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.
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.
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.
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.
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
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...
I'm a young dentist on a mission to be truly great.
As I learn and explore, I hope to share my experiences with my patients, my friends.
Eventually, I'd like this blog to demystify dentistry and make it less scary. I'm also passionate about preventing dental disease.
Outside of dentistry, I love martial arts, lutherie, and inventing stuff. I'm also fascinated by people of all types, and how they relate.