Greetings, friends. I am a SAVR patient and received an Inspiris Resilia tissue valve on 7/26/22. This is a long-winded story which started when I was 4 weeks post-op. The details are key to understanding the context in which my dental treatment decisions were made. In short, my providers did a great job of putting my heart first, but my GI system paid the price. I am sharing so that you may benefit should you run into similar circumstances.
8/23 - Not quite 4 weeks post-surgery. Started to notice pain coming from a molar on lower left (tooth #19).
8/25 - Visited my general dentist (who also happens to be my son-in-law). Prior to the appointment, I notified my cardiologist that I might need emergency dental work. They were concerned that I might have an infection developing and ok'd the dental visit. They ordered 2000 mg Amoxicillin and I took it 1 hour prior to my dental appointment with my general dentist. He checked #19 and found it was not temperature nor pressure sensitive. It also had been root canaled some years before and had a crown on it. However, #18 was temperature sensitive. His conclusion was that the nerve in #18 was dying and that was the source of the pain. He acted very quickly and was able to get me an emergency appointment with an endodontist that afternoon. The endodontist was informed that I am a heart patient and he asked me to take an additional 500 mg of Amoxicillin prior to the visit. This was about 5 hours after I had taken the initial 2000 mg. The endodontist performed a root canal on #18. He also ordered a 7-day course of Amoxicillin, which I started that night. He also recommended that I replace the crown on #18 as it was probably the cause of the failure. He recommended that this could wait a bit, but not months.
I went home, somewhat relieved...but quite numb.
8/27 - As this was not my first root canal, my expectation was that the discomfort would start to decrease by now. However, I was feeling pain. Once again, I could swear it was coming from #19, but thought I could be wrong and that the area was just sore from the root canal. The pain usually started in the evening, especially when I reclined. I have heard that it is fairly common for tooth pain to increase when someone reclines and increases blood pressure to the head.
8/29 - Called the endodontist and reported that pain was continuing. He advised that it could take as long as 1-2 weeks for it to subside. I accepted that advice and figured I'd just hang in there for a few more days. I was taking Amoxicillin 500 mg 3 times per day, so at least I felt I had that protection.
9/2 - Pain continued, especially at night. Clearly, this was something else. I called the endodontist again and described the pain. He said he would bring me in to check it out. That was the Friday before Labor Day weekend and the next chance to get me in was 9/6. In preparation for the 9/6 appointment, he ordered a 7-day course of Clindamycin and asked me to stop the Amoxicillin and start the Clindamycin. The Clindamycin supposedly has some advantages over Amoxicillin for dental infections, but is harsher on the GI system. I had completed almost 6 days of the 7-day course of Amoxicillin at that point. I kept my cardiologist posted on all of this using messaging in MyChart.
9/3 - 9/5 Not a fun weekend. Took my Clindamycin as ordered. I was (and am still) not allowed to take ibuprofen. Tylenol barely touched the pain.
9/6 - Went to the afternoon appointment at the endodontist. He took some new x-rays and recommended that he proceed to drill through the crown on #19 to see what was going on. There were 2 possibilities: (a) that the existing root canal had failed and infection was brewing down in the root tips, or (b) that the tooth was cracked and infection was creeping in that way. If it was (b), I would need an extraction. He drilled away and when get got a good view of what was going on, he reported that the tooth structure was intact. He then proceeded to perform an replacement of the old root canal. I had been tolerating the Clindamycin pretty well, except for some minor GI symptoms (diarrhea and some cramping) and I asked him if it was appropriate to extend the 7-day course to be sure my heart was protected until any infection cleared. He recommended against that and to just finish the 7-day course. He also recommended that the crown on #19 also be replaced....as soon as reasonably possible. I left there numb again, but much more confident that this had solved my problem.
9/8 - Took the last of the Clindamycin. The root canals appeared to be successful and no pain was coming from #18 nor #19.
9/9 - 9/12 - Dental problems seem to be solved. Still having some GI problems, but chalked it up to the usual reaction to antibiotics treatment. I was also taking probiotics 1-2 per day to try to mitigate the reaction.
9/13 - GI problems were significantly stepping up. Bathroom trips were up to 6-7 per day and not normal BM's at all. Cramping. Called my GP doctor and reported this. I did too much Dr Googling and became fearful that it might be a c. diff infection. One of the first probable causes of c. diff was listed as a recent Clindamycin treatment. This is also a highly contagious infection and could put my family at risk. I started to quarantine myself. The GP ordered a stool sample test.
9/14 - The test came back with "not detected" for about 7-8 bacteria and related toxins, but c. diff was not listed.
9/15 - Contacted my gastroenterologist. Until now, my only interaction with her was for colonoscopies. She ordered another stool test as well as blood tests. Again, all the components of the test were listed as "not detected". C. diff was not listed. However, I received a call from the gastroenterologist's office informing me that I did not have c. diff.
9/16 - now - I still have some symptoms but they seem to be decreasing each day. I continue to take probiotics. The gastroenterologist also recommended avoiding dairy products and to eat a low-fiber diet. I have an appointment with her a few days from now. I also have an appointment with my dentist about 2 weeks out to replace the crowns. It is supposed to be a non-invasive procedure, but I will be taking my 2000 mg Amoxicillin. Hopefully, my GI system will have calmed down completely by then.
The learning for me that it was necessary to protect my heart both from the dental procedures I underwent as well as the infections that might develop if we didn't act. I don't see any particular decision that could have been made better. Unfortunately, the luck of the draw was that I had 2 separate problems that resulted in me taking a total of 13 straight days of antibiotics. I generally do not have dental problems, so this was highly unusual and unlucky.
I intend to stick to the protocol of antibiotic prophylaxis for dental work, but I am now much more aware of the risks of a long course of antibiotics, especially with stronger drugs such as Clindamycin.
Has anyone had a similar experience?
8/23 - Not quite 4 weeks post-surgery. Started to notice pain coming from a molar on lower left (tooth #19).
8/25 - Visited my general dentist (who also happens to be my son-in-law). Prior to the appointment, I notified my cardiologist that I might need emergency dental work. They were concerned that I might have an infection developing and ok'd the dental visit. They ordered 2000 mg Amoxicillin and I took it 1 hour prior to my dental appointment with my general dentist. He checked #19 and found it was not temperature nor pressure sensitive. It also had been root canaled some years before and had a crown on it. However, #18 was temperature sensitive. His conclusion was that the nerve in #18 was dying and that was the source of the pain. He acted very quickly and was able to get me an emergency appointment with an endodontist that afternoon. The endodontist was informed that I am a heart patient and he asked me to take an additional 500 mg of Amoxicillin prior to the visit. This was about 5 hours after I had taken the initial 2000 mg. The endodontist performed a root canal on #18. He also ordered a 7-day course of Amoxicillin, which I started that night. He also recommended that I replace the crown on #18 as it was probably the cause of the failure. He recommended that this could wait a bit, but not months.
I went home, somewhat relieved...but quite numb.
8/27 - As this was not my first root canal, my expectation was that the discomfort would start to decrease by now. However, I was feeling pain. Once again, I could swear it was coming from #19, but thought I could be wrong and that the area was just sore from the root canal. The pain usually started in the evening, especially when I reclined. I have heard that it is fairly common for tooth pain to increase when someone reclines and increases blood pressure to the head.
8/29 - Called the endodontist and reported that pain was continuing. He advised that it could take as long as 1-2 weeks for it to subside. I accepted that advice and figured I'd just hang in there for a few more days. I was taking Amoxicillin 500 mg 3 times per day, so at least I felt I had that protection.
9/2 - Pain continued, especially at night. Clearly, this was something else. I called the endodontist again and described the pain. He said he would bring me in to check it out. That was the Friday before Labor Day weekend and the next chance to get me in was 9/6. In preparation for the 9/6 appointment, he ordered a 7-day course of Clindamycin and asked me to stop the Amoxicillin and start the Clindamycin. The Clindamycin supposedly has some advantages over Amoxicillin for dental infections, but is harsher on the GI system. I had completed almost 6 days of the 7-day course of Amoxicillin at that point. I kept my cardiologist posted on all of this using messaging in MyChart.
9/3 - 9/5 Not a fun weekend. Took my Clindamycin as ordered. I was (and am still) not allowed to take ibuprofen. Tylenol barely touched the pain.
9/6 - Went to the afternoon appointment at the endodontist. He took some new x-rays and recommended that he proceed to drill through the crown on #19 to see what was going on. There were 2 possibilities: (a) that the existing root canal had failed and infection was brewing down in the root tips, or (b) that the tooth was cracked and infection was creeping in that way. If it was (b), I would need an extraction. He drilled away and when get got a good view of what was going on, he reported that the tooth structure was intact. He then proceeded to perform an replacement of the old root canal. I had been tolerating the Clindamycin pretty well, except for some minor GI symptoms (diarrhea and some cramping) and I asked him if it was appropriate to extend the 7-day course to be sure my heart was protected until any infection cleared. He recommended against that and to just finish the 7-day course. He also recommended that the crown on #19 also be replaced....as soon as reasonably possible. I left there numb again, but much more confident that this had solved my problem.
9/8 - Took the last of the Clindamycin. The root canals appeared to be successful and no pain was coming from #18 nor #19.
9/9 - 9/12 - Dental problems seem to be solved. Still having some GI problems, but chalked it up to the usual reaction to antibiotics treatment. I was also taking probiotics 1-2 per day to try to mitigate the reaction.
9/13 - GI problems were significantly stepping up. Bathroom trips were up to 6-7 per day and not normal BM's at all. Cramping. Called my GP doctor and reported this. I did too much Dr Googling and became fearful that it might be a c. diff infection. One of the first probable causes of c. diff was listed as a recent Clindamycin treatment. This is also a highly contagious infection and could put my family at risk. I started to quarantine myself. The GP ordered a stool sample test.
9/14 - The test came back with "not detected" for about 7-8 bacteria and related toxins, but c. diff was not listed.
9/15 - Contacted my gastroenterologist. Until now, my only interaction with her was for colonoscopies. She ordered another stool test as well as blood tests. Again, all the components of the test were listed as "not detected". C. diff was not listed. However, I received a call from the gastroenterologist's office informing me that I did not have c. diff.
9/16 - now - I still have some symptoms but they seem to be decreasing each day. I continue to take probiotics. The gastroenterologist also recommended avoiding dairy products and to eat a low-fiber diet. I have an appointment with her a few days from now. I also have an appointment with my dentist about 2 weeks out to replace the crowns. It is supposed to be a non-invasive procedure, but I will be taking my 2000 mg Amoxicillin. Hopefully, my GI system will have calmed down completely by then.
The learning for me that it was necessary to protect my heart both from the dental procedures I underwent as well as the infections that might develop if we didn't act. I don't see any particular decision that could have been made better. Unfortunately, the luck of the draw was that I had 2 separate problems that resulted in me taking a total of 13 straight days of antibiotics. I generally do not have dental problems, so this was highly unusual and unlucky.
I intend to stick to the protocol of antibiotic prophylaxis for dental work, but I am now much more aware of the risks of a long course of antibiotics, especially with stronger drugs such as Clindamycin.
Has anyone had a similar experience?
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I took plenty of probiotics along with it and after....always take them after any antibiotics and eat plenty of live yoghurt.
