Wednesday, October 16, 2019

T-12 Days to Ironman Toothache Solved

Triathletes are Drama people
Nik, our dear triathlete, and awesome moresome photographer posted the above in relation to how tapering triathletes will tend to behave. The IG Story came right on que as most, if not all, of us taking part in the Malaysia Ironman (in Langkawi) is currently doing; tapering is important to keep both the body warm and ready, while not overloading on training. Think of it as an exam - where last minute attempt will often not result in favorable outcome.
Joining the Drama Wagon
About 5 months ago, during one of my travel, i had some issues with my tooth, it acted up and I thought it was due to the constant flying and air-pressure changes. I read it may impact, but I never had this issue in the past 4-years of having the privilege to go around the world. The pain comes and go, the typical uncomfy feeling in the mouth that doesn't radiates longer than an hour. sensitive tooth, maybe. In my last visit to the dentist (government dental clinic), i did scaling and that was when the pain started to be worse, and lasting more than a few days. The doctor wrote me a letter and asked me to head to General Hospital KL (GHKL) Dental department as they are not equipped for surgery to remove an impacted wisdom tooth.
Yes, impacted wisdom tooth.
No one love going to see dentist.
Not even Mr. Bean. Remember?
That's about the right reaction
So, with the pain that was radiating from the lower left jaw, pulsating and both dull and sudden throbbing, the past two days (T-12 and T-11), i had serious concern. When the pain did not go off after a few hours, then a day, I starts to freak out. The images of operation, cutting the gum, stitching it up, 2-5 days of recovery, root canal, and worse - Did Not Start (DNS) on race day.

Thanks Edwin Ng for the photo. Making me look good.
Emotionally, there is too much to bear after not being able to race since 2015 (my last race was 2014). Financially, these races and preparation are not cheap! I am not concerned of the training effort I put in, because I've been training as a lifestyle. I am prepared for races, just have to "brush" it up.
My plight for help was answered when a fellow Old Putera left a message on my posting
The Doc (friend from same Alumni), explained to me the risk of what I may go through. I was clear of what I will have to go through, be it before IM, or after IM. His last message was to "come see me". I made an appointment with him, as he is also teaching in the faculty (of dentistry), and I am never more glad. You see, I am supposed to see a dentist (a friend's wife) the day before, but she is out on vacation. I made appointment for Thursday (tomorrow, as this post is written on Wednesday). So, you can see how much i wanted to get this fix, soonest.
Part of Nizz's message after I pass her a brand new Garmin FR945. Operative word - RUSH OFF to dentist, which i never got to see yesterday (Tuesday)
And now, I have an appointment with a Specialist, and he is an Oral and Maxillofacial Surgeon at this University.
Arriving early at the Faculty of Medicine (Dentistry) of UITM was great for me. I've never knew of this place, as I will almost just stop at Sg Buluh Hospital. Arriving early also gave me the opportunity to relax. Yes, no one likes to go see Dentist. I am yet to know anyone that see dentist because it's "annual check up".
First One here, apart from the staffs of course!
Doc walked in right before 0830, the time we set the appointment. I then went to register myself as a patient (RM20 for specialist), and went to pay for X-Ray (RM30). Yes, it is unbelievable that the KKM (Dental) i used to go has never taken any X-ray of my condition, and refereed me to GHKL (Dental) directly - all these based on visual inspection of the tooth.
Love the colorful lead vest
The X-Ray confirmed that my left lower wisdom tooth (T38) is growing out side way (has been all these while). What I wasn't expecting was that the pain I am experiencing wasn't because of the T38, but T37 - the tooth right next to it. As the tooth was growing out at an angle, it limits my cleaning ability, particularly to floss between T37 and T38. The food residue has caused decay from the bottom at bone level (below the gum).
Red line is gum. Green is the decay. 
Based on the top pic, I was given two options:
1. Remove the wisdom tooth (cut gum, break tooth, work around jaw bone), then try to save T37 by filling it. However, there is no guarantee the filling will work (the prognosis will be poor), as there is no way to fill the hole under the gum/bone.
2. Remove T37. Leave T38 untouched. Live with the gap left by T37.
Doc explained to me in great details, making sure I am informed and know what I get myself into. The best summary he gave?
If i go with Option 2, i not only get to save T38, I get to recover within the next 2-days, and can continue to train.
That was the magic word. Now Let me share this photo again
Triathletes are Drama people
I agreed to the procedure immediately, more conscious of the his timing - and he told me it can be done in 30mins. I have freed up my morning, and I do not want to delay this more - if I can end the pain today, I do it. 
But of course, ONE photo before the procedure!
The game plan is to break the tooth into a few pieces and pull it out. It is not a normal extraction as it will involve breaking of tooth with hardware that whiz at 4000rpm. Then, it will involve carefully calculated steady hand movement to yank the pieces out, remove the roots completely, leaving the socket empty - and void. I swear the tongue will feel the void. 
Sparing the details of the minor operation, below were what I've learn in the process today:
1. I received no less than 4-injections to numb the left side of my face (and mouth) which is still numb after 1300hours
2. I may had been injected more as the process of pulling the tooth out was in progress (by then, the needle poking was dull in comparison to the force applied to yank it out - with forceps),
3. Why i have more bones in my jaw (torus, as dentist call it), which is due to the training (athleticism) I put myself in, 
4. I can graft these bones for any jaw surgery, if needed (wow),
5. I learn how much anesthesia should be given based on body weight (because Doc quizzed the other dentist in training while operating on me), 
6. I learn that Doc has impeccable bedside manners, i have lost count of apologies he said every time he believe he is hurting me (thank goodness I wasn't a sickening senior back in school). 
A photo after, being able to smile tells you I am happy the problem has been solved! A gauze was in my mouth
I made a joke before the operation, telling him about my resting heartrate - and promise him I let him know how my HR spiked during the operation. Here it is, the spikes happened during the time I was less than comfortable (I won't say "in pain", as he help me managed the pain really well). I started at 49bpm at 0826hours and ended with 45bpm at 0920, 10mins after the operation. The high was at 84bpm when I had my X-Ray taken, and it seems that the actual puling out only peak at 79bpm - when the last part was removed, including the root. See, Triathletes love their data - even when in pain.
Triathletes and Data
Thank you again Doctor OP sir. I can now rest assured that my tapering plan will go on as planned. See you soon, and the next time, hopefully we are swimming, biking or running!

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