from awful to just plain bad

that's the right wording to describe the state of our front yard at this time. yesterday canuck and i took complete advantage of the glorious weather and spent the entire day outside working on the front lawn. we pulled up two half-dead bushes, dug trenches around the soil-grass interface, pulled some weeds, raked a bit, trimmed our weeping mulberry trunks, and pruned our endless-summer hydrangea, which, much to our delight, has started to sprout. i was also ecstatic to see the daffodil bulbs that we planted this winter also starting to sprout, as well as our peony bush and hazelnut tree in the backyard.

unfortunately, our topsoil is clay-like and completely devoid of nutrients, there's more weeds than i can keep track of, and our lawn is just overrun with detritus. our neighbors were nice enough to give us gardening tips and lend us some gardening tools, but one of them politely confirmed our diagnosis - our lawn is crappola. actually, she was very nice and said, hey, rome wasn't built in a day and you guys are doing great, these things just take a lot of time. she was the one who taught me how to prune and told us where to get the new soil. did you know you can buy a "yard" of it and they just dump it on your front lawn? so you know what we're doing all next weekend. today when canuck gets home we're going to lay the fertilizer down as it's supposed to rain and be cooler tomorrow. the city girl in me just wants to throw in the hat - i didn't know it would be so much WORK! it's a joint effort, but i'm about to pick up the phone and call for professional help, just for the cleanup and setup. canuck vehemently refuses. we are going to tackle this ourselves, he absolutely insists. great. while our neighbors are sporting beautiful flowers and lush green lawns, we're just trying to bring ours back from the dead so it doesn't look like calcutta in a heat wave. but our neighbors are cheering us on. i think they find it adorable and amusing that we're trying so hard. we are first time home-owners, after all, and the youngest people on our block. maybe i'll just call the professionals when canuck's gone and have them do it , and then when he gets back he'll think that i did it all myself. hmmm.....

actually, it has been good for all of us. cookie hangs outside with us instead of in front of the t.v. and i've gotten tons of exercise from all this. plus it keeps us out of the kitchen and away from grazing. maybe i'll loose those 10 pounds i've been wanting to shed. and at least we're making a dent. awful to bad is a step up!

an interesting case

last friday i was double booked with an emergency, my colleague's patient was coming to see me for "extreme facial pain that kept her up all night." mrs. s, a woman in her mid-late thirties, presented with a dull, throbbing ache that originated at her left TMJ and would periodically radiate sharp, stabbing and almost debilitating pain all the way through to her left upper midline. her medical history was unremarkable. she was in the process of seeking orthodontic treatment for a collapsed bite, which had been "corrected" by her previous dentist by placing composite resin on the occlusal surfaces of her molars to open up her VDO. percussion of the upper teeth was negative, all of her teeth in the lower arch were mildly percussion positive, and there was noticable TMJ crepitus on the left side. perio pocketing was within normal limits. her recent dental history was unremarkable, except for a resto that was placed by my colleague on #36 back in september that had some "sensitivity for a while" and she was meaning to come back to have evaluated but just didn't have the time. radiographic examination was also unremarkable. just as i left the room to discharge my other patient, she had another attack of debiliating pain that shot across her upper midline again, to the point that she was reduced to tears. i quickly got out some hot towel compresses (we keep them in the office as a comfort measure for patients) and the pain started to subside with its application.

at this point i had a suspicion that it might be TMJ-related or neuromuscular and she was only in my schedule for a look-see, so i spent a few minutes trying to find an oral surgeon that could see her immediately for evaluation. luckily i did, and i sent her off with a script for motrin and percocet to be taken alternately. i knew she was going to someone capable and competent. but after she left i had sneaking suspicion about that "sensitive" #36. no way, i told myself, i've never seen referred pain radiate that far on an upper. nonetheless, i quickly spoke to the oral surgeon and asked her to evaluate the six (i had performed all diagnostic tests but one, as my office had run out of endo ice, a fact which i was not all to pleased with, that's another story for another time) but i was pretty sure that wasn't it. however, there was still that nagging feeling and i felt more comfortable having someone else take a look.

the OS called me back to follow up after she was seen. she had examined her, no, it was not the TMJ but her symptoms were consitent with trigeminal neuralgia and she was referred to a neurologist for further evaluation. when i thought about it, it made sense because tic deleraux does manifest itself as brief, intense and episodic pain. the OS was also certain that it wasn't the six, either. she would have done the same thing i had done - pain meds and a referral. okay, i did the best i could with it, i hope she felt better and i wished her the best of luck. eek, still that nagging feeling...

on monday i get a call at home from my office manager. mrs. s was seen at the ER today for sub-mandibular swelling, she was placed on antibiotics, can she come in tomorrow for an evaluation. absolutely, i said, i'll come in early to see her. when she came in on tuesday, she looked like hell. her submandibular nodes were rock hard, there was noticable swelling on her left side, and she was having trouble swallowing. she was given a script for clindamycin 300 mg tid, real big guns. this time i had endo ice ready to go (i pretty much had chewed out my staff for not ordering it after i had written it on the dry-erase board a week and a half ago when we were running low, but again, another story for another time) and i tested all the teeth in her lower arch. sure enough, #36 had no response to cold and was precussion positive. my diagnosis was acute apical abcess. i told her to stay on the antibiotics she was on, and we booked RCT for the next friday. as she was very anxious about having a root canal, this was her first one, i gave her a script for halcion 0.125 mg to be taken 40 minutes before the procedure, and the night before, if necessary. on friday i got in early again, we medicated her and i completed the pulpectomy. sure enough, i opened up the tooth and completed the pulpectomy and while there was no pus, it stunk to the high heavens. the patient was nice and relaxed, left in wonderful spirits, and is coming back tomorrow to complete the treatment. she said afterwards that it was the first time she had slept in over a week and that she had actually enjoyed herself during the procedure. she also gave us invitations to her jewelry sale next saturday!

i really learned a lot from this case. first, i learned the really wacky patterns of referred pain, and it only reinforced the importance of testing BOTH arches when a patient presents like that. i learned that even only moderately deep resins can have very detrimental effects on pulp health, all the more reason to caveat when placing such restorations. i also realized just how vital and critical endo ice is in diagnosis, and that pulp testing can give you such surprising and conclusive results - hence my mild discomfort and unease at dismissing her last week without having used it. i also learned that sometimes pain and infection sometimes cannot be diagnosed immediately, that at times things have to localize. and last by not least, i learned to just trust my instincts - that sometimes a doctor's intuition is dead on, even when you're not sure of yourself. sometimes i actually do know what i'm doing!

a return to normalcy - well, sorta

so the guests are out and i've vacuumed up the dog hair and washed and folded all the linens and got the house back in order. it literally took me all last monday to do it. i had a great time and all, but i am seriously rethinking doing the whole back-to-back famliy gathering thing any time soon.

the weather sucks and i'm sitting her waiting for spring. i'm cranky and moody and in desperate need of a haircut, which makes things even worse because i'm not feeling pretty. i just don't have the time to go out and get one. i want the sun to come out so i can get motivated. blech.

i start work at 1 p.m. today up to the evening and canuck is recording american idol on satellite so i can watch it when i get home. i hope sanj@y@ gets ouseted this time. i feel bad for the kid, i really do, and he's got a lot of charm and is a sweetheart, but this whole thing is losing it's novelty. i want either melinda or blake to win. i like l@keesh@, too, because she's a mom and lives in flint, michigan. for some reason i'm really attached to this group of contestants this year.

blech, again.

hostess with the mostest

i'm now on the second batch of family visitors. my dad and 3/4 of the tireless tetrad of fun are on their way back to long island after a brief stop in niagara falls. they left on wednesday, which gave me approximately 14 hours to clean, launder the linens, and do a massive food-shop to prepare for the arrival of my mom, stepfather, grandmother, and the two doggies. my house is bursting at the seams.

man, i'm tired.

today is good friday, so i'm marinating some salmon and defrosting some shrimp for a fabulosa, religiously-correct supper. my nana is exempt from the no meat rule because she's 81, weighs 80 pounds, and is diabetic, so she's getting a chicken breast and pasta alfredo. i made her pancakes, waffles, and bacon for breakfast this morning (i slipped and had a piece of bacon, so i am now damned to hell, for a short while, anyway). easter is the one holiday i'm NOT hosting this year, so i'll get a little bit of a repreave. now we just have to plow through a few more days of picking up after people, vacuuming the massive quantities of dog hair, entertaining, and moderating the heated political discussions between canuck, the "bleeding heart liberal-canadian communist" and my parents, who are stauch republican bush-supporters.

all-in-all, it's been pretty fun!

wicked!

my dad and 3/4 of my sisters are visiting from LI this weekend and the youngest, who's 13, showed me this clip from you tube. like, wow!