Last Sunday my son and I visited dad at his ALF. I was glad to see they had fixed the loose screw on dad’s walker. But my son pointed out that it was in backwards, so the long end of the screw (taped over) pointed inside where dad could walk into it. (This didn’t look like the original screw as it was much longer than all the others.) I wondered if I should try to change it, but since it was taped, it was in fairly securely. I asked my son if he had a wrench and he didn’t, nor a screwdriver, so we just left it. I hope dad doesn’t find it scratching or bruising him.
Sunday evening after checking dad’s mail pharmacy website, I emailed his ALF nurse to remind her that they needed to reorder his new blood pressure medication from the mail order pharmacy. He already had filled three 30-day supplies filled locally and his insurance wouldn’t pay for anything except a 90-day supply from the mail order pharmacy after that.
When the nurse responded by email, late on Monday, she mentioned that dad had awakened with a swollen lip and cheek again as he had in February. See “Dad Has a Fat Lip and Puffy Cheeks”. The nurse suggested I take him to see a dentist to see if he had a tooth infection.
By the time I received her email it was too late in the day to call a dentist for an appointment. I haven’t lived in this area that long and I still haven’t found a dentist that I am 100% satisfied with. The one I saw last year was reasonable, but practiced in one of those cut-rate dental clinics. Their “x-ray room” was just a closet with a kitchen chair in it. There was also an x-ray arm that could be pulled out and pointed at the patient.
I knew it was the least expensive way to go and helped keep down the cost of their dentistry, but I didn’t think such a set-up would work for dad. I wanted him to be comfortable in a dental chair that lay back so the dentist could examine him and he could get his x-rays in the same place. I also thought he might have difficulty getting the dentist I had liked because that dentist wasn’t in the office several days when I needed to go back for problems that developed.
I worried all night about where I could take dad so the new dentist wouldn’t come up with an expensive “dental treatment plan” and want to start pulling teeth. Dad has avoided dentists for years. Now that he is in his 90’s I want to do the least amount of dental work necessary to keep him healthy. One of the other dentists I had seen in the past few years seemed to look at me as an ATM machine he could just keep hitting for more money. I wanted someone who was patient focused. The complicating factor also is that with dad’s Alzheimer’s disease, I wasn’t sure how he would react or if he would totally object to seeing any dentist at all.
The next morning I phoned the ALF nurse to ask for suggestions for a dentist for dad. I asked which dentists take care of “residents like dad”. She suggested several local dentists. I telephoned the first one and he wouldn’t be available for weeks as he just had back surgery and was only working part-time with his regular patients. The receptionist suggested several other dentists including the one I thought was just after money. One she suggested had also been suggested by the ALF nurse.
Next I called the dental office suggested by both the nurse and the first dentist’s office. That worked out very well. The receptionist went back and talked to one of their 2 dentists and said I should bring dad in “right now”. I had to go get him first, but that was fine with them. I called the ALF and asked the nurse to have dad ready so I could take him straight to the dentist.
It was still fairly early in the day and dad wasn’t sure why he was up and ready so soon. He asked where we were going. I hesitated to say for fear he would object, but I did tell him and he willingly came along. I will add that he was not in any pain, either in his mouth or in his puffy cheek.
The dental technicians were all very nice and eager to help dad. They had no objections to allowing me to sit in the room by dad while he was there. One technician took 2 x-rays of the upper and lower teeth on that side of his mouth. She didn’t see anything obviously infected, but wanted to be ready for whatever the dentist wanted. He came and reviewed the x-rays and dad’s mouth. He pointed out that dad had one tooth that had broken off at the gum line. However, he said noting was inflamed or infected, and dad had no pain.
Dad was wonderful. He sat as quiet as a mouse and opened his mouth as directed by the dentist and the technician. I was a bit amazed as he had been afraid to go to a dentist in Florida 4 years ago when he had a bad tooth that needed to be pulled — unless I went with him and sat in the room with him.
The dentist concluded that the swelling in dad’s cheek was not due to his teeth. I asked if dad needed to do anything about the broken tooth and he said no. He said at dad’s age they try not to do any more than they have to in order to prevent pain and infection. Since dad’ mouth was stable, he would just leave it alone. I was relieved as I know dad has avoided dentists for years and is afraid to have work done. I just hope he can continue to avoid dental work.
I took dad back to his ALF and gave the paperwork to the nurse for his records. He continues to be on medications prescribed by the Nurse Practitioner from his physician’s office and the swelling has continued to come down. Last night I did some web surfing and found that dad’s new blood pressure medication (an ACE inhibitor) can have angioedema as a side effect. I sent an email to dad’s nurse suggesting she ask his physician if this might be the cause of the swelling and whether he should switch medications. The nurse responded that she will follow up on that, which makes me feel better. Such reactions occur rarely but can be serious.
It seems ironic that the new medication dad has been taking (to be filled by the mail-order pharmacy this week) may be the cause of dad’s angioedema reaction! The doctor may have to try a new medication instead.
So in the past two weeks, I have had to make unplanned trips to dad’s optician and to a new dentist. Dad looks confused by these excursions but so far is taking them in stride. Now if I can just see things settle down enough that the swelling goes away. We could both use some uneventful weeks I think!