My Warrior Princess Lia

Today is June 19th, 2015.  Writing this blog entry may span several days.  I’m not sure when I’ll publish it.

I’ve been offline for a while.  This is why.

Lia 11-0001

One of my favorite baby pictures.

Last Monday, June 15th, my daughter had her annual “school physical.”  Our pediatrician noticed a swollen lymph node on her right leg.  She sent her immediately for a blood test.  White cells were down.  Platelets were down.  She was anemic.  I got the call from my wife around noon while I was at the office.  I cancelled the rest of the day and went home.  I called my sister, a pediatrician.  I also gave our pediatrician permission to speak with my sister.  My sister expressed the potential for considerable concern.  And, I knew why.

Lia felt fine.  No fever.  No lethargy.  No loss of appetite.  An appointment with a pediatric oncologist was made for the next day.  Just that referral would make any parent very nervous.  Plus, as a dentist, I know a little “too much.”  He took some blood and looked at it microscopically.   It wasn’t good.    A bone marrow biopsy was needed and ordered at the hospital immediately.  We were told that the results would come in 24 – 48 hours.  We thought they’d do the test, and we’d go home to wait for the results.  Nope.  Lia was admitted to the children’s hospital on the oncology floor that same day.  Shit.  That wasn’t a good sign.

This was how Lia spent her 11th birthday.  Imagine being an 11 year old birthday girl who is feeling fine being suddenly thrown into a hospital and being poked and prodded.  My hope was that it was some sort of infection.  But, I knew what was more likely coming. Continue reading

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Posted in Editorial, What Happened Today | 84 Comments

Avoid the “Monkey Dance” with Road Ragers

road-rager-finger

Not the dude in this story.

Last night, at about 7pm (still daylight), I was taking my son to “stick and puck” at the hockey rink.  I live in a semi-rural area.  I  was going down a road that “Ts” into another road (3-way intersection with a 1-way stop.  Image below).   Both are two-lane roads.  A dude in a Mercedes AMG with darkly-tinted windows is in front of me and arrives at the stop sign.  We’re both signaling to turn right, which is how the traffic always goes at this intersection.  He stops… but, he’s not going.  I look to the left to see if he was waiting for oncoming traffic.  Nope.  There was no traffic AT ALL coming from the left.  The road is clear.  I wait for a moment… and another moment.  He’s still not going.  I suspect he’s probably on his phone, like SO many drivers around here.  There is enough space between us that I could go around him.  So, I do just that.  I swing out to the left side of his car and proceed to make the right turn around his stationary car.  (see illustration below)

None shall pass!

He apparently takes GREAT exception to this and pulls out to the right simultaneously (and hits the throttle hard).  He’s NOT going to let me get around him.  OK, no problem.  I’m not going to race, and my Camry isn’t going to get ahead of an AMG Mercedes.   😉   I back off to drop in behind him, and he brake checks me.  Then Continue reading

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Posted in Personal Security & Safety, What Happened Today | Tagged , | 2 Comments

The Civilian Defender – by Dr. Sherman House

revolver-science-3This is only the 2nd time I’ve posted a link to another blog article.  But, this one deserves the acknowledgement and is worthy of a hat tip!  My friend and colleague truly deserving of the term “Dental Warrior,” Dr. Sherman House, has written up an excellent article about self-defense.  Be warned… it’s necessarily a long article (in the spectrum of blog articles).  It’s NOT an article “about guns.”  It’s about avoiding trouble and a defensive mindset in the context of real world threats, which come in many forms.

An excerpt and summary of what Sherman covers:

…and here is what I feel should constitute the undergraduate education of THE CIVILIAN DEFENDER:

  1. Criminology/Street Smarts
  2. Defensive Driving
  3. Emergency Medical
  4. Legal Preparation, Aftermath and Rules of Engagement
  5. Less Lethal skills
  6. Handgun Carry Course
  7. Handgun Skills and Tactics Course
  8. Defensive Tactics

It’s WELL worth the 20 minutes of reading.

Click the link:  Becoming the Civilian Defender

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Posted in Personal Security & Safety | Tagged , , | 1 Comment

Saved Another Dentist From the Bus

Yesterday, I saw a patient for a 2nd opinion.  She had a full mouth rehab with implants and was reportedly not happy with the result.  I didn’t take any photos.  This will be a short and sweet blog post.  But, I hope it’s a story that resonates.

I met the patient and chatted with her.  I engage in conversation with a patient like this for a couple of reasons.  First, I want to get to know her (and her demeanor).  Secondly, I’m also evaluating the cosmetics and phonetics of her dental treatment.

Eventually, we got to her complaint.  She explained that she has implants on the upper and lower arches.  The upper arch is a bar-retained denture.  The lower is all fixed in three segments.  She felt that the teeth are “too far forward.”  Based on our initial conversation, I did not observe them to be proclined or protrusive.  Her ability to speak was good.  I did not notice any lisp or difficulty enunciating.

I asked what she had before.

Dentures.

How long?  Continue reading

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Posted in Practice Management, What Happened Today | Tagged , | 6 Comments

Habit #7 of Highly Effective Dentists: Sharpen Your Explorer!

Sharpen Explorer-Dull-Blog-1In Stephen Covey’s seminal book, “The Seven Habits of Highly Effective People,” the seventh habit is described as “Sharpen the Saw.”  In the book, “sharpen the saw” is a metaphor for self-improvement.  In the case of your professional development, and specifically in dentistry, it could be interpreted as improving your clinical skills or knowledge.  Taken more literally, if you’re a carpenter or lumberjack, it could mean… well… literally sharpening your saw.  Sharpening your saw, means you’ll make more efficient and more precise cuts.  That not only improves your results, it could increase your productivity / income.

Today, I’m going to take this same concept in the literal sense… for dentistry.  Dentists rightfully love to invest in gizmos that help them improve quality of care, outcomes, efficiency, and profitability.  But, when was the last time you sharpened your explorers?  I mean that literally.  When did you last take your explorers and make the pointy ends “pointier?”

Forgive me Dr. G.V. Black…

Speaking for myself, I have to admit Continue reading

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Posted in Dental Product Reviews, Tips & Tricks | Tagged , , | 4 Comments

Don’t Just Answer the Question.

answer-the-question-6We all get phone calls and emails from prospective patients looking for a new dentist.  Very often the only question these prospects ask is, “How much is ________ (a cleaning, a crown, an extraction, etc.).”  Another common question is, “Do you take my insurance / discount plan?”

As a private care dentist, I reflexively cringe when I get these questions.  Why?  Because the answer to the question is likely not what the prospective patient wants to hear.  My fees are not “cheap.”  If they’re asking about “price,” then that’s all they care about, right?  Maybe.

If they ask about an insurance plan (I don’t participate in any as a contracted provider), then all they care about is that, right?  Maybe.

Answer the ****ing question!

Oftentimes, it is all they care about.  But, it’s not necessarily the case.  I have heard all the practice management experts suggest that prospects ask those two questions, because it’s all they know to ask.  And, I think that’s true.  BUT…  Continue reading

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Posted in Marketing, Practice Management | Tagged , , , | 5 Comments

Easter Sunday Emergency Patient – my own son.

You can't really see it here, but #8 is gone.

You can’t really see it here, but #8 is gone.

My son is now fourteen years old, almost fifteen, and in ninth grade.  Back in fourth grade, his class was doing a “square dance.”  My son fell down, face-down on the floor.  Another kid fell on top of his head, smashing his teeth into the floor.  He was in braces at the time, and his two central incisors were significantly intruded.  He was rushed to the pediatric dentist, who happened to be across the street from his school.  She repositioned the teeth and the orthodontist (next door) fixated them using the brackets still attached.  I was upset, and my wife wondered why.  I knew what was to come.

Endodontic treatment was later done on one of the central incisors.  Not long after that, we noticed external root resorption occurring in the cervical region.  My endodontist conferred with a respected professor where he did his residency.  The conclusion was that nothing could be done about the resorption, and that we’d likely lose the teeth at some point.  I hoped we’d have some time… a lot of time.

Over time, it was also apparent that the teeth had ankylosed.  As the rest of him grew, the central incisors did not go with the rest of the crowd.  For cosmetic reasons, I did some bonding to lengthen the centrals.

Ankylosed centrals resulted in a reverse smile line. Corrected with composite bonding.

Ankylosed centrals resulted in a reverse smile line. Corrected with composite bonding.  This was 2 years ago.

Time.. ticking away with my sanity, hard to believe such a calamity

Time’s up!  We got almost five years.  My son came to me late Saturday night, “I was biting into a cheese stick and my tooth broke.”  The entire crown of tooth #8 (the one that was RCT’ed) was mobile and still attached at the gingiva.  I broke into a cold sweat.  Continue reading

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Posted in Case Presentation | Tagged , , , , | 11 Comments

Be a Puerto Rican Cowboy!

Say whaaaa?  It’s been a good while since I’ve written.  I’ve been rather distracted and uninspired.  I’ve also been busy with “life,” not the least of which is dealing with my daughter’s leukemia diagnosis and treatment.  I’m also a busy hockey dad.

Two nights ago, my son and I stopped at a Longhorn’s Steakhouse restaurant on the way home from a hockey tournament.  We’ve been there many times before.  The food is consistently good and reasonably priced.  So, we didn’t expect anything new or extraordinary.  We were hungry, and it was on the way home.

Actor Luis Guzman (from Puerto Rico), not our waiter. I'll try to get a pic of him next time we visit Longhorn's.

Actor Luis Guzman (from Puerto Rico), not our waiter. I’ll try to get a pic of him next time we visit Longhorn’s.

We were seated by the hostess and soon after, our waiter showed up.  He enthusiastically introduced himself as the “Puerto Rican Cowboy.”  Mmmm-kay.   He was one of those high-energy servers who just seemed to enjoy his job.  Along with the usual server banter and efforts to make sure we had what we needed (keeping drinks topped off, etc.), he would throw in a few words in Spanish… words that most non-speakers know like, “Gracias.”

When we got the bill, he signed off, so-to-speak, by repeating his moniker, “I’m the Puerto Rican Cowboy… buenas noches!” 

It’s all brand-bearings these days.

Pardon my “Fletch.”   😉   So, what’s the point of this story?  Continue reading

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Posted in Marketing | Tagged , | 10 Comments

What a Long Strange Week It’s Been.

I haven’t written in a while… uninspired and busy with my family’s “new normal.”  But, here’s what happened last week…

“I can’t help you with any discomfort.”

strange week x-rays-8236A new patient came for a problem-related examination.  He found us through our website.  He had a four-unit bridge #28 – 31 (#30 missing) and an RCT on #29 finished about 3 weeks ago.  His complaint is that one of the teeth is very sensitive to heat.  He pointed to #31.  Overall, the bridge looked decent, except for the facial and mesial margins on #31 being shy.  The margin on #29 isn’t perfect, either.  The RCT on #29 looked good, though that tooth was still sensitive to percussion (not unusual only a few weeks post-op).   “I’ve got my x-rays.”  The patient showed up with a copy of his FMX printed on a single sheet of plain paper.  This shit drives me NUTS!

bob-newhart-stop-itAttention all digital dentists:  Stop giving out WORTHLESS plain paper copies of digital x-rays!  It makes us ALL look bad!  Patients don’t understand why we can’t use them (not diagnostic).  And, they get upset that we either have to WAIT for proper emailed images or take them all over.

My front desk called the previous dentist to get emailed copies of x-rays.  His office obliges, and we got them immediately.  The images Continue reading

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Posted in Editorial, Practice Management, What Happened Today | Tagged , , | 7 Comments

“Successful Conversations Successful Practices” – Book Review

Successful Conversations book cover.Last week, I spent the day in the hospital with my daughter (getting transfusions and chemo).  I received Sherran Bard’s new book a few months ago, but I had not found the time to read it.  I brought it with me to the hospital and finally got to it.

I’ll just say that I really found this to be a great book… for a number of reasons.  First, it was easy to read.  Sherran breaks down most every conceivable conversation with patients into multiple short stories.  All the stories in “Successful Conversations” are real, true examples.  If you suffer from a short attention-span, the story format of this book makes it easy to stay engaged.

I read the book Continue reading

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Posted in Must Read Books! | Tagged , | 7 Comments

My Front Tooth Fell Out – case presentation

"Why did my tooth fall out?"

“Why did my tooth fall out?”

A non-regular (shows up for emergencies only) patient presented with a chief complaint that his lower front tooth fell out.  He needed a replacement ASAP, as he didn’t want to go to work without his front tooth.  He didn’t have the tooth with him.  What can we do?

Obviously, before we treatment plan any long-term solution, we need to step back and perform a comprehensive examination.  But, what can we do in the mean time to address his chief complaint?

Options for a quick and easy (and temporary) solution would include Continue reading

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Posted in Case Presentation | Tagged , , | 10 Comments