Patient calls on Tuesday morning in acute pain. See him. Complains of severe pain in the gums adjacent to a lower left premolar. Also unable to eat. Pain starting to radiate to ear.
Normally these are warning signs of a cavity invading the nerve and needs a root canal or extraction.
I took 2 X-rays of the offending tooth and both showed no pathology. The tooth did not respond to any diagnostic tests either.
There was some bruising on the gums which the patient himself attributed to toothbrush trauma.
I wanted to be sure so advised him to get a CBCT aka 3D scan to rule out internal resorption or a fracture. Placed him on an anti inflammatory.
The patient called in the evening stating he was in very acute pain and just not able to eat anything. He was on his way to get a scan.
I put him on a stronger anti inflammatory. I probed a little about temperature sensitivity and he said now having ice cream was providing total relief from pain!
BINGO!
That’s the textbook test to establish diagnosis of partial necrosis aka the nerve was dying. As a result, there are gases formed and that’s the cause of intense pain.
Applying cold to the tooth acts to reduce the intensity and hence provides relief from pain.
But the question of basic cause still was a mystery.
Imagine my surprise when I got the results of the scan and there was a very small cavity in the tooth and a very tall nerve, neither of which were seen on the X-ray.
The scan shows the inside of the tooth from the top, front and side at 1 mm slices. It is also more sensitive and hence was able to detect a cavity not seen on a 2D X-ray.
I got the patient in the next day and started his root canal. Needless to say the nerve was almost dead.
The patient has not had any acute pain since then and was finally able to eat and also get some sleep.
Pune has always had a rich tradition of “Ganpati mandals.” Associated with the same is a history of “Dhol Tasha troupes”.
Schools like Ramanbaug,Numavi and Jnana Prabhodini have had one for a long time. In the early 1990’s, 2 school boys yearned to play in a Dhol Tasha troupe.
They approached their “Shakha Shikshak” with a request to have their own Ganpati mandal, mainly so they can play the Dhol Tasha.
The shikshak agreed to have a 1.5 day Ganpati and the boys were able to get started with their Dhol Tasha dream.
Back then, any such organisations were invariably named after “Shree Ram” and so the “Shree Ram Pathak Charitable trust” was born.
The children raised some funds from their own parents and purchased the first few Dhol Tasha instruments and started practicing.
Now in rural America in states like Ohio, Idaho, Nebraska which does not a lot of Desi folks living there.
Eventually comes the inevitable move do suburban life, which is when the loneliness really sets in.
Weekdays are pretty much occupied by work ans household chores.
Weekends are consumed by grocery shopping and laundary. Social life is usually meeting local friends on Friday and/or Sat night and some outing on Sunday.
If you live on the East Coast, you are more or less living a life similar to the lockdown during COVID from Nov to April.
Initally healthcare was a Patient-Doctor relationship.
Then the Corporate Hospital Ownership came in and made it slightly commercial. People don't realize that this arrangement made it possible for doctors to avail of world class technology and deliver the best healthcare.
Now we have Venture Capitalists from Wall Street in the frame.
They are a purely financial institution and are only coming in to increase their profits by a large number.
They view a Hospital in the same way they view a Hotel or they view a Start up like Peter Thiel viewed FB.