Now if you search “dry socket” online, it always come up with a treatment called “packing” with a dressing to reduce pain and facilitate healing. When I asked my dentist about this, he informed me that he never used that method and he didn’t even order the dressings anymore. Still under the assumption that this dentist knew best, I took his word for it. But after another week of pain, while taking 9 mg of steroids a day and large quantities of antibiotics in order to reduce the possibility of an infection, I was not happy with the care I was receiving.
I went back on an antibiotic I had previously taken, but in a higher dose. The day I started the antibiotic, I had a hair appointment, a career counseling session, a presentation, and I was chosen group discussion leader for the week. After I presented in class around 3:15, I noticed that my head was itching like crazy. I just sat there itching my head without thinking (I'm sure I looked a little crazy). In my next class, my back started itching as well. I kept itching, thinking I was reacting to something from my hair appointment. But when I got home, I looked at my stomach and was terrified to see huge welts all over my body. Below are a couple pictures of the hives.
I immediately took some benadryl and decided to watch it to see if it got worse. The next day I was sitting in class watching it slowly spread up my arms and I started to panic. I drove myself to the ER and was given a large dose of benadryl and steroids. By this time I realized that I was going to be there for a long time, so I couldn't go to work or my other classes. That stay in the ER was a scary one. There was a man screaming at the top of his lungs down the hall. The nurses kept coming in to take away the chairs in my room to give to other people that had visitors with them. This was the first allergic reaction I had to an antibiotic, there were many more to come.
I went in for the final appointment with that dentist, and he scared the hell out of me. He said he would need to open up the surgical site and “make it bleed” and possibly put a bone graft in there. He kept saying "We just have to scrape the bone" and made a scraping motion over and over that made me cringe. I called my mom in a panic and we decided to get a second opinion. We no longer trusted this dentist. I texted him that I needed a dentist closer to home and figured that was it with his practice.
A New Dentist
This time, I was not going to pick a random dentist. My mom called my orthodontist and got the name of an oral surgeon he knew from other surgeons in the area. I got an appointment with them the same day that I called which was the same day that I decided I no longer trusted my previous dentist. When I saw the new dentist, I was very wary. I had stopped blindly trusting the dentist just because they wore a white coat. He heard my long story, and expressed surprise that I was experiencing this much pain a month after my intitial surgery. He immediately packed the dry socket with a clove dressing. He also diagnosed me with thrush in my mouth caused by all of the antibiotics prescribed by the previous dentist.
Its hard to see, but the infection can be seen growing on the side of my mouth. it was also in my throat making it feel like I had strep. He told me to stop taking the steroids immediately because they depress the immune system. I was shocked that the previous dentist hadn’t noticed the thrush. When I had complained to the first dentist about the sore throat he told me my muscles were seizing because of the dry socket pain. I began to trust the new dentist because he followed the procedures recommended by various surgeons online. I made an appointment with him for the next week. The clove dressing helped for a couple hours but then the pain returned with a vengence. That next week, the pain got worse and worse along with the swelling.
I remember sitting in my statistics class, with my head in my hands, in more pain than I had ever been in my life. I can only describe it as someone taking a knife to the nerve in my jaw and slowly scraping up and down the bone with it.
My entire body hurt and I could tell my jaw was swelling and numbness was spreading across my chin and lip (the swelling can be seen in the picture above). My dentist appointment the next day could not come fast enough. But this was the last week of class. That meant I had to stay on campus until very late that night in order to finish a statistics project worth 20% of my grade and a final project presentation for my social surveys class worth 15% of my grade. I tried not to snap at my friends and classmates for the normal actions and conversations that took place. Everything seemed to be going in slow motion, every word reverberated around in my brain. I drove to Target as quickly as I could and picked up the latest pain medicine I was prescribed (Tramadol). This was prescribed by my old oral surgeon who had oddly kept texting me. They said this was one of the strongest pain relievers that wasn’t a narcotic. I have had many migraines in my life that required medicine immediately. But I have never felt so desperate for pain relief in my life. I took the medicine and then rushed back to campus to work on my final presentation. All I can say is that night and the presentation the next day seemed like an excruciating long time. I am happy to say that the presentation went well, and I’m pretty sure the only thing that led on to my current condition was my swollen face. When I finally got to the dentist, he heard my symptoms and immediately said we needed to perform a debridement surgery.
I can distinctly remember desperately looking forward to the novacaine. Despite the imminent relief that it represented, sticking a needle into the epicenter of the nerve pain was NOT pleasant. And it seemed like no matter how many times they stuck me, the pain was never completely gone. Since I had eaten breakfast, I was not allowed any nitrous, something the dentist aid said would “help” with this kind of procedure. I was soon to find out why. The second the surgeon (we'll call him Dr. B) opened up my gums he could tell there was a problem. They tried to take pictures but it was too difficult to get the right angle. Much of my jaw bone was dead from an infection that had spread considerably. There was no way to tell when the infection started but he did say he found a small crack that could have allowed the infection to get in. He used a drill-like tool that removed bone and sprayed water on the site. They removed bone for at least an hour, constantly having to put more novacaine in. Then he got out a tool they called the "Bart Simpson". They called it this because the tip of the crow-bar sized tool had a jagged edge like Bart Simpson's hair. He used this as sort of a jack in my mouth to hold the gum away from the bone (at this point they were all the way down to the bottom of my jaw).
As I left the dentist’s office, they gave me a “jaw bra” that I was to wear 24/7. They had removed a large potion of my jaw and were afraid it would crack if I moved my jaw wrong. They also told me that the "jaw bra" would prevent a large clot from forming between the gums and bone. This would not allow the antibiotics to enter into the bone. The whole point of this surgery is to remove the dead, infected bone and allow blood flow to the healthy bone. At this point I was on oral antibiotics. The worst case scenario was having to get a PICC line put in and have to receive intravenous antibiotics. Soon, I would start expecting the worst case scenario.
By this time about a month had passed. I got this surgery the Tuesday before Thanksgiving. I did not realize I was going to have the surgery on that day so I had driven to the dentist alone. I’m sure I looked quite odd at the pharmacy afterwords with my jaw swollen and gauze hanging out of my mouth. They took pity on me, however, and didn’t mention my appearance while filing my prescriptions. Another prescription for narcotics, hydrocodone again.
Me wearing my "jaw bra"
A Brief Respite
It pretty much goes without saying that I was in a lot of pain after this surgery. Slowly removing bone from my jaw created a lot of inflammation and nerve pain. The first couple of days I was taking hyrdocodone around the clock. After the first very difficult days I was feeling better. My mom and I went to Emerald Isle for Thanksgiving. We both thought I needed a well deserved break. While I wasn't able to have any Thanksgiving food, I was able to eat Ramen noodles, something I was very thankful for. For some bizarre reason my first oral surgeon who had botched this whole thing began to text me asking how i was doing (he stopped after we snarkily suggested he pay for my preceding surgeries).
I had a dentist appointment the next week and was feeling very positive. I was taking my antibiotics religiously and wearing my "jaw bra" as close to 24/7 as possible. I went into the next dentist appointment with a smile on my face. The dentist aid that had been working with me exclaimed that I looked great and she was so happy to see that I was doing better! I reported that my pain, while still there, was significantly lower than it was. Dr. B informed me that things seemed to be going on the right track. He felt satisfied with the debridment work we had done and felt like the antibiotics were doing the trick.
After this dentist appointment, it only took about a day for things to start getting worse. One night I noticed that my chin had gone numb completely. The next day I realized that the pain was getting worse again. I called the dentist and went at their first availability. The second I told him my symptoms he said “Okay, you’re going to need to get a Picc.” Apparently the numbness and pain meant the infection was spreading along the nerve in my jaw. The swelling from the inflammation had put pressure on the nerve, causing me to lose feeling in my chin. I was not familiar with a Picc. I knew that my grandma had to get one when she had cancer. I was scared out of my mind at this point. I did some reading up on Picc lines. Apparently, a Picc is a catheter inserted into a vein in the arm that is threaded up into the Superior Vena Cava of the heart. That way the IV antibiotics that are pumped into the Picc are pumped right into my heart to be pumped into the rest of the body. The antibiotics would be at an extremely high concentration that oral antibiotics cannot achieve.
Since the Picc line goes directly into your heart, it is extremely important that the insertion and cleaning of the dressing is done in a sterile environment. The nurse spent about 5 minutes using an ultrasound on my arm to find the vein he wanted. Then he spent about 15 minutes preparing the sterile environment. Everything had to be covered with a sterile covering, including me. I was most afraid that I would be able to feel the catheter threading through my vein. It turns out, the only painful part was the stick with lidocaine to numb my arm. Then he slowly threaded about 36 centimeters of the line inside up to where he thought my heart was (apparently there was a lot of blood during this, I couldn’t see anything because I was covered up but my mom told me about it later). He flushed a bit of saline through the line and asked if I had heard anything. Confused, I told him that I had heard a pop in my right ear, something that I thought everyone had heard. However, he explained that that was the saline coming out of the end of the line, apparently sometimes the procedure can go wrong and the line can go the wrong way up the vein. It was sitting at the end of my brain stem instead of going into my heart. This terrified me. But the nurse just laughed and said we had given my brain a flush. He pulled the line out and re-threaded it. This time he said it went right into my heart. So I was good to go! There was about 36 cm of a foreign object sitting in my vein and heart. This is what I kept thinking, all that first day and night. I woke up the next day to a sore arm (it felt like I had lifted weights with just that arm) and a lot of blood around the site (see below, caution: its gross).
Thankfully, the fall semester had ended so all I had to worry about were 4 antibiotic infusions per day. After the first couple of days, it began to wear on me. I had to do infusions every six hours. I was doing infusions at 3pm, 9pm, 3am, and 9am for 40 minutes each time. Each of the infusions required a very particular routine of alcohol swabs, saline flushes, and finishing with heparin (an anticoagulant that sits in the line and keeps the end from clotting). Below is the set up for each infusion.
All I wanted was a full nights sleep but at that point I seemed to be doing alright. Dr. B had me set up an appointment with a CT scan specialist to get a detailed scan of the bone. This would show if there was more infection that needed to be removed. My mom and I drove the 40 minutes to this new doctor’s office. 10 minutes and $500 later, I had a CT scan done. The specialist asked me if I wanted him to give me an initial diagnosis based on what he saw. I was very interested about the process so I agreed enthusiastically. He showed me the different layers of the scan and pointed out one area that was a “possible problem.” He said he would talk to my dentist but at this time he couldn’t be positive I needed more surgery. I left his office feeling optimistic.
I went into Dr. B’s office the next day still feeling optimistic. I was in for a very rude awakening. He walked in looking very grim and just kept piling it on. He said there were three more infected areas that the CT scan showed. This would require more surgery to remove. But since we were removing even more bone, I would need to get braces put on (for the third time in my life) so that I could have rubber bands that would hold my mouth shut. It was either this or getting my jaw wired shut. This meant the next six to eight weeks I would need to be on an all liquid diet. Next, he told me that there was a possibility that the nerve damage to my chin could be permanent. I could possibly never feel my chin or part of my lower lip ever again.
With the large amount of bone we were taking out of my jaw, there was a possibility that I would need to get a bone graft, either from a bone bank or from my hip (I don’t know which scared me more). He wasn’t positive that we would need to do a graft this surgery but would decide once he opened the area back up (think how scary this was, I was going under anesthesia not knowing whether I would wake up with bone removed from my hip and put into my jaw). Finally, he said he might have to remove another tooth, the farthest back molar on the right side. There was a possibility that it was so infected that removing it was the only option.
At this moment I truly shut down. I had gone into the office that day feeling optimistic, something I hadn’t let myself feel for awhile. But then I was just absolutely crushed with these consequences that could last my entire life. I broke down crying while the dentist aids and my mom tried to comfort me.
I left the dentist office that day armed with another prescription for hydrocodone (this time with a lot more refills). I had gotten braces put on on Friday, my surgery was scheduled for Monday. When I was at the orthodontist I couldn't help but look around sullenly and see people much younger than me getting braces on (there were also people my age and older than me but I refused to see them at that time). But once I got back to the chair I met Renee, the dental assistant that would be putting on my braces. She was extremely nice and told me we weren't going to do anything that was painful. I don't know how she did it but she managed to get all of the braces on without hurting my very sore, infected jaw.
The weekend before the surgery was definitely a morose one. I had planned to have a Christmas party that Friday but I was no longer in a celebrating mood. I managed to finish all of my finals except for one. That one I had to accept as an incomplete for now.
Here's me in my braces which, thankfully, you can't see as they are clear.
The [Third] Big Day
On the morning of my third surgery, I was a bundle of nerves. Since this one would take place in the hospital I thought it all seemed more serious. When I got there, I went into pre-op. They explained that I would have a breathing tube and it would be taken out shortly after I woke up (this terrified me). The anesthesiologist came in and told me the chance of me getting sick or not waking up was very low. This also terrified me because so far every time a doctor or dentist had said “This is the worst case scenario” it had happened to me. So at this time I felt like I was jinxed. But my mom was there with me so I wasn’t as scared as I would’ve been had I been alone. Right before I went into the operation room they gave me some sort of anti-anxiety medicine that was so effective I was smiling and greeting all of the doctors as I was being rolled through the hallway.
As those of you who have had anesthesia know, I woke up what seemed like ten seconds later, but this time I couldn’t open my mouth and I had a bandage wrapped around my head (unfortunately, or fortunately as it was very awful looking, we did not get a picture of it). I immediately felt very claustrophobic because my teeth were held so tightly it felt like I was constantly clenching. Right away I was mumbling and asking for my mom. They said they had to wait a bit for me to get to recovery. But as I became more and more agitated they went and got her to try and calm me down. At this point I felt like I couldn’t breathe or was going to asphyxiate (a little dramatic I know but at the time it was very scary). After they found my mom and gave me some more anti-anxiety medicine, I was free to go.
There was about a week, one of the worst weeks of my life, that I could only have liquids or pureed food. Now this would have been bad in of itself, but unbeknownst to me, I had gotten C-Diff from the IV antibiotics I had been taking. So I was nauseous all throughout the day, making it even harder to choke down Ensure and baby food. I still can't even look at peanut butter or chicken noodle soup without feeling sick. Each night I spent laying on the bathroom floor, so that I would make it to the toilet to throw up in time. I will spare you the details but I will say that it is very scary to know you are about to puke and have to cut your way out of a wired shut jaw. It is also VERY painful to throw up when your jaw has been operated on three times.
Over this week, as my mom and I struggled to keep up my fluids and keep food down. I thought I was just being overdramatic (at this point I didn’t know I had C-diff) and being a picky eater as usual. But when I woke up one morning with a temperature of 103 degrees, we decided it was time to go the emergency room. This morning I distinctly remember breaking down and crying. For those of you who know me, this is extremely rare, I don’t cry often. But at this point I didn’t see how I was going to make it six weeks choking down baby food and protein shakes. I left my apartment with one of my favorite blankets because I was so cold from the fever. This ended up being a blessing because I was to end up in the hospital for a week.
The Hospital Stay
Right when I got to the ER they began doing a whole barrage of tests. Their biggest concern was that I had a blood infection on top of the bone infection. Having a picc line had increased the chances that I could have gotten another infection. So they took blood from me three or four times that afternoon. I also had an EKG, an MRI and many other tests. The whole day is a little hazy, but I distinctly remember a couple of things. I remember pleading for tylenol so the fever would come down and I could stop aching. I also remember shivering on the MRI table because they took away all of my blankets. I tried to hold still so they could get a scan of my head and neck but it was very hard not to shake. Then an Ear, Nose, and Mouth doctor came in, shot some novacaine in my mouth (which I can confidently say did not go into my gums because I felt everything afterwords), and then stuck a huge bioposy needle into the surgical site in my jaw to check for infection. This and the MRI confirmed that there was no lingering infection in the gum and tissue.
Finally, I remember just as I was about to leave, two male nurses standing outside my curtained off room, were talking about the (excuse my language) “Fucking hot 50 year old in the room down the hall.” In my half-conscious state this horrified me and I did not want either of these men to come in and give me a once-over. So I told my nurse and told her to keep them away from me (something I never would have been brave enough to do if I had been feeling normal).
Before I was wheeled up to my in-patient room, they gave me some morphine through my IV. I can only describe the feeling that came after as feeling extremely heavy. It was like a 100 pound weight was put all over my body. But it took my immense pain away immediately so I was very relieved. Here is a picture of me that first night in the hospital. At the time I did not know how bad the situation had gotten. But when I look back at this picture I see how serious this all was.
I was so dehydrated, they gave me about six bags of fluid that first afternoon and kept me on six different IV antibiotics through the night. For the first three days I was unable to eat anything. All I was able to keep down was little sips of water. I remember telling my mom that the thought of food made me want to die (this scared her a lot I think). I ended up being put on the oncology floor due to overflow from the ER. This was a blessing and a curse. Since I had then been diagnosed with C-Diff, I had to be in complete isolation. Since I was on the oncology floor, many of the patients had very depressed immune systems and C-diff can spread like wildfire through the hospital. So every time anyone came into my room they had to wash their hands, and put on gloves and a gown to cover their clothing. Then these gowns and gloves had to be removed and thrown away before they left the room. This meant that whenever a nurse came, and maybe forgot a saline flush, she had to removed the gown, throw it away, wash her hands upon leaving and then re-entering and then get another gown. At this point the environmentalist in me was cringing every time these gowns were discarded, we must have gone through a hundred or more during my visit. Below is a picture of my sister and her fiancé wearing the isolation gowns in my room. This is also the chair that my mom slept in all week (what a trooper).
But being on the oncology floor was also a blessing. The nurses on this floor were the very best in the hospital and they only had about three patients per nurse. This was especially good because the first couple of nights I required constant watching while they gave me pain killers and antibiotics.
I stayed at the hospital from the 20th to the 27th of December. It definitely was more of a somber Christmas than usual, but the nurses where great and the hospital staff was so sympathetic. There were even carolers and a therapy corgi! Neither of these could come into my room since I was in isolation, but it was nice to know they were there. I also received tons of flowers from family and friends which helped more than I can express.
Here are some of the beautiful flowers that I received.
I had friends visit as well as my sister. My mom slept on the chair in my room for my entire stay in the hospital. This was an immense comfort and she definitely advocated on my behalf when talking to nurses and doctors about my condition. I was generally too tired and felt my eyes drooping whenever they would come in to talk to me. I had to ask the nutritionist to leave and come back another time because I couldn’t keep my eyes open (the morphine was keeping me heavily sedated). After I had become more hydrated and the C-diff was more under control, I was able to start eating soft foods again. I lived off of Starbuck's coffee cake, Rice Krispies, and cottage cheese those first couple of days. Now we had to find an antibiotic that I could continue taking through my picc line. The antibiotic I had been on previously, Pipercillian, we found out I was allergic to when my nurse noticed a rash. So now the entire pencillian family of drugs was off-limits. We tried another antibiotic that I would only have to infuse once a day (which was great compared to the previous four), but I ended up having another allergic reaction to that one. We frantically tried to get benadryl as I started getting hives all over my body. This also meant that I would have to stay in the hospital one more night as we tried to find an antibiotic that I wasn’t allergic to.
On the 27th I finally was told I could go home. We found an antibiotic that I wasn’t allergic to, Vancomayacin. This required three infusions a day but each infusion had to be spread out over two hours so I would get Red Man’s Syndrome (a reaction to the medicine similar to an allergic reaction but it only occurs when it is infused too fast). After a couple of impatient hours while I waited to get my discharge paperwork, I was finally free to go. I had not left that small room in a week so I was very antsy. I was extremely weak and tired and could not walk long distance without getting winded. We had to call the home care nurse about five times in order to get my antibiotics in time for my next infusion. It was proving to be very stressful to have to remember all of my medications now that I had to administer them myself.
After a couple of days, my mom and I went back to stay at the beach house with our four doggies (pictured below).
However a couple of days after the new year, I started to go downhill again. I began having fevers and throwing up. We rushed to the closest emergency room, one in a very small neighboring town. This emergency room was way overrun, there were people laying on beds in the hallway and many sick people in the waiting room. I began to worry that I would catch the stomach flu they said was going around. They finally got me a room as they noticed I was very sick and had some serious preexisting conditions. As I kept pleading for pain and anti-nasuea medicine (I had thrown up all my pain medicine and had wrenched my jaw open making it very painful), they did an ultrasound on my arm with the picc line. It was no longer returning blood and they were afraid there was a blood clot in my arm. After waiting for about four hours without being seen my mom and I got frustrated and began to leave. The nurses saw this and frantically asked if I would stay, and told us they would get the doctor to finally see me. The doctor (who looked to be only a little older than me) came in and said I had a blood clot in my right arm. Because of this they would have to remove the picc from the right arm and put another one in my left arm. She also said there was a possibility of a pulmonary embolism since the clot was in a major vein. At this point I also broke down in tears. I was not prepared for another setback, I just thought I had been dehydrated again.
We agreed to let this tiny hospital put in the picc line even though we were nervous about their experience with them. My mom had to leave the room and I had to once again stifle my sobs so I would keep still. As she was inserting the picc I could tell she had hit a nerve, despite her having numbed the area with lidocaine (it was this night that I began writing this blog). After several days of intense nerve pain in my arm, it eventually settled down and I was able to move around without the nerve seizing up. The picc line specialist at Duke said they had put in a double picc when I only needed a single one. this meant they used a bigger size and irritated the nerve.
After this, all I had to do was get through a month of three, two hour infusions a day and about a hundred pills a week ( I calculated it out and it was 98 scheduled pills not including the extra ones I needed for pain). After awhile, I ran out of the break-through pain medicine. I think I then went through a small episode of opiate withdrawal. Since I had been on morphine around the clock at the hosptial and then oxycontin and oxycodone upon my release, I had been on a lot of narcotics. This proved to be a whole new challenge as I became anxious, achy, nasaeous, and shaky. Also odd things like yawning all the time and extra tearing in my eyes. But this passed after a couple of days and I was happy I no longer needed the break through pain medicine, this was a sign the infection was decreasing and the nerve canal in my jaw was regrowing.
A couple more weeks passed that were relatively uneventful, thankfully. I just kept trying to drink two and a half liters of water a day (something that is very difficult I realized). I also tried to go on some walks along the beach to get my strength back. However I would still get so tired after carrying in groceries that I would have to lie down to prevent myself from fainting. There were nurses coming each week to take blood samples and to change the dressing on my picc line. This is also sterile process so it takes awhile and is very particular (with sterile gloves and masks). One week, on the coast, a nurse from the small-town hospital came to take my blood as usual. Apparently I was very dehydrated because no matter where she stuck me (she ended up sticking me three different times) and no matter how much she moved the needle around, she couldn't get enough blood for the sample. Eventually she got enough blood (more than enough since she ended up throwing 10ml of it away). It did not end there though. She had a syringe attached to a tube and butterfly needle. For some reason she held the syringe up in the air and pushed, shooting blood at me across the room so I had to lunge aside to dodge it. Then she was unable to change the dressing on my picc properly and could not find the correct tools to put the extra blood sample in the vial. She then said "Fuck it" (to which I gasped from the other side of the room) and threw the blood away. For someone that was so dehydrated giving 20 ml of blood was a huge feat and I offended that she discarded it so flippantly. When my mom came upstairs after the nurse had left I was sitting on the couch, white as a sheet and shaking.
Above is a picture of me after I had been feeling much better after a couple of weeks. Now I am back in Durham and I am happy to report I received positive feedback, both from the infectious disease doctors and my dentist. I am able to eat soft foods now but I have to keep on the braces for a couple more months. My dentist wants to do MORE surgery to fix my TMJ problems in my jaw. I’m not sure right now if I will agree to it because I want to be done with anything to do with my jaw for a good long while. I also got the picc line removed (YAY!!) so now I am starting to feel like I am going back to normal. No more middle of the night infusions, and no more foreign objects feeding directly into my heart!
One thing I have taken away from all of this is an extreme guilt for using pain killers. As I’m sure anyone who has had a chronic pain condition can vouch, different doctors have different approach to pain. Some say it is ridiculous for you to be in pain during the healing process. They prescribe the medicine and say “take one or two every 4 hours on the onset of pain.” Others give you a severe look after your request for pain medicine and make you feel like you are doing something illegal. I felt like they didn’t believe how much pain I was in, like I was making it up to get more medication. I was taking what had been prescribed, as they recommended it. But after they kept giving me pill after pill in the hospital, they released me and left me to cope with the new dependency I had on the narcotics. This has been one of the most anxiety-inducing parts of this whole process.
Here is me sitting in the dentist's office on Jan. 27th, doing a lot better!
Here is a picture of Renee (the awesome dental assistant) at an orthodontist checkup on the 29th.
I will keep you updated as I might have to have another bone grafting surgery in the future. But as of right now it looks like I have beaten this bone infection (which makes me nervous to write since I don't want to jinx myself)!
