COPD stage 2 and dental surgery anesthesia options?

[ladyluck1]

January 2015


I have been diagnosed with asthma since the WTC terrorist attack.

As soon as my PCP was able to reopen her office, which was not for quite a while.  I went in to see her with breathing problems.

She diagnosed the condition of asthma especially since the burning carcinogens from the WTC had polluted our area quite intensely, and the burning stench, burning of eyes and throat continued, as did the WTC carcinogens apartment pollution which also came thru all of the apartment building air vents, and also through my terrace balcony door. The indoor air was as horrific as the outdoor air.

My PCP also prescribed Albuterol emergency quick acting inhaler. When Albuterol was taken off the market she prescribed Ventolin HFA inhaler. I used to go into my PCP for a breathing inhaling solution to help me breathe if I whenever I contracted bronchitis, and she also placed me on steroid, cough syrup and antibiotics for the bronchitis which at times left me very breathless.

Last March 2014 I developed bronchitis and went in to see my PCP, and she gave me a breathing test, and said my asthma developed into COPD.  

She prescribed Advair 250/50, and gave me a script for an Epi Pen as a precaution due to having become being highly allergic to insect stings.

She suggested I see a Pulmonologist which I did. My Pulmonologist is very well known and highly respected in the Medical Community. He is also listed in the Castle Connolly Top Doctors: New York Metro Area™ (1998 - 2008, 2010 - 2014). He also lectures, and attends conferences.  

My Pulmonologist  placed me on 1 new medication last Spring of 2014 of Spiriva, and increased the dosage of Advair 250/50 to Advair 500/50. I continue to use the Ventolin HFA Inhaler as needed, and carry the Epi Pen at all times

My Dentist faxed over Medical Request for Surgical Clearance and also asked for my Pulmonologist's written Anesthesia recommendation, which he gave as conscious sedation, along with his medical clearance for dental surgery as of November 2014.  

I had not heard anything from my Dentist for over 39 days after that, so I called and left a message requesting a call back asap, especially since i am in constant 2/7 mouth and infected periodontal disease pain.

My Dentist called me and announced the following which shocked me, and caused a severe COPD breathing attack right after he hung up.

He said " regarding your Periodontal Dental Surgery and 4 infected teeth extractions, if we use the anesthesia your Pulmonologist recommend which was  conscious sedation, the Hospital 's Oral Surgeon and Anesthesiologist stated you will die during the Periodontal Disease and various infected teeth extractions dental surgery".

To-date all of them refuse to do consultation by telephone with my Pulmonologist who gave me 2 of his telephone numbers to give them so they can contact him directly for a telephone consultation last November 2014, especially since they had anesthesia related concerns, and my Pulmonologist said together via telephone consultation they could resolve any anesthesia concerns, so I can have the Periodontal Surgery and infected teeth extractions.  

As of 1/17/2014 and to current date of 1/16/2015, no one ever contacted my Pulmonologist to do an Anesthesia difference of opinion/related concerns telephone consultation at all.

Instead I was recently notified by the Hospital Anesthesiology Division that they would not be giving me any kind of conscious sedation my Pulmonologist recommended at all.

They also stated they would not give me any IV sedation even while also knowing I successfully had IV sedation during 3 recent surgeries which I noted on my Hospital dental surgical hospital patient information forms, which I have outlined below.

The Hospital Anesthesiologist stated they would use local anesthesia for the periodontal condition.

For the Dental infected teeth extractions of which 1 is an impacted wisdom tooth, the Hospital Anesthesiologist stated all treatments are under local anesthesia or general, but did not specify which one, or both, and now I am totally frightened to do anything, and do not know who to believe at this point.

My previous IV sedation surgeries:
1st successful IV sedation surgery was enacted for impacted infected wisdom tooth extracted by Oral Surgeon.
2nd successful IV sedation Hospital surgery was enacted for restoration of vision to one eye in early 2014.  
3rd successful  IV sedation hospital surgery was enacted last Spring, by Vein Surgeon for dual leg vnus closure vein surgery.  

(BTW All IV sedation surgeries were highly successful, and I never felt any pain during any of the IV sedation surgical procedures, and awoke with no complications, nor any problems afterwards.

My Pulmonologist  again stated if they call him  only then can he communicate with them during a telephone consultation and together they all can resolve the Anesthesia concerns the Oral Surgeon and Dental Hospital Anesthesiologist both have, so I can have the Periodontal Dental surgery & Teeth Extractions and feel better  
  
All I know is in the past if there was ever any medical/dental difference of opinion a medical telephone consultation was mandatory and enacted, and only then was the patient given the correct diagnosis and recommended surgical procedure information.    

So now  I remain in horrific pain, am frightened, and have no idea who do I trust, and how should I proceed?  

At this point I am at a total loss as to which anesthesia would be safest, as I am also needle phobic and suffer anxiety if placed under very stressful painful conditions. I cannot tolerate pain at all which only brings on breathing attacks when highly stressed so an anesthesia which would include pain blocking during dental procedures and surgery is what I am hoping to receive. I also would need constant anesthesia COPD expert board certified monitoring, so anesthesia can be controlled accordingly.

I also need to be able to trust again....because now I feel abandoned.

My Pulmonologist suggested perhaps having the surgery enacted elsewhere, since a telephone consultation is not being enacted by the Hospital & their Dental/Anesthesia staff, but I cannot afford to pay again out of pocket costs for the 3rd full set of xrays. (There was a problem of full mouth xrays taken by a licensed Dentist which were unreadable).

Then the dentist in the Hospital's dental division took another full mouth of more xrays, and now I have lost all trust and confidence in this Hospital and its staff, and cannot tolerate any more 24/7 mouth and infected periodontal teeth pain to again begin another long wait of another round of going to some new hospital's dental division, and starting this entire procedure again....I already wasted times since October 2014 to present date of 1/16/2015 with this current Hospital, and this entire frightening continued dental surgical fiasco only continues without resolve, as foes my constant horrific 24/7 Periodontal guns and infected multiple teeth pain.

So if any professional can point me in the right direction now to have this addressed with the least amount of wait time and have a safe successful hopefully pain free surgical experience and the extraction of 4 very painful infected periodontal diseased teeth, as well as the above Hospital's outlined periodontal and rooting surgical procedure, I would be most grateful.

I can relate to this being the most painful experience I have ever encountered in my life, and  pray I can receive the information I so desperately need to proceed safely.

[ladyluck1]

I still respectfully await a professional reply relative to my particular COPD/Periodontal surgery and tooth extractions situation.

Kindly reply asap as I am waiting since January 2015 and it is now May 14th, 2015.

Thank you!

[ladyluck1]

Forgot to mention these are the procedures needed to be addressed and resolved during the Periodontal/multiple infected teeth extractions dental surgery:

Hospital Anesthesiologist stated:

Four quadrants of scaling and root planning under local anesthesia for the periodontal condition.

For teeth extractions local or general anesthesia, but  also stated all treatments are under local or general anesthesia.