Wednesday, November 13, 2019

Mining for that silver lining yet again: I see it, but…

Sunday night I was talking to my sister Courtney (well, we were exchanging emails) and I wrote I had to wrap things up and go to bed.

I told her that before this whole ‘temporomandibular joint thing’ came along, I used to stay up until 1-2am simply because I could.  I’m retired!

I’d sleep a few hours, jump back up around 6:30am, then doze off & on thru the next day.  You know how some people are morning people or night people?  I liked to consider myself both.

But after finally seeing a doctor two weeks ago (the terrific Dr. Marvi) for my tmjd, and getting put on Naproxen and Nortriptyline at bedtime, I was instructed to take it at the same time every night and go to bed within one hour.  So I’ve been taking it nightly at 10pm, going to bed at 11pm, reading for 1/2 hour before zonking out for 7 hours.  At least now, I was getting a good night’s sleep.

My sister responded with this:

Please don't gag when you see me trying to find the "silver lining", and I'm definitely not saying that everything happens for a reason because it surely does not; but it sounds as if your schedule is straightened out now, at least.  After the pain & pressure works itself out, you'll have a better quality of life with your new sleep-schedule.

I wrote back that it wasn’t worth the TMJD, and she promptly replied with an apology.  But she was right; that was a silver lining, whether or not I liked how it came about.

It got me to thinking about other silver linings I’ve seen but didn’t appreciate at the time:

In 1993, my shady landlord was arrested and his tenants (myself and 2 others) were handed eviction notices.  But I found a nicer apartment in a MUCH nicer neighborhood, and wound up living there 23 years.

In 2001, my poor dad succumbed to cancer.  But it motivated me to get my driver’s license and a car, so I could begin making weekly visits to see my mom who lived 65 miles away.  She died 3 years later, but we got to spend a lot of time together before that.

In 2014, my dipshot boss told me I’d be taking on additional work (after I’d been requesting help for 10 years and ignored).  It pushed me into taking the “early retirement leap” I’d been mulling over for a couple years, but was afraid to do.  His stunt gave me the kick in the pants I needed.

It got me to thinking about these silver linings yesterday, when I went to Mercy Hospital yesterday for my second round with the TMJD treatment.   It did not go as I expected.  After Susan (the same nurse I had 2 weeks ago) took my weight & blood pressure, she said “You’ve lost 10 lbs since your last visit!   Dr. Marvi isn’t here today, but Dr. Syed will see you in a couple minutes.”   I followed her into Exam Room 2.

aleem-salikI’m moving up in the world—my PCP Dr. Marvi is a first year resident, Dr. Syed here is a third year resident!

A couple minutes later, another nurse comes in.  “Mr. Morris?  My name is Gina.  I’m going to take your blood pressure again.”   Um… okay.

A few minutes after that, Dr. Syed enters the exam room, wheeling some weird contraption in front of him. “Douglas?   Before we get started, I want to take your blood pressure once more.”   The machine makes some happy chirping noises, and whistles a happy little tune when it’s done.   He wheels it back out then re-enters.

DOC:   Douglas, what do you think has been helping you the most with your TMJD?

ME:   The Naproxen—and wearing this occlusal splint 24 hours a day.  (I open my mouth and tap the hard acrylic to show him.)

DOC:   I was afraid you’d say that.  I’m glad you’re wearing the splint—but the Naproxen is not meant for long-term use and I fear it’s damaging your kidneys.  It’s usually prescribed for 10 days dosage max.   You’ve been on it 14 days.

ME:   I’ve read enough about it to know it’s dangerous. 

DOC:   You’ve lost 9.8 pounds since your last visit.   I don’t know how you managed 10 lbs loss in 2 weeks time but…

ME:   From not chewing.  I’m living on vegetable juice, water, coffee, scrambled eggs, applesauce.

DOC:   But your blood pressure… Douglas.  It’s thru the roof.   It was in red-flag territory on your last visit.  Your upper number has gone up by 15-20 since then.  That’s why we took your blood pressure reading 3 times.  I’ve alerted the attending physician, and we want to get an EKG.  

(After the EKG…)

DOC:   Your heartrate is too high.  We need to put you on medication for hypertension beginning today.   And we are doubling the Nortriptyline you take at bedtime, but you need to cut your Naproxen dosage in half, or stop taking it altogether.  Have you considered surgery on your jaw.

ME:   You’re the doctor, but I’ve studied tmjd enough to know that surgery is ONLY a last resort, and only to restore range-of-motion… not for pain.

DOC:   I’ve treated 2 or 3 other tmj patients, and you’re just like them—they’re experts on it compared to us, I’ll admit that.  Alright, well, we just have to hope the Nortiptyline will lessen the muscles spasm.  Let me feel your face… you’re either running a fever or dealing with inflammation.

ME:   The inflammation comes & goes throughout the day.

DOC:   Okay.  Go to the lab across the street on the first floor, submit your blood & urine samples, pick up your Carvedilol—that’s a BP med—from the pharmacy asap and start the dosage today.  We will see you here again in 2 weeks.

ME:  Er… okay.  Do you think the high blood pressure is from the jaw disorder?  It hasn’t exactly been a walk in the park…

DOC:  You had high blood pressure last December, before that kidney stone operation and before your TMD began.  You should’ve been treated for it then.

ME:  Oh.

So, here I am the next day—my jaw feeling sorer than usual without that awesome Naproxen (it figures the good stuff turned out too good to be true) and a little dizzy from the blood pressure meds.   I suppose one can say if it wasn’t for the jaw thing, I wouldn’t have known I was in stroke territory….

So yes, there’s a silver lining here, but right now I’m having a tough time seeing it!



  1. You might want to monitor your blood pressure at home. The devices are not expensive. I use the wrist one and checked it against the doctor's at his office for accuracy. I tend to test high at the doctor's office and normal at home. I have "white coat high blood pressure." It goes up from the anxiety of just being in the doctor's office. I mean we are not there for social reasons and anxiety can raise your pressure. Pain can also raise it according to my cardiologist. I sure hope you get your silver lining.

    1. Patti, thanks so much. This was helpful & made me feel better just reading this (the home BP monitor is a good idea). I was anxious enough before I got to that doctors office and yep, I think being there raises mine too. Thank you again. :)

  2. My wife had headaches every day, finally took BP medication, has not had a headache since. We use one of those home BP monitoring things daily.

    Maybe reduced BP will help with the jaw. One can hope, you never know.

    1. Thanks Joe, I appreciate you sharing that.. hope it helps mine too.

  3. Pain will elevate one's blood pressure. Glad you are getting it treated! Might be a little bit down the road before you feel good about the silver lining, but I'm sure its definitely there!


  4. Bingo! or Snap, or something. I had high blood pressure for years and didn't know. I thought it was normal to be hearing my own heartbeat in my ears 24/7. I'd go to the doctor for prescription refills and he'd take the blood pressure and say "it's up a bit" and that was it. No advice, no "let's get it down to normal" so I thought up a bit was okay. Then he retired and a new young doctor took over and didn't like the look of me. She took my blood pressure, sent me immediately back to the treatment room for an ECG, and then told me I'd got here under my own steam so she's trusting me to get to a hospital on my own, but I had to go "RIGHT NOW". So I did and found my blood pressure was way up in the stratosphere, cholesterol level following it and every time I ran for a bus I could have dropped dead. I spent the rest of that day in the emergency department of the hospital my daughter works at, hooked up to machines that go beep, while they waited for the BP to come down and eventually it did drop but only two points, so the hospital started me on medication and within a week my blood pressure had dropped 50 points and it has stayed there since. I'm still furious at the older doctor who didn't get me properly checked and started on BP pills. Once your blood pressure goes down, you might feel better physically, but it might not help with the jaw thing :( At least you won't be at risk of stroke anymore. Or not so much.

    1. River--wow, that's some story! I'm very glad your high BP was caught in time! I wonder why your old doc didn't sound the alarm? At the same time, when I had a kidney operation last December, I remember a nursing asst telling my nurse "Look at his BP" and the nurse not saying, just nodding her head. Anyway, thanks for reading (and sharing) River...

  5. Ahhh gee, Doug. I'm so sorry. You are going through so much right now. I hope you can find something that will help the TMJ. However, I'm glad your blood pressure was caught. That sounded scary.

    1. Thanks very much Kay... I think I'm gonna hold off blogging until I can come up with some cheerier posts :)

  6. Hi Doug, I stroll over from Blammo every now and than and am sorry to hear about your troubles. Nortriptyline certainly is a sleepy medicine. My wife was on it for a while and would fall asleep watching TV right after dinner even though she had taken her pills the night before. We were never sure just why she was on it.

    Blammo misses you!

    1. Hey Ken! It is so good to hear from you, I think about you, Andrew, Jeff, Iikka a lot. Yes, that Nortriptyline is a sleepy med--I hope your wife is better from whatever reason she was on that drug... and thanks so much for the kind Blammo message, I miss those guys a lot too. I need to head over there & check things out soon. Thanks again Ken, hope you are well.


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