Medical Stuff: Parting With a Couple of My Wisdom Teeth

Last week I had an appointment at the city hospital to have an oral surgeon remove both wisdom teeth on the left side of my mouth while I was put under general anesthesia.  It wasn’t fun, but it was certainly somewhat of an adventure since I’d never a.) had a tooth pulled  b.) had a surgery  c.) been hospitalized before, either in the U.S. nor Japan.

Since this is kind of a major procedure, and I couldn’t find a lot of in depth or recent information about what all it entailed, including hospitalization, or what the cost would be like with national health insurance (kokumin hoken), I’ve noted everything that happened from the first appointment, up until the aftercare appointment, in this long-winded entry.

 

When I’d had previous dental work done during college (back when I still had insurance in the U.S.), my dentist told me all my wisdom teeth needed to go, which is pretty much what any dentist in America will tell you because it’s the norm.  If she had showed me the x-rays of the two impacted teeth on the bottom left/right side of my mouth at the time, instead of just wanting me to take her word on it alone, it might have encouraged me to have the procedure done a little sooner.  But on the advice of family that I should wait and see if they even grow in or not first, I waited and never got it done before making the permanent move to Japan.

Finally the two on the left side of my mouth grew in to the point that the top one was scraping the inside of my mouth and causing sores, while the bottom was impacted and growing in sideways, pushing on the molar near it and allowing for food to annoying get caught in the gap between the two teeth.  It became more and more apparent that I was going to have to wo(man) up and make an appointment sometime in the near future because they needed to go.

A Japanese friend had just gotten his out and lived to tell the tale, so based on their advice to do it at the city hospital or, in the very least, at a very reputable oral surgeon’s clinic, I went in for an appointment and consultation at the city hospital because we happen to live right by it.  And hey, if you can’t trust the city hospital, who can you trust?

The First Appointment

Because I didn’t have a reference from another clinic to see about my wisdom teeth at the city hospital, I had to pay an extra free that was around 2,000 yen ($20 USD) to be admitted for an appointment and make a hospital registration card.  I was also put on the low priority end of the waiting list, which they estimated would be about a 2-4 hour wait to see the doctor, and they gave me a number to bring to the receptionist window at the dental area of the hospital.

In between waiting they had me take an x-ray of my mouth, and about 3 hours into my wait my number was finally called.  The doctor consulted with me about my x-ray, and told me by the look of it both bottom teeth were considerably impacted and would normally be the priority.  I asked if I could get all four out at the same time, and the doctor said it isn’t generally done that way in Japan for cases like mine, and that the most they would take out at one time were two.  Well, if that was the case, I decided I should just go with the two that were causing me so much trouble.

The doctor explained that generally wisdom tooth extraction is done by local anesthesia only, meaning that although you are numbed so you can’t feel any pain, you can see and hear what is going on inside your mouth.  If you have the procedure done by local anesthesia, you’re free to go home at the end of the day and only have the follow up appointment afterward.  Apparently a lot of countries do the procedure by local anesthesia, but the U.S. is not one of them.

The thought of not being completely knocked out made me very nervous, and so I inquired about the possibility of general anesthesia.  He explained that while it’s possible, it would require being hospitalized for a few days.  In my case, if I went through with the procedure this way, it would require three days hospitalization, with the surgery scheduled on the second day.

While it sucked I was probably going to have to miss some work for this, it didnt deter me from opting for general anesthesia over local.  At the end of the appointment, I discussed with the receptionist and doctor about available days to get the surgery done.  Originally I was shooting to get it done during Obon holidays, however since non-emergency dental surgeries are only performed there on Tuesdays and Thursdays, it would mean being hospitalized from Monday or Wednesday morning and both days clashed with my Hokkaido trip and the Lady Gaga concert I’d already bought pretty pricey tickets for.  So in light of that, I decided to get it done the first week of September where I at least had one day off from work, and wouldn’t be docked for using more than my 2 sick days allowance.  (By law you should have at least 10 days paid leave, but the Japanese Labor Bureau isn’t the best at enforcing these kind of laws, and so companies like mine tend to try and loophole them.  This deserves its own post sometime down the road. 😉 )

They scheduled me in for the operation, and gave me another appointment mid-August to come in for pre-testing.  I paid for my appointment, which was around 5,500 yen ($55 USD) with my insurance, including the non-referral fee.  I don’t know how most city hospitals are in Japan, but ours offered payment by credit card instead of cash only, and I live in a pretty rural town.

Finally, they gave me a medical information release form for my husband to sign and for me to bring back next appointment, and I was on my way.

The Second Appointment

It was pretty cut and dry, and took about two hours.  They took a pee test, a lung test, a chest x-ray, listened to my heart, took six vials of blood, and pricked my ear to time how fast it would stop bleeding.  That last one was a little wtf, and the doctor remarked on how big my ear piercings were so I shouldn’t mind it too terribly. I had to chuckle at his comment, since I hardly ever wear earrings and the holes tend to start to close up every now and then, leaving them much smaller than your average ear piercing.  Wonder what he would have said to someone with anything over a 18g? 😉

While waiting to take blood, a lady came who came in told me “long time no see” and started talking to me, which was awkward until I got called in before her, because I had no idea who she was and I was trying really hard not to give that away and offend her. ^^;;  Does this ever happen to ya’ll?

At the end I was given the OK to proceed with the surgery, and they gave me a hospitalization manual with multiple forms for Mr. J and I to look over and fill out (personal information form, emergency contact form, medical questionnaire, etc.), along with information on what to bring with me to the hospital for my stay (pajamas, slippers, a cup, chopsticks, a bath towel and hand towel, tissues, toothbrush, shampoo, a cardigan, underwear, etc.).  Only the map of the hospital had an English version.  There were no English pamphlets available, and I imagine this is the case at many rural area hospitals, so if you can’t read Japanese you’ll probably need someone to read it for you and help you fill out the forms.

Additionally they said a consultation with the person being charged with my care (Mr. J) would be necessary, where they would explain the procedure and aftercare, which could be done on the day of my hospitalization or sometime before during open hours.

I paid for my appointment, which was around 3,000 yen ($30 USD) with insurance and all that was left was to play the waiting game until early September.

Hospitalization & Surgery

Monday
I arrived at the hospital in the morning, where they showed me to my room and communal facilities, explained the meal schedule, and had me fill out more forms.  I could take regular meals for the rest of the day, but wasn’t to eat or drink anything (even water) from 10:00 p.m. that night until Wednesday morning.  They had A and B meals, and said if there’s something in particular I couldn’t eat, to be sure to let them know early on.  My only real “no way I can’t touch that shit” foods are natto and kani/ebi miso (crab/shrimp brains), and the latter is a bit too fancy to be appearing on a hospital menu, so I was relatively safe. 🙂

I had the option of being scheduled in to take a shower in the afternoon, and it would be my only chance for a shower until getting discharged.  Although I had already showered right before leaving for the hospital, and it didn’t make sense to take two showers in a row, so didn’t take them up on the offer.

A nurse measured height and weight, and throughout the day multiple nurses, the anesthesiologist, and my doctor and his assistant came to introduce themselves and check up on me.  Everyone was really friendly.  A few nurses tried their eikaiwa (English convo) skills on me, because I imagine my hospital hardly ever sees any foreigners.

One thing worth mentioning is that I didn’t have my own room, but a shared one (including shared bathroom) with other patients.  For some reason the bathroom had no soap in it, so I was glad I had brought my own liquid antibacterial. Out of the three other beds, two were occupied, and our beds were separated by curtains.  One of these patients was discharged later that afternoon, the other the second day before my operation, so by the time my operation was over I had the room to myself.  I was thankful for that, because I was in a somewhat miserable state after my operation, and it would have sucked to have been that really annoying person you get stuck sharing a room with.

© J // Washing Rice Blog

This is what my section of the shared room looked like. I was very thankful for the outlet over the bed.
© J // Washing Rice Blog

Between nurses and doctors popping in, I was left to my own devices, so I did a lot of reading, cellphone games, listening to music through my earphones, etc.  Pretty much anything quiet that didn’t disturb anyone else in the room.  They had a small TV in each room you could buy a TV card for 1,000 yen ($10 USD) and watch.  I’m not big on Japanese TV, and nobody else in my room was watching TV, so I did without it.

© J // Washing Rice Blog

© J // Washing Rice Blog

Lunch and dinner were fine as far as hospital food goes.  It was kind of like eating Japanese school lunch (kyushoku) when I used to teach at public elementary and junior high again.

Part of the hospital facilities included a small convenience store on the first floor and a restaurant for visitors.  The convenience store was really great for picking up items like tissues that were necessary, but not noted on the hospitalization pamphlet.  I also used it to to buy tea and water since the hospital tea service only came once or twice a day.

Mr. J came for the consultation in the evening and visited with me for a little bit before going back home.  I busied myself until lights out was at 10:00 p.m., and I slept pretty well, or as well as you can on one of those crappy bead pillows Japan is so enamored with. 😉

Tuesday
The nurses gave me a good morning call at 6:00 a.m., and asked me to be changed into my gown and ready by 10:00 a.m.

I dozed off for a bit longer and then called my mom in the communal room before it was time for me to get changed.

At 10:00 a.m. the nurses and my doctor’s assistant came to hook me up to an IV (called tenteki in Japanese).  The blood veins on my left forearm weren’t visible and thin so there was lot of nervous chattering amongst themselves in Japanese about not being confident about trying certain veins and debating which ones to go for (that I wished I had not been able to understand) and a few unsuccessful tries before they finally got it in.

By 1:00 p.m. I was prepped and waiting for admittance into the surgery room.  I’m not going to lie, I was pretty nervous.  The guy who was being operated on before me had his whole family waiting for him to come out, which was awesome for him, but only served to remind me I was going this alone since Mr. J had work and left me trying to hold back tears.

The got me up on the table and then I couldn’t hold back any longer and started crying a little.  The nurse was kind and wiped my tears, and when the anesthesiologist asked what was wrong, the nurse cracked a joke about me crying because of how scary his face was, which made me laugh and calmed me down a little.  Then they gave me the anesthesia, which I didn’t fight an immediately knocked me out.

I had a strange dream, which I can’t recall any part of, and then woke up suddenly and with no idea what was going on in a groggy haze.  They pulled the tube helping me breathe out of my mouth and then lifted me over to my bed and wheeled me back to my room, where I was to wait two more hours until the anesthesia completely wore off.

I was still really groggy, but uncomfortably hot and with a lot of stomach pain to the point I couldn’t stand it and kept kicking off all my covers.  At some point after the nurses left for a bit I swung my legs over to rest on the cool bar on the side of my bed, foregone enough not to care how this looked or who saw what, to which the nurse gave me an ironic “wow”, like the kind you say when someone’s trying to look sexy, upon finding me in this state.

Cooling down helped a little, but I felt something awful and threw up 3-4 times until they finally let me sit up in a position that wasn’t upsetting my stomach.  This was by far the worse part of it, and sometime around 6:00 p.m. and they gave me some good painkillers and my stomach finally calmed down.  I was still hooked up to the IV, which was making me pee every hour around the clock.

The strange part is that my mouth, despite there being a dull ache where they operated, wasn’t really bothering me very much in comparison to how upset my stomach got.  The doctor and his assistant came in to give me a vial with the teeth they’d taken out in it, and to comment that the surgery had gone well.

Mr. J came and visited me after work for about an hour until visiting time was over, which I struggled to stay awake for because it was what I’d been looking forward to the whole day, and then after he left I slept on and off (and between numerous trips to the bathroom) until around 6:30 a.m. the next day.

Wednesday
Finally, solid food!  I was looking forward to finally getting something filling in my stomach, but of course it was hard to open my mouth much, so I slowly savored the okayu breakfast they brought me like it was a five star restaurant meal.

Around 8:00 a.m. my IV drip finished, but they were debating giving me another small one and so I still had to wear the tube on my arm.

They sent me to see the doctor downstairs, who said again the surgery had gone well and everything in my mouth looked great.  He said I was good to check out of the hospital this morning or the afternoon, scheduled an appointment in a week to check up on everything and take out my stitches, and sent me back up to my ward.

A nurse came to tell me it was OK to start the check out process now or later this afternoon after lunch, but I was eager to get the IV out and relax at home, so I chose sooner over later, so they sent in another nurse to discuss the total cost of the operation and my stay, a then sent me back downstairs to pay for everything.

The cost came to almost 90,000 yen ($900 USD) for the general anesthesia, almost another 90,000 yen for the hospitalization, and almost 20,000 yen ($200 USD) for the operation and everything else.  So around 200,000 yen ($2,000 USD) total, which came out to just under 60,000 yen ($600 USD) with national health insurance.

I’d read that generally hospitals were okay about paying in installments, so that was what I had planned on doing (pay half now and the rest at the next appointment), but it seems that this was somewhat of a last resort option at my hospital, and the cashier urged me to pay the total with the same credit card I had used during previous appointments, so I did.

I presented my receipt to the nurse office back at my ward, who then told me to change into my clothes and pack everything up, and to call a nurse to come after to do a final check and take my IV tubes out.  I was so happy to finally get the IV tube out, because  caused me a lot of discomfort and dull pain the whole time I’d had it in me.

Checking out was very anticlimactic in comparison to the warm welcome I’d received coming in.  There was no one to send me off or really say goodbye, take care, etc. and I kind of just awkwardly left and drove myself home.  (I was OKed to drive, although like I mentioned before, the hospital is under five minutes away by car from where we live.)

I decided to take the rest of the day off work, took a nice shower, called my mom, ate some more soft food for lunch, and doped myself up on the painkillers I’d received so I could lay down and rest.  Could I have gone to work?  Well, technically I could have.  It would have been a tiring/sore day even with the painkillers, but not impossible.

Aftercare Appointment

Fast forward to a week after my surgery, I had an appointment to get the stitches taken out.  Overall the painkillers did their job, and I only experienced medium pain between doses.  That said, I only had five days worth of pain killers.  After they ran out, the initial surgery pain was gone, but the stitches caused me quite a bit of discomfort, especially at night while sleeping.  Even after the pain meds rain out, I took Ibuprofen everyday after for the discomfort.  (If you do this, make sure you take Ibuprofen and NOT aspirin.  Aspirin is a blood thinner.)  So needless to say, I was really relieved to finally have them out, and that there were no dry sockets.  The appointment was quick and mostly pain free, and only cost me 230 yen (about $2.30 USD) with my national health insurance.  I have one more aftercare appointment in two weeks to make sure the scars on my gums have healed properly.

If anyone’s wondering what I ate during my recovery week, I mainly subsided off of okayu (rice porridge), soups, eggs/omelettes/omurice (omelette rice), spaghetti, doria (Japanese/Italian-style rice), soft bread or mushipan (steamed bread), yogurt, fruit jelly cups, and steamed or mashed veggies.  With the stitches now out, I can open my mouth enough to enjoy sushi, onigiri (rice balls), sandwiches, and other soft foods, woohoo!  😀

 

I hope after reading my experience it eases any worries you might have about getting your wisdom teeth pulled in Japan, or having surgery/being hospitalized in Japan.  Comments/questions?  Shoot them at me below!

– J

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