Actinomycosis

It was two days before Christmas, and I had a sore throat. It seemed to be like my usual once-a-year sore throat that ran the course of a cold, coughing and nose blowing and a plethora of Kleenex consumption, and by the end of the week, I felt somewhat better. “But suddenly … This ‘but suddenly’ occurs often in stories. The authors are right: life is so full of the unexpected!” 1 But suddenly, the sore throat returned fiercer than before, and the infection—possibly via osmosis, I’m no doctor—attacked my gums, abnormally swollen and the deepest of reds, behind my lower molars.

But it was the holidays. First my birthday on the 30th. Then New Year’s Eve. Then New Year’s Day. So I suffered through the pain and opted for celebratory spirits. I can’t remember the last time I had gone to a general practitioner. I’m normally the picture of health, but I had plans to be out of town for a week beginning January 5th, and I didn’t have time to be ill. So on January 2nd, I set out to find a doctor. Mistakenly I went to a strip-mall Emergency Care center affiliated with a well-known hospital here in Houston. I thought this facility was like the Urgent Care near my house back in Plano. But no, I might as well have gone to the emergency room. They gave me a steroid shot, tested me for flu and strep, which by the way came back negative, and sent me home with an antibiotic and some Tylenol 3, and $5100 hundred later, I was on the mend, or so I thought. (Thankfully I have insurance and didn’t have to pay in full, but what the hell is wrong with our medical system?)

Over the course of the next week, my sore throat felt better, but my gums. Good Lord, my gums! I returned home on January 11th, the spring semester began on January 13th, so I just sort of curled up in my pajamas on the couch for the next few days and did my homework and submitted on line without leaving the house, and finally on January 16th I decided I must return to the doctor. Except this time, I knew I couldn’t go to the ER, so I set about finding a doctor on my insurance and finally had an appointment late that Thursday afternoon.

The doctor was young, like just out of med school, and with one look in my mouth, she said, “Are your gums normally like that?”

I sat on the examination table, my legs dangling, and shook my head “Um, no, that’s why I’m here,” I said. I had already gone through my recent history of sore throat and antibiotics. Yada. Yada.

“It’s like you have two pillars at the back of your mouth. That’s so weird. Does it hurt?”

“Well, it’s not comfortable.” I paused, keeping my snide comments in check. “They swell when I eat, and I’m popping quite a few Advil.”

“I think it might be gingivitis,” she said. “You need to go see your dentist.”

Now, I’m no dentist, but I knew without a doubt, the issue inside my mouth was NOT gingivitis. Gingivitis does not transform healthy gums into swollen mouth pillars. But with the office visit concluded and no co-pay since having already met my deductible for the year, I walked out the door and to my car in the lot, where I sat and dialed my dentist. Come to find out, my dentist takes off at two o’clock on Thursdays, the current time was past four, and he takes off Fridays. So I left a message with his answering service to return my call on Monday.

On Monday, January 20th, I made an appointment for Tuesday, the 21st. Approximately, one month from when the whole ordeal began, I would be getting some help, and I had great faith in my dentist. I just thought since it all started with a sore throat that I should see a medical doctor.

At my Tuesday appointment, the dental hygienist took X-rays and with one look inside my mouth she said, “I’ve never seen anything like this before. I will be really interested to hear what Dr. H. has to say.”

Flash forward a few moments—Dr. H. examined my X-rays and my gums. “Crystal,” he said, looking me square in the eyes. “You have cysts in the back of your mouth. I don’t think it’s any cause for concern, but I want you to be pro-active. I’m referring you to an oral surgeon, and we’ll send these X-rays over so that he can see what’s going on.” He handed me the card of the oral surgeon. “Thanks for coming to see me,” he said.

Once more, I had no co-pay. Once more, I walked out the door and to my car in the lot, where I sat and dialed my phone, this time the office of the surgeon. Monday, January 27th was the date of my next appointment.

Again there were X-rays, and then I saw the doctor. “Wow!” he said.

I couldn’t help shaking my head. Doctors say the craziest things. I looked in his eyes searching for the answer to the question—What does wow mean? I didn’t say it. I just looked at him with expectation for more information.

“I’m going to send you back for a CT scan,” he said. “The fee is $150, and your insurance won’t cover, but it’s necessary. Once I see the results, we’ll talk again and go from there.”

I nodded my okay, and the dental assistant ushered me into another room with a CT machine, where I stood stone still with my face in a contraption while technology circled my head, shooting more 3-D images. Afterwards, I returned to the examination room to wait with my feet propped up in the dental chair.

The results were there instantly, and once the doctor took a look, he returned to see me within moments. “The results are consistent with what you told me about your sore throat,” he said.

“Do you mind if I take notes on my phone?” I had the feeling I would be hearing some technical news.

“No problem.” He paused. “The infection from your throat has made its way into your gums and jaw bone.” He kept his eyes on mine, me looking up occasionally from my phone keyboard. “The bone doesn’t look normal. I want you to see the X-ray.” He pointed to the image on the wall and the areas of bone loss. “The infection is causing this bone erosion on both sides. See, this image should be smooth all the way around like this.” His finger circled back to the areas of healthy bone. “Your gums on both sides are really red, and the infection could be fungal, bacterial, viral, or all three. We won’t know exactly until we get in there, but we need to go in and clean out the dead bone and the infection and take cultures to see if we are dealing with anything else.”

The doctor gave me an official diagnosis that I asked him to spell, and he wrote it down and handed it to me instead: Actinomycosis.

And if you want to be grossed out, Google it. And if you care to pray for me, I’m headed into oral surgery at 7:30 on January 28. Oh, and thank you for bearing with me here to the end. Oh, and thank you for those prayers if you are that person.

Photo by Pixabay on Pexels.com

1 I borrowed the “But suddenly” line from last week’s studies: “The Death of a Clerk,” Selected Stories of Anton Chekhov, translated by Richard Pevear and Larissa Volokhonsky.