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Pain-free Dentistry

Last Thursday I had a couple of cavities filled.  Wasn’t brushing my teeth regularly, and was doing a couple of bottles of Pibb each day.  I’ve since changed my evil ways.

Some years ago I thought I could conquer pain.  Part of pain is fear.  I thought if I could trust the dentist, and realize that the pain was not causing damage to my body, and realize that the pain was part of making things better, then maybe I could accept the pain.  So, I tried it:  I asked a dentist not to use Novocain.  Yes, there was some pain, but I made it through the visit.  I kept that up.  Sometimes the pain was considerable.  One time, the dentist said, “Nothing makes you holler,” or something like that.  Another time, I said, “uhh, uhhh!,” in acknowledgment of the pain.  That was years ago.  I still don’t use a pain killer.  Dr. Hendrix, my dentist here in Troy, whom I highly recommend, says I’m one of only two people in her practice who don’t use Novocain.  But here’s the thing:  there hasn’t been any real pain in years.  It isn’t me, it’s the technology!  I figured out long ago that the pain came because the drill bits got hot.  Now, the stream of water built into the drill prevents the heat:  very little pain!  In fact, the pain from drilling is less than the pain from all those mysterious appliances the dentist puts between the teeth, and between the tooth and the gum.  That’s where the future in dentistry lies:  figure out how to cut down on the pain from those “accessories”, or whatever they’re called.  Someday, people won’t even think of using drugs when they have a tooth filled.

Not using a pain killer has advantages.  I don’t have to wait for an injection to take effect, or wait for it to wear off.  After getting use to not using a pain killer at the dentist, naturally, I didn’t want drugs for other procedures.  A root canal?  Get real… of course I used a pain killer.  But a colonoscopy?  I talked the doctor out of giving me anything.  Apparently, “full anesthesia” is common in our area.  (Sedation for colonoscopy seems to be a controversial matter.)  In my case, being alert was an advantage.  The doctor asked me what those little black grains were.  “Oh, I had some black rice the other day.”  In a second matter, I had a swollen lymph node, which led to a biopsy, which was a bit tricky, because a shoulder nerve was close to the lymph node.  I convinced the doctor to go with a local anesthetic, instead of a general.  He said that ended up being beneficial, because he had been able to ask me about feeling in my shoulder, to make sure the nerve wasn’t being damaged.  (Turned out I had something called “cat scratch fever”, which goes away with time.)

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My Sleep Apnea

Sleep apnea is when you stop breathing while sleeping.  After a while, due to lack of oxygen, you wake up.  The most common form of sleep apnea is obstructive sleep apnea, OSA, in which the airway in the back of the neck collapses during sleep.  As the airway starts to collapse in OSA, snoring may occur.

A less common apnea is central sleep apnea, in which the airway remains open, but the patient stops breathing, anyway.  (Perhaps it is called “central” because it is caused by the central nervous system.)

After not sleeping well for over a year, my doctor scheduled a sleep study, which is a night in the hospital with wires to monitor the brain’s electrical activity, oxygen sensor on the finger, microphone near the nose (to pick up snoring), and an infrared camera watching me sleep.  As I recall, the system found I had 12 apneas per hour.  (Over about 5 an hour indicates sleep apnea, as I understand.)  Perhaps this condition was brought on by gaining weight.  A long-term approach, then, is to lose weight.  In the mean time, the sleep doctor prescribed a CPAP machine (continuous positive airway pressure), which forces air through a mask into your lungs to keep the airway from collapsing.

In my case, my main complaint is that I wake up after three  or four hours of sleep.  Hopefully, using the CPAP will let me sleep longer.

These machines are pretty sophisticated.  The patient is not told how to change the settings, which is reasonable for most patients.  For myself, I wanted to know everything about the machine, so I went to the web, and learned how to access the software controls, plus I read the clinician’s manual, which explained what the controls do.

The primary variable with these machines is the pressure, measured in centimeters of water, cm H2O.  The range of pressures is 4 to 20.  I used my CPAP in auto-CPAP mode for a while, with a starting pressure of 8 and a maximum of 20.  For a while the pressure went up to 13 during the night, but one night it went up to 17.  I changed the auto-CPAP range to 9 to 20, and it went up to 17 consistently.  I tried getting used to these higher pressures by gradually increasing the minimum pressure up to 17.0.  The pressure would increase to about 17.9.  On about 5 nights I’ve seen the pressure at 18 or higher.  The number of apneas per hour is called the AHI, apnea hypopnea index, where hypopneas are less severe apneas.  The AHI at these pressures was often less then 0.5; that is, on average, half an event per hour.  (It isn’t clear if those are all apneas, or apneas that the CPAP did not successfully prevent.)

Those high pressures are hard to stand.  My mask, called a full facial mask, covers the mouth and nose.  When the mouth drops open during sleep, air enters through the mouth, drying the tongue out.  I purchased a chin strap to hold my mouth closed.  However, I finally realized that these high pressures are just plain uncomfortable, and that is why I was not sleeping soundly.  One feature of this CPAP is EPR:  expiratory pressure relief.  The machine senses when I exhale, and reduces the pressure by 3 cm H2O, which is kinda cool.  Nonetheless, these high pressures take several days if not longer to get used to.  There is some discomfort in the chest until the body is used to the pressure.

So, instead of focusing on reducing the number of events per hour (the AHI), I have been focusing on increasing the length of time that I can sleep without waking up.  I’ve switched from auto-CPAP mode to CPAP mode, which provides a constant pressure throughout the night, except for the very start of a session, when the pressure ramps up over five minutes.  (The machine also has an auto-ramp, which doesn’t start to ramp the pressure up until it detects from your breathing that you are asleep.)

I’ve gradually reduced the pressure, looking to find the point at which I sleep best.  I suspect a pressure around 15.5 may be best, but I need to go back and check that.

Jan. 20, 2018  Last night I was down to a pressure of 11.0.  The AHI was 1.8.  I woke up several times during the night, and finally got up after 3 hours on the machine.  I conclude that 11.0 is too low to help me sleep well.  I am about to go back to bed with the pressure at 12, and hope that I sleep better.  I’ll record nightly results below.

Jan. 26, 2018  Still at a pressure of 12.  Took some getting used to the pressure (didn’t expect that).  I’ve forced myself not to get up and stay up in the middle of the night (that may have gotten to be a habit).  However, I wake up many times during the night.  The last two days the AHI rose to 5, then 3 events per hour.  I suspect that, now that I’m used to the pressure, I’m sleeping more deeply, resulting in more apneas per hour.  I’m able to stay in bed for around 8 hours, but the quality of sleep is not good.

Jan. 27, 2018  Increased the pressure to 13.  Slept much better for the first part of the night, but then the pressure increase caught up with me, and the discomfort in the chest made it hard to sleep.  Couldn’t get back to sleep with the machine on, so I got up.

Jan. 28, 2018  Another night at 13.  Slept a little longer, but the pressure still wakes me up.  Since the quality of sleep is noticeably better, I’ll tough it out, and get used to 13, rather than lowering the pressure, and gradually getting used to 13.

Apr. 14, 2018  I talked with a sleep doctor, who put me on a pressure range of 6 to 14.  I’ve been on that setting for at least a month.  Playing doctor didn’t work for me, so I’m following the doctor’s recommendation.  From my playing around, it is clear that it is impractical to use the highest pressure necessary to completely stop apneas.

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Medical Possibilities

An early Star Trek movie had the Enterprise go back in time to capture a whale.  In a chase scene through a hospital, Doctor McCoy passes a lady on a cart suffering from some disease.  He asks her what’s wrong, she tells him, and says “but they’re going to do surgery to fix it.”  McCoy gets bent out of shape and says “Butchers!”, then gives her a pill that, we learn in a later scene, makes her well.

A few years ago my wide had a sonogram.  Watching those, I’ve always thought that the machine could be much better.  The technician records image after image, but the software doesn’t try to put them together to enhance the image.

Reminds me of the people on TV who want to hide their identities, so their faces are pixelated.  Surely, image processing could average all the images of a face and create a three-dimensional image of the face.  Why aren’t we doing that with ultrasound tests?  Maybe the software could built up a three-dimensional image from the scans.  Perhaps an accelerometer could be used to figure out the relative location of the probe.  I can imagine a surgeon wearing glasses for superimposing a 3-D image of the sonogram on top of the patient s/he’s looking at.

I’m having trouble sleeping.  Last night I slept in the Troy Hospital’s sleep lab, with all kinds of wires hooked up.  The technician says there haven’t been any significant changes in the equipment in the 13 years she’s been doing this.  All those isolated probes; there must be some way to get more information out of them.

Also, I’ve got a carpal tunnel problem (I’m just getting old).  So, they did a nerve conduction test on my arm and hand.  One pulse generator, one detector.

Maybe a company that uses linear algebra, etc. will considering exploring how to make medical equipment less of a butcher’s art.

By the way, the sonogram stuff is interesting.  I once had an echo cardiogram, which is a fancy ultrasound of the heart (it was fine).  With some effort, the technician got the screen to color code the velocity of the blood.  I surmise this involved the Doppler effect.

Update:  A friend provided links to what is going on in this area.

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Joomla!

I’m getting ready to launch a project whereby chemistry teachers collaborate on creating learning resources.  The main part of this involves making some kind of collaboration software available on the web.  I first tried using Moodle.  However, Moodle is an lms—learning management system—and, consequently, it has a course menu showing on every page.  I realized I really need a cms—content management system.  My web hosting company provides 30 or so different cms’s, which is overwhelming.  The three top cms’s on the web are WordPress, Joomla!, and Drupal.  WordPress didn’t seem powerful enough for what I wanted (I’m already using it for this blog).  Drupal is said to be quite complicated.  So, I went with Joomla!

Where is the link to Joomla!?  Some years ago I heard an advertising executive give a talk in which he said, “The best way to kill a poor product is to advertise it.”  He gave an example of some of Campbell’s soups.  An ad agency refused to do advertising for one of the soups, because the soup didn’t taste good to them.  (Campbell’s improved the soup.)  By analogy, Joomla isn’t yet in good shape, so I’m not going to make it live until it is respectable and working smoothly.  The main administrative task remaining is to set up the access control system and permissions so that people can edit pages.  I’m afraid that users won’t be able to create new pages; I may have to be the one to do that, but it is too soon to tell.

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Keeping Up with Technology

I use an Excel macro to send my grades from a spreadsheet to my website, where students enter a password to see their grades.  For over a year, now, the macro has not worked.  With help from our school’s IT folks, I tracked the problem down to CylanceProtect, a sophisticated malware/virus detector installed on all the school’s computers.  CylanceProtect lets macros run as long as they don’t try to write anything to the hard drive, which my macro was trying to do.  The solution is to store the macro in a particular directory (IT told me its name) where such macros are allowed to run.

Another problem with the macro was how to get a file’s location when it is stored in Microsoft Onedrive.  You’d think that would be trivial in VBA (Visual Basic for Applications), but it isn’t.   What is usually returned is a url instead of a directory.   I finally found a post telling how to get the directory path, so now my macro is up and running, again, and students can see how they are doing in my classes.

Since I’m editing web pages lately, I was, once again, wondering if there is a better web page editor available.  I’ve been using an older version of Adobe Dreamweaver at school, and Microsoft Expression (unsupported, but free) at home.  Amaya by W3C is a free, open-source editor that is OK, but hasn’t been updated since 2012.  Because Mozilla Firefox includes so many developer tools, I’ve often wondered if there is a way to edit pages within Firefox.  Mozilla now has a Learn web development section, though it isn’t easy to find.  in the “Complete beginner” section, they suggest starting with the Brackets text editor.  I’m thinking, “I don’t want a text editor, I want to edit web pages and see what the edited page looks like.”  Times have changed:  click the “live preview” icon and the content of the web page being edited is dynamically displayed in Google Chrome (or in Firefox, if experimental live preview is turned on).  This is an open-source product managed by Adobe.  I’m going to start using Brackets to create and edit my web pages.

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Updating the Website

I’ve added SSL/TLS security to the website. I had to pay $50 to buy a certificate to do that (the hosting company, opensourcehost.com, doesn’t support the free Let’s Encrypt certificates).  Now, these web pages have a green lock next to them in the address bar in Firefox, and the address starts with https://, which indicates that the site is secure in regards to having entered personal data, such as passwords, picked up while the page is being transferred from your computer to this site’s server.

Yet another bit of security was required by the school:  Troy University doesn’t want data transmitted over the internet by ftp because the data isn’t encrypted, so I had to figure out how to make SSH (Secure SHell) work on this site.  Fortunately, the required key is free, but it took a while to figure out how to get my preferred client, WinSCP, to handle SFTP (secure FTP) using SSH.  Now I can transfer grades and passwords to the site without worrying about them being intercepted along the way.

I’ve been thinking of adding blogging capabilities to the site for some time, and decided to do it today, so, now, WordPress has been installed.  Since it’s open-source, there was no charge.  However, to allow comments, I needed to have email capabilities on the site, so I’ve now got an extra email address:  cking@christopherking.name.  Fortunately, Microsoft Outlook handles this smoothly, and all my email is collected in the same “pot” as my cking@troy.edu email.