wisdom teeth removal
29 July 2005 18:04![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
juldeaWarning! Incredible whininess follows.
...
OOOOOWWWWWWWWWWWWWWWWWWWWWWWW. I am close to tears this hurts so fucking much!!! and I have freaking PERCOCET and it's not stopping all the pain! What do I need to do??
Also, I was really brainless this morning and ate something, which meant they weren't able to put me under general, which means they did the whole procedure - all four teeth - under local. Which scared the fuck out of me but ended up not being that bad. During the procedure at least, the most painful things were the shots of anesthesia - the actual tooth pulling was just a lot of odd pressure.
Right now, of course, different story. OOOOWWWWWWW.
Yes, the pills I'm supposed to take every four hours just hit the mark to take another, and I've been asleep most of the afternoon, so perhaps they work better than I think and I am just in pain because I'm due for another one. But right now I'm wanting to cry waiting for it to kick in.
I need to be entertained, immersively, for at least half an hour, and londo is asleep after staying up all night! Argh! Help!
...
OOOOOWWWWWWWWWWWWWWWWWWWWWWWW. I am close to tears this hurts so fucking much!!! and I have freaking PERCOCET and it's not stopping all the pain! What do I need to do??
Also, I was really brainless this morning and ate something, which meant they weren't able to put me under general, which means they did the whole procedure - all four teeth - under local. Which scared the fuck out of me but ended up not being that bad. During the procedure at least, the most painful things were the shots of anesthesia - the actual tooth pulling was just a lot of odd pressure.
Right now, of course, different story. OOOOWWWWWWW.
Yes, the pills I'm supposed to take every four hours just hit the mark to take another, and I've been asleep most of the afternoon, so perhaps they work better than I think and I am just in pain because I'm due for another one. But right now I'm wanting to cry waiting for it to kick in.
I need to be entertained, immersively, for at least half an hour, and londo is asleep after staying up all night! Argh! Help!
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no subject
on 29 Jul 2005 22:07 (UTC)no subject
on 30 Jul 2005 01:51 (UTC)no subject
on 30 Jul 2005 05:20 (UTC)no subject
on 30 Jul 2005 10:00 (UTC)no subject
on 29 Jul 2005 22:17 (UTC)no subject
on 29 Jul 2005 22:36 (UTC)One thing I forgot to do was to ice my jaw; ended up asymmetrically swollen. I really recommend remembering to ice.
no subject
on 30 Jul 2005 01:55 (UTC)no subject
on 30 Jul 2005 16:03 (UTC)no subject
on 30 Jul 2005 19:59 (UTC)Of course, my half-chipmunk smile now shows that I should've been informed.
no subject
on 31 Jul 2005 00:54 (UTC)no subject
on 29 Jul 2005 22:40 (UTC)no subject
on 30 Jul 2005 01:53 (UTC)no subject
on 30 Jul 2005 03:12 (UTC)no subject
on 30 Jul 2005 04:16 (UTC)that's not true
on 30 Jul 2005 14:06 (UTC)Executive Summary - read the introductory and FAQ of the FDA Orange Book, available at http://www.fda.gov/cder/ob/default.htm - many pharmacists don't know it exists or how to use it, but I use it personally if I am offered a generic choice over a brand name, so I can ensure it will be safe and effective.
Falsehood 1 - generics don't need to meet safety requirements.
Fact 1 - (simplifying it a little for the aske of brevity here) generics do not need additional safety and clinical studies beyond those done by the brand name if and only if they contain the same amount of the same active ingredient, and bioavailability is shown to be equivalent - that is to say, an equivalent absorption, distribution, metabolism, and elimination profile can be shown such that the same levels of the active ingredient(s) get to the site(s) of action in/for the same duration. What constitutes "same" vs. "not same" would be a good question outside the scope of this discussion, more related to #2 below. And finally, I must point out that just because a generic has the same bioavailability as the brand name, doesn't yet mean it will be approved for human use (again, see below). This is because the inactive ingredients may be different (many used to support the tablet-making process), and may have some impacts on the overall pharmacokinetics and effectiveness of the drug.
Falsehood 2 - generics are OK by FDA if they are as much as 20% less effective than the brand mame
Fact 2 - I am unclear where the "20%" came from, but maybe you have an FDA source for that. In order for the FDA to approve a generic drug, the drug company must prove either bioequivalence or therapeutic equivalence - you can find the definitions here, among many other places: http://www.dotpharmacy.co.uk/upgener2.html - in summary, the generic maker must show data that in the same individuals, in the same dosage regimen, the generic and the brand name result in comparable bioavailability.
Fact 3 - The FDA does not endorse a bioequivalent drug as being of equal effectiveness to a brand name - merely that it is safe, and should be effective; this is why generics are so much cheaper, the extremely reduced testing. However, whether by the generic company or an outside board, individual generic companies' products can be shown to be therapeutically equivalent to the brand name - if the brand name and generic name are bioequivalent, AND show the same efficacy and/or toxicity in clinical trials, then the FDA will specially note their therapeutic equivalence within their Orange Book. You can be much more confident that if the Orange Book shows Company A's generic percocet as equivalent to the Brand Name Company's percocet, that it should be both as safe and effective as the brand name.
If you made it this far, thanks for reading!
Re: that's not true
on 30 Jul 2005 14:47 (UTC)Thanks for writing! :)
Re: that's not true
on 30 Jul 2005 14:55 (UTC)Re: that's not true
on 30 Jul 2005 16:19 (UTC)The deciding factor for most people is the price - not everyone's got a medical plan like I do where I pay $10 for a one month supply of a brand name drug, and get my generics free. Generics generally offer a safe and effective alternative. And yes, there are some companies - generic and brand name - that end up on FDA shitlists. Read up on Able Laboratories, a generics company who had to take all products off market even after several successful FDA inspections, because they wbere "inventing data". Could happen anywhere, which is part of why prescription drugs are also commonly called "ethical drugs".
Why all of this? As everyone here has experienced I'm sure, not all generics act the same. Some may give you a headache, or some may not feel like they're working at all, although you had great experience with the brand name.
This is because the generic can use different "inactive ingredients", which include (among others): binders (which help the powder stick together as a tablet), disintegrants (which help a tablet dissolve uniformly in the stomach), fillers (like starch or lactose, to bulk up a tablet) lubricants (to prevent the powder from sticking to the machine when pressed into a tablet), coatings, sweeteners, and lakes (colorants). The use of these inactives is limited by the FDA to be neither intended or expected to cause any human pharmacologic response if administered alone or in the amount of the proposed compounded preparation.
So as I was saying - check out the Orange Book. You can determine with it not only which generics the FDA is satisfied have data to back the claim that they are not only bioequivalent, but therapeutically equivalent to the brand name, but which generics have been shown to be equivalent to each other. The Orange Book is a remarkable tool, and not very well advertised to consumers even within the industry.
The FDA recommendation is to choose a generic from a company with an annotation that indicates it is therapeutically equivalent to the brand name.
As a manufacturer, you can embody your tablet using the active ingredient(s) and (there are some rules I'm leaving out here) essentially any combination of these things to make it easier to manufacture or break down in the body - as long as a generic company proves their dosage form has similar bioavailability as the brand name and use the safe/effective amount of active, the FDA doesn't require extra testing, thus reducing the cost of that generic by many, many times.
Re: that's not true
on 30 Jul 2005 16:19 (UTC)As a side note, Over-the-Counter (OTC) drugs are called "proprietary drugs", not "ethical drugs" - to qualify as OTC with essentially little to no testing, the manufacturer has to evidence that they use "Generally Regarded As Safe and Effective" (GRASE, or sometimes just GRAS) ingredients in GRAS(E) amounts, according to the monograph standards set forth in the United States Pharmacopoeia (USP). This implies the ethicality has been taken out of the hands of the manufacturer, and in the hands of the third-party-yet-nevertheless-government-enforced-as-if-law USP folk. This gets kind of weird, as the Total Control With Whitening toothpaste put out by Crest needed full clinical studies, because it has one or two ingredients that don't have monographs, whereas most toothpastes, mouthwashes, petroleum jellies, et al. OTC products don't require extensive clinical trials (you can read the FDA's guidance documents on OTC qualifications if you search for it on their website, fda.gov).
no subject
on 29 Jul 2005 23:56 (UTC)Sorry, I can't come out and entertain either.
Recommendation: once the pain has subsided enough to eat (soft foods), go to Friendly's. Best place to go for a selection of soft foods - pudding, Fribbles, mashed potatoes, meatloaf...
no subject
on 30 Jul 2005 01:52 (UTC)Mm, Friendly's. I'll have to look then up online to see if there's a decently close one. :)
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on 30 Jul 2005 02:51 (UTC)no subject
on 30 Jul 2005 02:56 (UTC)no subject
on 30 Jul 2005 04:33 (UTC)I found that it was helpful to not only apply icepacks to the outside of my face, but to also drink lots and lots of ice water as a sort of internal icepack. It helped numb the pain, and it also helps blood circulation (though that last would be a bad thing if you accidentally dislodge the blood clots in your healing gums, so careful not to use straws or chew gum etc).
The most recent time I had teeth pulled they took my last two wisdom teeth out plus one molar that had been badly repaired by another dentist years ago. I was supposed to see my dentist in Somerville, which was a nice convenient distance from my folk's house in Brookline/Chestnut Hill where I traditionally recover from anything painful enough to require pain meds. Then they discovered asbestos or radon or something in the Somerville office and I had to go see the dentist at his other office, which was somewhere about 45 min away up route 128. I was so terrified that the pain meds would wear off before I got home and filled the prescription (note that I was driving myself home). But the dentist was very nice and actually gave me another shot of local anesthetic right before I left the office. (I've never had any of my wisdom teeth pulled under general anesthesia; it was never even offered to me as an option.) Then of course when I got back to Chestnut Hill the CVS near my folks house was out of percoset. Argh! So I had to drive over to West Roxbury to fill the prescription. I was so eager to get home, take a percoset and get to bed that I didn't notice when they forgot to give me the antibiotic prescription I also had filled. :-)
Anyways, my sympathies.
ick
on 30 Jul 2005 14:10 (UTC)I had two that were impacted. These aren't a humongously big deal, but they just don't pop out of your mouth easily. They come in all slanty-like.
The other two were a bigger deal - they were embedded. They were coming in sideways, under the gumline. They had to open up my gums, and saw out pieces of tooth as they went like cutting a juicy steak.
It was then I realized that my brain has a safety interlock against nitrous oxide anaesthesia. I was awake in the back of my head, completely aware of what was going on, and even grabbed the doctor's arm twice and told him I wasn't out. "Stop fighting it" is not what you want to hear. It took 3 doses of the gas and then an injection to get me out past the first few incisions, and I still woke up like 2 or 3 times in the middle of it.
I donno WTF I am gonna do if I ever need serious surgery... :(
Re: ick
on 30 Jul 2005 14:48 (UTC)If you have serious surgery, go under general. :P
Re: ick
on 30 Jul 2005 16:23 (UTC)I really hope there's new gases out there to which I don't have an idiopathic response. The wisdom teeth ordeal was the *worst*.
no subject
on 2 Aug 2005 23:10 (UTC)Advice: Try not to physically strain yourself too much until they heal.... I did and ended up swallowing some blood from my wisdom teeth which were aggravated by all the activity, which then consequently made me puke. Yay! :)