thing about the thallium test, other than cost, is that it starts at 8 a.m. and I'm not allowed any caffeine for twenty-four hours before. Yikes!

Meanwhile, I've been meaning to call my periodontist to schedule my second gum graft. I meant to call him before I left for Philly, but forgot. My sister, who's also gone through the misery of gum graft, laughed when I told her this and said, "Oh, you forgot to call your periodontist? I can't imagine why!"

I finally got around to it this morning, explaining that I'd meant to have the second graft over winter break, but, well, since there isn't that much break left, can I possibly postpone it until this summer?

The nurse checked with the doctor. "No. He wants you to have it now. There's already bone loss in that tooth, and it's important to save it."

I wound up having the second graft at four this afternoon. As I type, my mouth's full of putty protecting the graft and donor sites, and the anesthesia's wearing off. Gary and I went shopping after the procedure to stock up on soft foods: smoothie ingredients, applesauce, that kind of thing. The good news is that this doctor -- who's truly excellent, despite the hideous procedures he performs -- was very pleased with how things went and predicts that I'll heal quickly. Also, this graft is smaller than my first one (which covered three teeth, not just one), so if the protective putty comes off again, the pain shouldn't be quite as excruciating as it was last time. I have lots of ibuprofen and acetominophen, which I'm supposed to alternate, as well as Vicodin if I need it; that's the still-full bottle from last time, when I think I maybe took one of them.

When I told the periodontist about the upcoming thallium test, he pondered and then said, "Yeah, that should be okay. I'd say you only have a five percent chance of excessive bleeding in your mouth when you're on the treadmill. I did have one guy who got five grafts and then tried to run a half-marathon the next day, and he bled a lot."

"I'm not running a half-marathon," I said. Jeez!

The bad news is that the bill for this forty-minute procedure was $1,390. My insurance may reimburse a few hundred of that.

Oh, man. But losing a tooth would be even more expensive.

And now, dear readers, it's time to make myself a refreshing soy smoothie.

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