dental, Germany

Update to my dental implant saga in Germany…

I decided a few months ago to post about my experiences getting a dental implant in Germany.  I’ve been on this journey for well over a year, when I discovered one of my two remaining baby teeth had abscessed.  After visiting Dr. Blair in Stuttgart, we determined that it would be best to remove the tooth and replace it with an implant.

The process has not been without some anxiety both over cost and the procedures required.  But I think I will soon have a new smile and Dr. Blair has been great to work with.  So each time a new procedure is done, I write a post about it.  I had a fairly big sinus lift and implant procedure in January of this year.  After allowing the implant to heal in my bone, I went to see Dr. Blair today.  He cut away some tissue to expose the titanium screw that has been there since January.

I was told today’s visit wasn’t going to be nearly as bad as the sinus lift had been.  I requested calming drugs anyway.  Dr. Blair gave me two Ativan, which I took in the waiting room and I sat there for about an hour, waiting for them to kick in.  Once they did, I felt really mellow and calm, but not high or giddy.

I went into the procedure room and Dr. Blair and his assistant got to work.  First, I got two injections of numbing medications.  Both shots were uncomfortable.  One was going on the outside gum near the area getting the implant.  The other was on my palate.  There was a sting, then lots of pressure before the odd sensation of anesthesia set in.

I felt Dr. Blair get to work, but felt little pain.  His assistant kept suctioning out debris, but seemed to miss one side.  Or, at least that’s what it felt like to me.  The whole thing took about twenty minutes and ended with Dr. Blair putting in more stitches.  The worst part was sitting up.  Because my palate was numb, it was hard to feel my nose.  It felt like I was going to choke and/or throw up at the same time.  Dr. Blair reminded me to breathe through my nose, which was much harder than you might expect it to be.  I had to sit for a couple of minutes to get the hang of it.

Dr. Blair walked me out to Bill, who was waiting in the lobby, and told me to go home and take up to 600mg of Advil at a time.  Not one to question doctor’s orders, that is exactly what I did.  Bill put me in the car and drove me home on one of the most relaxing trips I’ve had on the Autobahn thus far.  I took a couple of Advil PMs and enjoyed a nice two hour nap.

I’ve been enjoying some really yummy Thai peanut soup Bill made me from scratch.  We go back to see Dr. Blair next Tuesday.  Bill will get a filling replaced and my stitches will be removed.  I’m guessing there will be new impressions made, too.  With any luck, I’ll have my smile back in no time.

Standard
dental, Germany

Adventures in German drugs…

No, not THOSE kind of drugs.  I have limited my personal recreational drug use to the few days I spent in Haarlem for my birthday last year.  That’s where I tried space cakes/marijuana for the first time.  Unless you count all the beer and wine I drink, I live a fairly drug free lifestyle.

Today’s post is about my experience taking German prescription drugs.  I think this is a notable occasion because, prior to this week, I hadn’t taken prescription drugs of any kind since 2004.  I have been very healthy over the last twelve years. Also, I never visit doctors unless I’m about to die.  Last time I saw a regular doctor was in 2010 and Bill had to drag me there, more or less, by my hair.

Anyway, because I just had dental surgery, I did end up being prescribed some medications by Dr. Blair, the wonder dentist.  And because of my ordeal on Tuesday and the fact that I needed to sleep off the meds that I took in his office, Bill ended up having to visit the apotheke for me.  Last night over dinner, he finally told me about his first experience buying prescription drugs on the economy.

We have just one apotheke in Jettingen and at the time Bill wanted to fill the prescription, they were closed for their three hour lunch break (12:30-3:30).  That seems like an extreme lunch break, but they also stay open until the relatively late hour of 8:00.  Because our local druggist was closed, Bill ended up going to Nagold, which is only a few miles from where we live.

Bill walked into what looked like a cosmetics store.  Someone immediately figured he was looking for drugs and pointed him in the right direction.  He handed over the prescriptions and waited.  Then he saw the drugs come down some kind of chute, where they were picked up by one of the clerks who waited on Bill.  I guess the pharmacist was in a back room dispensing the medications instead of hanging out in front.

The two ladies behind the counter then started speaking rapid fire German to Bill, who asked them in German if they could speak English.  One of the ladies said, “I speak a little.” with a bashful smile.  Naturally, her English turned out to be excellent.

She held up the two boxes, both of which looked pretty similar.  One was amoxicillin and the other was high powered ibuprofen.  There was also a bottle of prescription mouthwash called chlorhexamed.  That’s supposed to help clean the area where I had surgery, since I can’t really brush or floss vigorously there.

The clerk verbally explained to Bill how and when I should take my meds and then put little stickers on the boxes that showed when and how many pills I should take.  This is different from what I’ve experienced in the United States.  There, you get a well labeled pill bottle that has a lot more information on it.  It usually tells you who prescribed the meds and includes warning labels.  Not so in Germany, at least not this time.  I also noticed that my pills look very similar to one another.  In the United States, when you get amoxicillin, it’s usually a bright pink “horse pill”.  American prescription strength ibuprofen looks more or less like the white horse pill pictured below.

Very simple labels on my drugs.  It just tells me when to take them.  I’m expected to figure the rest out by myself!

 

Sorry about the blurriness of this picture.  I was using my iPad instead of a camera.  I took this photo to show something I find interesting about drugs in Germany.  These two pills look almost identical, but they are two different drugs.  One is amoxicillin and the other is ibuprofen.  The only difference in how they look is that one is very slightly fatter than the other.  

 

After she explained the medications and how to take them, she packed them into the bag pictured below.  And then she threw in a little something extra…

Two packages of facial tissues and samples of cough drops!  Total cost for all of this, 35 euros.  And that was before insurance.  I’m not sure Bill will even bother to make a claim for the drugs, since our limit for dental is only $2000 and my implant will cost way more than that.  

 

The goodies from the pharmacy were unexpected.  I have never had an American pharmacy give me free samples.  However, when I see American dentists, they usually give out “goodie bags” with floss, toothpaste, and a new toothbrush.  Dr. Blair doesn’t do that.

I’m excited about the extra facial tissues.  They really come in handy, especially when you find yourself in a public restroom that has no toilet paper.  And thanks to the much larger purse I bought myself for Christmas, I have plenty of room to carry them!

As for my recovery from Tuesday’s sinus lift surgery, I am happy to report that I’m feeling mostly fine.  It’s a little annoying to have stitches in my mouth, but I haven’t had a lot of pain, swelling, or bleeding and haven’t even really needed the ibuprofen that much.  I’m mostly eating what I want, too.  I can’t say the surgery was a lot of fun, but it wasn’t nearly as painful or traumatic as I expected it would be.  I get the stitches out on Tuesday.  I don’t even really notice them unless I happen to touch them with my tongue.

Maybe this doesn’t seem like something most people would blog about, but given my educational background, healthcare stuff interests me.  I also like how in Europe, people expect you to have common sense.

A year ago, we spent MLK weekend in Hamburg.  Maybe I would have liked to have traveled today, except that it’s snowing pretty hard…  I plan to stay in my nightgown all day and only venture out to shovel part of my driveway so no one sues me.

Happy holiday weekend!

Standard
animals, dogs, veterinary care

Results of our German veterinary surgery adventure…

I took my dogs to the vet yesterday.  Arran needed to get his stitches taken out after the surgery he had two weeks ago.  Zane was along for the ride, but also got his routine allergy shot because we were close enough to the next month.  Arran’s surgical wound from his surgery has healed nicely and he even removed three of the stitches on his own.

The vet removed the remaining three stitches, then gave me the news about the pathology report.  Unfortunately, I was right to be suspicious about the growth on Arran’s head.  It was a mast cell tumor.  The pathologist graded it at 1.5, which means he thinks there is a chance the cells could spread.  However, the tumor had clean margins, meaning there was no sign of cancer cells in the skin surrounding the tumor.  It was also a very small growth, maybe the size of a medium sized pea.

The vet explained that we could put Arran through tests to see if chemo would be useful for him.  But, she said the pathologist said if Arran were his dog, he wouldn’t do that.  It would likely involve a bone marrow tap, which would be stressful and painful.  Moreover, chemo has limited results with this type of cancer.  There is a chance that the surgery was curative, but unfortunately, mast cell tumors tend to recur.  I will have to watch him closely and have every new growth tested and/or removed.

I don’t know if I could say Arran has cancer like I could with the two dogs that preceded him.  My old dogs, Flea and MacGregor, had prostate and neural sheath cancer respectively.  Flea was diagnosed by the same German veterinarian when we lived here back in 2009.  We brought him in because he was having trouble peeing and pooping.  She initially thought he’d gotten into something that upset his stomach until she checked his prostate and realized that it was hard and irregular and looked like a map of Russia.

Both Flea and MacGregor had their diseases for awhile before we knew what was going on, so there was little we could do for them other than keep them comfortable.  Arran, on the other hand, is very strong and healthy, and as far as I know, the cancer was removed when he had his surgery.  Or, maybe it wasn’t.  Only time will tell.  But then, when it comes to life, there are never any guarantees.  Even if he’d never had a mast cell tumor, he could die in an accident at any time.  Or he could die of something totally unrelated to the growth on his head.  It does look like we caught the tumor early, though, so this news isn’t nearly as horrible as it could be.

Another bright spot in this drama is that the vet bill was very low.  Yesterday, I got the comprehensive bill for the surgery, toenail clipping, a couple of allergy shots for Zane, pathologist’s report, and prescription drugs.  The bill for all of that was the US equivalent of about $250 before VAT.  Since our vet accepts a VAT form, we didn’t have to pay that.  Even if we had, it still was a lot cheaper than similar service in the United States.

Arran this morning.

Well, I’ll just have to keep an eye on him.  Luckily he’s both cute and sweet.  Anyway, let my story be a lesson to you.  If you find any weird growths on your dog or anywhere else, it’s best to get them checked out before they turn into something sinister.  I am glad I didn’t acquiesce when the vet said maybe we didn’t need to remove that growth.

Standard
anecdotes, dogs, Germany, veterinary care

Veterinary surgery German style…

A few months ago, I noticed a small lump on our dog Arran’s head.  It wasn’t rooted to anything, nor did it feel irregular or overly hard.  I was still concerned about it, though.  When we visited our vet in early May for our other dog, Zane’s, allergy shot, I asked her to take a look at it.  At first, she thought maybe it was a tick bite.  But I hadn’t seen any ticks on Arran in the spot where the lump was and, being from the South, I have definitely seen my share of ticks.

The next time we brought Zane in for a shot, I had the vet take another look at Arran.  She made a note of the lump because then she knew it wasn’t a result of a tick bite.  Then she said she’d look again during our next allergy shot visit to determine if we should remove the lump.  We went in last Friday and the vet said she thought the lump had gone from lentil size to pea size.  I agreed.

So we made an appointment to take the lump off on Tuesday of this week, which also happened to be Bill’s birthday.  I was supposed to fast Arran prior to the surgery.  Perhaps as a sign of his increasingly senior age, Bill accidentally fed Arran on Tuesday, so we had to postpone the surgery until today.  Fortunately, Bill didn’t feed the dogs before he went to work, so I was free to take him in at 8:45 this morning.

The vet felt Arran’s lump and said it felt smaller to her and maybe we didn’t need to do the surgery.  On Wednesday of this week, though, it seemed to me to be a little bigger.  I have been doing a lot of reading about canine mast cell tumors and was afraid that maybe that’s what we were dealing with.  Mast cell tumors can get bigger or smaller within days and they don’t have a particular look to them.  Since the lump seemed to be changing, we decided it would be best to just take it out.

I have also lost two dogs to cancer, so I know I fear it more now than I might otherwise.  The tumor on Arran’s head was very small, covered with hair, and didn’t seem to bother him; but mast cell tumors can look totally harmless and later turn out to be deadly.

One thing about our vet here in Germany that is different than in the United States is that I am usually encouraged to wait for them to do the surgery if it won’t take too long.  In the States, most of the time, you take your pet in early in the morning and pick them up later if they are ready to come home.  Our vet doesn’t have boarding accommodations, so it’s best if I am around to look after my dogs.  I was also in the room when Arran was anesthetized.  I guess that’s for his comfort as he goes to sleep.  When I had my dogs’ teeth cleaned, it was the same procedure.  I stayed in the waiting room while the work was being done.

The surgery took less than an hour.  I asked the vet to trim Arran’s nails because he hates having that done and there have been a couple of times when he’s gotten one hooked in his collar.  I could hear the assistant trimming Arran’s nails as the vet came out and showed me the growth she’d removed.  It was covered in blood, looked kind of smooth, and was maybe the size of a large capsule.  It will be sent to a pathologist who will determine what it is and if any further treatment is needed.

Waiting for Arran to come to…  my very first paying job was working for a veterinary hospital.  I was having flashbacks of that experience today.

As Arran was waking up, I was encouraged to sit with him, again, likely for his comfort.  It took about a half an hour for him to wake up enough to leave the vet’s office.  He was wearing a cone of shame that was a little too big for him.  The vet gave me a smaller one I could try when we got home.  I did put that one on him and it does seem a bit better.

We have antibiotics to start on Sunday, but we don’t have any pain pills.  Hopefully, it won’t hurt too much as he’s recovering.  We go back on Monday for a recheck.  Perhaps then, we will be presented with a bill.  Can’t wait for that!  😉

At home, wearing the “cone of shame”…

I hate to put my dogs through surgery, but the last one we lost had cancer that went undetected until it was much too late.  I would much rather be safe than sorry when it comes to mysterious growths on my dogs.

Standard