My Recent Trail: A Medical Journey in the Dominican Republic

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
(Note: This is a long series of posts of a recent "journey")

Who would have thought upping the exercise and going paleo diet would lead to a long test of the Dominican medical system?

Certainly never occurred to me.

But that's changed. So I thought I'd tell my tale so folks have a better idea what's what here should they need info.

One question often asked by folks about living in the DR is the medical system. I've had a few chances to use it the 7 years living in the DR, a couple of motorcycle crashes, a planned colonoscopy & cardiac workup, but that's it. Nothing really chronic or extraordinary.

................................................

We've gotten some good, solid feedback on a large, 2-year project coming to fruition soon so three months ago I started the grind to actually get back into good shape, lifting weights, a lot of walking, aerobic swimming every evening after dinner and going hardcore paleo. I mean GOOD shape, even for a younger guy. After all, doesn't the camera add like 10-15 lbs? I'm a large human anyway, so I don't need that. And I LIKE serious, hard exercise.

Well, the project and MotoCaribe Tour season was on the horizon, so the mentality was like football Training Camp...

And in two months I'd lost 20lbs. Easily. Felt great and was making serious progress. I especially enjoyed the evening 40+ laps in the pool before going to bed. The sleep had been amazing. I was dedicated to losing much more and was enjoying the process.

But I had a nagging swimmer's ear, not too bad, but it wouldn't go away after three weeks as usual. At the same time I noticed a tiny hard spot below the ear and inside & up the jaw line that when I added firm pressure gave me a minor "electrical" twinge. Nothing serious, but the other side didn't have it. We all---me, Mom CB and Alida--- figured it was somehow all connected.

So I called a motorcycling buddy, a bright ENT @ Clinica Coriminas in Santiago named Andy, and made an afternoon appointment to visit him next time to town.

The day came and we got there at 2pm as suggested and signed in...#8, first-come-first-serve, gave the receptionist my cedula & insurance card. And waited. I actually took a couple of walks to pass the time. No big deal, all we had left to do was a PriceSmart run before heading back up the hill.

4:30 came and finally was my turn. It was both weird and comforting to see a friend in a professional environment. There was no motorcycle chat, all professional medical issues.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Doctors office in the DR are much different than in the states. Most of my career and life has been spent in the medical/surgical/high-tech homecare industry so I have a deep working knowledge of pretty much the whole enchilada, including being married for 11 years to the Department Chief of a large surgical hospital in the Tampa area. And I've had numerous orthopedic surgeries because of my long football background, ankles, knees, thumbs, biceps. So I've been on *both* sides a lot, business and patient.

Doctors, even in large private practices, just don't have the massive support staff as in the states. They don't have a gaggle of nurses, office managers, billing clerks, assistants, transcribers, filing clerks, etc. Few have large operations with multiple associates and all manner of patient exam rooms.

All the docs I've seen in the DR, even though highly respected and busy, had minimal staff & office space. Maybe a good waiting room---seeing how a doctor visit is often a family affair. A receptionist. His personal office, generally not large. And an exam room. That's it. And it can all be clean, neat, modern and well equipped.

There usually isn't a lot of storage space. Patient records are nowhere to be seen, except in the docs' computer...and the doc entered them himself during the interview.

Andy's office was no different. They have a shared waiting room---with couches really close to the ground that Dominicans don't mind but I found uncomfortable. There was a modest receptionist kiosk for two docs.

When we entered Andy's office I was first struck by the very modern equipment, the exam chair and various devices, and softish lighting. His desk, adorned with numerous high-tech monitors, printers, computers, etc. was organized and functional.

I sat in the big exam chair, he turned up the lights and we talked. Instead of taking the ear exam light that is typically used---you know how the doc pretty much shoves it down your ear---he had a camera wand that he put a clean tip on, and gently guided it into my infected ear canal...and I watched on a monitor in front of me. He explained what I was seeing. He put another into my nose---and I learned that something like 56% of all humans have some degree of cleft palate, and I'm no exception. I really liked the technical equipment and seeing what he was talking about.

He felt the knot under my jaw and explained, in detail, the process we would use in diagnosis. Initially I was to take two antibiotics for two weeks, get a IM antibiotic shot (yea), stay out of the pool and see him in two weeks. No problem, easy enough to do. We chatted motorcycles briefly and left, picking up my ID from the front desk---insurance covered the visit without additional payment. We went to a pharmacy by the parking lot, & got the meds and went home.

I followed the instructions to the letter, and while the swimmer's ear went away in a week, the little hard spot didn't. I was mildly concerned but not worried because it hadn't been symptomatic to speak of unless I pressed it firmly.

Two weeks later we went back, same time, same drill. Andy was pleased about the ear, but not so about the hard spot. He's concerned, so I'm concerned. He ordered a contrast CT and a sonogram of the area done soon and to return with the results. The next day we went to HOMS radiology department, got insurance authorization, and had the tests.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Insurance authorization is another interesting concept in the DR. Most larger clinics have offices for insurance reps. In the states you cough up your insurance card at the docs or medical provider's front desk and they work their financial magic---and you rarely know costs, etc., unless there is a co-pay or non-covered service. Here, you go to the provider's office, get a form or prescription for service then go to your insurance company's office for authorization; you know exactly how much your out-of-pocket will be. Once OK's, you're given a voucher to take back to the provider and pay the difference to the cashier BEFORE a service is delivered. At HOMS, the insurance companies have offices in the basement in cubbyholes; the bigger the insurance company, the larger the office.

We got to HOMS early in the morning before the insurance rep had. We wanted to get it done early with the hopes of getting the results in time for an afternoon meeting with Andy.

Because of some confusion in the radiology department over precisely *which* CT scan---Dominican efficiency on display---we had to make two trips downstairs to the Palic office. Finally, after an hour we got it done and went back for the tests.

First was the sonogram. I like how the Dominican medical community makes great use of sonograms unlike the states. They are safe, effective and cheap. The doc administering mine spoke no English, but we got it done. My only objection was he gave a single tiny paper napkin---like in a cheap restaurant---to clean up a few acres of goo still glopped wetly on my neck & jawline. He never figured out what I wanted before I put on my shirt. I finally had to take a wad from his stash to clean up. He thought me odd, no doubt.

Back to the radiology. We were told the results would be ready at 2pm. Good.

I was not to eat before the CT scan because they were going to put a contrast dye in my veins, so I was hungry. So was Alida, but she got something to munch while waiting. I wasn't so lucky.

Finally, my name was called. Like most Americans I have three names, two "first" names and one last one. When I offer my ID, clerks generally write all three down. And like clockwork, whenever I'm called in public, I'm called by first and middle name...not last. So many think my last name is "Charles", phonetically pronounced "Char les'" I'm used to it. It's a Dominican thing...

So I get called for the contrast CT scan, and go another waiting room. Then I get called again---"Senior Char les'"---and go winding through multiple hallways in the radiology labyrinth, following a tech. Well, I think she's a tech. I could get lost in here.

I'm put in a really cold room and stripped of jewelry and shirt. I know dye will be injected so various physiology will show up better on the scan. A lab tech enters with her "kit" and IV pole, complete with IV bag.

I'm no big fan of needles, especially IV needles. Been around them a LOT in my life. And I'm told I have "tough veins" so nurses, docs and techs have a more physical time accessing them. When this tech starred the process, I KNEW she was going to have a rough time---and, at the sticky end of the needle, so would I. How did I know? #1: The room was really cold, and my veins had retreated to warmer climes. #2---and this one bothered me---rather than put my left arm & hand significantly below my heart for more pressure to pooch out my veins, she actually had me LAY DOWN AND TRIED TO ACCESS THE VEIN WITH MY HAND HELD UP!

She poked and poked and prodded and poked some more. No joy. Then she had another tech try, more poking and prodding. Finally, I guess it worked, they got me hooked up, the fluid flowing and shot the dye in the port. I did look at the back of my hand and it was very clear they had gone THROUGH the vein at least twice, and I had a big lump of confused escaped blood in a dome the size of a quarter.

Finally, my head was strapped down, my noggin inserted into the machine, and 10 minutes of various odd clicks and urk-whacks later, all was done, the techs removed the IV, I dressed and found my way out. Too bad we were told the test would be ready the next morning at 9am. Damn. Can't see Andy today. Back up the hill...
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
We got to HOMS the next day early again, really before they opened, just to get the tests. We were told the sonogram was to be ready the day before, but it wasn't. Shocked. Then we found out the CT would not be ready for a few hours. I wasn't surprised, but whenever we go to Santiago we just figure we'll spend the day there anyway. So we went visiting and shopping, and had yummy fried chicken for lunch at Do?a Mary's behind the old Nacional. Bonus.

Finally, the test results were done and we went to Andy's office, again with a wait. This time I bro8ght my laptop and worked on some spreadsheets for a document, time well spent. I now suggest to folks to bring work to a doctor's office, because you'll have some time to get some done.

Andy was not surprised about the ear being well. We gave him the tests---and discovered that HOMS had just put the CT in the envelope, and not the sonogram. CRAP. That means yet ANOTHER trip back to Santiago the NEXT day. This was getting really old, and we were burning through a lot of time and gas.

He did look at the CT and was mildly disturbed at what he read in the radiologist report: there was a clearly defined cyst, about 13x23x3mm in my right jaw, and a noticeable depression where bone should be---but wasn't. Wow. I was surprised, and frankly when he described the next steps was rather anxious. But he needed to see the sonogram first. We left, went up the hill---again---and I did my own research about what it could be. And I'll tell you that *some* of the possibilities were not at all pleasant.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Next afternoon we picked up the sonogram at HOMS and went back to Andy's office. We felt like we lived there now and had a personal relationship with the parking attendant across the street.

Andy read the report and watched the sonogram on his large, HD monitor. It was perfectly normal. His concern was tumors of saliva glands. Nada. I mentioned some of the info I found and he pretty much spanked me for playing doctor. Understood. But he also understood my concern and projections.

He said his job was done, and referred me to a facio-maxillo surgeon in Santiago, explaining this guy was excellent, and he'd make a personal call explaining my situation & our friendship. Personal referrals are generally positive. We left. A half hour later, Andy calls with the surgeon's cell number. I'm driving, so Alida calls him and we agree on an appointment the next afternoon at 3pm. His office was in Los Jardines. That night I researched and, yes, indeed he was a well-regarded surgeon. I felt confident, but had no idea what was going to happen.

So once again we trekked down the hill to the surgeon's office. Keep in mind a referral to a "surgeon" is pretty clear: something invasive is going to happen. I just didn't know what, because there had not been an actual diagnosis yet; just the elimination of ENT issues.

The surgeon was running late from surgery. His office was as first world and modern, clean, tasteful and professional as any I've seen anywhere, and that gave a feeling of confidence. Because of the personal referral, we were ushered into his private office before he arrived. Wow. Like an art museum, and he had dozens of bona fides displayed on his wall.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
One thing I've learned about the medical community in the DR: one does not have to go to Harvard or Emory or Penn to be an excellent, and one does not have to be a resident at John Hopkins or Mayo to be a top doc. Few Dominican physicians have that pedigree---and it's largely unnecessary. There are numerous top schools and residency programs all over Mexico & South America.

And this surgeon had great certification in medicine, dentistry, oral-facial surgery and facial plastic & reconstruction. But while comforting, I wasn't at all fond of the immediate concept that all his experience may become very, very personal.

He came in and was low-keyed but an impressive man, cordial and straight forward, wearing a headset that recorded his every word somewhere; his notes were ongoing. He took the CT scan & sonogram, read the reports, and put him on his wall monitors. He paged his assistant to take me to another office for a full facial scan, like dentists use. Once again, super modern equipment and professional staff. 10 minutes later we were waiting in the lobby for results. And 5 minutes later, the doc stuck his head out of another door and pointed for us to follow him to an exam room.

This exam room was like on an alien mothership it was so modern and well-equipped. I was sat in the exam chair and the doc strode in. With a flick of a remote control a digital image appeared of what was my entire jaw, form one side to another. He pointed to one area and said "this is what we need to do."

Seems I still had upper and lower wisdom teeth on the right side. I had forgotten which side I'd had them remover before. They were not impacted. Yet. But what was happening was a slow-growing cyst had developed---docs don't even know why---*below* the lower wisdom tooth, and it had "displaced" a lot of the jaw bone there. The Cliff Notes solution:
1) Have a root canal in the last molar that seemed to be in part of the cyst

~Then~

2) Remove upper and lower wisdom teeth.
3) Cut a flap through the gum to the jaw and remove the cyst & clean the area
4) Sew the area back up.
5) The bone, about 65% eroded in that area, would grow back

Oh, and 2-5 all under general anesthesia.

He took us to his endodonist for a quick exam, and she said her part would be no problem. I had to have the root canal first, then the surgery the next day or shortly thereafter.

I actually felt better. The full facial scan was clear what the problem was. Now the hard part: fixing it. I knew it wasn't going to be fun. AND, based on the jawbone, I better not get into ant fights lest I break the dang thing...THEN I'd have a REAL problem.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
We go back in the docs office. He laid out his plan in full. I asked "how much?" He said "RD$14,000 for the root canal and RD$50,000 total"---although I knew there'd be more, always is. We told him we'd start working with the insurance company to make it happen and just as soon as we got clearance we'd go for it ASAP. His receptionist helped put together some treatment plans/diagnoses and faxed them to the insurance company before we left. It was late in the afternoon, so we wouldn't know anything until the next day at the earliest. I knew, however, it was going to happen even if I had to pay cash. This was much too important to quibble over a few pesos. We left to go up the hill.

I was mildly relieved as was my mother who had felt abandoned during this whole process. An end was in sight, I just needed to get it on and get it done. However, Alida was disturbed. She wasn't sure, but RD$50,000 + RD$14,000 seemed awfully high. She spent some time that evening talking with her sister, a really good dentist.

We got the word from the insurance company they wouldn't pay much at all for a "tooth extraction." I thought that odd; it wasn't a dental problem really, but a tooth was in the way of a cyst actively eating bone. Alida called the surgeon to ask for a discount---and got a shock: he denied quoting RD$50,000. He now said RD$60,000.

More calls to her sister who strongly suggested we were getting the Gringo Price and to seek a second opinion from an oral surgeon she knows well and trusts. So the next day that's what we did.

When we arrived at Dr. Franco's modern office in Los Jardines he was waiting for us. Seems we have some friends in common. Dr. Franco, a sharp, younger guy who is also a marathoner, called his colleague, an endodonist, another younger, very sharp guy & a bodybuilder, into his office and we had a collective pow wow in medical & technical terms. Not only was their suggestion less aggressive and far less expensive---even though insurance would not be involved---it also made a lot of sense: easy does it, step by step, nothing radical. But the root canal first, then he'd go to work on the wisdom tooth & cyst, an area in which he had some experience.

We all agreed, and an appointment was made for the next morning with the endodonist. So back up the hill.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
And next morning, down the hill to the endodonists' office, another very modern facility. He was ready to rock and put me into his space-age chair. Instruments and syringes with needles were all over; I knew their destination. But something was bothering him, he said, something wasn't making sense. So before we start the root canal, he wanted to do some tests to see if, indeed, all the roots were dead. So he did a cold test all over the last molar---and then announced: no root canal needed, the tooth was healthy. No procedure.

That was the BEST news I'd had in a while. Yes! He charged just an office visit and we made an appointment with Dr. Franco the next week for the wisdom tooth and cyst extraction.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
While I was not looking forward to wisdom tooth extraction, I was feeling pretty good about the situation. I had a great deal of support for folks who knew how to navigate these waters with my best interests at heart. I'd seen some excellent medical practices. And I had some experience with possible Gringo Pricing, although it may be unfair to make that assessment. That's what second opinions are for.

With some dread, the day came and we headed down the hill to Dr. Franco's office. I was NOT looking forward to the morning at all, but it had to be done. We arrived and he and his assistant were ready to rock. He had spoken with the endodontist so knew the situation better.

I sat in his chair---another very modern medical facility with state-of-the-art equipment---and he began. No gory details---and no nitrous oxide either. Dammit. I wanted to escape this part, better living through chemicals...

The anesthesia was delivered with a minimum of discomfort and he used a lot. In a while my whole half of my face was numb. He got down to business and I just tried to put myself in a happy place through all the cutting, grinding, leveraging and tugging---at one point his assistant was pushing on my head hard in one direction while he took a small howitzer, oil drilling rig and earth mover in another.

It took over an hour, but finally it was over. He said the removal was difficult because I have "strong bone", I must drink a lot of milk. He also said as soon as the lower tooth was gone the cyst practically burst itself. It's gone, aspirated, and he injected some antibiotic in its space to finish it off. The cyst was just an infection of unknown origin and should not be a problem anymore. He took out the upper wisdom tooth at the same time since I was already numb and didn't need it.

Dr. Franco did a great job, I had no pain or physical discomfort at all during the procedure...and I was soooo glad it was over. My face was numb and I was tired and ready to go home. We settled our bill and had some prescriptions delivered, antibiotics & pain medication.

So, happy the ordeal was almost over---just a follow-up appointment with Dr. Franco in a week---we headed up the hill.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Dr. Franco said to eat only soft food for 4 days, and by the 5th day start adding regular food but nothing too extreme. AND, take the antibiotics & anti-inflamatories. No problem, I dutifully complied.

By the 5th day post-op I was feeling really well. I hadn't eaten anything but softish foods so far, mostly starches, the bane of paleo. And I was looking forward to getting back in the nutrition & exercise groove that was temporarily abandoned because of this significant health issue.

One of the snack foods I enjoy that are 100% within the paleo diet are chicharonnes. No carbs, some fat, tasty and with a nice softish "crunch." And on the 6th day post-op, feeling really good, I was doing some photoshopping & spreadsheets while munching on a small bag of them. None were hard at all, just "normal."

At 3:30pm post-op with the pain finally manageable and based on the surgeon's "what to do" print out, I was biting into a softish but crunchy delight and *heard* my jaw go "pop/crack" and a serious pain shot through my jaw from top to bottom, 7.5 on a scale of 10, and when I cracked my mouth open at all---at all---serious localized pain.

I thought I had broken my jaw at the surgery area. Pain and swelling and sharp localized pain, the kind that won't let you think about anything but pain.

So down the hill we rushed while Alida's sister, an excellent dentist, arranged Xray's and some attention by an oral surgeon skilled in such matters. Dr. Alonso.

By 6:30pm, and after a second 3D CT scan, the results were in: no break, but too damn close. The jaw flexed and what I heard were bone fibers giving way but not breaking. Not good at all.

So looks like NOTHING but super soft food for a month, absolutely NO chewing at all, and a bunch of meds, pain, anti-inflammatory & antibiotics. The doc was concerned and made me repeat the orders back to him.

Protein shakes will become my new friends for a month.

It could have been worse, and from the looks of the CT my jaw is a mess and I'm really lucky all I have is pain.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Late that evening Dr. Alonso called. The one scan he needed the radiology people screwed up and I needed to have it done again. So down the hill we went to get to the scan first thing, 8am. The techs knew they screwed up the day before and were very apologetic.

My jaw was hurting badly. It was swollen and I couldn't put any pressure without significant, stabbing pain. It just didn't seem right to me despite what the doctor said, so I'm glad we're back.

We get the scan and head to Coriminas. Alida cringes every time she rolls over bad pavement because she knows how much it hurts, but not much we can do about it.

I'm floating on a fog of pain meds but it still hurts. I am sooooooooo tired of this entire episode and am becoming rather cranky at life in general.

We get to Dr. Alonso's office---which is right next door to Andy's office at Coriminas---and he has the image already on his Galaxy phone. He doesn't say anything. He doesn't have to. I can see it for myself: my jaw has a fracture half way down from the top, clear as day, no mistake.

I know what that means. He knows what that means. Alida knows what that means. And Dr. Alonso had already spoken with Marcia, Alida's sister...so SHE knows what that means.

He said I had no choice: I needed an open reduction, the jaw reinforced with a titanium plate with screws, and my jaw wired shut for a month. Like I said: I knew what it meant.

We told him we'd work with the insurance and as soon as we knew something, let's do it. He wrote some forms for the insurance company and gave me a prescription for pain. We went back up the hill and Alida got on the phone with the insurance company. By 2pm the next day we got all the approvals from the medical committee. We called Dr. Alonso who told us he reserved an OR for Tuesday morning at 8am.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
Mmmff rrum mphhpm mmrwlsss

That's what I sound like when I try to talk.

My jaws are wired shut, my new reality for a month.

Tuesday was the Big Day. Last "meal" I had was a protein shake at 8pm Monday evening. Doctor's orders were NPO after 10pm. We packed for an overnight stay and went to bed early, sleeping fitfully, part from pain, part from angst.

The alarm went off at 5am. I'm not sure if that was early since I was already awake.

We left for Santiago at 6am, and checked with the surgery receptionist on time, 7:15am for the 8am operation. The receptionist promptly asked us to go down to administration & get the insurance paperwork. I stayed upstairs while Alida took care of that task since Spanish would be critical. Half hour later Alida returned, the receptionist called me and all the forms & disclaimers got filled out.

I was led into a 16x24 room right off the receptionists tiny office (I counted the ceiling tiles) that was the pre-op area. I later learned it was also the recovery room. I was given a paper robe, mesh hat, mesh booties & a plastic bag for my clothes and asked to change into appropriate attire. Mission accomplished. I gave Alida my watch & wedding ring, she was told her to go wait, and I gave her a kiss. I knew things were about to get real.
There were some fellow patients also waiting silently on their beds, and one was a year-old girl who was crying and clinging to mama. She didn't look ill.

I climbed onto my bed and a few minutes later a tech came and inserted an IV line into my left hand---not the most joyous experience---and got the Ringers flowing into my veins. It was 8:30 already. And I laid & waited. One patient got wheeled away.

I had plenty of time to observe. I've spent a lot of time in ORs in my life all over the US in a former life as a scrub tech, a high-tech OR/ICU/Anesthesia equipment rep/sales manager, being married to an anesthesiologist for 11 years, in high-tech homecare...and as a patient from numerous athletic injuries. The waiting room-I didn't know yet it was recovery-was very clean, and although the equipment was a generation old, all worked well, O2 & suction from the walls, storage, curtains that could be rolled back around beds, you name it. And it was cold, at least 65?, and I was close to naked...with just a sheet between me and freeze.

At 9:30 an attendant came & I was rolled through the second door toward the OR at the end of a long hall. On the way 2 OR doors were open & I saw a beehive of activity & blood. I was surprised the doors were open. In the states an OR is sacred and a sterile barrier exists between the suite and hallways.

At the end of the hall I saw my surgeon, Dr. Edward Alonso, a young, incredibly bright man...and with hands & skill from God as I later learned. Happy as always, he and his staff helped me onto the operating table, and a nurse proceeded to get me aligned properly, arms spread Christ-like on armboards (I had a moment to think "So this is like a lethal injection...without straps"), sticking electrodes on my chest. I looked up at what appeared like a alien space ship of lights of every kind aimed in my general direction: no doubt Dr. Alonso would have all the light he needed. Dr. Alonso was directing traffic quietly efficient. I looked around. This must be the orthopod room, because the glass-faced cabinets were filled with devices & boxes by Stryker and other orthopod manufacturers whose names I recognized.

I looked up and there stood a big guy, not Dominican-looking, in scrubs and a cloth hat. "I'm Dr. Ramirez, your anesthesiologist. I have a few questions", and he peppered me about my medical history. He'd done this before, no doubt...

I got connected to t ECG machine & pulse oximeter, the Anesthesiologist laid down several syringes filled with golden liquids next to my left arm. Things were moving fast now.

In my numerous surgeries on ankles, knees (twice), thumbs (each), biceps tendon, etc., I always like to test how strong my will is from the sleepy-time drugs. That was the plan for today.

The anesthesiologist injected a syringe into the IV line. This was it, goin' down! But then I got a surprise: he brought a mask at the end of double tubes---a clear disposable anesthesia mask & circuit, I should know as I used to sell them---toward my face and said "breath in deeply". I'd inhale, he'd move the mask away while I exhaled. I was going to have anesthesia gas, not just IV anesthesia.

"Breathe in deeply." OK. Mask from my face. Exhale. "Breaaaathe"...this time I could smell it: the gas. I asked the doc: "Isoflourane?" He chuckled. "Why" (I'm getting a little dizzy now.) "I used to sell it." Another chuckle, "No, something else, it's called..." and just as he was telling me the name of the inhalation drug....nothingness.

Blissful nothingness...
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
I don't really remember waking up. I sorta remember being conscious. Barely. I felt good. Restful. I noticed my mouth wouldn't move and I had something between my lips & teeth. Back to sleep.

I don't really know how long I laid there, but it was actually nice. I had no pain or angst, but I was really cold, trembling. I kinda muffled some sound, enough to get the attention of a attendant who came over. "Muy, muy frio" trying to escape my clenched mouth...shaking from cold...and she brought another sheet & black blanket and put it on me, and took a pillowcase and laid it across my shoulders. I warmed up and slipped back to sleep.

This was a radical---and from my perspective---welcomed difference from surgery in the states. There, you are abruptly awakened and harassed to not rest. I hate that part. You just want to sleep but they refuse. Here they just let you sleep. Nice.

I'm in and out, a little more aware of what's going on. I'm in a corner across from the hallway door to the OR's, and I'm aware of beds coming and going. A nurse came over and changed my Ringers solution---I'd gone through a liter---and put in two injections into the port. Nice lady. I went back to sleep.

Sometime later, I look up and Alida is there, smiling. I'm glad and she's glad. I try to smile but my mouth won't move. I'd forgotten why I was there for a moment. She said something---I don't know what, I'm still groggy---and is gone. I test my mouth again. Nothing. No movement, and there is a bunch of *something* in it. I go in and out peacefully.

There is a little girl in pain, crying, in the bed 4' away. Mom or grandma or a kindly nurse is singling "Twinkle, twinkle little star" over and over in Spanish to calm her, poor baby. I look over and see both legs in a plaster cast. Sad, I hoped she gets better. Her crying doesn't bother me at all.

I'm waking up more, stiff from lying in the same position, moving my body to get more comfortable. More patients from the OR are in the room buy except for the baby, all are fairly quiet. A teenage girl against the opposite wall is twisting in her bed and her mom tries to comfort her, "tranquillo, amour."

I can't find a clock. I've become obsessed with what time it is, a little disoriented but awake. I look for watches on people. No joy.

I'm aware I have no pain at all. I was expecting half my face, the side where Dr. Alonso went to my bare jawbone to attach the titanium plate with screws to be a mess. It wasn't. I felt my jaw. It wasn't really that tender, actually far less than before the surgery. And didn't seem very swollen. My mouth was weird though. But no pain.

My throat was sore, and I had minor chest congestion. Had to be from the endo tube and anesthesia gasses. I hocked up some phlem and had to swallow it---no spitting anything out for a month. The situation was setting in now. I knew the throat would be fine quickly.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
I found a watch on a nurse. It was 3:30pm. I had been there for 7 hrs! Wow. Sleeping through most of it comfortably.

Dr. Alonso came by for a minute, looked me over. He gave me a thumbs up, and I returned it in kind. He patted my shoulder, smiled and left.

I needed to pee. I was pretty much awake by now. I called an attendant over. Now keep in mind my limited Spanish, drug-induced brain fog---and the fact my mouth is wired shut. It was comical to try to tell her I wanted to walk to the ba?os to pee. It took her a while to understand, but finally I made a firehose gesture at my crotch she "got it." "Oh! ??pee pee!!" she gleefully exclaimed to the entire room. I felt like a tiny boy. I thought she got it, anyway. She went away and rummaged through a cabinet and brought back a urinal. No way. I convinced her to let me WALK to go pee. Reluctantly, she helped me up---I really didn't need it---and took my IV bottle to the bathroom where I proceeded to drain at least a liter of IV fluid and drugs my liver & kidneys caught. Ahhhh....MUCH better. Back to bed.

Alida came in and said she was trying to get a room, they were full & folks were slow checking out. I thought that odd at the time, seeing how it was past 4:30 already. She said she called her cousin who is a board member of the clinic to see if he could help, and he got us on the top of the list. She left and I laid back down. I was ready to leave, just a lot of waiting now.

I still had no pain, but having my jaw closed tight was odd. A nurse gave me a small, cold box of apple juice with one of those skinny straws. It was fantastic, even trying to use the straw outside of clenched teeth.
More was happening in the room. They were obviously busy that day. A guy across from me had a weird cast on his lower leg with one of those cold-water machines plugged into it. It looked painful. The baby was gone, as was the thrashing girl. A big, muscular young guy in his 20's was just laying there, bored. I have no idea what he was "in" for, but he had the IV.

I reached down for my charts at the end of the bed and glanced through them. I was told my surgery would take 45 mins. But the chart said I was in at 9:30 and out by 11:15, a lot longer than 45 minutes. A nurse came by and scolded me; seems I'm not supposed to be that curious.

Finally! Alida came in and said our room was ready! A male attendant came and bundled my IV bottle onto the bed along with my charts and proceeded to wheel me out. Problem is he didn't realize my feet were sticking out 6" and he kept banging them into things. I made him understand.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
The room was on the same floor as the OR suites. Here, to get to the rooms requires being buzzed through a security door, folks just can't wander around like in the US. It makes sense, though. The clinic itself isn't air conditioned, just certain parts, like the hospital rooms, OR, doctor's offices, etc. But not common areas.

I get wheeled into the room. I just wanted to stand up, but the attendant refused, and made me roll over to the bed. OK. Fine. I'm here. He moved the rolling bed and I stood up to his chagrin. I needed to stand. Felt good.

The room was small. We were told we had a "suite" but looks like the first available was a regular room, about 10 x 12 with small bathroom. There was a closet & sink in the room, and two chairs, one a fold-out sleeper thingy, since it is routine for family members to stay with a patient 24/7---another radical departure from the states.

We had packed a bag and Alida got my clothes out, clean undies, mesh shorts & T-shirt & my flip-flops. I peed again---I had gone through another bottle of ringers---and Alida slipped the IV bottle through the sleeve of my T-shirt so I could put it on. Finally! I felt almost human.

And a TV! I flicked it on to see if there was a US news channel because it was election day in the US. I was hoping for Fox; I got CNN instead. Could have been worse. They could have had MSNBC. The polls weren't closed yet so Wolf Blitzer and his gang just blathered about stuff.

Dr. Alonso and his assistant came into the room. He seemed pleased I was having no problems at all. I thanked him profusely and told him he has the hands of God, I had no pain. And it was true. I felt better now than when I came to the hospital with a fractured jaw. He seemed pleased and they left.

A nurse came in and put some more drugs in the IV line, and made sure I was washing my mouth out with a special solution. I was. An attendant came in with a jug of ice water and apple juice box. Yum. I sucked it down. Another nurse cane in with a nice icebag and I put it on my jaw as instructed, off and on for a while.

My phone rang. It was Alida's sister, a fine dentist who referred us to Dr. Alonso. She and her mother were coming y, did we need anything? Oh, hell yes! I wanted a chocolate milk shake! They were on their way and Alida went downstairs to the cafeteria for some food that she brought back up.

I watched some TV. The polls had closed and results were trickling in for the east coast. WV Senate got called quickly.
Marcia & their mom came in...with a chocolate milkshake from Bon. I let it melt for a while knowing the thick ice cream wouldn't go into my mouth.

We socialized for a while. I love her family, so much love. They were happy I was happy and it was a very nice visit. Everyone is so concerned. Their family Whatsapp is all aTwitter...;)

They left and I enjoyed a simply marvelous melted milkshake while I watched the returns into the night. Alida fell asleep on the weird fold-out chair...after we had a tech guy come in and show us how it worked. Looked uncomfortable.

Lights out when the AK senate results were in.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
I didn't sleep well. Heck, I had pretty much slept much of the day before. But the nurse came in at 6:30am to add a bag of Ringer's and drop off an apple juice box & more water & ice for the ice pack. We eventually got up and moving.

Dr. Alonso came in at 8am with a bunch of instructions & prescriptions. I was ready to leave, but here it's not so easy. Earlier I mentioned there were no beds available in the late afternoon? Well, that's because a patient is not allowed to leave until the bill is settled 100%. So we---or, more accurately---Alida had some paperwork to shuttle between the insurance company's office on campus to the administrative office...after the admin got their bill organized. That took a while, so I just watched TV.

Finally, all was done, and we owed RD$3500 to leave. But the ATM's weren't working---I even went out to try---so we had to put that and the RD$950 prescriptions on a credit card to leave.

So leave we did. It was glorious to be outside, a little tired & weak, but feeling better than the day before.
We stopped at La Sirena to buy two tubs of protein powders from the nutrition store there, and some powdered milk. That will be my food for a month.

So we're home, settled back in, dogs and cats all excited and our own bed.

I feel MUCH better, am happy to report no pain, and am learning how to eat through a straw.

You'd be surprised how much your mouth affects your life. Three little things I've discovered---besides not being able to speak so folks can understand you:
  1. 1) Straws are difficult to use if you can't open your mouth
  2. 2) Little bits of whey & fiber from the shakes & medicines clog the spaces between your teeth, so you have to swish stuff around a lot to get it all through
  3. 3) No fiber in your diet means, well, intestinal issues, so a supplement had to be added, and
  4. 4) Try shaving without moving your jaw. Not easy, and can't get a great shave.
I go see Dr. Alonso on Tuesday. Hopefully he'll say I can start working out a little again and not have to take things so easy. We'll see.

But so far so good. All in all, my surgery experience was VERY positive and I am blessed to have been referred to such an excellent facial surgeon. All the work was on the inside of my mouth and I am assured the bone will begin growing back quickly, fully recovered in a year.

I'll continue the updates on what life is like with your jaw wired shut...
 

davetuna

Bronze
Jun 19, 2012
1,071
0
0
Cabarete, Dominican Republic
hey CB, you can get some flaxseed (you can grind your own or buy it as a powder) (you can buy wheat bran as well like US$2) and chuck some in your drinks for fibre. Also i am sure you will be buying a juicer if you don't already have one.

take it easy

dave