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I Thought It Was Just a Toothache

My dad reveled in telling the story of being diagnosed with high blood pressure. “They checked my blood pressure and almost called a Code Blue,” the story went. “I told the nurse, ‘I came in to get my ears cleaned!’”
In my case, I thought I had a toothache.

“My mouth really hurts,” I told Tammy one Friday. “Maybe I have a toothache.” “Then you need to the dentist,” she said, reaching for her cell phone.

Later that morning the dentist picked and prodded my teeth and took x-rays. I refused to identify a particular tooth as the culprit, thinking back to the time my second bicuspid was drilled twice before an endodontist informed me that my lower molar needed a root canal. “I don’t see anything,” the dentist said. “I’ll put some bonding on the tooth in case there’s a microscopic crack that’s temperature sensitive.” I assured him I’d wait until he was in the office on Monday before taking any chances on a cold smoothie.

Late Saturday afternoon, however, the pain struck again. The pain gods honored Sunday as a day of rest, but as soon as I arrived home from my early morning run on Monday the pain struck.
“This is related to exercise,” Tammy declared. “It happened after you ran on Friday, after you mowed the lawn Saturday, and now today. I’m calling Dr. McClung.”

The pain was so severe that I passed up on the opportunity to concur that mowing the lawn might be hazardous to my health.

Dr. McClung found time to see me that morning. I related my symptoms in a detailed chronology, just like we lawyers expect from witnesses to traffic accidents. Dr. McClung said something about my heart and blood pressure, then left the room. He returned a few minutes later and handed me his cell phone.

“Mr. Owen?” a female voice inquired. “Your stress test is scheduled for 6:30 tomorrow morning. No food or drink other than water after midnight. And no caffeine for 24 hours.”
I handed the phone back to Dr. McClung with a quizzical look on my face.
“This could be a heart problem,” he explained. “If there’s a blockage in an artery the pain could be transferred to your mouth. And I can’t pick it up on an EKG, so I’m sending you for a stress test. No more running until we figure this out.”
“Geez,” I said. “Tomorrow you’re finally releasing Nick to run and now you’re grounding me. Are you conspiring against us?”
Despite the potential severity of the situation, I enjoyed seeing my doctor face the  quandary of wanting to explain his medical decisions while his HIPPA training prevented him from acknowledging that my running partner is also one of his patients.

Walking out of the office, I could hear my dad’s cardiologist telling him, “Your heart could go at any time. You’re a walking time bomb.” I wondered if I was a time bomb. I thought my exercise routine had changed history, but both my father and grandfather died of heart attacks in their 70s.
The next morning the cardiology technician explained the procedure. “We need you to get your heart rate up to 139,” he explained. “If you can’t reach that rate within 10 minutes, we inject an agent to increase your heart rate.” Given that my average heart rate during a run is 144, I worried that I’d never make it by just walking.
I considered suggesting that the kids start calling me in random succession. Nothing raises my heart rate like unexpected calls from the kids.

The cardiologist came in and asked about my medical history. When he asked about chest pains, I answered, “No! Mouth pains.” My own story was taking hold. “I came in for a toothache and had open heart surgery.”
I listened as the cardiologist dictated the “patient history.” When he dictated, “Patient denies having diabetes,” I considered saying, “My son has diabetes. It’s not something the patient can ‘deny.’”
The treadmill started on incline level 1 and increased every three minutes. After two inclinations my heart rate finally reached triple figures. I started to walk faster and at the 9:18 mark my heart rate reached the magic 139. The technician injected the dye and a minute later the treadmill stopped.

That evening I attended a gubernatorial candidates’ forum to hear Booth Goodwin. I walked over to greet Kay Goodwin, asking how she was holding up during the rigors of the campaign. “I’m fine,” she said. “The question is how are you?” Before I could answer, she added, “The Judge said to check everything out. He loves to read up Web MD, you know.” I promised to follow doctor’s orders.

The next day the cardiologist reported that I’d passed the stress test with flying colors. I rushed over to Dr. McClung’s office, expecting to be released for the Friday morning run.
“Come back to my office,” he said.
Getting summoned to the doctor’s office is generally not a good thing.
“There’s a another test, called a CTA, that’s 90% accurate,” he explained. “But insurance companies don’t like to approve it, so it will take a few days.”
I pondered how pain resembling a toothache would justify a high-tech heart test, but I followed doctor’s orders.
“I still can’t take the trash down the driveway,” I told Tammy. “Seriously, my dad had his first heart attack taking out the trash.”
The approval came through the following week and that Friday I passed a second heart test.
“Well, it’s not your heart,” Dr. McClung pronounced.
I mentioned that I’d experienced a couple of pain episodes that week.
“Have you been behaving yourself?”
“Yes,” I said. “Tammy refuses to let me take the trash out. And I obey her.”
Three days later I entered an MRI tube for a brain scan.
Fortunately the results arrived within a couple of hours. “Well, you don’t have a brain tumor,” Dr. McClung said. “So that’s good.”

I was finally released to run while awaiting a referral to an ENT specialist. That ended with a referral to a third imaging facility for a CT of the jaw.
“Have you ever had a CT with contrast?” the nurse inquired.
“Yes.”
She looked surprised and asked, “How long ago?”
“Last Friday,” I said. “I do these every week.”
Later that day I received news that my jaw was fine, though something showed up around my thyroid. Quite frankly, I’d rather they had told me I had a broken jaw.
“The thyroid wouldn’t be causing the pain,” Dr. McClung said. “But since we’re getting you checked out let’s get an ultrasound of the thyroid. Can you come over now?”
I left the office immediately, noting the receptionist’s raised eyebrow when I told her I was leaving for a doctor’s appointment. To quell any suspicions I left the hospital wristband on to serve as my doctor’s note.
At this point, Tom Goodwin, our managing partner, insisted I go to the Cleveland Clinic. Tammy took over and called Reggie — we’d moved from “doctor” to a first name basis — to ask about a referral.
While Tammy and Reggie discussed the options, I checked in with my enododontist to find out if I’d visited three imaging facilities due to an abscessed tooth. After taking an x-ray and poking all of my teeth, he concluded, “It’s not your teeth.”

Reggie called that afternoon. “Cleveland is telling me that the soonest they can see you is June 23,” he said. “And I’m telling them that’s not soon enough.”
“That’s right,” I said. “If it’s a neuro problem I’ll be dead by then, and even if it’s not, Tammy and Tom won’t wait that long.”
“If necessary, I’ll call Greg Rosencrance,” Reggie said. “He’s from Charleston and is now medical director.”
“I used to play tennis with Greg,” I said. “You won’t violate HIPPA if you tell him I’m the patient.”
At Tammy’s insistence, I sent Greg a personal message on Facebook. The staff had come through with an earlier appointment before Greg saw my message, but he offered to help if needed, assuring me that his skills as a medical director were better than as a tennis player.
“Can you be at the Cleveland Clinic at 8 a.m. on Thursday?” Reggie asked. “I hope so, because I told them you’d be there.”
“I’ll make it happen,” I promised.
Tammy and I drove up Wednesday afternoon and found our way to the clinic so we’d know where we were going in the morning. We discovered that the clinic sprawls across multiple city blocks, not counting satellite facilities dotting the suburbs.
On Thursday we arrived in the midst of a downpour and opted for valet parking. The lobby seemed to stretch for several blocks. We wandered for a few minutes until a clinic staffer asked if we needed help. She directed us to Building S, where we continued in search of a directory.
Another employee stopped to see if we needed help.
“We’re looking for Dr. Gretter, in neurology,” I said.
“Neurology covers six floors,” the woman said. “There are some offices on 3, but I don’t know which department. But you might start there.”
“Thank you very much,” Tammy said. Rather than taking a shot at the third floor, we continued down the hallway to look for an information desk. We were rescued by Mike, an usher, who pointed us to the main information desk.
“May I help you?” the attendant asked.
“Yes,” I said. “I have an appointment with Dr. Gretter?”
“Your last name”?
“Owen.”
“First name?”
“Richard.”
“Date of birth?”
“Twelve five fifty-eight.”
Name and birthdate seem to be required for everything but coffee at Au Bon Pain.

“Ninth floor, building S, which is through the tunnel on your right,” the attendant directed. On the ninth floor I repeated my name and birthdate, which entitled me to fill out a medical history. Soon I was escorted by a nurse to an exam room where she took my blood pressure and asked if I was in pain.
My dad would have said, “No, I just wanted to see the Cleveland Clinic.” I answered that I was not presently feeling any pain.
A few minutes later, an older gentleman wearing a white coat and holding a cane and papers in his left hand stopped in the doorway. He nodded pleasantly and said, “Good morning, Mr. Owen, I’ll be with you in four minutes.”
He returned right on schedule.
“So you’re here for cluster headaches,” he said.
“I’m here because I have severe mouth pain,” I answered. “I can’t say if it’s cluster headaches.”
“Very good,” he said, pulling a lap writing cushion from the window cell and taking out a pen. “Tell me what’s going on.”
I provided a complete medical history that required only one or two follow up questions.
“Any hearing loss?”
“Not that I know of,” I said. “Maybe you need to ask my wife though.”
He chuckled and made a note as he continued to study my records.
“Very thorough report,” he said when he finished reading Reggie’s letter. “Let’s move over to the exam table,” he said, swinging his chair toward the table.

I sat down and the doctor started moving my left foot up and down, instructing me to hold the foot in place while he tried to push it down. I followed his orders without question. He looked up with a smile. “You come in here complaining about headaches and I’m playing with your feet,” he said. “You’re probably wondering about me.”
“I follow doctor’s orders,” I said. “And I don’t read WebMD.”
“That’s good to know,” he chuckled.
Eventually he reached for his cane and stood up to examine my left hand and arm before reaching my face. “Now we’ll have a look at the right side,” he said, holding on to my left arm for balance while he moved across the table. Presumably he had determined that I was not suffering any left side deficit.
He concluded the exam and told me that he needed to review the MRI scan. He suggested that I get a cup of coffee and return within half an hour.
Tammy and I went to the lobby in search of a coffee shop. Fortunately, Mike, our usher, spotted us at once and asked what we needed. “Is there anywhere to get a cup of coffee?” Mike recited all of the options, ranging from Starbucks to the hospital cafeteria and then pointed us in the right direction.

Thirty minutes later we returned to 9S. I introduced Tammy and Dr. Gretter. We all walked back to the exam room where the doctor told us that he did not see anything on the MRI, but he wanted to order a more refined scan showing “smaller slices of the brain.”
“Okay,” I said. “I’m familiar with the MRI process.”
“Should you look at the carotid artery?” Tammy asked.
“Well, that wouldn’t hurt,” the doctor said.
“I hate to come up here and not rule anything out,” she said with a hint of insistence in her voice.
“We’ll put the schedulers to work,” he said as he turned to the computer.
Back at the front desk the staffer picked up the phone and started placing calls to the various departments to schedule the ultrasound and MRI. “Have you ever had an MRI?” she asked. I just answered yes.
“Do you want to do the MRI here?”
“Yes,” Tammy said. “We came from West Virginia.”
“I mean, is it okay if you go to one of our branch facilities in the area?”
“Of course.”

The ultrasound team on the 8th floor was standing by and the MRI was scheduled for the following morning.
After completing the ultrasound, we met Greg for lunch. We talked about our kids and the operations of the clinic. And of course I offered a bookmark for None Call Me Dad, “available in both print and Kindle versions.” I briefly reviewed my symptoms and the course of treatment to date. Greg nodded and said, “Well hopefully we can help you figure something out.”
Our last stop for the day was for lab work, located in 15S. We found our usher, and Mike was more than happy to escort us to the lab.
That evening at dinner we talked about little more than my condition.
“I just hope they figure something out,” I said. “Preferably something that does not involve surgery.”
“Me too,” Tammy sighed.
“Dr. Gretter has been at the Cleveland Clinic for 50 years,” I said. “He’s probably seen it all.”
“I like your doctor,” she said, adding with a grin, “I just hope he doesn’t retire before he figures out what’s going on.”

The next morning I reported to the Beachwood imaging facility and provided my name and birthdate. A few minutes later a nurse summoned me. She confirmed my birthdate before directing me to the changing area. “Put on the blue scrub pants and the lovely green gown,” she said. “Since the boss is here today I’ve got to make you wear scrubs.”
I couldn’t tell whether she was joking or not. I just followed orders.
When she returned I joked that being outfitted in scrubs bearing the Cleveland Clinic logo I might start doing MRIs. She “apologized” that the branches did not have the special designer scrubs used at the main clinic.
“Now that you mention it,” I said. “They asked me if I would be willing to do the test at the branch instead of the main clinic, but no one told me about about the designer scrubs.”
The nurse took me into another room to insert an IV. I sat down and offered my left arm. “This one seems to work best for IVs,” I said.
While I was completing my fourth MRI in as many weeks, Tammy received a message that Dr. Grettter wanted to see us before we left town. My first thought was that the doctor had reviewed the tests and decided that I’d be staying.
I arrived on the ninth floor prepared to recite my birthdate. “You’re here to see Dr. Gretter,” the receptionist said. “Just have a seat.”
“Are we that obnoxious?” I whispered to Tammy.

Dr. Gretter came out and escorted us back to the exam room. Perhaps sensing my hypochondria, he smiled and said that the test results were fine. I believe the medical term for a brain scan showing no signs of a tumor is “negative,” which still confuses me. When talking about my brain, I consider the absence of a tumor to be “positive.”
“You have episodic paroxysmal hemicrania,” he declared.
Tammy and I stared back with blank faces.
“EPH,” he said before going on to explain that he would prescribe a non-steroid drug to take for 30 days.
As for the cause of “EPH,” the doctor had no details. “It could be something viral. No one quite knows for sure.”
On the way back to Charleston, I sent my mom a text. “All tests clear.”
“Does this mean it’s all in your head?” she texted back.
“LOL,” I answered. “I thought it was just a toothache.”

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