Tuesday, August 24, 2010

Goldilocks vs. the Dentist

Part One: Terror in the Chair (Holy or Unholy)

The dread kids with autism feel at the thought of going to the dentist, and the dread their parents feel at the thought of taking them have been well described by Tim at Both Hands and a Flashlight. And no matter how we handle it, we're going to feel guilty.

Our dentist is the gentlest, kindest, most engaging man I’ve ever met. He reminds me of Mr. Rogers. Goldilocks absolutely loves him. When he knows he has an appointment, he says, “I get to visit Dr. N., my dentist? Hooray!” and runs to the car.

But it wasn’t always this way. At first, Dr. N. was not sure he could handle a patient with autism. He referred him to a “pediatric/special needs” dentist who he said would give him a sedative. He teaches at the university dental school, but he didn’t feel comfortable prescribing a sedative, because he felt that was outside his area of expertise.

The “pediatric/special needs” dentist was horrible. She refused to give the sedative she had promised, and instead, put her knee on his chest and told Mama to hold his legs, all the while scolding him for being “naughty”. He was so terrified, she couldn’t even do a basic exam. Mama Bear promised Goldilocks he would never have to go see that mean lady again.

When we reported this to Dr. N., he was shocked, and said he would never refer anyone to her again. He also agreed to give Goldilocks a chance. He scheduled him for a slow time of day with his gentlest, most patient hygienist. At the end, he came in, introduced himself, shook hands, and sent GL home with a big bag of trinkets. With each visit, he did a little more of his usual exam, eventually working up to a cleaning, complete exam, and x-rays.

But on his last visit, Dr. N. found a cavity. Next visit will be GL’s first filling. Dr. N. is willing to try it, but is still not ready to prescribe a sedative. GL has his daily meds, plus an extra Trazadone tablet to be given PRN, and we’re going to try it with that.

When GL had stitches, it took four men to hold him down, and he was two years old! Now he’s thirteen. Once, after surgery, he had a bad reaction to morphine. The doctor said not to give him any more morphine, but wouldn’t start a new pain med until the last dose of morphine was out of his system–and they had just given it. He got so upset, he stood on the femur that had just been sawn through that morning. Desperate, the nurses put a bolus of valium in his IV. Have you ever watched an animal be put to sleep? We had a cat once that was dying and in misery. Mom wanted to be certain he was out of his misery, but couldn’t bear to watch. She asked me to take him in, and watch to be certain he was dead. GL’s response to the valium looked exactly like that. It was frightening, disturbing even. But when he awoke, he was calm, and they were able to give him a different pain med.

All this to say, medication makes me uneasy, but compared to GL’s meltdowns, or seeing the “pediatric/special needs” dentist again, (which would bring on a meltdown, if not in her office, once we got home) temporarily drugged out of his mind doesn’t sound so bad. But I’d rather have the Versed they gave him before surgery. About an ounce of liquid in a dose cup, and it apparently didn’t taste too bad, but once it started working, although he was quite awake and alert, when they asked if they could take his Game Boy away, he didn’t care.

Part Two: In which we Hope to Avoid the loss of anyone's Teeth or Fingers

Today was filling day. Before he left the house, I gave GL his bedtime meds, plus everything else we’ve been told we could safely give him. Ever notice how it doesn’t feel as safe when it’s your kid? But I didn’t know what else I could do. Mama Bear took him to the dentist. I had to promise to take him to the library for DVDs afterward before he would get in the car. I stayed home with BB, who has been having issues of his own.

MB said that GL didn’t yell or fight, but Dr. N. seemed nervous about the whole thing. GL spent the whole time worrying aloud, which made Dr. N. more nervous. GL tolerated the needle fairly well. MB gave everything less-threatening-sounding names, which helped a lot. So the needle was only a “pinch” that would make his tooth “tingle” not “sleep”, and the drill was only a “scraper”. I know it sounds like lying to the kid, but to him, names are everything, and the wrong name can send him into a panic far worse than the procedure itself can.

Near the end of the drilling, GL hopped out of the chair and said, “I’m done!” Only those who know him very well can appreciate the finality that phrase carries. That’s when Dr. N. looked Really Panicked. You just can’t leave a tooth like that. Since they were past the point of no return, MB resorted to bribery, something we desperately try to avoid, because no matter what you offer, GL always tries to negotiate for more. She offered to take him to the store to buy a DVD. He got back in the chair, and let Dr. N. finish drilling and filling as quickly as he could, hoping GL wouldn’t change his mind again. Dr. N. was embarrassed, saying this wasn’t his best work, but it should hold.

MB found a boxed set of all three Stuart Little movies for $10. I hope he doesn’t expect three DVDs next time he needs a filling, but it was enough to keep him busy until bedtime. Still, he kept coming to me with sad, tired eyes, asking to go to the library for more DVDs. I told him I’d take him when he finished watching these, knowing that won’t be until tomorrow, when we were planning to go anyway.

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