friday night puke fest

yet again, a plague is upon the house, and yet again poor cookie caught the worst of it. my FIL was up all wednesday night vomiting and feeling miserable and took two days off of work as a result (and it has to be real bad for him to do that). i was wondering when it was going to float our way, and all seemed well up until last night. cookie had a bit of a diaper rash, so at about 10 p.m. we took a quick dip in the tub to wash up. after about an hour of struggling and putzing around (because bedtime is a nightly adventure for us) we got her down for the night. she finally fell asleep and canuck and i were just settling in ourselves when we heard that dreadful, liquidy gagging noise. "oh crap, she just threw up." all over the place, all over our room and her bed 'til there was nothing left, what a mess! we changed her pajamas, stripped the beds, cleaned up best we could and took her downstairs so she wouldn't wake everyone else up. we got her settled, but the poor kid, as soon as she would fall asleep she'd wake up dry heaving and crying for mommy every twenty minutes. this went on for about 6 more hours. so we slept, or should i say lay down 'cause i didn't sleep at all last night, downstairs on the living room floor with cookie on a sleeping bag (ceramic tiles so it was much easier to clean up the puke). i was literally covered with puke and phlegm and spit all night long, because after a while it was pointless for me to keep cleaning myself off (ahh, mommyhood!). i had to be at work at 9 a.m. and was ready to drag myself up to the bolton office when the dry heaves hit me, too, big surprise. i called in and today cookie and i were two sickies hanging out together. she's keeping down fluids now, but now the diarrhea has arrived and now we're putting it back into her as fast as it's coming out. and to boot, now my MIL is sick to her stomach, too! stupid plague.

it's funny, because i remember a time long, long ago when my friday night puke fests involved bars, movies, sex (!), and alcohol. those days are long over, but at least i had quite a bit of experience dealing with the puke part and i put my acquired skills from those years to the test. at least college was useful for something....

and it really wasn't all that bad. my poor cookie puss ;-(

"the latest adventures of dr. mommy and the great cookie-puss," or "cookie takes a dip"

it was a beautiful day today - warm, sunny and, even better, my day off. i'm working tomorrow and friday, so i wanted to take full advantage of my free time with cookie. i really try to take her out to various places downtown on my days off in order to get her exposed to city culture so she can occasionally step outside the bubble of suburbia. being a city girl myself, i don't want cookie or any future cookie monsters to grow up sheltered from the city environment, as that is always a risk when growing up in the 'burbs. downtown toronto is pretty damn cool and very foot-traffic friendly, so we head on over there every free minute we get. she loves taking the subways and street cars, and that's all it takes to keep her entertained so she's a nice, cheap date! last week we went to the st. lawrence market on front street and picked up homemade pierogies and fresh bacon-wrapped scallops for canuck's birthday this past monday, and the week before that we met him at work on college street for a quick picnic lunch. today we headed down kipling avenue to the lakeshore, where there's a terriffic park to walk around and hang out and dip your feet into lake ontario.

after a walk in the park, a quick snack and a pee break for mommy, we went to the lake, took our shoes off and dipped our feet in. the water was freezing, but refreshing! there happened to be a group of dogs playing in the water - their owners would throw tennis balls into the middle of the lake and the poochies would swim all the way out there to fetch 'em! cookie went nuts, she absolutely adores any kind of dog and they were all quite friendly. just as we were about to leave and i bring her to the edge of the lake to rinse our feet off, she literally takes off and jumps into the lake, fully clothed and everything! she was almost completely submerged, and i had to run in there myself to snatch her before she went under! we both wound up sopping wet and muddy, and of course i, not anticipating a day of full swimming, did not pack accordingly. so i stripped her down, put on a dry diaper and put her in the carseat (mud and all) for the short drive home. then it was straight into the bathtub for both of us! and during the whole ordeal, our digital camera happened to get wet and is now destroyed, but i did manage to get a few good shots in beforehand!

beautiful shot of the downtown skyline. can you see the CN tower???

cookie throwing stones into the lake, trying to make them skip.

this is the only head-on shot i could get of her, since she's constantly in motion and it's impossible to get a good still shot!

free donuts....sooooo not worth it

my junk e-mail folder in hotmail is packed with exactly that - junk. i go in every now and then to purge and to make sure someone long and lost isn't trying to reach me, as i have all people not in my contact folder automatically sent to the junk mail pile. so on saturday i saw a message with the subject "dunkin donuts or krispy kreme?". if any of you know me at all, you know that i LOVE donuts, any kind, i absolutely love 'em and even make them myself on my days off. i could eat tim hortons every day without batting an eyelash, and have even had lengthly converstations with people about KK vs. DD and the implications of each (because this is very important and valid subject matter). so of course a message like that would pique my interest! i opened the file and the message asked me to pick one or the other for a chance at a $100 gift certificate to either. i clicked "krispy kreme" and was told that i won $100 gift card, yay! all i had to do was fill out the address to send it to and complete a short survey. hmmm.... okay. i wanted it sent to my mom so i put her name and mailing address, and my e-mail address and that's it. then there were some questions about online education and what courses i would be interested in, so i fudged the answers and clicked on the "next " button. another survey about more online education degree programs. feh, okay... yet another questionaire about products i use and want free offers on, i clicked "no" on all 50 of them. then another form to fill out asking for my SSN and that i would be charged $9.99 shipping for my new sprint cell phone. WTF??? sorry, i don't need the donuts that badly, so i closed out the program thinking that would be the end of that nonsense.

yesterday i talk to my mom and she says, the strangest thing happened - i get a call from a car dealership in paramus new jersey saying that i've just been approved for an online auto loan, call us back to reply and follow up. whoa! when she contacts them to find out what the hell was going on, it was my e-mail address linked to it! holy crap, all i did was look for free donuts! i didn't fill out any auto loan questions!!! good thing i didn't give them my SSN, could you imagine what a disaster that could have been? i didn't even complete the whole thing and already they're soliciting. and of course, i check my junk e-mail box and its FILLED with messages to my mom (remember, my mom's name, my e-mail address) about free offers and all that other crap she should claim.

i can't believe i did something so bone-headed. all for free donuts. i mean, jeez, i'm a dentist, you would think i could afford all the donuts i want! from now on, i'll just get my stuff the old fashioned way - with cold, hard cash.

i heart rubber dams!

since my last post was a rant, i have to counter with some happy stuff. i just switched bonding agents and i am ecstatic with the results! i also started using a rubber dam for all my composite fillings and it gives me such piece of mind to not worry about tongues and drool getting into the way of my nice, dry field. you get a perfect bond every time. ahh....

i heart you, rubber dams!

first day on the job!

so i made it through my first day on the job in bolton office! this office was a well-oiled machine, let me tell you. i didn't have to get up, or ask for, or switch anything, as my assistant anticipated my every move and as a result we flew and flowed quite swimmingly. i did some extractions, some restorative, some exams, and i managed not to kill or piss anyone off! i only ran behind beacuse of this one girl i was treating who had massive decay on her front teeth, and i was trying to bond them but her OH was so poor she kept bleeding into my field. i successfully removed all the caries, but after about an hour of heroics i had to temporize her and put her on chlorhexidine rinse and then told her to come back when the swelling and puffy gums have improved. she was only 14, and i felt really bad doing that to her, but i know how especially important her front teeth are and i really wanted to do a good job. i thought she would be pissed after all that time and no results, hell i would be at least disappointed, but she wants to see only me from now on because she says she feels very comfortable with me. and that made me feel good.

then back at the office downtown today and what a world of difference. we just got another new assitant to replace V, who left suddenly (and not too pleasantly, i might add) and she really is a sweet girl and i love her as a person, but she just graduated assistant school and she doesn't know ANYTHING! i ask for a perio probe, i get a root canal explorer. i ask for crown and bridge material (tooth colored, right?) and i get pink denture reline material. nothing was set up for my root canal this morning, and i wasted over a half an hour looking for stuff that should have been set up before i started, which i asked her to 3 times before the patient arrived. when i finally finished, i couldn't do the post like i had planned because all of the reamers were missing/mixed up/MIA. and just as i threw in the hat and was like, screw it, let's just temporize, she shows up with the reamers i need. by this point it was too late because my patient already had an appointment scheduled with the hygienist next and i couldn't let her run behind. so an hour and a half of wasted time in which i should have done a root canal AND a post, time wasted on getting up and getting crap that should be set up for me and explaining things that even a person fresh out of school should know. and i'm not trying to be a hard ass or a prima donna, but in order for things to run efficiently you have to hustle and anticipate. and forget the hassle it causes me - what about the inconvenience to the patient? now this poor woman has to come back for another long appointment to do something that should have been done at today's long appointment and wasn't. i've been really trying to teach her tricks along the way, trying to be helpful and understanding even if it means i fall a bit behind because i know what it's like to be the new kid in town. but at this point i don't even know how she graduated assistant school! how could you not know what a perio probe looks like??? how can you not distinguish between crown and bridge acrylic and denture reline material??? and finally today my patience wore very thin when it compromised my treatment and i lost it. what happened was completely unacceptable - i have to draw the line somewhere.

a day off!

ahhh.... so with all the long weekends and stuff coming up (my first victoria day in canada!) and with me consolidating my days AND starting this new position, my schedule's been wonky. but at least i had today off and cookie and i took advantage of the break in the rain to head downtown and hit the pavement. we accompanied daddy on the train on his way to work and walked to u of toronto's campus where we had a home-packed lunch (i refuse to buy food nowadays and bring my lunch everywhere, hey, it's saved me thousands of dollars) in front of hart house. then we walked all the way down yonge street to the st. lawrence markets where i picked up fresh pierogies and bacon-wrapped scallops for canuck's birthday on monday. i LOVE cooking and shopping for food and am eagerly looking foward to when we move and i can dominate in the kitchen once more. we close in two weeks!!!

by the book means nothing...

my first day of dental school we got a huge lecture from one of our profs about ethics in health care, our responsibility to the public, et cetera. this was followed by a speech from another prof (who incidently had it in for canuck and almost failed him in his course, despite the fact that canuck was in the top 10 of our class) who basically told us, "at some point in your career, you will get sued! doesn't mean that the lawsuit will come to fruition, but someone will bring a complaint against you to the office of professional discipline (the royal college of dental surgeons here in ontario) at least once in your lifetime." since then, i've pretty much been petrified and every little thing, right down to that tiny little margin on a crown, is taken within the context of that conversation. don't get me wrong, my dentistry is not soley driven by litigation - i care very much about each of my patients and the quality of my work because morally and ethically i'm obliged to do a good job, and hey, my calling card is pretty much in that patient's mouth and who wants a bad rep? but litigation is always in the back of my mind. that's why i try to do everything pretty much by the book. i try to keep good and accurate records, explain things over and over (and over) again, don't cut corners on procedures, and if i make a mistake, i try to let the patient know immediately and then fix it. all that effort, though, doesn't mean that i always get the outcome i want.

you would think that the "trickier" procedures like molar endo, extractions, crowns, etc. would be more difficult to master and would most likely have post-op complications and keep me up at night thinking about it. so imagine my surprise when about 40% of the resin fillings i've done have post-op sensitivity to biting. in two cases, the sensitivity was so bad it developed into irreversible pulpitis and i had to do root canals, even though the fillings weren't deep at all AND i removed the resins and placed ZOE sedatives. i called my endodontist friend and asked him what the heck was going on, am i doing something wrong, is this normal, and he actually gave me so great insight. apparently, he says that about 1/3 of his business is from composite resin cases run amuck, and that i've done nothing wrong, but he thinks posterior composites are garbage. now, i'm not one of those dentists that runs around and claims that amalgam is toxic and can kill you and rip 'em all out, whatever. there is absolutely NO science behind that twisted logic. i have amalgam in my office and am equipped with the traps and everything, but patients simply don't want silver fillings any more because they are "ugly". so i'm going to try some new things that dr. endo suggested: first, i switched bonding agents from a one step to a two step (the stuff we have now is crap and i never had a problem with the system i used in new york) and second i'm going to use a rubber dam for ALL restorative procedures, not just RCT, so i can get a perfectely dry field and ensure proper bonding. AND i will always give patients the option of amalgam restorations and talk about side effects of composite. and the irony of it all? ZERO post op complications from endo, crown and bridge, and surgical extractions!

so, it's a bummer, but i guess the only way to perfect your trade is to have things go wrong so you can tweak and perfect. but what a blow to the ego sometimes!

on being a mommy..

we just got cookie down for a nap, FINALLY. man, she really is a handful. she's a very willfull kid - very sweet, bright, articulate, and has great disposition, but extremely willfull. i don't know if it's the age (she's approaching two and a half) or if she's a particulary tough kid but man what a ride these past few months have been. she won't listen to me or canuck, and we're both simply at a loss for disciplining her. she constantly tortures poor maui, who's not my favorite pooch in the world, but the poor animal does need a respite from her once in a while. she runs around, doesn't come when you call her, crawls under the table at mealtimes chasing the dog, says "no, no, no!" all the time, takes a nap all by herself when nonna's watching her but refuses to sleep when canuck and i are home - it's just a constant uphill battle. i've tried everything so far and i can't make her seem to get that i'm serious when i punish her for being bad. so far, we've tested "time out", standing in the corner, taking away toys and t.v., swats on the tushy, distraction - everything. i don't want cookie growing up into some spoiled punk, but at the same time i don't want to be a monster who yells all the time, which is what it feels like i'm turning into. i guess all parents feel like this during this phase of development - to use that old cliche, "they call it the 'terrible two's' for a reason," i suppose. but it doesn't make me feel any better. cancuk and i both have a theory that maybe all the people in the house may be a contributing factor to her acting up. it's really crowded here, and we are anxiously awaiting our move and some more space. today nonna, nonno, and zia were out at a function and it was just me, canuck, and the cookie in the house. it was blessedly quiet and we actually have had a nice afternoon togther, just the three of us. i miss those days and am eagerly looking foward to returning to normal. now that she's asleep we're going to watch the rest of good night and good luck. i think when we move, we might enroll her in daycare part-time so she gets a chance to socialize and have some structure and routine. she plays with the kids on the block, but i think she needs something more organized.

these creatures should come with an owner's manual.

and that' s my blurb on being a mommy - the good, the bad, and the ugly.

on being a dentist...

convincing people that they need treatment when a tooth is asymptomatic is a real challenge that i face every day. and it's amazing what supervised neglect over time can do, and how you can throw a curveball both at someone and surprise even yourself. take this gentleman i saw today who was visiting our hygienist for his recall and perio maintenance visit. i pop in for my five-minute exam when she's through and i see his bitewings, noticing a rather deep, old amalgam that clinically looks intact but is pretty darn close to the nerve. i think there may have even been some zinc phosphate base in there, the filling must have been done when he was small (dinosaur stuff, he's about my age, late twenties, early thirties, and they used that when we were kids. it's real old school). when i see something like that, i'm like, hmm, maybe we should get a periapical (root view) of this tooth, make sure nothing's going on under the nerve. i wasn't expecting to see anything significant, really, it was more for my edification and his peace of mind. imagine my surprise when i see a nice, big old radiolucent area on the distal root, right on the side where the filling has barely touched the nerve. in a nutshell, the tooth is dead, has been for quite a while, and now the low-grade, chronic infection has infiltrated into the bone. this probably took at least a few months if not years to develop. so now i had to explain to this gentleman why he needs a root canal on a tooth that has never caused him any pain whatsoever and had never been singled out for anything of significance in the past. didn't anyone tell him that this filling was deep when it was done and that it may cause problems in the future? didn't previous docs before me take a fleeting glance at this tooth and say, "hey, let's keep an eye on this one because it looks like it could potentially be trouble"? so when i, a doctor who has never even seen him before today and who he knows from a hole in the wall, propose this expensive and invasive procedure, why wouldn't be thrown for a loop? and i have to ask him to soak about $700 to save a tooth that isn't even bothering him. i took him to the consult room and explained everything to him and he certainly seemed to understand and accept what i was saying, but the first thing out of his mouth was, "why didn't anyone else take a picture like that?". ummm....how do i annwer a question like that??? yikes!

and then the next patient totally threw me for a loop. a young gentleman walks in for a complete exam but complains of some nagging discomfort on his upper left side. so i take a radiograph and find an existing filling that wasn't deep at all, but i did notice significant pathology at the root. i was so baffled i had my assistant re-take the picture three times to make sure it wasn't an artifact, because i don't want to schedule something like a root canal without being totally sure. but there it was, and the tooth was sensitive to percussion, no evidence of fracture or anything. the nerve just....died, i guess. i suppose these things happen from time to time and you read about them in dental journals and textbooks and see them in lectures, but you don't expect to see them in your chair. it's like that saying, don't go looking for zebras in barns (or something akin to that!). but every now and then you get one.

and that's my blurb on being a dentist.

i got this link from margaretf's blog - she always has the best quizzes!

Your Toes Should Be Dark Red

Sexy and a little dangerous, you give off a totally vampy vibe. Your flirting style: Straight forward and seductive Your ideal guy: Powerful and a little intimidating Stay away from: Mama's boys

What Color Should Your Toenails Be?

coming up for air at last

so it's been over a week since my last post, but certainly not 'cause of a lack of goings-on. we had our second viewing of our house on thursday and i love it more and more every time i see it - it will make a perfect home for our family. they guy who's selling also had a content sale yesterday and we managed to pick up 2 leather couches, a leather loveseat and chair, a deep freezer, a lawnmower, a rug, two lamps, and a kitchen hutch for about $2 grand. he also has this bedroom set that's solid cherry wood, imported from italy and of i'm sure impeccable quality, but it's just so, so...shiny and glitzy and ornate and too tony soprano for my taste. he wants to sell it to us for another $2 grand which is less than a quarter of what he paid for it and canuck's salivating over it because it's italian and imported, but it's really just not my scene. and then my father-in-law was trying to haggle the guy over the price while i was standing there and i was like but i don't really want this stuff... at the same time, i didn't want to insult the guy by emphatically saying NO! just because something's expensive and high quality doesn't mean i have to like it. so canuck and i are hammering this thing out, he's trying to convince me and i'm really resisting. ugh, married life. arguing about furniture. it can be so banal sometimes.

my sister-in-law contracted a new version of plague, which was passed down to cookie, which was then lovingly transmitted to me. the fever's passed, but the poor kid's still congested and snotting all over the place and has become quite crusty. nonna and i have developed a new technique to get the medicine down without her upchucking and it's been very successful, so she was way more comfortable this time around. daddy and nonno also just put up a swing set in the backyard so she can run around and have a great time. i'm not going to take her to the park down the block anymore - there's so much glass and garbage everywhere! i can't believe a country and city that pays so much in taxes doesn't clean up their parks. canuck and i are actually going to write to the city and complain, since cookie almost picked up a shard of glass when reaching for her ball on the tennis courts. yucky! but the backyard is nice and roomy and we saw 2 ladybugs on one if the rose bushes - that means good luck! cookie named them "lady" and "baby".

slow week at work again, but i had a job interview on saturday in an office outside the city. this office was insane - LCD t.v.'s in each operatory, three associates (one of whom i will be replacing) three hygienists, all new chairs and beautiful furnishings, and quality materials to work with. they can guarantee that i will be booked three days a week, which is really nice. downside: young family practice which means A LOT of kids. the day that i spent shadowing the owner there was a 5-year old girl who cried so hard it was impossible to get anything done on her. she started the work, got her numb and even prepped the tooth for a filling and the girl completely freaked out midway and wouldn't even let the doctor put in a temporary. so she left with a big old hole in her tooth. the doc couldn't do anything but give the mom some cavit temp material to put in the prep when the girl calmed down at home, and gave her a referral to a pediatric specialist who will probably use nitrous. now, i love kids and i love dentistry, but i don't love the two together at all. it's kind of like peanut butter and hamburgers - each are wonderful on their own, but i wouldn't put peanut butter on my hamburger. some people might, sure, and that's okay. but not me. i simply can't stand to see a child cry and be afraid of me. anyways, i also have two more interviews downtown, which means fewer kids but you never know what you're going to get there. some of this places are insurance mills that are incredibly unethical.

i don't want to give up the gig i have now, since despite the fact that i'm not making as much money and the office is loaded with freaky people, i still like the place and i have a sense of loyalty to my staff and patients there. but i do have to scale back if i wind up taking this position and i really don't want to break the news to my office manager who's been trying so hard to get me booked. there's just not enough new patients to go around and i've completed treatment on the ones that have been compliant. there's nothing left to do, except doing unecessary dentistry on virgin teeth just to make a quick buck. it's also hard to be as booked as my colleague, someone who's been there for seven years and already has an established patient base and referral system all set up. i really don't want to, but i may wind up working over 5 days a week now, as opposed to the 3 1/2 i wanted so i could spend more time with cookie. but this is how it goes when you just get out there and are starting from scratch, which is essentially what i'm doing now. i guess i'm paying my dues, right?

so enough about my week, hopefully i'll have some good news in the next coming days. i hope the two ladybugs in the yard were a good omen ;-)