Saturday, October 10, 2015

Days 7 - 10: Dental work

Part of this trip was planned for Bruce to get new teeth. I had made arrangements through a dental tourism facilitator for Bruce to go under sedation, have all of his teeth removed in one sitting, and temporary dentures placed. We have worked closely with Bruce's doctors at the VA to ensure he is healthy enough for the procedure, including the specific medications to be used for sedation, so this has been a well-planned process. The facilitator I chose was Tijuana Dentist Center, run by Jim Crayne, and the dentist was Dr. Humberto Muyano. We've been pleased with the dentist, but underimpressed with the facilitator.

I had been in good contact with Sylvia in Jim's office until just as we were getting into Tijuana. I had directions to the clinic from the border, but I did not have an actual address. I thought the office address on the website was where we would be having the dental work done. So, when we came into Tijuana earlier than planned, I e-mailed the office to let them know. I gave them the name of the hotel we were staying at and asked for any different directions. I had heard nothing back by the time of our appointment.

So we ordered a taxi, giving him the address on the website. There was no dental clinic there. I was finally able to get an answer calling the clinic, and let Sylvia talk with the cab driver. After this, we got in the general vacinity. I called again and found out we were dropped off a block away. So, we walked to the building we were directed to and waited for Jim, who was running a bit late.

While we were waiting for him, another gentleman with broken English was very insistent that we needed to let him take us upstairs. He repeatedly told us, "The dentist is up." Finally, I called Sylvia again. She spoke with this guy and determined that he was not associated with the dentist with whom we had an appointment.

Jim finally arrived and took us into Dr. Muyano's office. Jim had left us under the impression that we would go in Wednesday, get sedation and the extractions, then come back for the temporary dentures. That was not the doctor's game plan.   The doctor planned to do an exam the first day, then schedule anything else. (A much better plan, but Bruce was not happy with it.) For this exam, Jim was there and helped translate. This has pretty much been the last we've seen of Jim.

The doctor proposed leaving the bottom front teeth in because they could be saved with a little work, pulling the molars, and doing partial dentures on the bottom. The top needed to go and be replaced with dentures. This was priced out to a little bit more than initially quoted, but I liked the plan better because there weren't so many teeth going at once, and Bruce insisted that there would only be one session of tooth extraction.The cost was still about a fourth of what it would have been in the states, and unlike Ecuador, he would get sedation. Because of the number of teeth that would need to be extracted at once, the doctor insisted on an EKG and consultation with a cardiologist before proceeding. A highly reasonable request, especially with Bruce's uncontrollable atrial fibrillation. Jim left before the cardiology consult, but left money and instructions for our cab back to our hotel when we were done.

The nurse came down from the cardiologist's office, and escorted us up. She took the EKG, and we went in to see the cardiologist. He read the EKG, listened to Bruce's heart and lungs as well as just about every pulse in the upper body that would be audible. He checked with us about what options had been tried for the a-fib, agreed there wasn't anything else to do, and said he should be able to undergo the procedure. The total charge was $80 USD.

The anesthesiologist's office came down and spoke with Bruce; the dentist did some prep work, and the plan was to return the following morning for the surgery.

Jim called Thursday morning, saying our hotel was further out than he anticipated, so he was sending someone else to pick us up. She got us on time. As anticipated, the dentist and anesthesiologist were a little bit late, but that's okay. When the got there, they promptly went to work. Hooked up the IV, gave him drugs, and Bruce went to sleep. Since we (yes, both of us) had been fasting, I stepped out to get a bite to eat. When I got back, Bruce had woken up and was refusing to let them work until he talked to me. Mind you, he doesn't remember any of this. Medazolam really does work. So, I insisted they put him to sleep better, and the anesthesiologist produced just a tiny little bit of propofol. That did the trick. It did it so well, that the anesthesiologist had to insert a short tube to support the airway when Bruce started to swallow his tongue.

When the procedure was over, Bruce woke up nicely, not remembering anything, and not feeling much pain. The doctor had prescribed some amoxicillin and a pain reliever that I had never heard of. When we got back to the room, we discovered that the pain reliever was an NSAID, so we didn't want to use that. Thankfully, we had some Vicodin his doctors at the VA had prescribed for his last abscess, and that's been working well. If we need to, we can always run back up to the San Diego VA if he needs more. That's one reason I wanted to do this close to the border instead of further inland. Vicodin and other narcotic pain medications are not available in Mexico.

The doctor asked me to call him on Friday to let him know how things were going and gave me a number to call at any time if there were any problems or concerns. I didn't call until the afternoon (when Bruce was awake), and they were very concerned that they hadn't heard from me, but happy that he was okay.

We've gotten very lucky with the hotel. A waitress in the restaurant has seemed to take Bruce under her wing. We asked if the restaurant could make him just some broth, but they would not. This waitress (who will remain nameless) offered to make him some at her home and bring it to him so he could have something to eat. She asked that we not tell anyone because she could lose her job over it. Needless to say, we have made it worth her while. And, this morning, she made him just plain scrambled eggs (which is not on the menu) when we went downstairs for breakfast this morning.

The only problem with the hotel has been the bar that had their grand re-opening last night. They're right under our room and not associated with the hotel - just a tenant in the building. Live music until about 6:00 this morning. And, not good live music. The drummer and bass player aren't on the same timing; the instruments aren't well tuned to each other, and the vocals have a disonance with each other that shouldn't be there.

Bruce is not ready for pictures, yet, so there are none in this post. He has a follow-up appointment on Monday. Jim will be sending someone to pick us up.

Bruce is feeling much better, so I may leave him at the hotel tomorrow and do a little sightseeing.

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