Monday, June 21, 2021

Adventures in dentistry: Invisalign

For the past year and a half, I've been undergoing a six-month course in tooth-realignment. That's right. Eighteen months of a six month therapy. So let me explain...

Let me take you way back to tell you the whole story. In March of 2019, my weight had reached something in the neighbourhood of 330 lbs. I'd been trying everything for years to get that down again, but will power and the tide of biology conspired against me. Finally one morning at work, sitting there alone, I remembered the wife of a friend had had bariatric surgery and it had been literally transformational for her. And for the first time, I decided maybe I needed to give that a try. For what it's worth, I had the surgery not quite a year and a half ago, and I'm glad I did. So much has changed... including what I'm about to write about.

One thing led to another. Getting onto that program, which is a long process nearly a year from start to finish, meant that I had to see a cardiologist. He sent me to a sleep clinic. They told me I stopped breathing during sleep somewhere in the neighbourhood of 80 times an hour. Think about that. So, they recommended I get a CPAP machine to keep my airway open during sleep. I got it in November of 2019 and I've used it every night ever since. But one morning I woke up with a terrible ache in my jaw. I wondered if I'd fractured it. For days, I could barely chew. Back when I was in my 20s and I had my wisdom teeth extracted, my dentist advised me I should get braces because my teeth were badly misaligned and by the time I reached my 50s and 60s, I might start getting hairline cracks in my jaw. Well, this experience sobered me up to that, and so I started looking around for an affordable program.

I found Invisalign, which promised to do the job for somewhere around two grand; a lot less than other programs and with the added bonus that it was being done with transparent plastic rather than wires. So I went to see them, they showed me what they could do over 6 months, and I signed on.

The 18 pairs of aligners arrived in January, 2020. Here's how it works. You put a set it and, other than eating, leave them in all the time. You wear each set for a week, but every third set you wear for two weeks. So, 18 pairs comes out to 24 weeks, just about six months. Starting in mid-January, my therapy would have been completed around early July last year.

When I started out, my teeth were fairly crowded. I had buck teeth in the uppers (the left one out further than the right), with the outer incisors slightly tucked in behind the inner ones. My bottom teeth were worse. The two incisors on the right were pretty much okay, but the front left one was turned almost sideways, facing toward the left, and the outer left incisor was tucked in behind that one. Generally, you couldn't even see it. I looked like I had three bottom incisors because one was almost completely hidden behind another.

This is a picture of what my teeth looked like when I put my first aligners in. Please excuse the coffee stains. :)

Left is right and right is left here, of course. So, as you can see, only three incisors are visible along the bottom. There's an eyetooth there on the right (my left) that seems to be in its place. Space needed to be added there to move it forward. As well, on the top, you can see how the teeth overlap somewhat, almost like a poker hand. This is the mouth I've lived in since I was a tween.

Each Sunday night I would switch to the next set of aligners. They're tight, and they take a minute or two to seat properly using little tubes of plastic they call "chewies" that help you gently bite down and sit the aligners down over your teeth. Early on, they ached quite a bit for a day or so, but as the process went on, that really lessened. Maybe the therapy simply accustomed the teeth to moving as time went by. All I can tell you is, at some point, I stopped waking up Monday mornings still feeling it.

This was a fairly simple process at first. The first two or three sets were no problem. Then one Sunday night I found I was having a really rough time getting the aligners on; especially the bottom one. I was getting this pronounced wow in the inner arch, folding the plastic such that it formed a salient that poked at my tongue. I mean, I'm talking about something like a quarter of an inch here. It was very noticeable. I thought maybe my teeth weren't keeping up with the therapy, and I hoped they would catch up. In coping with that, I ended up getting an inexpensive Dremel tool to buff the wow and the edges of the aligners down (they can be fairly sharp). The aligners ship with a nail file for doing this, but I needed that Dremel to really get anywhere. It became a weekly thing for a while. Put in the aligners, let them deform, then Dremel the point down to a sort of inverted U gap behind my incisors.

About half way through the process, this was where we were at. You can see the bottom front left incisor has been turned to at least face more or less the same way as the others, and some room has been opened up in the hopes of bringing that outer one out from behind it. So, you know, decent progress...

The set and week is actually printed onto most of the sets I had, and at one point, around the start of June, I happened to look at them and I noticed the numbers for the upper aligners and the lower ones didn't match. The lower set I was wearing was several weeks in advance of where I was in the therapy. Well, that would explain why they hadn't fit and deformed so badly for some time. But the upper one was actually a couple of weeks behind where I'd gotten to... they were actually moving my teeth back where they'd been before!

Do I need to say I was livid? I got in touch with them and demanded they reassess my therapy. I told them I'd start putting the payments in escrow if I didn't get some action. I told them that, in my opinion, having a therapy that reversed the course of the treatment verged on malpractice. They sent me an impressions kit to make new molds of my teeth and advised me to keep wearing the current set at night so my teeth wouldn't start reverting to their old positions. I wore that set for about six weeks waiting for the new ones. They were pretty shagged out by the time the new ones arrived.

It was an entirely new set of 18 aligners. I was starting over again. This time I opened every set and checked the numbers, making sure they were in sequence and matching. They all were. I sealed each set in a sandwich bag and labeled it, and started over. This set arrived in August, which meant the new therapy would send in February. Now they were a lot easier to seat on Sunday nights and I pretty much stopped with the Dremel, not even bothering to buff off the edges unless they were particularly sharp.

You have to order retainers at some point, and just as I was about to do so, I broke one of the points of my lower left 12-year molar. I guess there'd been a crack there for a long time, because it broke while I was chewing bread. I went to the dentist who suggested I wait till the end of the Invisalign therapy to repair the gap, which was essentially just cosmetic, and to let Invisalign know they'd need more impressions to get the retainers right. So, that's what I did.

This is where my lower teeth were at just prior to the break in the back molar (it's the one with the white filling; the forward interior point is the one that would shortly break off). You can see that hidden incisor was really coming forward by then.

Fast forward to February. Filling is in and the point is reshaped. I get my impressions kit. Send it in. I'm doing this to get my retainers made. They send me back an email saying they'd received my request for a "touch-up" and were evaluating it. I nearly sent back an email saying, "Oh, no, I'm just ordering my retainers," but I stopped. Touch-up, you say...? Well, let's just keep our powder dry and out mouth shut till we hear back from them. If they want another thousand dollars, I'll just say "retainers, please". But if it's part of the therapy I'm already paying for, well...

As it turned out, it was, and they sent me another nine sets. So, another three months of tooth-straightening above and beyond the... oh, I can't even do the math anymore. This time, though, the numbers on the aligners were strictly Week 1, Week 2, Week 3/4, over and over. Each set of three was numbered exactly the same. I had to essentially trust them that they'd ordered them correctly. But in checking the first set against the last, I could see very clearly the progress between them, and so I sealed them all up again, labeled them, and got back to it.

So, that was late March. It's now mid-June, and last night, I put in what will almost certainly be the last of all those sets of aligners. I have to wear these another two weeks (at least), or however long it takes for the retainers to show up.

The last time they asked me to check in on my progress, a couple of weeks ago, this is where we were at...

Forgive the little red arrow; I drew that on there to show a friend which tooth had seemingly come out of nowhere in the past year or so. Yeah, that one is finally visible without you needing an angled dental mirror to see it.

It's been a long time, this "six month" therapy that's gone on for seventeen. But for all that, the results really are remarkable. I can't show you the original animations from last year anymore; they're long gone from the site—which is too bad, because those were profound. But I can show you what just these last three months represent...

It's been a long haul; a lot longer than I imagined. There were some real ups and downs at first, but aside from the original screw-up, I'd have to say that Invisalign has treated me with respect and addressed my concerns and, if I'm being honest, gone the extra mile for me. Would I recommend the process to friends I care about? Yes, I would. I don't imagine my experience with the misnumbered aligners was typical. Stuff happens. But when I told them about it, they made it right. I'm hoping that, aside from making me less ashamed when I smile, that maybe this will head off those "hairline cracks" warnings my dentist gave me 30 years ago.

Wednesday, June 16, 2021

How to destroy a closed road

So from what I’ve come to understand, this all started with a landslide in the early 1990s.

Kirby Road is a sideroad that runs across a certain portion of York Region (which is immediately north of the City of Toronto) in its west end. It crosses the region, with the odd dog’s leg here and there, from Dufferin Street at the east end to the regional border at Albion-Vaughan Road at the west. There is today, however, a gap in the road, from Huntington Road on the west side to about half way to Hwy 27 on the east. Along this run, Kirby Road’s course was substantially shaped by the course of the Humber River, and at some point in the early 1990s, about 30 metres (100 feet or so) of Kirby Road fell into the river below, causing the closure of that stretch to vehicle traffic.

There is a newer, single-lane track that Google purports to be “Kirby Road”, but I honestly don’t know if it were ever actually a stretch intended for casual traffic. I have a feeling it was mainly there as a convenience to Toronto and Region Conservation Authority (TRCA) vehicles looking after the area.

It’s kind of a shame, because almost immediately east of Huntington Road, Kirby is carried over the Humber by a bow arch bridge, designed by the locally renowned Frank Barber, that’s verging on a century old. I’ve heard it referred to as McEwen Bridge, and supposedly, it was built in 1923. It’s in rough shape, frankly, and the region probably didn’t need much excuse to close it to vehicular traffic in the first place. The landslide was certainly justification, since the bridge served no other purpose at the time than perhaps field access to a local farmer, and even that’s no longer an issue anymore.

The bridge is kind of key to this, because it’s the main reason I dropped in on the road from time to time over the years. It was one of three such Frank Barber bow arch bridges over the Humber that I’m aware of, all of which were still drivable well into the late 20th century. The one on Langstaff Road was, I believe, the first to close; made redundant by a road realignment at some point in the 70s or 80s.

The next to close was, I believe, the one on Major Mackenzie Drive, sometime around 1990; again, due to road realignment. I’ve blogged about that bridge more recently. It was completely demolished last autumn, without replacement.

The last to close, I think, is the bridge in question; the one on Kirby Road, which closed sometime in the early 1990s due to the landslide. While the one on Langstaff seems to have a future as a quasi-official pedestrian crossing, McEwen Bridge’s days might be numbered. That’s not really my main point here, but it’s related to it directly, and I’ll come to that.

I was first out there in September of 2006, and I blogged about it here. Quite a while ago now; more time’s passed since then, probably, than between when I was there and the original closure. I was there one rainy late summer Saturday morning, by myself. I took the track sight-unseen, heading down from the far east end to trek down to the bridge, if I could, at the far west end. A round trip of about 2.5 km as the crow flies, though there’s a non-inconsequential descent/climb about the halfway mark.

I’m reasonably sure this section was never paved (though apparently I formed just the opposite opinion back in 2006). It was probably always a dirt road that could be considered two-laned only in the most generous sense: if you were careful, you could probably avoid hitting someone coming the other way. It would never have been a very travelled stretch at the best of times.

Before I go on, let me give you a small sample of what I'm talking about... what's being lost. Here's a short video I shot in July of 2007 when I was out there with Larry. This is us heading down the wooded trail of the hillside down into the floodplain where the bridge is to be found. A bit of a challenge, but hardly Mount Everest. Look how beautiful it is. Shaded by trees. A clear, smooth, soft path. Interesting bits of nature within arm's reach all the way down.

Did you enjoy it? Don't get too fond of it. What you just saw has been destroyed.

This is what it looks like now...

A bit off to the side, you can actually glimpse the remnants of the trail, like some snake that's been run over by a truck full of boulders. Look, you can even see one of the old white rectangular trail markers painted onto that tree left of centre.

The first time I was there, I never saw another soul in the two or three hours it took me to walk it and linger at the bridge. I felt almost like I’d discovered something. I came back about a week later, partly to pull a joke involving a ruined truck left on the old roadside, and partly to explore a field on the north side of the river that’s subsequently been planted for reforestation. That time I did see other people there, from a distance. Every other time I’ve been there, as far as I can recall, I’ve been in the company of someone else, and encountered at least one other hiker. But it was always a narrow, natural trail through forest and fields; one benign enough that you could—and I, for one, typically did—take the entire route barefoot without much issue. Clay, mud, hard packed soil, soft pine needles, grass… the river itself, if you so chose. It was a genuine cornucopia of pleasant tactile variety on a trail that I’d characterize as moderately challenging, but rewarding. Others must have thought so as well, because the trail became increasingly popular as time went by. It became rare not to see half a dozen cars parked haphazardly at the Huntington Road end on any given weekend.

But apparently, that wasn’t good enough for York Region and the TRCA; oh, no. A moderately challenging nature walk on nature’s own terms? Oh, Lord, we can’t have that! So right now, this very moment, the entire route is in the process of being formalized. Sanitized. Wrapped in plastic and for-your-protection paper cordoned like a hotel bathroom. This pearl of nature, the gem in the raw, is being carved and shined up to be cast before swine… widened, paved, guard railed, diverted. Y’know… “improved”. The pretty, single-lane wander up and down the hillside, tricky as it was in wet weather… it’s been eviscerated; the hillside scrapped out, replaced by some twisty contrived granite intestine with hand rails that sits like a fat, spikey snake on the face of the land. A shaded stroll once roofed by towering trees is now a baking meander under unrelenting open sky. Awash with either asphalt or, worse, pea gravel, it’s certainly no place for grounding anymore. No, if you want to encounter nature here anymore, you’d better do it hermetically sealed in boots. Pea gravel’s no fun even in sandals.

They’ve turned a quiet, slightly obscure two-hour hike, a real communion with nature, into a half-hour forced march where nature intrudes on a tongue of the city thrust into it. It’s no longer a place your kids wander slowly, stopping to encounter flowers or interesting bugs right at their elbow; it’s a place where they screech and run and get hustled through and nature is a quaint remnant safely out of reach on either side of a ribbon of street. It’s now a dog toilet for the kind of suburbanites who show up in 4-wheel drive SUVs they wouldn’t dream of taking onto so much as a gravel road for fear they’d chip the paint. Meanwhile, chain link fencing has been put up at either end of McEwen Bridge. Fortunately, hikers have insisted their way through it, though it remains as a grievous eyesore. The implication, to me, is that the bridge’s days are numbered, and when the third phase of this vast “improvement” takes place, its ancient rugged charm will probably be replaced by some pre-rusted steel yawn dropped in situ; yes, you’re welcome; thank you very much Your Majesty.

I hate what they’re doing to this trail. What they’ve done to it. What they’re going to do. And it’s happening all over the fringe of Toronto. Something not unlike it just happened not far to the west in the vicinity of Bolton along Duffy’s Lane. Sporadic “improvements” have happened along the closed section of Concession 11 on the Humber’s north side. Meanwhile, they do everything they can to make it difficult to simply walk the closed course of Huntington Road just north of the Kirby Road intersection. They’re either “improving” the trails, or trying to make them impassible.

Can you people just not leave the trails alone? Let us enjoy them for what they are? Limit yourselves to coming in every four or five years to trim the overgrowth back and keep them passable? Must every trail either have the charm officially formalized right out of it, or else be shuttered up VERBOTTEN because it’s too expensive or impractical for you to ruin it? Can you not JUST LET IT BE…?

Okay, that was my screed. Let me put my photos where my mouth is. Judge for yourself. Which of these experiences looks more like the one you'd like to have? If you were going to drive 30 to 90 minutes to get out here on a weekend, which views would you want ready to greet you when you stepped out of the car...?

Here's what the beginning of the hike at the east end of the road closure used to look like.

Here's how it looks now...

The rest of the trail to the hillside descent looks pretty much just the same. But here's what you used to see as you went along...

The now-eviscerated hillside, a sea of organized gravel and granite to push back the unseemly chaos of nature, used to look like this...

...Instead of this...

The walk along the bottom land to the river and McEwen Bridge used to look like this...

...Instead of this...

Finally, let me show you a real gem. This is the climb up the old road course to where the landslide that closed the road happened. It's gorgeous. Wide, well-packed, tree-covered, and historic. People once drove here on their daily business. Here are a few shots of it from 2006, a dozen years or more after it was closed to vehicle traffic...

It's still there. But it's become far more occluded. I'd go so far as to say I believe they'd been deliberately letting trees fall across it to frustrate climbers...

Why couldn't we take just one tenth, one twentieth, of the money we're wasting making the place look fugly, and simply clear some of that detritus out? Keep this trail open? Sure, it's dangerous at the top, but look at this...

They went and added this, a bench and a big stone slab, overlooking an even longer drop at the top of the hill! Now, why couldn't they have put something like that near the edge of the landslide at the top of a much more beautiful and natural trail? A sure way of preventing people from failing to take notice and falling, and much more spectacular and direct view, overlooking the river itself? If it occurs to me, why didn't it occur to them?

Anyway, I hope I've made my case. These "improvements" are no improvements at all. They're simply the gelding of nature. Taming it. Taking away what little power even a relatively benign little walk like this has to surprise and challenge us. Pave paradise; put up a parking lot.