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May 5, 2003

Kevin Connolly, MD
Bradford Health Services
437 South Main Street
Bradford, VT 05033
fax 802-222-9276

Re: Infection in jaw

Dear Dr. Connolly:

This is to bring you up to date on the condition of my sinus and jaw. You should have copies of records on some of my past surgeries and infections.

After several failed surgeries to close the right oral sinus fistula and stop the infections, I had another surgery by Paul Kuo who was out of the service (Cambridge, MA) so was not fully covered by the insurance. This surgery did not close it directly but after about 6 months the hole finally sealed of its own accord.

There has been numerous breaches of the sinus cavity and membrane since 1998. This last surgery did not result in a complete closing as evidently the membrane was open at the base of the sinus cavity. As I was on my feet sometimes 12 to 14 hours a day at work, it allowed the sinus fluid with bacteria and toxins resulting to collect in the damaged area which did not heal. The infection gradually eroded the bone especially in the area of the prior fistula opening in the jawbone. I had felt tired and with loss of energy for some time but did not make the connection as while it was in the bone I did not feel any specific pain.

About 5 weeks ago I used by wife's treadmill and did some jogging. The pounding resulted in the area between the lower jaw and gum filling up with fluid and was quite painful. It was almost exactly the same as what happened before when the sinus membrane was perforated and it ate down causing the sinus fistula. I immediately applied hot water soaks and lay prone with my head back while massaging the fluid back up into the sinus. That was when the pain really arrived and I discovered there was a lot of bone loss under the gum starting where the old fistula hole was but especially where the fluid collected below. There appear to be several cracks or lines along the jaw bone that are extremely painful indicating infection possibly inside the bone. There has been a considerable loss of bone at the bottom and outer side of the jaw with the side of the tooth nearest the infected area having become greatly exposed as the gum has moved up with the loss of jawbone. The pain and infection appears to start in the same general area of the prior fistula and work out and down where the sinus fluid would gravitate to between the jaw and gum.

When I found that the infection was spreading into my ear and down my neck, I went to an emergency room on April 18, 2003. They physically observed it and prescribed Augmentum 500 mg twice daily for ten days. When the infection was not eliminated toward the end of the ten day period, I called your office to make an appointment. You were on vacation so Dr. Brezina was kind enough to see me. She physically observed the site and prescribed an additional 10 day period of 500 mg augmentin twice a day. And advised if there was not significant improvement I should contact you when you returned this week or go to emergency room if there was any worsening of the condition. While taking this prescription I got out of cycle a couple of times and in trying to get back on schedule a couple of times the period between doses was less than every 12 hours and actually being closer to 8 hours. There was a noticeable improvement in the easing of the infection and painful areas. Taking the doses every 12 hours for 20 days does not appear to be strong enough to knock out the infection. As a consequence the dosage of twice a day if stricly observed would have lasted to the morning of this Thursday but now being on schedule it will last until Tuesday morning.

As a consequence I reviewed my prescription record during the last infection caused by sinus leakage and discovered that I was first put on the same 500 mg every 8 hours for 5 days which was increased to 1 every 6 hours for 14 days which finally knocked out the infection.

I am enclosing a copy of that portion of my prescription record from Rite Aid showing the prescriptions and dosages.

As to the sinus membrane breach, being at the bottom of the sinus cavity, I have spent much of my time laying prone with my head back. I am also sleeping without a pillow and the foot of my bed is raised so the sinus constantly drains away from the damaged area. It does appear to be healing on its own. Now sensation has returned to the area so I get a stinging sensation when the sinus fluid starts to get into the injury and I immediately lay down. I have already had 3 unsuccessful surgeries leaving more damage and scar with perforation/breach of the sinus membrane.

I think that if I can remove the infection and keep the sinus fluid away from the damaged area long enough mother nature will regenerate the membrane.

Is it possible to get the prescription dosage increased to the level that was needed the last time to get rid of the infection in the first sinus perforation and infection?

This is also to confirm the annual physical examination your office has scheduled for June 25, 2003 at 10 AM.


Bernard J. Wolfe, Jr.