Thursday, August 21, 2014

I'm getting FICOI. Layaway at Detroit


This is I'm not sure what to make of Detroit.

It's 3:25 am California time.  There's a godawful eyesore from concourse A to concourse B:
This is the self styled "Vegas Light show."  Aargh!!!! 

On the plus side, the sunrise is beautiful.
It beats the crap out of San Francisco fog.


However, I think SF beats Detroit in many other ways...

Thursday, July 24, 2014

I have TMD

As of yesterday, I have a temporal mandibular disorder (TMD).  I've included a work up because it may be helpful for others to see how I work up a case.

"I've been working 6 days a week, 10+ hour days, and my responsibilities have increased (with no increase in pay, and more bills to pay).  I'm having a dull ache on opening on the right side, but is fine at rest.  There are no joint noises noted.  My right jaw muscle is sore to touch.  I can open, but it hurts to open all the way,  Chewing makes it worse."

My thinking sequence:

1. What is affected?
         The Temporal Mandibular joint is comprised of nerve, muscles, and a joint.  Each type of injury will manifest differently.

2. What caused it?
          Masking pain is bad.
Removing the cause of pain is ideal.
Diagnosis is key.

3. What do we do about it?
          The best situation is to create conditions for optimal healing.  Often times, the best treatment is nothing. 
         Merely managing pain is a second resort, and only for various severe circumstances.  Pain pills, muscle relaxants, and surgery all have side effects.


Okay.  Hete's my work up:
1. What is affected?   
+Muscle, specifically right masseter.   
     The area is tender to the touch.
     There is a soft end feel---max opening is possible, but with effort.  Think of forceful over stretching a cramped muscle.
+There are no joint noises, possible indications of osteoarthritis. 
+The pain is only during function, ruling out nerve damage (constant pain, no pain)

What caused it?
-no trauma noted.
-no fever noted, ruling out infection/inflammation
-no medications were noted, thus ruling out inflammation 
+ elevated stress was indicated.  
        Because of the muscle pain was likely from elevated stress, the cause of pain is likely psychosomatic.  This is fairly common in today's society with more stress.

What do I do about it?
+ The cause is psychosomatic.
+ In my case, I need to reduce my stress, exercise, and relax more. 

I hope that this is been helpful for you. Thank you for checking out my blog.

Saturday, June 14, 2014

Traveling tips

I'm on my way to a wedding--red eye flight.  This is my first non business related trip in a long time.

Here are tips that keep me from going crazy:

1. Good Luggage--
+mine is slightly smaller than standard, so it won't get rejected.
+great spinners--less strain
+expandable.
+lifetime warrantee
+my policy is one carry on bag, no problem
+packing cubes and folders make for fast TSA approval--no wrinkles, on the clothes at least.

2. Smartphone
+eboarding pass
+econfirmations
+infinite maps regardless of terrain
+in a pinch, it accesses currency via PayPal and bank sites
+with the Sleep Cycle App, it acts as a very effective way to combat jet lag.

3. Flashlight
+Mine is the 4sevens quark miniAA.
+you never know when you'll need it, my best use of a flashlight was to explore the ruins of Siam Reap at 3 am.  I believe it was the royal library.

4. GPS
+for any business trip where you need to rent a car, a reliable gps is very useful.
+at 1 am, do you really want to fumble for a map?

5. Portable office
+Mine is a refurbished MacBook Air and a used Fujitsu S1100.
+This combo has been immensely useful for taxes and tracking deductions.

6. A great pen
+In Japan, many are too bashful to speak English.  Signs, pictures and maps are universal.
+Keeping a Journal is a great way to be sane.
+in a pinch, they can be used for personal defense.  

7. Sense of Humor
+this is probably the most important thing for a traveler.
+Delays?  Layovers?  Fodder for jokes or bonding
Ps. If I were the model's dentist, I'd be ashamed.  Look at those hyperextended incisors!  And the embrasures are excessive!  (Yes, I'm a dental nerd).

Thursday, March 13, 2014

The kindness of strangers--SFO

I'm at SFO waiting for flight UA-1536 to Vegas.  

At first it's smooth sailings.

At 5:59 PM, I got a call from United airlines warning off possible delays.
I leave for SFO at 7:49 PM (late, I know).
The promised Bart is missing--arrival at 9:00 PM.  No worries...flight at 10 PM.

Then stuff gets messy.  

I get on blue line--wrong way!  At Westfeild, I and a fellow straggler hustle to reverse course: 9:03 PM.  Gate 3 at 9:10.

Meanwhile, UA1536 is noted as on schedule to *leave* at 9:18 PM.

Security check.  Crap!  Nice airplane lady waves me to front--still another row!  9:12 PM.  The couple in front of me graciously lets me pass.  9:14 PM.  Security doesn't body search me (unusual).  9:16 PM.  I barrel to gate 73 and almost knock over a dainty brown haired dude in front of his son.

And the flight is delayed to 10 PM.

Thanks to all the gracious strangers.
I really appreciate your consideration.

I love my job

Some days are awesome--like today.

There's a young lady from LA.  She's a new patient.  It's first time to the dentist by herself.  She says she needs a root canal, and shows me this: 
The dentist in LA lopped off half her tooth.  To their credit, all decay was removed.  Sadly, there was no attempt to temporize things--just a grungy cotton pellet with a spot of dried blood.

So I pray.

The tooth is infected, but the nerve is dead.
The tooth is open.  I file the canal.  The apex locator isn't working, so I pray and feel for the apex.

And God answers.
This is *exactly* what I want.  I finish cleaning and shaping.   Irrigate with my special mix, and fill the canal:
Gracias a Deus!

The rest was fun: build up core with Fuji iiLC.  Reinforce with A2 composite.  Create a layered buildup that looks like God intended:

The tongue side is uglier.  I wanted to make sure that this tooth doesn't get fractured.  (The stain is blood under the composite overlayer--no worries.  It didn't interfere with the core Fuji buildup.

Uurgh.  Ugly.

Anyways, I have to thank God that my patient is out of pain and can smile.

Wednesday, March 5, 2014

FEMA training--aargh!

As part of my job with the San Mateo Medical Center (great team), I am required to have all sorts of non-dental related training.

Some of it is good (emergency codes, first responder protocols), some useful but boring (hospital safety, OSHA, sexual harassment), and some are hard to apply outside the public sector (medical billing fraud compliance remediation as a hospital.)

Recently, the whole dental team was assigned FEMA's NIMMS (national emergency medical management system) training due to a mandate by President Obama.

In short--be prepared, and don't trust your government...or at least FEMA.

In long: the NIMMS training has some good principles (watered down versions of classic military standard operations).  However, these principles are needlessly cloaked in jargon--very wordy, poorly presented jargon.  

The instruction is geared towards bureaucratic cratic self preservation and image control instead of actually helping people.  There are moderately useless diagrams that are informationally empty.  There are pointless videos.  The questions are needlessly obtuse, and test based on key words instead of true knowledge.

Base principles (I'm not making this up)
-do not skip chain of command
-do not take initiative 
+before doing anything, it must pass through at least 4 levels of bureaucracy 
+the PR guy is at top
+the logistics guy (who gets stuff done) is at bottom
+resource acquisition must go through at least 3 levels of bureaucracy--but must be sourced/funded locally--then resubmitted to regional--then state--then interstate--then FEMA--then Gov

What I'll be doing in response to training:
- get fit.
       I don't care about getting a bikini body.  Rather, I want to never need FEMA or any government "help" if possible.  Instead, I'll be a first responder.
-get reserves
      I'll be sure to keep 3 weeks supply of food/water.  At the rate FEMA works, 1 month may be better while they (request authorization to distribute.
      I already have emergency shelter/food in the car.
      Maybe I'll put together a "bug out bag"--no guns mind you--food, first aid, navigation, fire, and possibly dental related supplies for field treatment.
-get equipped
       I really want an Aseptico portable op.
I used an Aseptico taskforce portable unit in the jungles of Cambodia, and I can vouch for it's reliability, portability, and good worksmanship.
       In the event of a major emergency, I want to be there for my patients--not some career bureaucrat from FEMA
-get training
       I hope to become fluent in Cantonese and Spanish by 2015.  As of yesterday, I finally have internet.  I hope to make wise use of YouTube and various podcasts.  I see this as a matter of respect for my patients----sorry, no Arabic, Urdu, Mongolian, Russian, Farsi or Hindi is planned at the moment.
        I may look into basic field survival, foraging, bushcraft, and field medic training in the future.  I thought my friend ( and prebably the best gum surgeon IMHO in the east bay) Dr. Karl Ching was nuts for learning man-tracking and extreme wilderness survival.  Now I think he's wise...

Sheesh!  I sound like an alarmist!
    

Wednesday, February 26, 2014

CPR training--déjà vu?

Reminds me of a classic transition to the judo scarf hold--Kesa-gatame.

Note: new standard is 30 chest compressions to / breaths--aim for 100 bpm.