Start with tires, end with teeth

Monday, August 22

For Aug 21 CPAP. Reported figures. Time on 4 hrs 58 min with AHI=1.01. Events: 0 CSR, 5 H, 4 RERA. No mask leaks (max= 21 L/min). Oximetry: Two blips below 88% on the CPAP & off, but fine all night. Actually, the down was lower on CPAP than off.

I have taken care of a bunch of medical planning issues all day, answered emails (not finished), done dishes, and put medications for the week into my little case.

John went to town in the truck to pick up our new tires for the RV trailer that had been installed on their powder metalized-coated rims to rejuvenate the old pitted/weathered ones (34 years old) that were causing one of the 15-year-old tires not to stay inflated.
1-NewRVTrailerRimsTiresSeveral colors are possible but because the trailer has “earth” colors, John picked orange. It is Kobota-orange and brighter than the trailer’s colors (somewhat faded). Hubcaps cover most of the rim, so only a little orange shows. The technology is new to us, but not new.

The tires are not top-of-the-line, but good enough for a trailer that doesn’t go anywhere. Well, it did go up on wood blocks, likely until a fire causes us to evacuate โ€“ or we decide to become vagabonds.

Note the brand: Venezia! Sounds sort of Italian. Not so. Not even from The Rubber Capital of the World โ€“ Akron. They are produced in Thailand. Oh, the tragedy!

While out to photograph the tires, I stepped over to John’s number one garden where he was watering his little hen & chicks. They are within a 6′ fence because the deer love these tasty treats. 2-John'sHen&ChicksNurseryWe gave away 12 pots the beginning of summer, a couple last week, and more need to be separated and potted anew.

I talked to Janel at Hospice Friends and will stop by tomorrow before 2:30 to see her and pick up some stuff for my neighbor and me. She suggested giving me a light hospital blanket to fold and put into a pillowcase to use in the dental chair this Friday to protect my back. Great idea (and it worked perfectly).

Tuesday, Aug 23

For Aug 22 CPAP. Reported figures. Time on 4 hrs 45 min with AHI=0.42. Events: 0 CSR, 2 H, 8 RERA. No mask leaks (max= 14 L/min). Oximetry: SpO2 up all night on & off CPAP except right before I stopped the oximeter and might be from moving to a different finger.

Today starts my Amoxicillin three times a day (8 hr intervals) for 10 days.

I went for my INR at KVH, and found out late afternoon that it was high, at 3.2. From there on to Hospice Friends, on my way to the 2:00 Jazzercise (taking $3 to Katrina, although I will not likely be there next week, but I also owed some from last month). We meet once a week, and pay 50ยข/day for the class.

I carried a container of Early Girl and cherry tomatoes. Everyone was happy. While there, I picked up keys from Anne so I can get her mail and water her plants for the 2 months she and her son are gone back east and south. This year a friend’s younger girl will take care of the cat I took care of last year.

After today’s vigorous aerobic exercise, I went to Physical Therapy for my Progress Report. I did not do as well today as I have done in the past, on most all the measurements.

I stopped by Safeway to pick up my Telmisartan (Micardis) at the reduced price (still a lot for 90 tablets), $67.89, through GoodRx. I take cash for the purchase, as I cannot qualify for a co-pay through insurance at my regular pharmacy because the price for the same amount is triple this cash price (for some reason).

The temperatures were quite hot today. I came home tired.

Wednesday, Aug 24

For Aug 23 CPAP. Reported figures. Time on 5 hrs 42 min with AHI=0.00. Events: 0 CSR, 0 H, 11 RERA. No mask leaks (max= 8 L/min). Oximetry: Good all night, with one blip to 88.

I shall begin midweek today with a Facebook photo posting and note from Tony Bynum, professional photographer extraordinaire, from Montana, and my friend from long ago, since he was our geography student at CWU and in resource management.
3-Tony Bynum PhotographyElk
Tony’s comments to his Facebook friends are below, marked with a left column.

Once in awhile you get lucky. ๐Ÿ™‚ Just another day at the office โ€“ yeah, right! Sat at this location for the past 10 years or more waiting for a shot like this. You can imagine how I felt … All those days waiting, hoping. Everything has to be right, the light, the wind, the sun, and the animals. At the end of the day, I would have never have been able to bring shots like this to reality, if not for our public lands keeping it wild. See: www.tonybynum.com for more photography in the wilderness.

Early 5:00 a.m. Amoxicillin. I went to food bank for music, and ate a little, but I left without going to SAIL exercise to come home to work on medical records, in consultation with my family physician’s records keeper. I did not take my friend, Gloria, with me because she had other appointments.

The rest of the afternoon I worked on 7 pages of Medical history (in a form they emailed me as a .pdf file so I could print out, fill in by hand, and also then scan into a .pdf of all the pages plus a paged of my medication dosages, and ship back with my signatures and all the information. Again, this was necessary to share all details to be considered for an evaluation of my left shoulder by Dr. Richard Roux, an orthopedic surgeon. Before I can even schedule an appointment, I have to do all this paperwork, after the referral from my family physician (that I received Monday, this week). I had to consult with the record keeper at my primary care doctor’s office to coordinate dates on procedures connected to medical ailments over my past. In addition, I had to get the full name of a drug I was allergic to in the past and what my reaction was. That is the second allergy on my list. I know Heparin as the important first “allergy,” of which a H.I.T. would be fatal. I wear a medic alert bracelet for that and for the various artificial parts associated with my heart.

Now to send the count for tomorrow’s music to the people who will set up the chairs. Done. We will need 10; ended up needing 11.

This evening we went to the neighbors to carry in the stuff from my car I got from Hospice Friends and take them a few each of peaches, plums, nectarines, and cherry & pear tomatoes. After lugging the stuff in, John walked home to feed horses, deer, cats, and do a few other things, and I stayed to visit.

Thursday, August 25

For Aug 24 CPAP. Reported figures. Time on 4 hrs 21 min with AHI=0.69. Events: 2 CSR, 3 H, 10 RERA. No mask leaks (max= 21 L/min). Oximetry: Good all night, only 2 blips to 88%, SpO2.

Early morning call (7:56 a.m.) about scheduling an appointment for my shoulder evaluation with the orthopedic surgeon. I was dead asleep, having been up at 5:00 a.m. to take an antibiotic first dose for the day. Laid back down with a heating pad on my shoulder and neck.

I had cancelled my teeth cleaning for this morning, because I was afraid the extra Amoxicillin was going to raise my INR, which cannot be above 2.5 for Friday’s surgery. Therefore, I will just go play music at Hearthstone, afterwards, go for an INR late afternoon (at the hospital lab, a block north), to see if it is below 2.5 (required for surgery), and call my Coumadin counselor to report the number. Ended up having a vein draw rather than a pinprick and called before 5:00 to get the reading. Happily, it was 2.0, so I am good to go for the surgery.

We had a lot of music folks today. Pretty cool. At one point we had 4 fiddlers.

Finally changed my nose piece and tubing on the CPAP; I need to do the filters.

Friday, August 26

For Aug 25 CPAP. Reported figures. Time on 6hrs 37min with AHI=0.00. Events: 0 CSR, 0 H, 10 RERA. No mask leaks (max= 10 L/min). Oximetry: Great all night.

Introduction: Dental Implant Surgery, definition by the Mayo Clinic staff:

Dental implant surgery is a procedure that replaces tooth roots with metal, screw-like posts and replaces damaged or missing teeth with artificial teeth that look and function much like real ones. Dental implant surgery can offer a welcome alternative to dentures or bridgework that doesn’t fit well.
How dental implant surgery is performed depends on the type of implant and the condition of your jawbone. But all dental implant surgery occurs in stages and may involve several procedures. The major benefit of implants is solid support for your new teeth โ€” a process that requires the bone to heal tightly around the implant. Because this healing requires time, the process can take many months.

My surgery was a follow-up from 5 months ago when I had a tooth pulled (a root canal that became infected and was realized when the gold crown came off and could not be reseated. The surgeon had to take my blood platelets and insert bone graft materials to regenerate the bone in which to connect the implants. That requires a minimum of 4 months.
Because of my heart issues, and valve replacement, I have been on Amoxicillin 3 times a day since Tuesday, and my premed (4 500 mg tablets) occurs an hour before surgery, so I took it on the way down to Yakima; John driving. I was at the dental surgeon’s office for check in at 11:00 a.m., and surgery prep began at 11:15. Surgery lasted 1.5 hrs. I went through the surgery, and am providing some description below. We left the office at 1:00 and came home via my Ellensburg pharmacy for Oral Rinse (a pint and I’m only supposed to dab a Q-tip in two places twice a day). Insurance doesn’t cover it, and so we had to fork out $15.48. My pain killer (not working) was only $3.49. Saddest is that my blood doesn’t want to clot either. The 30 minutes of biting on gauze pads (they gave me) has not stopped it. I continued for a couple hours and finally stopped, and the bleeding slowed. I continued with cold compresses to my cheek on and off for 20 minutes. (That’s primarily for swelling.)

During the prepping, I was able to have help with setting up my three “pillows” I brought for the chair. I had folded a light hospital blanket and put into a pillow case wrapped to half size, to place between my back and the back of the chair, which had pressed uncomfortably (and painfully) 5 months ago in the beginning surgery setup. The second pillow I sat on โ€“ a pillow case around an egg-carton type foam pad. The third pillow was my normal smallest sleeping pillow, which we put under my left shoulder/arm.

Surgery went for 1.5 hours, I was awake the entire time, and knew everything going on, what was said, and when my anesthetic quit working. The pressure of stretching all of my mouth’s facial skin and lips was painful and I had no numbing for that. Pressure under my chin was also required. The doctor had two immediate assistants, (1) running the suction, pulling out my cheek, advising on positioning of the drill and screwing in the implants eventually, and this person also took X-rays of the jaw as we progressed; (2) handing drill bits, controlling the direction and speed, changing implements/tools/inserts, accepting measurement directions from the surgeon, and acting as another set of eyes to position from her side (right) of my mouth. I was able to see (and hear all the tools used and the directions given). I also received explanations of the process and what was happening along the way. The doctor asked in advance if I wanted such information, because many patients do not want any explanation while the surgery proceeds. I assured him I wanted to know everything he had time to slip in between instructions to his assistants. A fourth person was also helping with various tasks, and with setting the X-rays that proceeded throughout. I had a heavy lead cover protection over me the entire time.

I had had a 3D CT scan at a previous visit, and the surgeon, Dr. Tew, created a plastic form with the emplacement locations he used (with it placed in my mouth) for setting up the hole drilling into the bone to house the implant “screw” (metal post). During surgery to place the dental implant, the oral surgeon makes a cut to open the gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed.
Because the post will serve as the tooth root, it is implanted deeply into the bone, but not so deep as to reach the nerve. Also occurring during the surgery was attaching the abutment to the top of the metal post that will be the base attached to the crown. That work will be put off for early next year.

I will not wear the CPAP machine for a week after oral surgery. I learned that by myself 5 months ago. It was not a pleasant experience to start the blood flowing again, after two days. I was told not to drink from a straw, but nothing about the CPAP’s interference. I rewrote their post-operative procedures and questions. Not everyone is the same, but I am to stay off a week, sleep doctor’s orders. I do not have sleep apnea problems, but am on it solely to increase my SpO2 (blood saturated oxygen percentage level for my organ health, particularly my heart).

My afternoon recovery was painful, and I alternated doing all the things suggested, and took another pain killer, but I guess the Yogurt and the Ensure was not enough to counteract the “empty” stomach, and I suffered from a little nausea. Thankfully, John had picked up some generic-Sprite for me when he got the pain meds… and oral rinse.

While resting, John went through and explained some of the photos that arrived from a trail worker during the Jack Creek work in Icicle Canyon this past weekend. We just received these photos today.

Here are a three of collages John can review what he described to me and I tried to share below each.
4-JackCr_IcicleCanyon8-19-21-16Starts with Jack Creek a mile away from the trail work; sign entrance to two Alpine Wilderness Trails, Paula working on root removal, and John working on the top of a large root. The tree is already dead but removing the entire root might destabilize the tree, causing it to fall, and ripping up the newly refurbished trail. He took about 6 inches off the top, using saw and ax.5-TheRockPoleStoryJohnPaulaAlanThis is the rock and pole story at the end of a lot of hard digging by Paula and Carol to expose the rock. The previous day, thinking they were done with the heavy lifting, they had carried a continuous rope puller out to the truck …

Maasdam Rope Puller

โ€ฆ and some other gear. John got his rock moving stick, Alan has a shovel, and the iron bar is in the hands of the lady.
6-AlanRootBradDumingJohnBrokeRcksJohnBehindTurnpikeAlan with a large removed root, Bradley dumping rocks John broke up from a nearby granitic, and well weathered, boulder. Alan watched from the end of turnpike, and on the right look past the turnpike and see John creating the buckets of small rocks with a one handed sledge hammer (aka, single Jack).

Tonight we also had some nice views more to the northwest from our back patio.
7-CollageTwoNWSunsetsOurPatio

Saturday, August 27

For Aug 26 CPAP. Not using; however, I recorded the oximetry all night: Without the machine, the SpO2 jumped below 88 a few times, below 80, twice.

This morning I was up early to take my antibiotic and acetaminophen, but I did not take any pain pill. I managed to sleep until 9:00 a.m.

John fed the 3 outside cats, picked some cherry tomatoes, and left for the Eberhart orchards to pick a few boxes of Gala apples, early ripeners. Honeycrisp won’t be ready until later. We have two neighbor things going on and want to provide a box of apples to each. He got about 90-100 pounds of good apples and another box of windfalls to give to the fawns and their mom.

He went by way of Ellensburg to buy gasoline, a bucket of ice cream, and 2 frozen pies.

About 11:30 a.m. a car drove in (not John), so Annie announced it. I walked out and received a beautiful flower arrangement sent by my dentists. Here’s a photo.

8-WilliamsFloristDelivery8-27-16-11amThe photo is outside (overcast today then). On the right is the florist and the card from the sender attached. I appreciated receiving the pretty flowers from my dentist and my surgeon for yesterday’s activity in my mouth.

9-CollageJustFlowersFlorist&John'sInside the house I added a picture of the flower delivery vase beside a vase with the gladioli John brought to me when he got home. Both are in my kitchen window to cheer me when I fix my liquids mixed with filtered water and mix in a heaping tablespoon of New Zealand Whey (protein powder manufactured in Canada). I received a container of it from Tanya Myers, that John brought back to me with several boxes of apples picked this morning.

Temps went to 82 high today, but so did the wind gusts (to 43 mph twice).

John and I had a piece of Key Lime pie this afternoon and for supper, I had a yogurt with another whopping tablespoon of whey protein powder. Then before bedtime, we’ll have another piece of Key Lime Pie with our strawberries on top. I should be able to slither those down my throat and chew a little on the right side, if needed. The crust is crushed graham cracker so not as hard as a flour-based cooked pie shell.

Hope your week was fine.

Nancy and John
Still on the Naneum Fan