So far, it does not have the severity of a C. Difficile takeover. But yeah, unappetizing liquid at unexpected times. The timing could just barely have been more precise: Tomorrow is the day I should put on the wearable heart monitor. I am planning to call them and ask to cancel that. (Tomorrow morning, as it was too late today.) I was hoping to walk my usual route in the hills with the monitor on; as it looks now, I will not walk very far from the bathroom. While I am sure it would be interesting to have my heart and blood pressure monitored while sleeping, going to the bathroom and trying to rehydrate, that is not really what I was thinking of!

On the bright side, the swelling in my face was gone already yesterday. My tooth is still lose and I suspect that its movements are irritating the wound, but there is really nothing I can do about that. I will stop taking clindamycin when I have developed serious diarrhea, as requested by the accompanying leaflet. If the diarrhea keeps getting worse, I should next consult a doctor. (Provided there isn’t a month’s wait this time? There is no clause for that in the product sheet.)

So far I have eaten just yogurt and the probiotic milk drink, as I have done since the cure started. But I should probably add some cooked water and salt if this continues.

Edit later in the evening: Now that the antibiotic has been out of my body for some hours, there is definitely some pressure building in my face again, although slowly.  You’d think it would not come back once it was gone. At some point the immune system should be able to deal with it: This is not some kind of new superbug, to the best of my knowledge, it was contained for several months before the surgery with no symptoms except a loose tooth!

Well, at least perhaps someone will read this and take my warning to not have oral surgery unless your life is on the line.

Yesterday late in the afternoon was when I cracked my first capsule of Dalacin (clindamycin), a broad-spectrum antibiotic. The reason why I was prescribed this was that the infection had been inside the bone, and the bacteria that can lodge there are anaerobe (they do not need oxygen to live). Penicillin has little or no effect on these. On the other hand, clindamycin is a pretty extreme measure, as it kills pretty nearly every bacterium there is except hospital bacteria with resistence, and a few strange creatures like the infamous C. Difficile, destroyer of intestines.

So, a day and some hours later… nothing much has changed.  I still have a slight swelling. I wish I had taken pictures before the whole thing began so I could compare, but to me it looks like I have a small pouch on my right lower jaw as well, that is slightly larger than the left. But the difference is so small, I may need to ask a few coworkers whether they can see it or whether it is just a trick of my imagination. It certainly feels like there is a swelling, and it is periodically tender, but I have to wonder whether this is a sparrow I am hunting with a cannon.

My body temperature follows the usual curve, only a bit later in the days now that it is weekend. There are short periods of feeling cold and stiff and unwell, but no more than an hour or so. These seem to have no relation to when I take the antibiotic. Once the temperature reaches 37.5C, it stops and gradually slides back down over several hours.

My appetite is pretty much shot, but there is still no queasiness or diarrhea. I drink a probiotic milk drink with my clindamycin along with the requested amount of water, and a little yogurt. That is pretty much all I can get myself to eat. But that is the least of anyone’s worries, since I have enough fat to last me through weeks of undereating. While I am not technically overweight, I am much closer to that than to underweight. It feels strange to not spend a noticeable part of the weekend exercising, though. But one is not supposed to do that with an infection, I read once in my youth. Perhaps I should ask the universal wisdom of the Internet whether this still applies?

The Internet says yes, exercise diverts resources that your immune systems should have used, so take it easy. No need to stay in bed unless your body decides so on its own, but don’t challenge it in any way. Also: “I just had oral surgery for a bone graft about 7 weeks ago and found that the antibiotic, which was Clindamycin, made my muscle ache some” says one athlete. So, it might have limited itself.

The after-effects of the dental surgery unfold in slow motion. Which is better than fast motion, but still disturbing. The small swelling on my upper jaw has diminished, but there is now a small swelling on the side of my lower jaw (still on the right side). So basically the swelling seems to be “sagging” down. I assume there is some kind of lymph node or something there that has had an influx of the bacteria.

Finally accepting that I may need the clindamycin after all, I took one capsule. The product sheet said to swallow it whole, but it is far too large for that. I can barely swallow mustard seeds! Ever since I was a child, I have chewed everything three times as long as the people around me, because if I don’t, the food sticks in my throat and I have to try to cough it up. I am not sure whether I have a really small opening or this is just an acquired reflex of some kind. But antibiotics are kind of moot if I choke, so I bit it through and washed it down with a glass of water. Afterwards I drank some more water and a probiotic milk drink, in the hope of dodging the Chlostridium Difficile. (Bacterium which tends to cause horrifying and even life-threatening intestinal infections in clindamycin users. It runs wild because the broad-spectrum drug kills every other bacterium in the gut, most of which are friendly.)

Can you chew clindamycine? Random person on the Internet says: “It’s can be done but it’s not recommended because Clindamycin irritates the lining of the stomach and intestines and cause an upset stomach (that’s why it has the capsule.) They do have a liquid form called Cleocin which may help if you or the person you’re prescribing the medication to has a hard time swallowing pills. Hope this helps.”

Why am I not surprised? I have been bothered by acid reflux and stomach pains off and on for years, to the point where my doctor recommends not taking aspirin (or rather the equivalent in Norwegian, of course). I also providentially forgot to replace my anti-acid chewing tablets. DRAMA! On your Internet NOW!

OK, at least I know which of the alternatives is Scylla and which is Charybdis. I am now on my way from Charybdis (the all at once whirlpool) to Scylla (the blow-by-blow reef).  Wish me luck! I am not going to give up until I look down on my dead body. Actually, if that comes to pass as some people say, that’s probably just the beginning. But I won’t be able to blog from there, so keep me in your prayers for your future edutainment!

I actually wrote an open letter to my body on Google+ about its mixed signals. On one hand, this morning the pain was gone; my pulse was back to normal (for me, that means low); and there was no hint of fever. I felt fine, to the point that I might have been tempted to take a long walk if not for one detail: There is a small bulge on my face, on the right side (where the dental surgery was). It is only visible near the nose, fairly straight up from where I had the surgery, but is tender a bit further. Also, the pressure in it felt stronger later in the day, and my right eye has been leaking a couple times. So something was definitely going on.

Around 8PM, things began to change rapidly. I started to feel cold, even though the room temperature was the same. Soon I was shivering. My pulse naturally went up, although not racing. I also began feeling generally unwell.  This lasted for about an hour. By the time I stopped shivering, my temperature was 37.5 C, which is actually similar to what I have after work. (I stayed home from work today.) Usually my temperature gradually falls back to 37C before bedtime.

My apprehension fell far short of the horror of today. If I had known beforehand what would happen, I would have politely declined the dental surgery altogether. But I did not know. There was so little information in advance that I did not even know for sure whether today was the day of the actual surgery, or whether they were going to check things out and give me a new appointment. But things get worse from here.

I survived (so far), but I was in some doubt almost from the start. They asked whether I used any medication and whether I was allergic to anything, both of which I answered no. I did not think to mention the heart rhythm thing, which is still not clear what is, or whether it is dangerous. The doctors all seem to think not, unless it lasts for many hours or is accompanied by pain and / or breathing difficulties.

There was no chest pain of breathing difficulties today either. But a while after the local painkiller shots, just after the cutting away of my gums, my heart rhythm changed. It did not get faster, but very strong. Specifically, a bit down from the actual heart, further down from the bones of the chest, a little to the left, a spot started to beat. Putting my hand on it, I could feel the skin and whatever was under the skin actually move out and in with each heartbeat, very strongly. I am not sure whether there usually is a spot there that moves with each heartbeat; it may be there always was and I never noticed. That would be like me. My body is not very real to me until I am in danger of losing it. -_- It is still beating now, that spot, but not with the extreme strength it did then. This strength gradually faded and we resumed the surgery without further complications.

The dental surgeon stitched the opening – they had cut a fairly large hole – and gave me a prescription for painkiller and one for antibiotic. So far, so good. After waiting a little, I went to the drug store and got the drugs. I don’t expect to use the painkiller, as pain does not bother me unless it is extreme or in unexpected places. I was about to take the antibiotic when I read the sheet that lay in the package, and something seemed strange. It said that Clindamycin was used for severe infections where penicillin was ineffective, and there should be bacteriological tests and resistance analysis before using it. There were repeated warning to seek help if severe diarrhea occurred, even as far as 6 months after treatment. Now my hackles were up, and I went on the web. It turns out that this drug is the typical reason for a very dangerous intestinal infection (Chlostridium Difficile), to the point where the European Center for Disease Prevention and Control has recommended that Clindamycin be avoided in clinical practice.

So – take the antibiotic and risk a life-threatening bowel infection? Or not take it and risk wound infection and potentially blood poisoning (sepsis)? It is like sailing between Scylla and Charybdis: If you stay clear of one deadly danger, you necessarily come close to the other. Now I feel, to stay on sea a moment longer, that I should not have rocked the boat in the first place.

The pain is not a problem currently. When the local anesthetic began to wear off, a quote from the old computer game Alpha Centauri came to mind: “Pain, even agony, is no more than information before the senses, data fed to the computer of the mind. The lesson is simple: you have received the information, now act on it.” (Sheng-Ji Yang.) Now, agony may be too distracting for a lesser soul such as I; but ordinary pain is welcome when there is reason for it, so as to discourage foolhardy behavior.

If only the pain preceded the foolhardy behavior at every turn! But then we would all be wise, eh?

My heartbeat is faster than usual, but not in the “racing heart” (tachycardia) category. It is like when I have an infection or has overtrained and damaged the muscles a bit. This is to be expected, since my body has sustained an actual damage and the wound is surely releasing plenty of stress chemicals. There may also be an ongoing infection below my radar. Stress hormones are probably a good thing when there is an actual physical stressor. I doubt they came into existence by an explosion. Intelligent design beats stupid design at every turn, so I doubt a mechanism common to pretty much every animal would be counter-productive. The problem with stress and humans is that we create stress where there is no reason for it, by perceiving threats to the mind as if they were threats to the body and could be fought by the same reactions.

This time however there is a legitimate threat to my body. I am not used to that. Still, the Azumio stress check clocks me in at a stress level of 21, which is probably closer to restful waters than to the valley of the shadow of death. Although the valley certainly looks closer from here than it did yesterday.

Tomorrow is the day I am scheduled for my visit to the dental surgeon. There is no information, just a postcard, so I don’t know whether they are going to explore the tooth and have me come back later, but since they have the X-ray I assume they will try to go through with the procedure: Drill a hole into my upper jaw where the root of the infected tooth is, and remove the small pus-filled chamber. This seems kind of risky, in the “bacteria and blood don’t go well together” way. I generally feel that my health is important, but not worth dying for. Hopefully it won’t come to that.

I kind of feel obliged to inform you of any extraordinary risks I know of beforehand. That said, the <a href=”https://play.google.com/store/apps/details?id=com.azumio.android.stresscheck” target=”_blank”>Azumio Stress Check app for Android</a> measures my stress level to 2%, which I suppose is about as low as you come without entering Nirvana (of Buddha fame, not of Kurt Cobain fame.)

And of course we can take comfort in the thought: “Why worry about tomorrow when you may die tonight?”

As I wrote on Google+, time for my bi-weekly trip to the emergency room!

Of course, I did not know that when I came home from work. We got off work early due to the impending Easter, which is taken quite seriously in Norway. Most people are not Christians these days, but they still take their days off  very seriously, if not the religion.  So, I was home early. I ate lightly – only a cup of yogurt – because I wanted to take a half-hour walk and big meals require energy to digest.

The route around the eastern part of the town center usually takes 30-35 minutes, depending on how fast I walk. Today my pulse started out pretty low, so while I did not run, I held a decent speed. Then when I was about halfway through, the pulse began to increase. Since I wear a pulse watch while exercising (even light exercise such as walking) I could see this before I could actually feel it.

The pulse rose more slowly this time than last time (March 19). Last time it rose more slowly than the first time (March 8). That time it rose more slowly than last fall, when I had to go back to town by ambulance. So there is a change here, it seems. I assume this is a good thing, but I don’t really know, since nobody knows what is happening to my body.

I simply walked, slowly, to the emergency room. I know quite well where it is by now.  Once there, I waited just a little while and a nurse let me in. There was only one patient before me, who had run out of some kind of medicine. I suppose that is an emergency, albeit one that could be easily avoided if you use your medicine as indicated on the package. For some reason the emergency room in Mandal does not have actual emergencies when I am there, thank the Light. I mean people coming in after falling down stairs, crashing a car or accidentally putting their hand in the electric bread cutter at the supermarket. Light send that we avoid this in the future as well.

The nurse recognized me from the first time I was there, although of course she did not remember my name and data. She put me on the EKG bench and ran the machine. This was when I learned something quite interesting. While lying there, I experienced several pretty strong palpitations, where my heart suddenly struck much harder than usual, making me nearly jump with the sudden contraction. This was exactly what I had hoped, to catch one of these in action, and here I had several of them! Except… not really. The EKG showed that my heart had beat fast but very regularly all the way through.

So, whatever I experience as palpitations is not that. When it happens, I can feel it like a small “hit” in the center of my chest or slightly to the left, and a kind of “echo” around the body. But there is no electrical discharge that corresponds to it in the EKG. Whatever it is, it is evidently not my heart. I have no idea what it is, but still, this could be very useful information. The other clues we have is that I don’t feel palpitations if I keep my breath in (but even I can’t do that for long) and that they only start when my weight is below 87 kg. Basically I did not have them when I was even marginally overweight.

The tachycardia (racing heart) was real and measurable though. The speed was slightly less than the two previous times. Perhaps this is gradually fading, or I am getting better at controlling it. It did not last as long into the evening after I went home, either. But it is a bit early to say that the next time will be even easier. We still don’t know what it is, after all.

The doctor guessed my resting pulse to 80. It is around 55. This intrigues me because from my lung volume I ought indeed to have a resting pulse of 80 or more, but I don’t. My heart is usually far too slow, but then occasionally it runs off. It’s like we used to say about our old horse at home: “Only two gears, too fast and too slow.” Well, I suppose having a workhorse of a heart is not the worst thing that can happen.

At this speed, I may just be able to squeeze in one more trip to the emergency room before I get to see my state-appointed doctor. Although at some point I guess we just have to accept these episodes and sleep them off or something. I still want a Holter monitor (portable EKG though). One acquaintance on Google+ had similar symptoms to me and nothing showed up on the EKG, but while wearing the monitor through the day her heartbeat was all over the place. I doubt that is the case for me, but it would be nice to at least rule it out. Having completely unexplainable disturbances of the heartbeat is not really a great way to encourage serious exercise. I intend to tell my doctor (the fitness nut) as much, if I eventually get to see him.