teeth

welcome to another episode in my long history of healthcare complaints 🙂 although i actually haven’t written about this subject in a while, so if we met post-2019 then maybe all this is new for you

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i flew back home from sf two weeks ago. my job at asimov ended at the same time and i cried a lot during offboarding, which is a first for a job i guess? i’m somewhat sad because hanging out in group houses and working at asimov was probably the most agency i’ve ever exercised and it felt incredibly freeing, whereas now i’m back to… living at home and doing not-as-interesting quant work and i will soon be immersed in school again. oh well

on the flight back i watched nomadland which was really beautifully produced and well-paced despite barely having a plot (i mean that as a compliment). also the ambient soundtrack and the sonnet 18 scene were phenomenal. then i watched memories to choke on, drinks to wash them down, which is a cute hour-long movie about hong kong. it comes in four independent segments and i liked all of them except the first one. the film does a good job of conveying the economic and racial and ideological tensions in hong kong without ever letting them take precedence over the storytelling, which i think is quite difficult to accomplish. i’d probably want to rewatch sometime but it seems to be fairly obscure and difficult to find 

i came home to spend some time with my parents and see plano people and get my wisdom teeth removed. of course i’d rather be in new york or sf right now as each city contains maybe a third of my friends, but being home hasn’t taken as much of a toll on my social life as i expected, since i’ve been proactive about scheduling calls and opening messenger rooms

the wisdom teeth removal ended up going pretty poorly. i still maintain it was probably the right choice to insist on removing them now anyway since they were not growing in a healthy direction and complications increase with age, but i definitely didn’t properly think through the risk i was incurring before making the decision

the surgery itself went okay. it was my first time on anesthetics, which was an interesting experience that resulted in me remembering how to speak chinese more fluently and the initial recovery was fine. i took a break from work and spent two days reading the anthropocene reviewed, which i enjoyed a lot – it’s full of hope and gratitude and understanding, all of which i am very much in alignment with. maybe i wish there was more original content as many of the best essays from the book i’d already listened to on the podcast but that’s mostly on me

when you get teeth removed the main symptoms afterwards are mouth pain and swelling, which were pretty bad for me as i got all four wisdom teeth removed. i was prescribed antibiotics, painkillers, and steroids to reduce swelling, but i was curious about my pain tolerance so i only took the antibiotics (the other two are clearly optional, whereas you actually need the antibiotics to make sure open wounds in your mouth don’t get infected). anyway, the mouth swelling and pain didn’t bother me too much, though that could be because i got lucky or perhaps i am just good at distracting myself or whatever, so in the end i really didn’t learn much about my pain tolerance

one of the other complications that can start a few days after surgery is dry socket, which is when the blood clot covering a tooth socket gets dislodged, exposing the bone / nerve underneath, and supposedly the symptoms are “severe throbbing pain that extends from your tooth to your cheek and ear”, so i was supposed to call the doctor to get extra treatment if i ever felt this. in theory you can also just check if the socket looks exposed, but it can be hard to get a good look into your own mouth, especially for teeth at the back

so anyway a few days after the surgery i started feeling consistent pain in my right cheek + ear area but i couldn’t tell if it was “throbbing” and i especially couldn’t tell if it was “severe”. i consider getting shot or impaled or losing a limb to be severe pain, and the worst pain i’ve ever felt is at least an order of magnitude milder than that, and the cheek pain i was experiencing was also significantly more mild than the worst pain i’ve ever had, so how am i supposed to know if i have “severe” pain when most people live their entire lives on the shallow end of the pain spectrum? 

medical language should be as precise as possible. it should not be metaphorical and it should avoid terms such as “severe” and “mild” and “throbbing” and “sharp” and “burning”, because after years of sifting through online medical information and talking to doctors and experiencing different forms of pain i no longer know what these metaphors mean. and it especially doesn’t help that when i concentrate enough on sensing a pained area the pain often recedes or changes in perception. pain is just pain, and i can objectively tell you where it is, when it begins and ends, what it seems to be caused by and what it seems to correlate with, and so on, but i really don’t know how else to communicate pain, and arguably this is the level of objective granularity medical professionals should be striving for anyway given the importance of their work. i don’t blame them, since it’s not their fault they’ve been trained to communicate so vaguely with patients, but next time i need to see a doctor and they ask what i’m majoring in i’ll say premed and maybe that will help

anyway i ended up not calling my doctor, because i couldn’t really see any socket problems and decided i did not have “severe throbbing pain”. dry socket is not that big of a deal anyway if you take care of your mouth properly so hopefully this is okay

the antibiotic i received was clindamycin, which i was supposed to take every six hours. at some point i probably swallowed a pill with insufficient water or something because it got temporarily stuck somewhere in my esophagus or lower sphincter (pills don’t just fall down your esophagus; they get squeezed and pushed through the tube, so you might be surprised by how much water it actually takes to ensure everything get cleared). this is usually not a big deal since lodged pills, like food, eventually unlodge themselves, but clindamycin is a fairly strong compound that can irritate your esophagus tissue or induce ulcers when in direct contact so now i have some kind of esophagitis and eating and drinking and swallowing saliva are pretty painful

which is acceptable, like, okay i have learned my lesson and will be more cautious about the proper way to swallow pills in the future, and if my esophagus pain resolves in the near future then i think this is a reasonable price to pay for the increased awareness i’ve developed about my body. but what is less acceptable in my opinion is that i went to the ER back when i didn’t know what was going on and a) the first thing the doctor asked was for me to rate my pain on a scale from 1 to 10 b) we talked for a bit and i showed them my prescription and they did not see any potential issues or connections with the swallowing pain

which, again, i don’t fault the doctor for. the good studies i found on clindamycin-induced esophagitis all came in the past few years and even the linked study from 2019 suggests this trigger for esophagitis is still heavily underreported as doctors default to treating more serious triggers like acid reflux. doctors usually diagnose based on the facts they learned in school, however many decades ago that was, because nobody has time to constantly update their knowledge base in a dynamic field like medicine, so i’m pretty sure the doctor had simply never encountered the relevant information. the only reason i know so much about my conditions is that i spend way too many hours reading as much as i can every time my body feels something it has not experienced before, and if you did this every time you saw a patient you wouldn’t be able to see many patients 

but it is much clearer to me now how broken information flow in the healthcare system is. new medical research has a hard time reaching doctors because they are too busy, it has a hard time reaching patients because they usually aren’t curious enough to seek it out, and i’ve already explained how bad doctor-to-patient communication can be. we only get away with this because modern science is pretty good and most of our information is reasonably correct, but this is still very troubling, especially when new problems like covid flood our systems with mostly-incorrect information

i am really starting to understand the appeal of ai telemedicine now. kind of unfortunate that this is all happening five months after i left my healthcare job