Random PCS Thoughts Today

I have been feeling somewhat in a more pseudo-artistic/literary mood today and not so much a "scientific mood" as perhaps is my norm.  In lecture, I even waxed rather MORE poetically about various physiological functions that is already my norm also.  It was sort of akin to a "Van Gogh" sort of day for me..... with the earless fellow often being somewhat of an inspiration for me philosophically in terms of seeing the world through the eyes of an "artist".... something I wish I had more of inside me. I cannot paint here, except for the following feeble attempt with words: 

There is a quiet, deliberate "magic" to be had in the ritual of packing and smoking a pipe.  It is an art form that requires patience and perseverance.... things that seem almost forgotten in today’s rather frantic, hyper-connected world. For a man of my grey and furry-faced years having witnessed a fair share of Falls and Winters, the pipe is not merely a pastime; instead, it can often be a sanctuary. The process of smoking a pipe begins long before match or lighter is coaxed into ignition. It starts with a tactile pleasure of selecting the right blend.... and yes, this is often by feel..... feeling the ribbons, or cube-cut grains of tobacco between my fingers, and when ultimately a blend is selected..... carefully filling the bowl with a gentle, yet firm level of pressure that is impossible to teach, but instead becomes natural with practice. When well practiced, you innately KNOW.... you tamp it down just so... not too tight nor too loose.  It really does incorporate a gentle, subtle touch that arises through the subconscious, with nary a thought required. 

To me, the slow, methodical packing of the bowl and then smoking the pipe serves me as a meditative preamble that can, if I allow it, help me to briefly step away from the treadmill of modern life and anchor myself firmly in only the present moment. That ability, in many regards is an aspect I miss so tremendously.  Instead of being buffeted by virtually any and every thought or stimulus, the packing of the bowl and then quietly smoking my pipe can truly can hone my mind so readily into..... literal FOCUS.

When the flame finally is nurtured into the leaf, another true reward begins as a rich, velvety plumes of aromatic smoke drift around me. The depths of flavors I experience across the papillae of my tongue, through to the olfactory epithelial cells of my nasal cavity are both vivid and in some facets indescribable with mere words.  And, with my pipe, the flavors and tastes and aromas shifting subtly from the cranial aspect of the bowl and morph and meld into variations all the way through the caudal remnants in the heel. As I watch the thin gray ribbons of smoke twist and dissolve into the air, I feel a profound sense of grounding. In those fragrant clouds, the anxieties of the day seem to lose their grip, and what mentally emerges is a sense of warmth and quelling and quieting of anguish.

Of course, with it being 2026, the briar also serves as a physical bridge to history and is a tangible connection to my own history and the generations of my family who came before me.  Holding onto the bowl of one of my older pipes while indulging...... its warm bowl in the palm of my hand feels akin to shaking hands with an old friend. 

Ultimately, my love for the pipe boils down to a stubborn appreciation of an unhurried life. In a world that demands we do everything quicker, more electronically, and more "gizmoey", my pipe has been at times, a quiet, smoky rebellion of sorts as well.  Not rebelling against FAMILY as may sometimes occur in the young, but rebelling against the modern thought that NOW is now and is all that matters. 

Looking back on the above, I am not sure it would be classified as "artistic"..... but whatever it is, it represents a lot of the thoughts I am having on this second in a row PCS 9+ day.  

* * * *

• Running was at an awfully damn cold 37 degrees F (~2.5 C) this morning.  And, it was purely in the dark, only illuminated by my headlamp (Ha, a TRUE headlamp.... which I attached to the baseball cap I keep on my head when I run.).  I am trying to resist the change to running on the indoor track.  But, the transition to the cold of Winter seems to get harder and harder each season.... and hell, 37 degrees will be considered BALMY in two months when it will likely be -10 to -15 F (-22 to -25 C) some of the time.
• I am hoping my wife will feel up to swimming this afternoon.  With her antibiotic on board, she IS feeling considerably better.... but still she may not feel up to it.  

PipeTobacco

Pam Thoughts & Then Other Things

 

Pam J wrote the following in comments about antibiotics I made, so I thought I should respond:

"by taking an ineffective antibiotic, are you contributing to the overall resistance of bacteria in the general population"

Pam's statement of an "ineffective antibiotic" is, I think, meant along the idea of this restatement of her question.... 

If I DO NOT have the bacteria in my body that an antibiotic is used for..... and yet I take that particular antibiotic..... am I contributing to the overall resistance of bacteria in the general population?

My answer..... NO.... if I do not have that bacteria IN MY BODY, my taking the antibiotic medication cannot affect the development of resistance in that bacteria..... since it is NOT in my body.

Bacterial resistance to antibiotics occurs from dosage related issues.   For instance, if a person has a bacterial infection and takes an antibiotic for it...... but..... stops taking the antibiotic prematurely...... in other words..... DOES NOT TAKE THE FULL COURSE of that antibiotic..... THAT is when antibiotic resistance can occur.  By stopping the medicine when you begin to feel better (instead of taking all that was prescribed).... means that there is a reasonably good probability that SOME of the bacteria may not yet have been destroyed in your body..... and those that remain are the bacteria that were better able to resist the effects of the antibiotic.  BUT, since they are still alive.... when they reproduce.... they become more ABUNDANT in the population of these bacteria than the ones that were initially destroyed by the antibiotic.  

When this incomplete taking of clinically prescribed antibiotics occurs again and again, the overall impact is to have the population of the species of bacteria become stronger and potentially resistant to that antibiotic.  It is a standard principal of the natural selection pressures faced in the evolution of any species.... and also relates to the concept of the "Selfish Gene" by Richard Dawkins and the "Shifting Balance Theory" of evolution put for by Sewall Wright.  When a population is "bottlenecked" (meaning reduced in number to a few survivors).... the population that rebuilds in subsequent generations will be comprised of the genes of those survivors.... not the ones who were killed in that bottle necking event.  

The REAL culprit is SUB-LETHAL DOSE antibiotic use (like in agriculture)..... where these animals are given antibiotics to fatten them up quicker.... and the dosage of antibiotic is LOW.... lower than what is NEEDED to kill any bacteria they may have in their bodies.  So, when a cow gets a continual, low level dosage of an antibiotic.... a dose that is sublethal to the bacteria it is designed to kill.... the body of the cow becomes a percolating cauldron that will PROMOTE any bacteria of the sort for that antibiotic that is in the cow's body.... to evolve into strong, more resistant, and more powerful forms over generational time periods.  

* * * * *

Pam J also mentioned the concept of "herd immunity" which is an important concept, but is not related to antibiotic resistance.  Herd Immunity references a communal VALUE of having a very large percentage of organisms be resistant (by prior exposure or by immunization) to a pathogen...... TO PROVIDE a wall or barrier to others in the population who are not or cannot be resistant (through age, other disease or something else).  

The basic application would be akin to..... if you live in a community who has a ~97% vaccination rate for pathogen A (let's say cholera for instance)..... herd immunity.... for that community would be strong..... and the sheer barrier provided by the ~97% who are immunized.... would give very good protection for the ~3% who are not or cannot be immunized (say newborns who cannot be vaccinated yet, or folks with autoimmune disorders who cannot get some immunizations).  

But, if the community had instead, say only ~80% vaccination rates for pathogen A.... the shield or barrier of "herd immunity" would be substantially weakened.... because with ~20% not immunized, the pathogen could (based upon mathematics/statistical analysis of populations) very easily find a conduit chain of non-immunized people within that community and the pathogen could take hold.  

Real numbers of needed percentages for "herd immunity" to be valuable would VARY depending upon the strength of the pathogen, the density of the human population, and the effectiveness of the vaccine.  Herd Immunity determinants would need to be modeled mathematically/statistically using those parameters.  

* * * * *

Haha!  I did not really mean to be so utterly verbose in the above.  But, I wanted to try to give at least a general explanation.  I apologize for the long windedness.  

What I REALLY had been planning to talk about today, was my VERY STRONG PCS today.  My Pipe Craving Score.... for reasons I am not really sure about.... have sky rocketed again.  I am most assuredly at a 9+ on the scale.  

It took tremendous effort while running this morning to focus and complete my rosary.  My mind kept side-tracking to so many varied memories of exquisite pipefulls of pipe tobacco I have experienced across the decades.  

But the 9+ scale measure also means I am feeling what I also equate with an actual "hunger" for simply the act of indulging in smoking my pipes.  It feels beyond simply WANTING to smoke a pipe.  Right now, it feels akin to my NEEDING to have a pipe.... almost like I need a NUTRIENT like Vitamin C.  

So, my feelings are intense, deep, and strong for some pipe tobacco right now.  In my mind, I keep visualizing having a gentle, smooth, warming bowl of Prince Albert.  Not sure why I am fixated on specifically Prince Albert at the moment.  But, its creamy, thick texture, and its palpable, palatable, and yet mild flavors.... and imagining the warmth of holding the bowl in my hands.... that is what my mind has been envisioning and has been desiring all day long.  

PipeTobacco 

Still About the Same...

The other day, Pam J asked why I would want an antibiotic if I did not think I had a bacterial infection.  I gave a brief response then, but I thought I would elaborate on some thoughts about it today:

• Today, I am about the same as I reported on Friday.  Still some jaw pain, still some tooth pain, still some ear pain and still a red ear canal AND fluid behind the eardrum (middle ear).  No worsening of the pain, but no improvement over Friday.  I am still eating with my bite splint.  It is keeping me from reaggravating the joint area.
• I DO think I have a bacterial infection.  The clinician didn’t think so….with no testing….but I have a red ear that has considerable fluid behind the eardrum.  
• Fluid behind the eardrum stems from poor drainage and is a great ration for bacteria to thrive and grow.  Viruses infect cells….. they generally do not just grow eun fluid in the middle ear.  
• The reason I am so aggravated at the "Antibiotic Nazi" is that she just PROCLAIMED it was likely a virus... with no real testing or diagnosis what-so-ever.  She has NO actual knowledge of whether it is viral or bacterial.  She is just touting "party line" b*llsh*t about not prescribing antibiotics due to "antibiotic resistance".  
• I still think MUCH of the "antibiotic resistance" issue is WAY OFF THE MARK.  I DO FIRMLY BELIEVE that antibiotic resistance IS a crucial, critical, and important issue.  But, I DO NOT BELIEVE that proper use of medical antibiotics would have much IF ANYTHING to do with the worries about anti-biotic resistance.  
• Let us say.... IF I had a bacterial infection and TOOK THE MEDICINE AS PRESCRIBED (until it was finished), then the potential for the antibiotic to give me relief and fix what ails me is THE PURPOSE of the antibiotic, and IF I TAKE it fully as prescribed, the risk of any antibiotic resistance would be VERY LOW. 
• Let us say..... IF I had a VIRAL infection..... viral infections should clear relatively quickly.  But, I am in week THREE NOW.  But, more to the point....  if I did NOT have a bacterial infection, then there WOULD NOT BE THE BACTERIA there to "become resistant to" and if I took the full regime of the medicine, the AGAIN, would be virtually NO ability to cause antibiotic resistance...... if it were VIRAL!
• Globally, livestock consume ~70+% of all antibiotics produced (well over 100,000 tons per year).
• LIVESTOCK CONSUME these antibiotics to GAIN WEIGHT FASTER to get the animals to market FASTER.
• LIVESTOCK are given these antibiotics at SUB-CLINICAL LEVELS...... in other words.... LOW DOSE LEVELS..... the VERY PROBLEM that PROMOTES the development of anti-biotic resistance.  Normal clinical doses for a normal clinical time are MUCH LESS LIKELY (EXTREMELY UNLIKELY) to induce bacterial resistance.  
• Swine and poultry generally consume the largest share relative to animal biomass, followed by cattle and sheep. 
• Usage is highest in Asia, followed by the Americas, Africa, and Europe. 
• To top it off now..... my wife came down with the exact same symptoms as me during the weekend (except no jaw pain as she does not have TMJ).... and she just called a few moments ago..... she saw a different clinician.... AND SHE WAS PRESCRIBED AN ANTIBIOTIC...... and will have taken her first dose before I get home today. 

PipeTobacco

Slow Progress

The following may be somewhat "unpleasant, too much information" for some.  It is, to an extent for me as well truthfully, but regardless... it is true.  The above disclaimer is to simply guide those who may be somewhat "squeamish".  The "squeamish" part I will try to color the first word of the bullet in RED to allow those of weaker constitution to skip it:

•  My damnable TMJ/Ear situation is GRADUALLY dissipating.  I still FIRMLY believe I would have been helped by, benefited from, and would be fully back up-to-snuff IF I had been prescribed an antibiotic for my red, hot, fluid-filled middle ear.  But, the "Antibiotic Nazi" dictated, "No Antibiotic for You!" (referencing the "Soup Nazi" episode of Seinfeld). 
• Current standing of my pain experience..... My ear pain is down to ~30% of what it was at its peak pain level.   My wisdom tooth pain is down to ~20% of what it was at its peak.  My pain in trying to close my teeth together (to chew food) is ~15% of what it was.
• The above pain decreases have come FROM the near 24-hour a day wearing of my bite splint since visiting the "Antibiotic Nazi".  
• I still feel a STRONGER amount of pain if I try to fully close my teeth together chewing for the length of a whole meal.  And when I have done so (to CHEW FOOD), it exhausts me from the rise in pain.  The pain when chewing food in a meal is down ~50% from its peak.... but, after I chew food, the pain will persist for a good two or three hours after I am done and the pain will radiate up into my ear as well.  
• I have several bite splints currently (I have more than a dozen I have chewed through and have had to discard over the years as well).  There are TWO I primarily use... one for sleeping, and one for daytime use.  
• Potentially TMI:  Because I desperately want this to resolve, and because I also want to CHEW FOOD (I NEED CHEWABLE, HIGH FIBER FOOD) or I get cranky (emotionally) and constipated (physically).  Only having soft, slurpy, low-to-no vegetable type foods just does NOT cut it for me. So.... (warning) I have devised a somewhat "grotesque" plan I have adopted the last few days.  With one of the "other" bite splints I have... not the primary two.... I have taken to WEARING the bite splint WHILE I eat (and CHEW) food.  My reasoning..... the space taken up by the splint on my upper teeth ultimately means I do not have to FULLY CLOSE/FULLY CLENCH and MESH my lower teeth to chew.  I have found the last two days that I can chew most foods reasonably successfully with my bottom teeth grinding the food against the base of this bite splint....... PAIN FREE.  
• Again, potentially TMI: This is NOT the most elegant way to eat.  It is VERY, VERY SLOW going as well.  The most difficult parts are a) it does not do as good of a job in grinding the food for swallowing, so the bolus (technical term for the mouthful of food being prepared to be swallowed) is "chunkier" than I ultimately would like..... BUT, it is REAL, chewable, high fiber food.... salads, high fiber breads, VEGETABLES, etc, and b) it can be rather "sloppy"..... I have learned how to slowly do this and to also be able to FULLY close my lips successfully while chewing with the splint in place.... but all manner of the food does go up and around and within crevices of my bite splint and upper set of teeth.  And, this displaced food is not a simple task to remove or dislodge.  I instinctually DO NOT SMILE, grin, or do any facial expression that will show my teeth while eating in this fashion.
• BUT.... at least in the short term.... it is WORTH IT TO EAT NORMAL FOOD without PAIN.  
• After eating, I have to IMMEDIATELY go to the bathroom/restroom to brush and scrub my teeth and my bite splint.  
• It is my HOPE that by doing this for a few more days, perhaps ALL the swelling, all of the infection (I am convinced I have one of the ear), and all of the pain will more readily dissipate if I do not reaggravate my jaw by trying to chew with pain.  
• I DID go to the Retiree's Cigar Group yesterday.  It was good for my mental/emotional well-being.  Although I was a bit later than desired, I was able to talk with four of my regular friends for the first half hour, and after they left, a few folks remained..... one of the loud talking duo that is semi-regular stayed, a fellow who comes up about once a month from where he lives about 2 hours South stayed, and a NEW regular (I now have acquired some seniority!) who has been coming in for the last 5-6 weeks stayed as well.  It was just, pure, plain, pleasant chatting and socializing.  It felt very good.  
• Thinking about the pipe museum I briefly wrote about (where I saw the pipe carved to look just like a tenor saxophone), it had me remember a pouch of pipe tobacco I had from that place as well.  It is called "Three Brothers" and I spent a bit of time rummaging around to find it this morning.  I opened up the jar (I had jarred it in a small pint Mason jar), and the aroma brought back a lot of beautiful memories.  I even remembered more vividly things I had seen at the pipe museum as well.
• Thinking about the future... my Dad's 103rd Birthday is a bit over a month away.  Maybe I can plan to go to the cemetery on his birthday and perhaps I will have a pipe of Union Leader to be able to taste what that 60+ year old pipe tobacco is like.  Or, maybe I should take the "Three Brothers"?  I do not know.  But.... doing something like this.... does seem a good, safe "special circumstance" opportunity I can probably have.... and now that it came into my mind.... I can begin to contemplate the BEST pipe to have if I do get to participate in this very special indulgence.  

PipeTobacco
  

"Positive"

 

The above painting image is "Autumn Reflection" by Leonid Afremov.  I admire his impressionistic style.  

I am trying in the ways I know how, to work to pull out of my very harsh emotional state.  

Part of what I am trying to do (to accept).... is that for the time being, I will feel discomfort and pain in my jaw/ear region.  I will work to do what I can to alleviate that pain.  I will strive to move as best as I can beyond it, and hope that it will..... sooner rather than later.... dissipate.  

Another part of what I am trying to do is move beyond the emotional hurt.  That is in many ways more difficult.  The best I have determined for me to have a modicum of relief from it is to simply try to "ignore" it as best as I can.

* * * * * 

• So, I forced myself to run, and run hard this morning.  I had not ran for a week due to the pain of my ear and teeth.
• Last night, I put together my Eb Contrabass (aka contra alto) clarinet and played some "Bossa Nova" style music I had been interested in learning.  It has been perhaps 3 months since I last did anything with this song, and at that time, I was working on it with my much smaller alto clarinet and my alto saxophone (both also Eb).  But, I had always thought it would be especially fun to play with my almost six-foot tall contra alto.... and I had not actually played my contra alto at all since I had the beast in for a tune-up this Summer.  [Note, I primarily play my Bass Clarinet (Bb) in the community band.... and that alone usually eats up all available music time I end up having each week.  But, I thought that perhaps taking (forcing) some time into my day to pick up my contra alto, might help my mood.]  In case you cannot picture what a contra alto looks like, I have inserted a photo below:

• I am still following "Antibiotic Nazi" 's suggestions of taking a STRONG antihisamine and an NSAID each evening before bed.  She said to take Motrin, which I did the first evening, even though I worry about Motrin's impact on the kidneys and the liver.  I had probably not had a Motrin in perhaps 15 years, so I had anticipated it would be helpful.  But, it was not particularly so.... so I converted to aspirin, which is safer for the kidneys and liver.... and I already have been taking a low dose aspirin for its anticoagulant properties.  I still think I need an antibiotic for my red, fluid-filled middle ear..... even though the "Antibiotic Nazi" did not concur with my thoughts.
• I picked up and forced myself to start a new novel last night as well.  I thought it could help distract me.  I had finished my prior book perhaps two weeks or so ago,, and when I fell into the torture chamber of ear and jaw pain, I just tried to immediately go to sleep.  It felt nice, working my way into a story.
• I did not go to the Retiree's Cigar Group last week because of my ear and jaw.  This week, I am intending to go regardless.  I want to have the congenial talk with my friends.  
• Most of my wind instruments (other than my soprano clarinet).... my alto clarinet, my bass clarinet, my contra alto clarinet, my alto sax and my tenor sax.... all have the basic shape and design of my full bent tobacco pipes.  I always found that entertaining to my mind.  A long time ago, I was able to visit a pipe museum.... and there they had an actual briar tobacco pipe that was carved and shaped to precisely look like a tenor saxophone.  Way back then when I had gone to that museum, I thought that was one of the coolest things I had seen there by far.  
• Tonight, my wife and I are planning another trip to the U's BIGGEST dorm's cafeteria for dinner.  It is really a pretty amazing place, and it is filled with all sorts of very pleasant choices.  And, not having to do any dishes is always a bonus.  I like the variety, which is typically larger (and healthier if you choose carefully) than a typical restaurant.  
• And, if my wife is able to do so timing wise, we are hoping to swim before going to the cafeteria.

PipeTobacco

Roller Coaster

She knocked very timidly on my office door.  So timidly, I was not really sure if the student had knocked on my door or of the door of my nearby neighbor.  

When I opened the door, she stood there, with an expression that could best be described as a "deer in the headlights" look upon her face.

"Are these your office hours, Dr. Pipe?"

I nod.  Besides talking about my office hours in class the first week, these hours are listed in each classes LMS (the electronic, gizmoey classroom I use for storage of things for them).  They have also been listed in all of my syllabi that students have had in paper and electronic form for the last 6 weeks (the entirety of the semester, thus far).  They also have been my office hours for a Tuesday, for at least the last 15 years if not longer. 

She doesn't say anything.  Time continues to tick,  I hear the ticking of my analog clock on my bookshelf.  It is steady like a metronome.  

"How may I help you?"

She stammers.  "I was hoping to ask you some questions about our exam tomorrow."

"Please come in." I say as I direct her to my student chair, and I sit back in my desk chair.

It takes her several minutes to organize herself, as she is one of the students who is very "gizmo" focused..... she does not do anything on paper, it is all electronic for her, on what appears to be an i-Pad.  

So.... she proceeds to ask me a few questions related to "where" material for the second lecture exam STOPS (I said this in class, just yesterday) because I continued to lecture about OTHER aspects of the Respiratory System yesterday, beyond what was on this new exam.

"Well, do you remember yesterday, when I finished discussing the role of the mucous membranes that line our facial and cranial sinuses..... I said specifically that.... that particular slide was where I was concluding lecture materials for the second exam?"

"Yes. but then you continued." 

I wanted to roll my eyes, but kept from doing so.  "Yes, the slide of the mucous membranes I showed, was only the second slide I showed in class...... just five minutes after class started.  I needed to continue on with lecturing for the remaining ~85 minutes of class.... and I said right at slide three.... 'This is where I am beginning materials for the third lecture exam.' "

Some students are extremely pedantic.... they cannot grapple with trying to see the forest as they are so focused on the trees. I suspected this student represented such a case.

Eventually, she did get down to asking me some questions..... per se... mostly she was referencing aspects of a review sheet I provide, and asking me "what I meant" when I listed a topic in my review sheet.

"In the review sheet, you say to know 'roles of the immunoglobulins in the development of the five hypersensitivities associated with our immune responses'.  What do you mean by that?" 

Gritting my already sore teeth, I waited a beat, relaxed my jaw, and said, "Well, more importantly, what do YOU think I am alluding to with that statement?"

She then proceeded to read back to me, nearly verbatim, my lecture about allergens and hypersensitivities.  She has "accommodations" to record my lectures. Apparently, she works to write them down word-for-word like a scribe.  

"Ok.... what you have stated is all GOOD information.  What you have read to me is ACCURATE.  But, what I want you to tell me is..... 'What does it mean, and why is it important?' " 

The deer-in-the-headlight look appeared again on her face.  She sat there, and it probably took her a full minute to have her wrap her head around my question and to try to figure out a response.

She stammered.... and then went to read a subsection of what she had read to me before from her notes.

"No, do not read to me again, a section of your notes.  Please tell me in your own words, WHY this concept of hypersensitivies is important."

I let that sit for a long, rather overly pregnant pause.  She is "lost" in her thoughts.

"Ok, how about this...." I state, "you are hoping to someday become a nurse, is that right?"

She nods.

"All right.  Tell me two reasons WHY knowing and understanding hypersensitivies of the immune responses is IMPORTANT for you as a potential, future nurse."

It was very much like pulling teeth (which part of me wishes I could do to myself).

But, she slowly worked through several of her "questions" over various topics in the last several lectures..... which.... each time, I reflected back onto her... to have her explain to me what the concepts she could recite.....  MEANT and WHY they were important.  

She was getting more stressed, even though she clearly knew (memorized) nearly everything I stated in class.  I tried to be encouraging to her every time I guided her to explain the "why" of a concept.  

Eventually, her stress hormones got the best of her and she began to cry.  

That was NOT what I was hoping for.  

I then tried to give her a bit of a "pep talk".

"You clearly have knowledge of the DETAILS we talked about in class.  But, if you recall, in our third lecture of the semester, I showed you a slide about a teaching and learning concept called "Bloom's Taxonomy."  Do you remember that slide?"

She nodded.

"Your knowledge of the DETAILS is an important part of learning, but it is in most regards, basically memorization.  I am striving, to the best of my ability, to get YOU and YOUR CLASSMATES to see science MORE DEEPLY, in a MORE NUANCED fashion.... where you can learn to apply those details to facets of your future career and also to everyday life.  I am trying to help you see science in an analytical fashion.... where the DETAILS you learn will serve you in your future career to help you see and diagnosis what a patient may need."

Eventually, she was calm enough that she could go back to her dorm to study or who knows what else.  

* * * * *

Am I any different than this student?  I have been weeping and cursing at my lot.  My jaw still feels like hell.  My ear feels as if it is sitting in molten lead. I go from wanting to quit it all one moment.  Wanting to say to hell with it the next moment, wanting to run away the next, and then I have a moment of clarity and of peace, and I feel less horrible.  

Until whatever the hell this is.... begins to go away.... I have to better manage this.  I need to realize and accept that it tends to affect me the hardest.... and it hurts to damn most.... in the morning when I wake up.  It has nothing related to snoring or apnea, as I have asked my wife to monitor if I have been snoring or showing any signs of apnea (negative).  So, I guess what I need to do tomorrow..... is to NOT lay in bed longer than usual, and to get up and FORCE my hurting, tired, angry body to go on a damn run.  I have not ran the last few days due to all this sh*tty pain.  But, maybe, if I force myself back into my routine, maybe I can force myself back into a less horrible place physically, mentally, and emotionally?  

I am so, so very tired of trying to pick myself up by my bootstraps.  I am so damn tired of hurting.  I am so damn filled with chaos in my mind.... I love my one kid.... but at the same time I am SO, SO, SO, HURT and also SO, SO, SO VERY ANGRY at that kid.  It ADDS to the physical torment of my jaw and ear ailments.  

Folks asked yesterday about why I do not visit our "Family Doctor".  I am not sure about elsewhere, but around these parts, there is a "shortage" (cough,shortage my posterior) of clinicians.  Our prior family doctor retired.... and his practice was taken over by a nurse practitioner.  She is not really a whole lot of help.... and tends towards the same "Antibiotic Nazi" approach to things as the Physician's Assistant I unfortunately had at the Redi-Med.  And, GETTING an appointment to see our beloved "Family Clinician" (aka the nurse practioner)..... usually requires a several day wait..... so I have been going to the Redi-Med.... hoping I may be lucky and get the kinder Physician's Assistant, instead of the "Antibiotic Nazi" I had the other day.

PipeTobacco

  

 

Brief

 

I realize I am not know for brevity.... but I will try my best:

• by last Tuesday, my TMJ had flared so very badly that I was in such pain, that I think "agony" would be an appropriate term. My entire jaw, ear, joint, and impacted wisdom tooth on that side of my face was swollen, inflamed, hot-to-the-touch, and extremely painful. My ear felt like it was on fire.  I lavaged my ear canal with a mixture of warm water and a bit of hydrogen peroxide.... because I have sometimes had relief in doing so by flushing out a built up earwax plug.  But, even though I squirted and squirted a lot of fluid into the canal.... not a speck of ear wax was removed this time.  Apparently my ear canal was clean.  
• I then called the dentist and feared for the worst.  He was not able to get me in until late Wednesday afternoon.  I kept just pushing on, doing my regular crap.
• My fears were VARIED....... ranging from a) that I fully destroyed my TMJ joint on that side of my mandible, or b) my dormant, fully impacted, fully gum covered sideways pointing wisdom tooth decided to awaken and push against my other teeth or worse.... tried to erupt in my hinge space, or c) things even worse that I was imagining and not going to describe here.
• Since Monday, the SWELLING of that side was so significant, that I could not CLOSE/CLENCH my teeth together.  The best I could do was get the teeth on that side (my right side) about 3/4 of a centimeter apart from touching before the pain was BEYOND agony.  And, my lower mandible was especially swollen that it pushed my whole right side jawline forward.  The entire hinge area of the right side of my mouth was greatly swollen. My whole side of my face was so sore and hot, and my ear was so painful. 
• At Wednesday's dentist appointment, he took X-rays, saw NO sign of any disruption of my wisdom tooth, nor any aberration of nearby tissues, nor any decline in my TM joint itself... all appeared fine. THIS WAS A RELIEF, but also perplexing.  And, when he had me performTMJ  "bite tests"..... basically, he would put his fingers in various locations in my mouth and ask me to bite.... and report degree of pain..... not a damn one of the classic TMJ pain pressure points would hurt at all!  NOTHING.
• This confused the dentist, and he suggested, as he could see the swelling, could feel the "heat" of the inflammation along my mandible.... that what I needed to do, was wear my bite guard 24/7 for a few days (I had already been doing this for a week).... and only eat soft foods (which I had began to do Tuesday, as it was too damn painful to even try to chew ANYTHING..... and I was not successful at any of it because I could not close my teeth together anyway. 
• There wasn't a damn thing I could do, but take the damn advice.  I hated eating all the soft things..... I did not have any vegetables to speak of, did not have any salad, did not have any popcorn, did not have tacos, burritos, or taco salad....... I had pureed soup, sloppy-soft macaroni and cheese,  refried beans from the can (fat-free).  
• The above is what I ate basically for several days, with damn near no fiber.  This got be very constipated again which was another pain.
• Still through all of this I did my damn work, even though I was perpetually exhausted from the pain.  I was continually in pain.  I gave up on running Wednesday, as the jostling up and down felt painful on my mouth and ear.
• By the time Friday rolled around, it was still horrible, and I went to the Redi-Med, thinking..... now that tried what the dentist advised to no avail.... that perhaps I had a middle ear infection that was acting a bit differently.  
• My ear hurt like hell all week.  I told the dentist that, but I guess he doesn't concern himself with ears.  But, when I have a TMJ flare up.... it usually DOES make my ear hurt like hell.  But, when I USUALLY have an ear infection, I tend to also have a sore throat.... I didn't really suspect my ear as the culprit with all the symptoms going on along the side of my face.  
• So on Saturday, after helping at one of my wife's events, I went to the Redi-Med.  Unfortunately, I played "Russian Roulette" at the registration desk there.... and ended up getting the Physician's Assistant that I "kindly" label the "Antibiotic Nazi" (after the Soup Nazi from Seinfeld).  This PA is NOTORIOUS for NEVER PRESCRIBING ANY ANTIBIOTICS to ANYONE who gets her. 
• She looked in my ear.... and said it definitely had "water" behind the eardrum and was a bit "red" but that she "didn't think it warranted an antibiotic".  In my mind, I went through, rather rapid fire, some of the most vehement curse words I could think of.... words and phrases so harsh, I probably should go to confession just for thinking them.  Then she "prescribed" her nothing mix of bullsh*t over-the-counter allergy crap that she always suggests.
• So, I am back at work again today.  When I finally figured out I had an ear infection, I began the one "treatment" I know of that can help (somewhat).... I would put isopropyl alcohol in my ear canal and let it sit there ~10 minutes, before letting it drain out.  It can, somewhat isotonically help draw water from the middle ear through the tympmpanic membrane to alleviate the pain of the fluid pressure.  
• So, it is still difficult, but the pressure is less, and it seems like the swelling is a bit less.  
• My next step, if it does not resolve is to travel across town to a different Redi-Med in hopes that there is a more normal clinician there who, when they see the signs of an EAR INFECTION, will prescribe the appropriate antibiotics.  But, there is also the possibility,that after all this time (it is now over a week total), that my immune responses have developed enough of a primary response that it may start to resolve.  
• But, it angers me so much that a simple antibiotic to resolve my ear infection was not given.  
• And, I am SO DAMN HUNGRY and WANT TO EAT FOOD I CAN CHEW.

PipeTobacco