eek, back to work!

i can get used to this whole staying home bit, but then my brain gets kind of fried and i get caught up in the whole daytime t.v. (unsolved mysteries, raymond and law & order re-runs, etc.) and i got absolutely nothing done today. it really is true, the more free time you have, the less you actually accomplish. i'm back to work tomorrow after my recuperation and i have a doozy of a schedule to greet me when i arrive - implant impressions, molar endo, crown impression, 3 new pedo exams, and dozens of hygiene checks await my eyes and hands. gee, i hope i remember how to do actual dentistry after all this time off!

i've been using my free time to delve myself into all things cookie, who has lately been walking around commanding orders like tarzan. "me want more milk!" "me want to watch sponge bob 'lil bit." "mommy, me want a sandwich." i don't know what's driving me more crazy, the incorrect grammar or the incessant demands. she's recovering from some sniffles herself, poor kid, but that certainly has not quashed the little dictator inside. mercifully, she seems to have escaped whatever tummy bug i was carrying around, but she seems to have transmitted her little sickness to canuck. and just in time for the holidays, too. viruses - the gift that keeps on giving...

gastroenteritis, part deux

okay, wtf??? i never get sick, but this is the third time this month that i've been ill with something. two weeks ago it was 24 hour "fever and ague". over thanksgiving weekend it was "hey, my left sinuses are going to be perpetually stuffed and drip down my throat all night" and today i'm holed up in my house with a stomach bug. this one takes the cake, though, crossing that line from kind of annoying to mildly debilitating. i woke up at about 3 a.m. tuesday morning feeling like i had rocks in my stomach, like something was just not right. i had some adventures in the ladies room and tried to sleep it off until i had to be at work at 10 a.m. when it was time for me to leave by 8:30 my stomach was reeling, but it was too late to cancel my first patient who has to premedicate with antibiotics (and they wreak havoc on her system and i didn't want to put her through all that for nothing), so i hauled my ass into work. it took me two hours to prep, temp, and final impression her crown because my hands were shaking (came out great, though!) and i couldn't even cement the temp on myself because i broke out into a cold sweat and had to run to the bathroom to dry heave (there was nothing left at that point). my colleague bailed me out and cemented the temp for me, and the office sent me home, green and feverish. my patient and i are very friendly and she was incredibly appreciative that i came in feeling like that, so it was worth it. i spent the rest of the day holed up on the couch, bundled up and shivering, and i managed to keep down some advil, one piece of toast and a coke. today i ate three small meals and i felt well enough to clean the bathrooms, so i'm well on the road to recovery! i think next time, though, i'll just stay home when i feel that crummy...

wicked accurate!

yup, in 29 days, i'll be 29.

Your True Birth Month Is December

Logical Patriotic Ambitious Not egoistic Loves praise Loves to joke Fun to be with Not pretending Loves attention Short tempered Hates restrictions Loves to socialize Loves to be loved Loyal and generous Impatient and hasty Changing personality Good sense of humor Honest and trustworthy Influential in organizations Takes high pride in oneself Active in games and interactions

What's Your True Birth Month?

thought i'd take a crack at this one...

You Are a German Shepherd Puppy

Intelligent, quick witted, and a bit aggressive. You've got the jaw power to take a bite out of anyone you choose.

What Breed of Puppy Are You?

mmmm, bread....

now that the weather is colder and i'm having a little more free time on my hands, i've thrown myself into my kitchen. some time ago, i read a fabulous book called the omnivore's dilemma, and it's about the challenges we face in north america as a socitey that is surrounded by so many food options. why is it that we have this abundance of food, and yet our nation is one of the unhealthiest countries on the planet? how does the military-industrial complex play a role in what is served at the dinner table? what are the differences between the industrial, pastoral, and personal food chains? and how has the definition of "organic" changed over time? oh, this book was a real treat, absolutely wonderful to read because i simply adore food and cooking (funny because i am a picky eater, but what i do eat i chose very carefully and am a bit of a food snob) and it shed light on a lot of things. this is a great compliment to fast food nation because it takes things to a bit more of an intellectual and esoteric level, but at the same time is very imformative and completely changed the way i view food.

this book actually sparked my interest in vegetarian cooking for numerous reasons which i will not go into detail right now (the timing was impeccable because i read it right around canadian thanksgiving) and i've always loved to bake. so i've been cranking away in the kitchen, making crispy fried tofu with stir fried greens, vegetarian fried rice, vegetable hot pot with cheese triangles, fresh tomato lentil soup, the list goes on. i've also started up making my own bread now. last week i made a loaf with organic spelt flour and sesame seeds. it's called a grant loaf and the recipe was made accidently by an English woman during WWII. it's fabulous - really easy to make because it requires no kneading and only one rising, and has a very high vitamin B content. it supposedly cured all of the inventor's digestive problems. last week i also made a maple pecan loaf. this one was way more labor-intensive. i had to knead this dough for a good 20 minutes or so before i felt any semblance of elasticity and the dough is so coarse that you really have to work it. what a work out! ah, but it was worth it! my whole house smelled like a bakery for days and i got two loaves from the recipe. makes wonderful ham and cheese sandwiches, too!

pulpotomy or pulpectomy, shouldn't you know the difference?

so this happened about a week ago, but i've been waiting until i had the time to jot this down in completion. this was the situation that took place and the conversation that ensued:

got called into the office an hour earlier than my start time to see an emergency. sure, no problem. boss lady pulls me aside and says, "hey, this emerg is actually a classmate of my daughter, he's in a lot of pain. they actually want to see me, but, well, i just can't right now, i don't have the time. just take a look and see what you can do."

"okay, sure no problem."

a brief history, 6 year old boy had a bunch of restorations completed under general anesthesia about 2 weeks ago and was having spontaneous pain in his upper right quadrant. i seat him and take a quick peek. no fistual or parulis, but #54 has a composite resin resto, is very percussion tender (all other teeth WNL) and is slightly mobile and extruding from the socket. my assistant takes a periapcial which showed a deep MO resto on #54 touching the pulp horn, but no evidence of furcation or periapical radiolucency. my diagnosis was pulpal necrosis with resulting acute periapical abscess, pretty much a no-brainer. the only treatment of choice for a non-vital tooth is pulpectomy, but on a primary tooth that treatment has a very limited prognosis due to the tortuous root canal configuration and limited use of obturation materials (can't use gutta percha because it can't resorb during exfoliation). i decided that the best thing to do would be to extract and place a space maintainer. now, i see kids and they're alright, and i do some extractions, but here's a six year old who goes under for treatment and who is already antsy and fidgety in my chair. needless to say, this was not something that i felt comfortable enough to take on. also, the infection was pretty nasty and that would make it even more difficult to freeze him completely. my recommendation was to place him on antibiotics and have him return to have the tooth taken out in about a week, with subsequent placement of a band and loop space maintainer on the #55. i was all ready to go and was just finalizing things with the mom when you-know-who walked in and starts examining my patient, asking him where it hurt, et cetera.

i told her, "i already made my diagnosis, #54 is necrotic and needs to be extracted and we're going to place a space maintainer."

"well, it's better to save the tooth whenever possible. you should try to do that."

the mom says, "just do whatever it is that will guarantee that he will not longer be in pain and that he won't have to come back here again."

boss lady: "oh, sure, baby teeth root canals have a great prognosis."

mom: "but if they take it out, i know there will be a problem with shifting, right? my other son has a space maintainer."

boss lady: "oh, he doesn't need one because the canine and the second baby molar are there, the teeth won't move that much, right dr. mommy?"

me: "actually, i would place a space maintainer, just to be on the safe side."

boss lady: "well, maybe that's what they teach in the states!" chuckles, then exits the room.

at this point i'm fuming, but i know that woman was an acquaintance of hers, so i wasn't going to make her look bad in front of an acquaintance. i go to the ladies room and when i come back she's in the room with the mother again, talking.

"so dr. mommy will go ahead and start that root canal for you." and she indicates she wants to talk to me.

"okay, go ahead and start the pulpotomy on him."

"um, dr. boss, the tooth is necrotic, and you can't do a pulpotomy on a necrotic tooth."

"right, okay, go ahead and start the pulpotomy and bring him back to finish it a nd you'll need formocreosol, too."

"the tooth is necrotic, you use formocreosol for a pulpotomy, which is for a vital tooth. i think the tooth really should be extracted, because it's necrotic and has a very poor prognosis. i want to place him on antibiotics and bring him back for the extraction when the infection has cleared up."

"yeah, but he's in a lot of pain and i told the mom that you would treat him today. and now she wants to save the tooth."

now, i should have told her then and there to fuck off. i should have told her that if she wanted to save the tooth, go ahead and do it herself, good luck. she interefered in my diagnosis and treatment, completely contradicted what i said in front of the patient, and was now ordering me to do her scut-work. but i didn't. i had a kid in pain in my chair who was now prepped for me to start work and a mom who just wanted some relief and a good night's rest. man, was i in a pickle. so i went in there, numbed him up, and opened up #54. pus came up thru my access and the tooth stunk, but surprisingly there was a vital nerve in the palatal canal, which i removed. as expected, he was crying and uncooperative and i felt horrible doing putting the kid through all of that. i wasn't able to modify my access in any way or open it up more because after a while the poor kid just pooped out. there was probably some pulp tissue left, but the tooth was opened just enough to relieve the pressure. i irrigated with some saline, placed cotton in the access, gave some to the mom, telling her to change the cotton several times a day, and put him on 300 mg Pen VK three times a day for a week. when i called later that evening to see how he was feeling, she said he was sleeping for the first time in days. without the boss breathing down my neck behind me, i told her to have the tooth taken out, and she did a few days later. and he WILL be getting a space maintainter.

the best was when i had stayed behind for over an hour after the office closed to see two walk-in emergencies. one of them was a patient who hadn't been there in over two years. #37 was broken, ML cusp sheared off. i told the patient the tooth definitely needed a crown, spoke to him about the treatment, insurance and financing options, et cetera. he was good to go, wanted to book it ASAP. now why is it that i and the other associate had all these openings in our schedules and this guy had to wait three weeks to book the crown with her? even though i was the one who stayed behind and treatment planned it? and she never even said thank you for staying late, even after those emergencies that i stayed behind to see booked hygiene appointments for themselves and their families.

i officially gave them notice last week. and i've never felt better.

best halloween ever!

it was a beast to carve, but with the help of a stencil and a wicked pumpkin carving kit (two knives for bulk and precision carving) canuck and i cranked out this beauty. cookie went nuts for it!


We didn't get too many trick or treaters, just a few larger groups of kids so now we have all this excess candy lying around. which is bad, bad, bad, 'cause you know who will eat it...

cookie went as a princess - she's wearing a tutu under her "princess fur coat" and these plastic beads/pearls that i bought from walmart for $2 that stunk to the high heavens like skunk - maybe it was the plastic or something, but man, did they reek! cookie didn't seem to mind, tho. she refused to take them off when we got home!

yeah, i'm cute. now gimme some candy!