Monday, June 30, 2008

Update

Well we went to the doctor's Monday morning.
I am sorry I didn't write.
It is not because the poop has hit the fan it was just I didn't have time.
Monday was doctor's appointment, lunch with Grammy, then my son and I went to the Rays vs Red Sox game in Tampa. Long day.
Yesterday was work, write this, run and visit a good friend at the hospital (Just had a new baby).

Oh before I forget, I watched I am Legend this weekend. Very Good. Man were those dudes scary. The dogs were wicked scary.
I finished the Lone Survivor. VERY VERY GOOD book. They are making a movie from this book. Nothing like crying while reading the book and not wanting to put it down. So you just wipe the tears and try to read through the fog.

Okay here is the update...

Not much has changed. The baby still has a Cystic Hygroma but I did pin him down and ask him a bunch of questions.

Let me tell you about our visit....
The doctors office is on the second floor of a medical plaza across the street from the downtown hospital.
We got the first appointment of the morning. This is before the parking lot fills up and the only way to park is to valet. Yes, that is what I said. You have to valet after 9am at a doctors office.
We also got the early morning appointment because he has a tendency to run behind. Hilda's first time going there was at 10am appointment. She waited TWO HOURS for this dude.

Isn't it funny how we allow things from doctors?
I just look at my office and the hell I pay from some of my patients when I am running 12 minutes behind.
After about 10 minutes they start looking around. They start getting antsy. They start asking the front desk a bunch of questions about my status.
I would have ZERO patients if I made them wait this long.

So we get there at 8:15 for the first appointment of the morning (appointment time 8:30).
The reception area, which was actually a room that you had to walk into. The room had a bunch of people in it. Wait a minute... we have the first appointment. I am starting to realize I am not in Kansas anymore.

The nurse comes in and walks through the room whispering a name. Who is she calling? Turns out she was calling our name.
We yell out, "Did you just call Hilda?"

She goes and gets her vitals checked and then comes back.
About 5 minutes later we get called to go get our sonogram.
The tech introduces herself and we began the ultrasound.
This is a 10-15 minute deal when the operator is moving the wand around with her right hand and typing with her left hand.
So for the first 5 minutes she is not saying a word. And if you know me this is unacceptable.
So I pipe up and say, "Can I ask you some questions?" I didn't know if she was the kind of person that needed to have complete silence when she worked.
She said, "Yes".
So I said, "What is going on?"
So she started with, "Here are five toes. Here is his femor. This is the skull."
Okay now there is a HUGE ELEPHANT in the room and everyone is pretending to not see it.
So I said, "Is the Hygroma still there?"
She said, "Yes and it appears to be bigger." Then she proceeded to show us from every perceivable angle.
What, she wasn't going to say anything if I didn't?
I guess people process things differently. And she was waiting to talk until I said it okay to.

She did all the measuring and then said, "Okay, I am going to show the doctor all this and he will be right in.
Then it was just Hilda and I in the room.

I want to go back to last Monday when the hammer came down.
Every day I was asking my wife how she was doing. And she would say "fine".
I knew she was not fine but I didn't know how to make it better.
So during the week we spent a lot of time together.
I was just trying to be there. We didn't do much, we just hung out.
She didn't want to talk about it, so she didn't really answer the phone.

But what we did talk about is what we were praying for.
She said she was praying for us to be part of the 25% (remember the doctor told us that there was a 25% chance that the hygroma will go away and the baby will be fine).
It is weird to ask someone what they are praying for.
I began to tell her my thoughts.
I told her that I am at peace with anything. I can see God looking down and asking Himself who can handle this kind of issue.
It would be us.
We have a great marriage. We have the means to do anything this baby needs. We have great faith. We have the house big enough to handle anything. We have a family that would welcome any baby.
I told my wife I was praying for the strength to handle anything he gives us.
That's it.

So here we were in a room together and we just found out this thing is still on the back of our baby's neck.
And it wasn't that bad.

Then the doctor came in and started to look at the baby with the ultrasound machine.
And again, no talking.
I broke the silence and asked him if I could talk to him while he works.
Then I started in with the questions.
One thing that I found out is that it could be a heart thing. Meaning there could be a heart issue and the fetus is producing a lot of lymph to try to handle this heart issue.
But all the percentages were still the same.
He then asked us if we wanted to do an amniocentesis at 15 weeks.
I asked him how the results of the amnio help him. Will it tell him anything that will help him diagnose anything? He kind of scoffed and said the amnio was to help US.

Then he says, "Do you have any questions?"
DO I HAVE ANY QUESTIONS?
Do I have questions? Yes, I have questions. Where do I start? Okay lets start with...
What the f!@#$%k am I suppose to do?
There is so much running through your mind and you know you have to doctor in front of you for about 1 minute, so the pressure was on.
Of course, you draw a total blank. Total stage fright.

So we schedule the amnio in 3 weeks. I guess we can narrow it down what the real issue is.
He says we will find out if it is chromosomal problem...if it is a trisomy 13, or a trisomy 18 or if it is Turner's syndrome.(Anyone heard of this?)
But I think this is the only thing the amnio will tell us.

After that I think we just wait.

We are trying to educate ourselves as best we can. We have some people in the biz. We know a neurosurgeon and we are great friends with our pediatrician. We are getting the ultrasound notes faxed to both of them.

Well that is it for now.

Things are okay at the Gammichia house.
I so appreciate all the notes and stuff. I really means a lot to me.
And to all that didn't write but are still praying...thank you.

Friday is the 4th of July. NO BLOG.
I would write one but I know no one would read it until next week anyway.
So we will see each other on Monday.
Have a great weekend.
Go spend lots of money. Spark the economy.
Faithfully,
john

Friday, June 27, 2008

Nasty letter

Hi all,
Thank you all for the out pouring of e-mails and comments. I appreciate you all.
We go back to the OB-GYN on Monday, and as you might have guessed, it has been a tough week.
Trying to contemplate life and work at the same time is pretty hard.

But I got a blog this week from the ghost writer.
I told him or her that this was his or her best one yet.
The blog is transparent. The dentist puts himself out there. He or she is telling us about something really crappy that happened.
That is what this blog was suppose to be about...being real.
None of this, "things are always going to perfect if you only do this stuff."
So I hope you like it.

Who has received this letter? OK, not this exact letter but one that attacks you at so many levels that comes out of nowhere from a patients you can’t even mentally picture.

I should let you read it first. Just tell me I’m not the only dentist who has had “this” ex-patient.

Dear Dr. Ghost,

I do not wish to remain an active patient at your practice for many reasons. I have been meaning to write you about this matter for about a year now. First of all, I was not pleased that you could not take time to return my phone calls. I called your receptionist and asked her on several occasions if you could please call me when you had time. My husband who is also in the medical profession must make time to call patients back. I am sure this applies to dentists as well. Your avoidance in the matter concerning my incisor crown or veneer made me question your ability to provide a quality result, especially for an important occasion which was my wedding. As a result I went to a practice that specialized in cosmetic dentistry. I would have appreciated you being more honest about your limits and assisting me in finding someone who could make a perfect match. Instead you left me in the cold and coming back for an appointment where I thought I was going to have my crown or veneer put on my incisor, but was told that it was my last molar that I was there for.

The crown you did place on my molar was another issue. It was completely amorphous and did not match the other teeth well. I am relieved that you did not work on my incisor after all. I should have been leery because I had heard you speak of letting a “friend” make your crown, veneers, etc. You should consider your professionalism at your practice and avoid too much office gossip and flirtations with the clients.

It is because of these reasons I will not be returning and am sad that you could not be honest with your client. Your office staff is wonderful and I will miss them. I have found a great practice and a dentist that is honest. Please consider calling your clients if they have a question. It can cause you a good client.

Take care,

Ex-Patient


Ok, where do I start?
I wrote her a long letter, which remains in her chart. I chose not to send it and it will lay dormant until it’s time to shred it
.
She may be right about some of my conversations during treatment. My task is to do dentistry while the patient’s mind is somewhere other than at my office getting drilled, injected, incised, or hurt. It’s more fun to talk about what Simon Cowell said the previous evening on American Idol, the merits of owning a Prius, or which was the best Star Wars film of the six.
I have never flirted with any of my patients.

I return 100% of my patient’s calls. Not only that but also all RCTs and extractions will get a call that evening. Long appointments that may involve the electrosurge will get a ring from Dr. Ghost. She’s way off again.

She hadn’t been to see me since April of 2007. I received this June 11th of this year. I would love to have given her a nice smile again. What dentist shies away from that opportunity?

My records show we did tooth #31 for her and two small composites. I believe #9 have an ugly large MIFL. Restoring it was elective. It is challenging to “match” a single central whether you are a “cosmetic” dentist or not.

My wife was upset that I wasn’t that upset about the “flirtation with clients” statement.
I could easily brush that one aside. The ones that got me were the attacks on my honesty and on my capacity to deliver quality dentistry.

In my letter, which never went out, I explained that I had, as patients, several ex-employees, their spouses, hygienists from other offices and their spouses, as well as a few dentists. Now, somehow, they must have figured out something about my capabilities, integrity, and professionalism to choose me, Dr. Ghost, over the estimated 800 plus other general dentists in central Florida.

I suppose I put this letter out there for those of us out there who have gotten a letter that resembled this one. You aren’t alone.

It’s sad that it takes away the thrill of all those who do appreciate what you do for them. Like the lady who the very next week made a beautiful painting for me and matted it. Or, the guy who told me I was the best dentist he’d had since moving to Orlando in 1993.

They’ll let you know all throughout the week, months, years, and then you’ll get something like this once every two years and you wonder if it’s possible you are the same person that all those countless satisfied and happy patients have been telling you that you are.


I told you it was good. Misery loves company.
I can't say I have ever got one of these letters but I think a couple of patients here or there have thought it (I know, hard to believe).
I loved the flirting thing.
I especially liked when she got mad at him for talking during the procedure.
At our office if you don't like gossip or talk not about teeth then you are in the wrong place.
I try to talk but it always is not around the patient it is with the patient. I think Ghost writer is right about making it not about the procedure.
Now my father would disagree. He has come from a different era. Very professional, all the time.

Have a great weekend,
Think of my family on Monday morning,
If you get a blog things might be going our way.
If you don't, you will probably understand.
Thanks again,
john

Tuesday, June 24, 2008

Forest Gump

Life is like a box of chocolates...you never know what you are going to get.

I am going to talk to you today about something that is going down in my life.
I have always been open about my life and I don't see a reason to stop.

My wife went to the doctor on Monday morning. Because she is 39 years old, and because about a year ago we were pregnant and she had a miscarriage, we decided to go to a high risk OB-GYN.
I did not go with her because I had a previous appointment. And I really didn't see a need for me to go. "I will watch the kids, you go. "

But when she came home she was a mess.
This is what she said happened...

She said they brought her back right away. She had a regular ultrasound done and one of those cool 3-D ultrasounds. The tech was oohing and awing about how good the baby look. She was saying how he/she is moving and waving and all that.
Then the doctor came in. He looked at all the stuff and very curtly said there is a problem.
The baby has something called a cystic hygroma at the base of his/her neck. Apparently there are some ducts that allow lymph to flow from the head to the rest of the body. If the ducts are blocked it is will swell. This is what is going on.
I called the doctor to get the information myself. He is not a very emotional guy. He basically says it like it is. The neck is suppose to be 3mm and it is 5mm. This could mean a couple of things. We will do an ultrasound next week and everything could be fine, he claims there is a 25% chance of this (that is not very good odds).
There is a 50% chance there is a chromosomal problem such as Downs or Turner's syndrome,
and a 25% chance it will get worse and the baby will die in utero.
Wow. I know I have just hit you with a nuclear bomb. Now you know why my wife was a total mess when she got home.

The doctor sent her home with a xerox copy of a medical journal article on Cystic Hygroma. The article was all in medical-eze and impossible to understand, and the article included all gorey pictures of what you kid could look like when it is born.
You know how there are people made for certain jobs and some are not. Well this guy was one of these guys that wasn't.
You know like the pediatric dentist that hates kids. Yeah, that guy.
To his defense he is a high risk pregnancy guy. He is going to have to deal with a lot of issues and if he involves himself in all his patients and their problems then he will go coo coo for coco puffs.
You would just hope he would get involved in just one case...OURS.

I want to tell you how I am doing.

I am okay.
As you know I am Christian. I believe there is a God up there and He is looking out for me. I believe He has a plan and it is just my job to live it out.
It is not my job to question it, it is my job to obey.
He never said it was going to be easy. He never promises a cake walk.
If you read the Bible it is filled with stories (not stories like fiction, more like history) of people the Lord molded.
It is filled with success stories of people being obedient to God and tragedies where people were not.

I try not to hold on to things of this world too tightly. Money, job, house, friends, family.
I know stuff is going to happen to me. I know stuff is going to happen to my family. I know stuff is going to happen to my kids. I try to prepared myself for this.

I love my kids and my wife more than word can describe. I thank Him for my kids every night. I thank Him for keeping them healthy that day. But...I know that things could change tomorrow.
You remember Heather, the 11 year old that has brain cancer.

So when we got pregnant I thought this is the best thing ever. But I have reserved some space for some issues. Does that make sense? Am I a walking Psychology text book, or what?
I don't think there is anything we can do about it. I don't think going crazy right now is the best thing to do.
I was telling my wife, "We can handle this."


I wanted to tell you this for two reasons...

#1. If someone knows anything about Cystic Hygroma and could maybe shed some light on what is going on for me. I would love for you to email me. If someone knows someone that knows something about this, let me know.

#2. I believe in the power of prayer.
If you all could pray that we are one of the 25% of the cases that things just work themselves out.
But if we are not then I ask you to pray for my wife and I to be able to handle anything that is put in front of us.
That we will be able to glorify Him in the way we handle ourselves.

That HE gives and HE takes away. It is not easy sometimes and I could get all Jesus freaky on you but I won't.

Thank you in advance for your prayers.
I appreciate all of you.
john

Monday, June 23, 2008

Lecturer numero dos

Finally finished the book. Not good.
I moved on to the next book The Lone Soldier. It is about a group of Navy SEALs that go into Afghanistan at the height of the war, (shortly after 9/11) and they get into a world of poop. The author is the only guy that comes out of it alive. And this is his story.

I watched two movies this weekend...
Bella it was OK, I give it a 7.
and I saw
Pan's Labyrinth, not good. This was a Spanish film (with subtitles). I give it a 4.

I talked to you Friday about a lecturer I saw at the FNDC. The lecture was called Smile Makeovers. I talked about how this guy was a Tier IV dentist all the way.

Now the other lecture I went to was called How to Get Your Patients to Accept Comprehensive Treatment. By Nate Booth
This lecture was PACKED. They ran out of handouts. When I lecture they say lets make 100 handouts and there are still 75 laying on the table when I am done. This guy make 50 for an audience of 300.
Anyway this guy was a dentist for 10 years, but stopped practicing dentistry about 15 earlier. He then went back to school to get his Masters in counseling. Then he worked with Tim Robbins for a bunch of years. Now he is doing his own stuff.
Now this guy is not the total opposite of the last guy but a lot different.

I think Friday's guy is not a lets have a relationship kind of guy. He is an " am the best dentist for miles around and if you need the best and want to pay for the best, here I am" kind of guy.
Which is okay.
Today's guy is Ritz-Carlton, five star service kind of guy.
Build a relationship.
Treat someone that is coming to your office like they were coming to your home.
When they come in move from around the counter and go to greet them in the reception area.
Stuff like how to talk on the phone when someone calls. He talked about internal marketing and external marketing.
He gave us this example of this dentist in Oregon who works 4 days a week and grosses 2 million dollars a year.
He talked about how he uses Billboards and radio shows and people just flock into his office.
He is a father of 3 and a great family man.
You guys know how I feel about us comparing ourselves to other people.
He didn't talk about how great of a dentists he is. Or what all his problems are...but if you take a snapshot of the books it all looks rosy.
And we left feeling like pieces of crap. Thanks Dr. Evil.

Dr. Booth is kind of rah-rah kind of guy.
He made us stand up and turn to our neighbor and put our arm up boy scout style and swear to be their energy partner.
I hate this kind of crap. I came to see a lecture about how I can treat my patients better and I am now Rachael's energy partner.
Now once you got past the fact that he just embarrassed you, he had some pretty good things to say.
I think that him and I agree in that it is not about selling dentistry. It is about educating them about their problem and telling them you can help them with their problem.
This is a bit salesman-ish but he talks about saying, "now is their anything that will get in the way of you getting optimum treatment.
"Yeah, the $12,000 bill might get in the way".
But you know what he is saying. Make CareCredit available and make it easier to pay.
I get that.
Now for me (and yes it is always about me) it is okay if they don't do it. I can sleep at night because I think I did the best I can do. I have been thorough, I have educated, I began a relationship. What else can I do?
Now lets say I was not doing what Dr. Booth was saying before this lecture. This is something I can go back to the office on Monday and start to implement.
Friday's guy I could not do this.
I would have to shut down and study at an institute for a couple of months.

This is what I am going to do.
I will keep Friday's lecture in back of my mind. But I will work on Dr.Booth's lecture today.

Thats what I have got.
Anyone got any opinions?

By the by, I will not take offense to you not writing me back or giving me you suggestions about the AGD meeting.
NO ONE.
I will not let this bother me. I will not hold this against you.
I know this is a love-kinda like relationship. I love you all and you kinda like me.
I am going to get all Stuart Smalley on you.

Just messing with you, but if my title sucks I blame all of you,
See you Wednesday,
john

Lecturer numero dos

Finally finished the book. Not good.
I moved on to the next book The Lone Soldier. It is about a group of Navy SEALs that go into Afghanistan at the height of the war, (shortly after 9/11) and they get into a world of poop. The author is the only guy that comes out of it alive. And this is his story.

I watched two movies this weekend...
Bella it was OK, I give it a 7.
and I saw
Pan's Labyrinth, not good. This was a Spanish film (with subtitles). I give it a 4.

I talked to you Friday about a lecturer I saw at the FNDC. The lecture was called Smile Makeovers. I talked about how this guy was a Tier IV dentist all the way.

Now the other lecture I went to was called How to Get Your Patients to Accept Comprehensive Treatment. By Nate Booth
This lecture was PACKED. They ran out of handouts. When I lecture they say lets make 100 handouts and there are still 75 laying on the table when I am done. This guy make 50 for an audience of 300.
Anyway this guy was a dentist for 10 years, but stopped practicing dentistry about 15 earlier. He then went back to school to get his Masters in counseling. Then he worked with Tim Robbins for a bunch of years. Now he is doing his own stuff.
Now this guy is not the total opposite of the last guy but a lot different.

I think Friday's guy is not a lets have a relationship kind of guy. He is an " am the best dentist for miles around and if you need the best and want to pay for the best, here I am" kind of guy.
Which is okay.
Today's guy is Ritz-Carlton, five star service kind of guy.
Build a relationship.
Treat someone that is coming to your office like they were coming to your home.
When they come in move from around the counter and go to greet them in the reception area.
Stuff like how to talk on the phone when someone calls. He talked about internal marketing and external marketing.
He gave us this example of this dentist in Oregon who works 4 days a week and grosses 2 million dollars a year.
He talked about how he uses Billboards and radio shows and people just flock into his office.
He is a father of 3 and a great family man.
You guys know how I feel about us comparing ourselves to other people.
He didn't talk about how great of a dentists he is. Or what all his problems are...but if you take a snapshot of the books it all looks rosy.
And we left feeling like pieces of crap. Thanks Dr. Evil.

Dr. Booth is kind of rah-rah kind of guy.
He made us stand up and turn to our neighbor and put our arm up boy scout style and swear to be their energy partner.
I hate this kind of crap. I came to see a lecture about how I can treat my patients better and I am now Rachael's energy partner.
Now once you got past the fact that he just embarrassed you, he had some pretty good things to say.
I think that him and I agree in that it is not about selling dentistry. It is about educating them about their problem and telling them you can help them with their problem.
This is a bit salesman-ish but he talks about saying, "now is their anything that will get in the way of you getting optimum treatment.
"Yeah, the $12,000 bill might get in the way".
But you know what he is saying. Make CareCredit available and make it easier to pay.
I get that.
Now for me (and yes it is always about me) it is okay if they don't do it. I can sleep at night because I think I did the best I can do. I have been thorough, I have educated, I began a relationship. What else can I do?
Now lets say I was not doing what Dr. Booth was saying before this lecture. This is something I can go back to the office on Monday and start to implement.
Friday's guy I could not do this.
I would have to shut down and study at an institute for a couple of months.

This is what I am going to do.
I will keep Friday's lecture in back of my mind. But I will work on Dr.Booth's lecture today.

Thats what I have got.
Anyone got any opinions?

By the by, I will not take offense to you not writing me back or giving me you suggestions about the AGD meeting.
NO ONE.
I will not let this bother me. I will not hold this against you.
I know this is a love-kinda like relationship. I love you all and you kinda like me.
I am going to get all Stuart Smalley on you.

Just messing with you, but if my title sucks I blame all of you,
See you Wednesday,
john

Friday, June 20, 2008

I saw this guy last weekend.

Hello,

Did I ever tell you that I will never put a book down? I don't care how much it sucks I don't stop. If it is bad I will read it day and night just to finish it.
I am doing this right now with the Operational Instructions book by Anne Lamont. It is not that it is terrible but it is just not good.
But I have bought a new book called The Lone Soldier.
I am dying to read it. I know I will start by Monday.
Anyone read it yet?

Now lets get to it,
I mentioned I went to the Florida National Dental Conference this weekend.
I went to a couple of courses and my head is still spinning.
I want to tell you about them.

I went to a three hour course on Smile Makeovers. As have dabbled in lecturing, I think the person talking has to be credible. I think the vibes the presenter gives off is important to me.
You know...Can I trust this guy? Do I buy what he is selling?
If it is a 65 year old guy talking to young people about how it is being a new dentist. RED FLAG.
This guy I couldn’t read. He was wearing some nice slacks (do they still call them slacks or is that just what my mother calls them) and a polo shirt. No suit. Hmm?
He started the lecture with I am busy with the reconstruction part of my practice but the day to day stuff is slow so this when I start lecturing more. Hmm?
That is weird because I know for a fact that lecturing is not that profitable. It’s cool but not profitable.
He is a Pankey grad, so he has that going for him.
He has created a Tier IV practice. He doesn’t do kids and he doesn’t do fillings or small stuff. (Now to me this is like saying he practices on the moon. How can you not do fillings? What if during one of your full mouth reconstructions someone has a tooth that has occlusal decay? Do you refer to another general dentist to do a filling? Do you wait until it needs a crown?)
So this is all in the first 10 minutes of the lecture. So I am getting a pretty good picture of who I am listening to.
Now to his lecture.
His slides are magnificent. And I just don’t say this about anyone. He takes pictures of the patient during a New Patient Exam in a mini studio ( in the space where his panoramic machine used to be) in his office.
Even the slides on his PowerPoint were damn good. They looked like they were professionally done. Not the pictures but the slide. So not only is he Tier IV at the office but in his lecture as well. Damn do I feel small.
He was a little stiff for me. No jokes, no smile, just down to business. Never raising his voice (very monotone). But this kind of goes with everything else.
Anyway, I will tell you the long short of his lecture. The second half of the lecture was talking about one case and I want to tell you about it.
He saw a woman for a New Patient Exam and she didn’t return. But she eventually came back. Only after she had 28 units done in the Arizona area for about $38,000.
She was miserable. Her jaw was hurting and she could hardly open her mouth.
Now she hated dentists and wanted all her teeth out.
He said it took about 6 months of pampering to get her to trust dentists again. He equilibrated her after an initial occlusal splint therapy. Once she said, “Can you do what you did with my splint and do it with new crowns?” he knew she was interested in the dentistry he provided.
After proper mounting and lab wax ups, after significant amount of study and education of the patient, he got started.
He says the dentist previous to him used all porcelain crowns with Unicem. He said this was a major issue because the stuff would not come off. Even to the point of breaking teeth to try to get them off. When he showed photos of the preps it was like a war zone.

Now the temporary phase. Pretty good temporaries. I mean he was no Frank Spear but good.
Because she had lost some teeth she now went in for implants on the upper.
While she was waiting for the implants to integrate this allowed him to go to completion on the lower.
He does his arches in 3 sections. He never takes a full arch impression. So he did the posterior right, then the posterior left, then the anteriors.
Once he finished the mandibular arch he flashed a photo and pointed out some mistakes.
Now he does professional wax-ups. He uses the best labs in the world.
Let me just take a second to tell you about the kind of labs he uses. They charge $550-600 a unit, no this is not a misprint. He says that the lab picks the doctor. He says they interview you. And they will tell you if they will work with you. He says that they an take up to 6 months to get a case back to you. Hmmm?
Back to the case…My thing is that he does the all the pre-treatment work up (mounting, studying and waxing) and there are still mistakes. He was saying how the canine was too high and the buccal of #28 stood out a little. How does this stuff still happen after all the mounting, studying, waxing and temporaries? (I mean if it is going to happen with or without the months and months of pre-treatment work, why do it? I mean, I know the answer, I am just saying.)
Then he began to put in all the uppers. 3 sections.
Like I said before, they were magnificent.
But here is the catch. I TOOK FIVE YEARS TO COMPLETE THIS CASE.
Oh, yeah and $85,000. Yes I said, EIGHTY-FIVE THOUSAND DOLLARS.
It took over 80 visits.
I can see a year and a half with the implants and the occlusal study but five years.
The lecture was good. The lecturer was very credible. But there are questions.
Am I the $38,000 guy?
Am I okay in my Tier III world.
My stuff is good but this guys stuff was WOW!!!
Do I change and try to do this?
You know what I am saying?

I will end here because something exciting happened yesterday that I want to tell you about.
I also need your help.

The AGD called yesterday and asked it I wanted to give a lecture at the annual meeting.
She then went on to tell me what I was being asked to do.
Apparently last year the annual meeting rolled out a new thing where they have a dude (like me) giving a 50 minute lecture on the exhibit floor. You know off to the side but right in front of everyone.
The exhibitor wears a microphone and the audience wears headsets (to block out all the outside noise).
I know it was late notice and someone like Gordon Christianson had to drop out and I was first on the SUCKA list, but I don't care. (She was funny, she said that I could think about it over the weekend and I said, "I don't need to think about it. Yes.")
This is how I roll. Don't think, DO.
It is going to be on Thursday at 3:20pm. I know we talked about a BBQ but maybe this will be the next best thing to sloppy joes. I will ask if I can bring the beer.
I want you all to come. I will have special blog VIP seating.
This is just another reason to come to Orlando in 4 weeks. If you haven't signed up, it is getting late.
I know I am always the one doing things on the last minute but NOT this year.
I am growing, what can I say.

But this is where I need your help.
They have given me until Monday to think about what I am going to talk on.
And you all know that the name of the course is what brings people in. I went to a course this weekend and it was called How to Get People to Accept Comprehensive Treatment and there was 300 people in the room.
Can I tell you I have spoken to 7 people before? My title must suck.
But I digress.
What do you think I should call it? The subject matter will come later but the title is important.
I am thinking something like...
Meat and Potatoes. No I am serious.
I (think) I am a dentist's dentist. I am not too advanced. I am not all about mega research but I am about the stuff that goes down day to day.
I can do a mean filling and I am passionate about doing everything well.
You have seen and read alot about my stuff.
What do you think?
How about...
Top Ten ways to make your practice stand out.
or
Exquisite Fillings

See what I mean, I need your help.
YOU MUST HELP.
Lets brain storm together.
Write me your title suggestions.

Thank you in advance,
john

Wednesday, June 18, 2008

General Dentistry

Hey all,
Nice to be back after a couple days off.
I am back to the grind after a four day weekend.
My staff and I had a great time at the FNDC. We had lunch and dinner together, then we went and saw the Wallflowers in concert. The FNDC usually has some kind of concert or show on Friday night.
Talk about a fall from grace. One year you have a top 5 song on the charts and the next year you are playing for 200 people at a dental convention. Wow.
But a good time was had by all. Even my associate came and hung out. It is great to get out of the office and spend time together and have no pressure.

Anyway I did want to do a little magazine review on the latest General Dentistry from the AGD.
I usually pick it up and skim through it. I will read an article or two. This month though, everything jumped out at me.
As an aside, do you get like 40 magazines a week? I through away more trees in a week than I care to think about.

I have always thought the AGD's publications were great. Thing about the periodicals is there never seemed to be strings attatched to the articles.
I know people (I love saying this, "I know people", it makes me feel cool) at the AGD and can attest to their integrity. There are rules put in place so an article can not be a reason for an advertisement.
Like have you ever noticed that in a magazine like Dentaltown (which I haven't even opened in 4 years, so maybe I shouldn't comment on it) there is an article on how great the Root ZX is and wouldn't you know there is a full page ad for the Root ZX on the next page.

Anyway, I read the AGD's stuff.

Back to the magazine...
So the first article is on Fosamax and bisphosphanates. Everyone needs to know about this. This is the HOTTEST topic in dentistry right now. I had a man that was in last week that is having problems with an extraction site (he took his own tooth out) and he is on an oral bisphosphinate.
I don't know what the heck to do and then I read the article.
Great stuff.
Next article Lab Communication. Also great stuff.
I kind of have a different situation. My lab is less than 2 miles from my office. All crowns that my ceramist needs to know about I just tell my patient to drive over with me.
I drive by his place everyday and stop in about 2 times a month.
But this is article is about how lab communication is coming into the 21st century. No more drawings to communicate what you want. You take a picture and point out what you want (aren't computers grand).
Next,
Polishing porcelain...there are things in my practice that I know there are things out there and I know all I have to do is ask and I just don't. I am working and thinking to myself, "there has got to be a better way to do _____."
One of things that I always said, "there has got to be a better way to do this" was polishing porcelain. Well, it turns out there isn't. Thanks for this, it makes me feel good. And that is what is all about.
Now the next article I read twice.
Prosthetic implant challenges.
Here is a dude that is putting himself out there. I love this type of writing. He says in the introduction, "What happens to the restorative dentist when the surgical results are compromised?"
He is saying, things are not always perfect, let me show you one of these cases.
The case turned out great but one thing about this article is it left me wanting more. So I wrote Dr. Strong an email.
At the end of the article he did not leave any information about himself.
So after some finagling, I was able to contact him.
By the by, I encourage all of us to write authors emails. I have done this for a long time.
I once wrote dude that was doing "research" and wrote an article on teeth bleaching. Then at the end of the article it states that he was paid by the bleaching company he endorsed. RED FLAG.
I challenged him on it.
Needless to say, he was not happy. But it is the internet, he can't hurt me through the computer. I don't think.
Sometimes I write people to tell them they did an awesome job and sometimes I write them to tell them I don't agree.
But in the case of Dr. Strong, I wanted to know who screwed up. Was it the surgeon? Was he pissed when the patient came back?
I asked him these questions in the email.
I hope he writes me back and I will let you know about the conversation.

A couple of articles later....
Preheating resin composite. Wow. I have know about this but I didn't know how to do this. Now I do. They tell you why they do it. The article tells you how to do it.
And I am not even half way through the magazine.
Next article was about a simple bone cyst. Guess what walked into my office last week.
A BONE CYST!!! Yes, I am not making this stuff up.
I had a conversation with my oral surgeon and I ended up scanning the article (and the oral diagnostic question at the back of the magazine) and sending it to him.
A couple of articles later...
Calcium hydroxide affects sealing of warm gutta percha.
WHAT?!!
This affects my daily life.
I will not bore you with all the articles, but it was page after page of articles that speak to me, mister general dentist.
The article were succinct. Get in, get out. This is how I read and how I shop.
The photos were mostly all great (I still need pictures. When I was 9 years old, I wouldn't read a book unless it had pictures. Things haven't changed much).
The authors are not paid. There is no one profiting from writing an article or endorsing a product.
That's what I am looking for in a magazine.
If you didn't get it, you can look it up on the agd.org website.
http://http://www.agd.org/publications/issue/?PubID=17&IssID=722

Great stuff this month AGD.
Keep it up.

On a personal note...
I had to go to the hand surgeon yesterday. I having pain in my right index finger.
I am having trouble shaking people's hands. I cannot open a water bottle, I cannot squeeze the top to unscrew it.
You know it does worry a dentist a little when the hand starts hurting.
My surgeon and I are on a first name basis. I broke my wrist two years ago, playing basketball.
Then I had surgery on an old injury on my left pinkie. Then after I stopped playing basketball, I thought playing flag football was a good idea...NOT. I broke finger on some one's belt loop.
But this problem was not self induced. I was worried.
He took some xrays and there is nothing structurally wrong.
He says take some Ibuprofen TID for 3 weeks and come back in.
Yesterday was the come back in appointment.
Of course I didn't take the meds like I was suppose to but it is better. He says he could just shoot some juice in the joint and there is a chance I would never think about it again.
I decided to wait it out. If I can avoid a shot in my finger, you bet your sweet toosh I am going to.
I will keep you posted.
Oh, I watched August Rush on Monday. I give it a 5.

Talk to you Friday,
john

Monday, June 16, 2008

Ghost Writer, don't blame me.

I had a great weekend.
Father's Day has come and gone and I did't even get a nap.
But back to the daily grind (wait, that is funny).
I went to the FNDC and have a whole bunch of stuff to write about but I wanted to give you the second of two blogs by a ghost writer.
AGD annual meeting in 4 weeks. I can't wait. Look are we going to have that BBQ at my house or not?
I look forward to meeting some of you.
Lastly, I watched the movie, Gone Baby Gone this weekend. I thought there were too many F-words and some tough stuff (like kidnapping of a 5 year old) but if you can get by all of that, it was very good.
But back to this blog.


In the spirit of my last blog, which was actually written months ago I’ll tell you that I’ve tried a few efforts to market the practice.

One of my patients is a wedding consultant who we encouraged to urge her clients to whiten teeth with us. Her incentive was $20 per whitening treatment. We special printed over 100 sheets for her to put into a binder she gives all of her clients.
The results have been dismal. We started in January and have zero patients from this effort.

Then, we sponsored a hole at a golf tournament. I took off an afternoon from teeth and sat under a tent giving away practice t-shirts, beer, sodas, bottled waters, peanuts, floss, toothbrushes, pamphlets, etc.
I knew a third of the golfers from being associated with the group. It’s been two months. Zero patients.

Ok, back to the future or back to now. I’m running off at the laptop again and a few events converged on Friday that gave me pause for reflection.

1) My wife is midway through her third pregnancy. We have two girls, ages 5 and 7.
At lunchtime on Friday we were going to learn the sex of our next kid. Long story short, it’s a boy!!!
I would have gladly accepted another girl. I’ve been there and done that and could do it again. But man, a boy!

2) Later in the afternoon as I’m picking up something for my father in law for Father’s Day I’m checking different radio stations and come across Sean Hannity speaking of Tim Russert in the past tense. Immediately I call my wife to check the news on TV and sure enough he’s collapsed and they were unable to revive him.

3) That evening I attended an alumni meeting for my dental school. I went to Maryland. I live in central Florida where I feel a million miles away from the life I knew in Baltimore. I look back fondly on those 4 years and feel I’ll never lose the affection I have for many of my classmates. Not to sound corny but they are like brothers to me although I only see them once a year at best.

I met with a group of much older dentists from my alma mater. Let me put it this way; I’m from the class of 1999. The next youngest guy graduated in the 60s.
A charismatic man by the name of Dr. Joseph Cappuccio spoke of the challenges and importance of maintaining a strong alumni presence. At the same time he expressed his disappointment in the general apathy and the change in mindset of younger dentists who are motivated more by the financial rewards of our profession than anything else.

Dr. Cappuccio was generalizing of course on what is an obvious trend in our culture.
I suppose his speech upset me and motivated me to become more active beyond my local study clubs and dental society.

We are all footnotes in a long drawn out story that is unfolding in our universe. I watched throughout the weekend as they honored the memory of Tim Russert. It seems he understood his role as a father and a son. He cherished both and seemed to get the importance of what his Dad had done for him. He was passing that on to his own son in a way that has caused me to reflect about what I should be doing in my relationship with my son in the years to come.

My own Dad passed away in 2005. I don’t believe a day goes by that my actions aren’t influenced in some way by the way he brought me up. Those of us who don’t have our Dad’s around anymore can only strive to live a life they hope their father’s would be proud of. Our Father’s Days are weird and can seem somewhat empty.

Ok, let me wrap this up before I bring everyone down even more.

It’s important to appreciate what your dental school did for you. They weren’t obligated to educate YOU. They took you in and spit out a dentist after 4 (you fill in the blank with your adjective of choice) years. What else would you be doing with your days or your life that could have such an impact everyday?

Being a Dad is an awesome responsibility and privilege.

We should be in awe of the enormous sacrifices made for us by our fathers to put us wherever we are now.

Finally, “Think of your forefathers! Think of your posterity!” maybe John Adams might have said this once?

I thought it was going to be all on marketing. But it just goes to show you that every dentist has lots going on in his or her life.
Just when you think dentistry is important, a good father and news guy drops dead at like 55 years old. It puts teeth a little down on the priority scale.
Thanks ghost writer.
See you Wednesday,
john

Thursday, June 12, 2008

Ghost Writer, don't blame me.

Hey all,
I am at the Florida National Dental Conference this weekend.
My staff and I are meeting at the convention center this morning. I will be in meetings all day.
This one is just a warm up to the AGD annual meeting in July, so don't get the wrong idea.
So I asked my friend to drop another blog for us. Remember this dude. He the one that wrote the dark blogs about two months ago. He was in a bad place then and it doing okay now. He is passionate about his work and is a cerebral kind of guy. I hope you like it. Oh, the book I am reading is Operational Instructions by Anne Lamont. It is a writers memoirs about pregnancy and the first years of parenthood. She is extremely liberal but extremely funny.
In so many ways we disagree but we can laugh together.
Enough about me....


Whenever I step foot outside the office, like many of you, I see things with my dental eye. I notice what other professionals are, or are not, doing. I particularly like to evaluate different businesses and organizations. If you carefully observe your surroundings there are valuable lessons everywhere.

We are all aware of the “e myth”. The book essentially explains that you must work on your practice rather than work in it. You should try to model enterprises such as McDonalds who have systems in place that are the same from location to location. They are a well branded and extremely consistent. They are model franchise business as we all know.

There had been a recent slow down at my practice that caught me off guard. November and December of 2007 were my worst back to back months since 2003. Back then my overhead was much less and my personal expenses were easier to pay for. New patients and comprehensive exams were abysmal. These are usually signs that things were going to be bad for a while. I had to do something that I had never done before. I had to promote my practice and myself.

Recently my wife and I got away from it all by visiting the charming southern towns of Savannah, Georgia and Charleston, South Carolina.

I’ll start with Savannah.

We booked ourselves at the historic district’s Holiday Inn Express on a Thursday night. The hotel and particularly the staff embodied the “WOW factor”. We stayed a single night on our way to Charleston. In that short period of time they made an impression on me that compelled me to write the manager a letter. I really want to know what the mission statement of their organization is. I want to know how they choose to hire such gracious people. Every single person in the place greeted us with a smile and asked us how they could be more helpful. We felt like true guests in their home. The housekeeping women were almost freakishly friendly. The bellhop was a memorable young kid who parked our car for us and left the our keys in our room while we got a head start on getting a table at Paula Deen’s restaurant.

I could get more specific and go on and on. The point of my story is that I doubt I would stay anywhere else in Savannah when I return.

Isn’t that the kind of service we all strive for in our offices. The kind of service and “WOW” that keeps patients from ever considering another dental office. For me it was a lesson learned. Internal marketing does work.

The next evening we were in Charleston and had met with a buddy from dental school, his wife and his twin three year old boys. We decided to hit a kid friendly fried seafood place. As we walked down the street there was a young girl wearing a Hyman’s Seafood t-shirt giving out samples of hushpuppies. Once the sweet fried nuggets hit your taste buds you knew you had to give Hyman’s a try. Hyman’s had been giving out samples three blocks away from their restaurant. We quickly made our way there.

Once inside you quickly become aware of all the notable celebrities who had dined there from the autographed photos on the walls. Then when you sit at your table there are little metal plaques that tell you which rock band or actor had sat where you were. I believe Hootie and the Blowfish, AC/DC, and Hulk Hogan had dined at our particular table at some point.

There were multiple business card sized cards that had memorable quotes with “Hymans” printed on the other side. They also had a deal where if you spent over $30.00 you were entitled to a $4.00 t-shirt that said “Hymans Seafood” on it. I wear that t-shirt at least weekly now. More promotion. As you left there was only one way out and you had no choice but to visit their gift shop. The place was loaded with every imaginable souvenir with, you guessed it, Hyman’s Seafood, somehow embroidered, printed, stamped, ironed on, painted, etched, or molded on it.
Hats, t-shirts, mugs, shot glasses, key chains, sweatshirts, tank tops, and Christmas ornaments, just to name a few.

What’s the point of all this? Well, Hyman’s was packed. Later that night we walked by and there was a line half way around the block. The following night a similar line developed of people waiting to be seated at Hyman’s. It was a hit. Obviously their marketing scheme worked. External marketing works. Lesson learned.

We took the trip back in early February and have already implemented some of the tactics used by Hyman’s and Holiday Inn Express at my practice. I’ll get specific on the next blog.


Next Blog?!!! Boy is he getting a little too comfortable on our blog.
I liked it and would like to hear what he has to say.
Maybe we will keep him.
Have a great weekend.
HAPPY FATHER'S DAY,
john


Wednesday, June 11, 2008

Back to Dentistry

Okay back to dentistry.
Great for some and not so great for you non dental types.

I watched Juno this weekend. Being pregnant my wife was crying and I was like, "this movie is stupid."
I did not like it. I thought Juno was a smart ass and she lost her credibility when she was trying to be endearing.
I like that it had some redemption but for the most part I didn't like it.

I finished The Shack. It is a book that is fiction but give the gospel story. This is why it is going around Christian circles.
People love it.
It was just another way of telling people about God and His character. There was this dude that was sad. God wrote him a note to meet Him at the Shack. Where it gets crazy is God is this big black woman. Jesus is also at the shack and so is the Holy Spirit (all different "people").
I obviously love the message, but I was fairly neutral about the book. I didn't think it was particularly well written.
I thought it could be better.

If you have a movie or book that you love let me know because I am running low on my Queue at Netflix and I don't have any good books in the pike to read.
I am reading a book right now but I don't know the name of it. I will let you know on Friday.

Top 10
Okay here is some more.
I went back and have only done 9 so far.
Here are some of my other products that are my "must haves".

SE Bond.
Okay, lets not have a 4th generation vs 6th generation argument.
I have been around the block (not that way....okay maybe that way too) a few times with bonding materials.
I have went to about 50 hrs of adhesive dentistry C.E. and everyone has their opinions.
But more than any other product, this one is the one most compared to.
It gets all good grades from CRA and REALITY so it is good with me.
I left SE Bond for awhile and went back to 4th generation stuff (in one of my many quests for perfection and not finding it) but...I went back.
Easy to use.
It is a solid product.


Expasyl
Oh, my gosh this stuff is awesome.
People tell me it is expensive. You know I am the kind of guy that doesn't care how much things cost. I need it, I don't care how much it is. I tell my people I don't tell me because I don't want to know.
Its like my kids tuition. I don't want to know. I know it is expensive but I really don't know how expensive. I want them to have it. If I knew the cost I might reconsider or resent someone.
But expasyl is always in my room. I don't care if I am doing a crown or a facial filling. If I need something to stop bleeding...expasyl. I have tried all the hemostatic agents and none of them work near as good as this product.
The worst is when you are doing a build-up and have it isolated. You think the hemostasis is good. You put some etch on the tooth and you touch the gums with the etch for a second and here comes Mount St. Helen's.
This is where mild mannered Dr. Gammichia turns into cussing, ticked off, throwing stuff Dr. Gammichia.
So instead of throwing stuff I use expysal

The phone.

I know you think I am a nut case but the phone is HUGE.
If you can learn how to use it and teach your people how to use the phone it is money in the bank.
Am I a master at it? NO
But you know what? I have been using a phone for a long time. I know how it feels to be on the other end of a bad phone call.
I also know how it feels to be treated great on the phone.
So this is how I want people to feel (the better one) when they call Dr. Gammichia and sons dental practice.
Once we have learned the art of being nice on the phone then we work the phone.
"How much do you charge for a cleaning or a crown?"
Anyone get this call?
Well, this is a huge opportunity. They already know they need a crown.
Charm them. Educate them, right then and there the differences between crowns and dental offices.
I use the phone at home too. I can get my office computer at home. So I find out what I did that day (because I can't remember stuff like that) and I call my patients. I don't call everyone but I call everyone that got a shot that day. Fillings, crowns, root canals, extractions.
And let me tell you, this is the BEST thing that you can do to shock the crap out of people.
One thing before you start calling people.
I think I lost a male patient because I think he thought I was hitting on him.
Two woman also thought I was putting the moves on them. One husband made his wife leave the practice. One patient brought me into a room and asked me if I was interested in her.
I am not lying. I can't make this stuff up.

Two more.
A pen.

What?!! Did he say a pen.
Every new patient gets a hand written letter by yours truly.


I want them to feel special. I want them to think that I am special. I want them to know that they are not a number to me.
I want them to know that I know there is a dentist on every street corner and I am glad they are giving me a chance. I want them to know that I care what they think and if they need anything they can call me personally anytime.

Every kid that I see for the first time get a card written by me.
In the card I say something like, "WOW, you are a great patient." Something to this nature.
We put some stickers in the envelope and makes the kids day.
Is this a pain in the butt? Sometimes. I get behind on my letters and it takes me a half an hour to catch up but...it is worth it.

Last one (for now)
The syringe.


What is the biggest fear of EVERYONE that walks in your door?
"Do you have to give me a shot?"
"How many shots do I have to have today? "
So what do you do?
You perfect your technique in the shooting area.
Am I the best at it? NO
But I recognize the benefit to getting better at it.
Anyone used this Profound stuff yet. This is super topical.
It will get people almost tooth numb before you give them a shot.
It is made from a special pharmacy in Seattle or someplace.
Look it up online. It is expensive as crap (see what I mean) but it is awesome. Kids do not feel the shot.
Anterior infiltration... this stuff really helps.
Palatal...even if it helps a little.
You know what I am saying.
I take at least a minute to two minutes to give all my injections. Slow baby (Barry White voice).
Just a few of my favorite things.
I hope you like the list.
I am sorry I broke it up with the story but it was fresh in my mind.
If you like anything that I might of missed, please tell me.
I am interested in anything you've got for me.
Anyone use the ISOLITE?
I will talk to you Friday.
Ghost writer on Friday,
I will miss you,
john

























Monday, June 9, 2008

Billy III

Great weekend for me.
I don't know if I ever told you but every Saturday morning me and the kids go out to breakfast with Grampi.
My father and I really love doing this with the kids. We have really good discussions and the kids look forward to it. And they are creating a bond that we hope they will continue to desire as they get older.

But I have to tell you about what my four year old did. We are driving home from grampi's. And we are sitting at a light. And a FedEx truck drives up next to us. So Noah rolls his window down and says, "Hi". The driver says, "Hi" and thinks its done.
But Noah continues with, "My name is Noah. What is your name?" The driver replies with "My name is Cecil."
Then out of nowhere Noah says, "I am a big fan of FedEx."
Four years old. A big fan of FedEx. Hilarious.
I flipping lose it. The driver was loosing it. I was laughing so hard and I laughed all weekend. I am continuing to laugh as I am writing this.
I tell you, those kids of mine make me laugh all the time.

Billy,
Billy is in juvi in New York. We and our friends are in Orlando. I never told you how he got to New York.
Just a quick aside, when Billy's left our friends house to go with his mother, the only place they could go was New York. Her mother and grandmother were now living in New York. So Billy and his mother pan handled (with a dude they met at a homeless shelter) to New York, where they are now.
So he is in juvi. Our friends hear from him or about him about 3 times a year. Our friends continued to try and stay in touch with him. His aunt (our friend) tried to be a rock in Billy's life. When things are bad, remember you have an aunt and uncle in Florida that love you.
When things are bad, maybe you will remember what it feels like to be loved by your family.
Thinking maybe when things hit the fan you may think to rely on this family for some sound advice.
Now Billy, kept being moved from facility to facility. It was more of the same. Mom getting involved and things not getting any better for anyone. But this also made it very difficult for his aunt and uncle to keep in touch with him.
Now I told you that we prayed for a someone, anyone who was solid, to get involved in Billy's life.
It didn't matter if it was a correctional officer, the jail minister, a distant family member, just someone.
Well the answer to prayer came in a distant cousin.
This woman, to this day I don't think my friends know how she got involved, began to take an interest in Billy.
She was in her early 40's, married with 4 kids of her own. But she began to visit Billy.
She began to see the dysfunction is the relationship he had with his mother and grandmother. She wanted to help Billy.
He was coming up to a hearing where he might get out. I think he served 2 and half years.
His cousin asked Billy if he thought he might want to move in with them.
He realized that the situation with the mother and grandmother was a road he didn't want to go down again. So they agreed to give it a go.
He got out. My friends began to have a relationship with Billy again. They spoke to him about once a week and just told him they loved him, they wanted him to know his family was pulling for his success.
After a honeymoon period, they cousins expected Billy to do something.
The dad of the family owned a bakery and went to work at 4am. Well apparently this didn't fit into Billy's schedule.
I mean me and you would jump at the opportunity to do something with our day. We would jump at the opportunity to be productive...regardless of the time.
So when Billy woke up the adults were gone and I think the kids were at school.
Idle time for a 17 (yes, he was 17 now) year old is not good.
He slowly started to be a latchkey kid. He would just start to hang out with some of his old friends. NOT GOOD.
He got a job at a Taco Bell and that lasted about two weeks.
He worked at a nursing home for about two weeks.
I don't suppose he is much different than any other 17 year old. Lazy and bored. Problem was he has a history of making very bad decisions.
Then he started coming home late and not being very productive in a household that was "trying" to show him by example.
They would take him to church and he hated it. They had the youth leader call Billy to see if he wanted to do anything and he said, "NO."
What were they to do?
So they sat him down and asked some things of him.
If you want to stay here you have to do A, B, C and D.
Seems reasonable.

Billy chose to not live there.
WHAT!?!!

So he was then put back in the hands of the state and they put him in a boys home.
It wasn't long before he was living with a girl that had a kid who's baby's daddy was in jail.

Okay lets take a step back.
When does it become Billy's problem. Up until now we have been blaming Billy's shitty family.
But now Billy is 17 and old enough to know that this decision is going to lead to destruction and this decision, even though might be harder, could lead to something other than destruction.
My wife and I were arguing about this. Billy is now making his own bed.

His aunt is crying herself to sleep. Feeling like he needs one more chance he will snap out of it.
Well, in the last couple of week, we heard Billy was running from a gang. He called his aunt scared out of his mind. He messed with some dudes on such and such street and they own this street and I can't go out of the house because they own this street. I can only go to this street but I have to walk on their street to get to the safe street. The girl I am living with, her baby's daddy is getting out of jail on Friday and I have to leave here house.
Are you kidding me? This is real. I am not making this stuff up.
So he asked his aunt and uncle for some money so he could get on a bus and leave the state and go to Miami. His other grandmother lives there with his half brother and sister. Did I mention his other grandmother has been incarcerated for check fraud?
But this is where he thinks he should be?
My friends told him NO on the money thing. They will get him food, a place to stay, a job... but they will not give him money.
Also lets not forget that if he leaves the state this is a federal offense. He is still on probation.
He somehow found the money and left for Miami last week. This is where he is at to begin the next chapter in his life.

This is where the story ends. There is no happy ending. There is no redemption.
I would be a terrible screen writer.
I know this was long but I wanted us to step out of our comfort zone a little and know there is pain out there.
Some of it is self inflicted, okay, most of it is self inflicted.
There are Billy's all over. Families are being ruined because they want to give the Billy's of this world one more chance.
And maybe that is all he needs is one more chance.
I just pray for all those kids that God will work a miracle in their lives, in their family's lives.

I specifically pray that God will work in, my nephew's, Billy's life. I pray for miracle because that is what is going to take.
Pray that that counselor back when Billy was a kid and gave him a 2% chance was wrong.

I will see you Wednesday.
john

Friday, June 6, 2008

Billy II

Billy is this kid that came to live with my friends when he was almost 6 years old.
He had not been in school because his drug addict mom was in the throws of her disease.
Grandma has a lot of the same issues and great grandma doesn't speak English.

So my friends wanted to salvage this kids life.
They brought him into their new home.
If you want to get up to speed you have to read Wednesdays post http://agdblogs.blogspot.com/2008/06/billy.html.

Anyway Billy and his mom were going to give it a go.
Billy couldn't wait.
One, he was going to be with his mom. I think he always felt different at school because he lived with his aunt and uncle. He would always be around rich private school kids and they would all talk about their families. Soccer moms coming to pick them up in the mini-van. Everyone appearing to have the ideal family and Billy's mom is no where around.
Two, she was his best friend. She made sure of this. She was the kind of person that the only thing she had was Billy. So she would always be upset if Billy had more than her. Sad really.
So instead of discipline he got friendship. It is hard being a parent for the first time to a 6,7,8, 9 year old.
As a parent you realize that creating boundaries is what your kid needs. I mean if you are with them everyday you learn real fast that if the "rod of discipline" (not necessarily the paddle, it could be restriction, or something to that affect) is not there, things will go south fast. You, as a parent realize if you are not addressing issues the issues will escalate out of control.
But if you are on the outside looking in, of course you just want the kid to like you. You want to have fun.
Three, rules suck. I mean my friends were working hard to put this kid in the "circle of blessing", meaning having rules. If you obey, you are in the circle where there are rewards and happiness. And if you are out of the circle and not obeying the rules there are consequences and no fun.
But to a kid it feels a little oppressive.
So if I tell a kid, I tell you you can have all the blessings but not be in the circle. TAKE IT.
If you don't have to obey rules and everything is great. OH YEAH.

So Billy jumped at the opportunity. FREEDOM.

He had friends, he had a family that loved him, he had a church, he had baseball teams and basketball teams. Everything you think every kid would love to have. He left them all behind.

So mom and Billy had a great summer. I don't know what they did. But, as you can imagine, Billy came back changed. Living with a drug addict, I would imagine is alot different than living in suburbia.
Now 11 and a half and it is time to live back in Orlando.
Well it was probably what you can imagine.
Billy didn't want to be there. Billy wanted to be with his mother. He acted out his anger.
He ran away. He got all up in my friends face saying, "Come on, you want to go?"
This was a bit of an issue when now my friends have their own kids that are watching all this go down.
He hated school (school is stupid, I mean no one who goes to school does anything with their life. Besides all the teachers are jerks).
He would wake up in the morning and say, "I am not going to go to school today. Oh, and there is nothing you can do to make me go."
By this time in the morning, the uncle was already at work, so there really wasn't anything the aunt could do.
Things escalated at the house.
He would run away. Cops were at the house a lot.
He would call HRS (family services) and make up a lies. Now this is a big deal because remember my friends had their own kids. The agency came out and did interviews and a house search. Scaring the bejesus out of them.

Battle lines were being drawn and Billy kept stepping all over them.
He was daring our friends to kick him out. But they were hellbent on changing things for Billy. They didn't want to fail. Because if they failed they realized there was almost NO hope for Billy.
Well as all this was going down Billy continued to talk to his mother.
"This is bullshit mom I want to be with you."
So mom decided to pull the trigger.
I mean, she must be a real piece of work.
Much to the dismay of my friends. They pleaded with her, "talk to him. Make him stay at least til the end of the year."
She said, "No, right now".
She was in control.

The aunt was beside herself. She loved this kid like her own son. Her sister was taking away a part of her. Now don't forget when Billy was born she was there. They all lived together before she got married. She changed his diapers. She took care of him when mom "went out for bread".
But the uncle knew it was probably best. He was about to lose his temper. He could of done things that would of affected the rest of his life (with his own kids).
He knew it was time for Billy to go. He told me he felt relieved he was gone.

She didn't have any money.
She didn't have food.
She didn't have any place to live.
She hadn't thought of what school to put him in.
There was no thinking, just doing.

So Billy and his mom lived out of her car for a couple of months.
Literally reversing 7 years of hard work in no time flat.
She got him into school and he was in fights constantly.
Because of mom's street smarts, she told him, "Go to school and let people know you will not be picked on. So I want you to get into fights so people will know not to mess with you."
So from private Christian school to this.
He went from tutors and Sunday school to fighting people for respect.

So it wasn't long before Billy was detained. I don't know if he was arrested but he had to leave the school. The government decided he was going to have to live in a boys home.
I have always thought this was a good idea. Take a group of delinquents and put them in a "home" together.
With mom still supporting him with, "you better let them know you are not going to take any shit from anyone."

For the next five years this was Billy's life. In for a year and then out for a month. In for 2 years, out for 2 weeks.
In addition to learning the art of fighting, I think Billy met some really good people in jail (oh, yes, it was juvenile by now). People that were going to help him when he got out. People that were going to get him his own street corner to sell drugs on.

The aunt has always been a bit of a bleeding heart. Give him a chance, look at the cards he has been dealt.
Now the uncle has been hardened by the facts. Every decision Billy has made has been more and more destructive.

3 years ago Billy got out. By this time his mother is doing drugs and his grandmother is a full on alcoholic. What did he have to come home to? (It was really sad. My friends were helpless at this point because now Billy and his mother lived states away.)
This literally lasted 3 weeks until he was busted again. This time, I think, it was for drugs.

He was sentenced for 5 years.

This is where this story will end for the weekend.

I know I have not put you in a great mood but...
His aunt and uncle (and family) have been praying for someone to take an interest in Billy's life. Someone that would take care of him when he got out.
Someone that would love on him unconditionally...that person showed up.
I will tell you about it on Monday.

Have a great weekend.
2 weeks until Fathers Day.
Faithfully,
john

Wednesday, June 4, 2008

Billy

The top 10 list is going to be put on the back burner for a couple of blogs.

I want to interrupt this dental blog to talk to you about my this kid I know.
This is going to take me a couple of days to tell this roller coaster of a story.
There is some sensitive stuff coming but I want to tell you so that if by chance someone is dealing with this stuff they may feel a bit encouraged.

I am going to get right into it.
By the way I though "No Country for Old Men" stunk. (I don't care what Bruce S. says about it).

It was November of 1997 when our friends went home to see their family.
Real quick, our friends had been married a year and a half and had just bought their first home.
Things were going great for this young couple.
But things were about to change in my friends life.

They soon realized their nephew was in big trouble. We will call him Billy. Billy was 5 and a half (almost six) and had never been in school. He lived with his mother, grandmother and great grandmother in a one bedroom house. His mother was a drug addict, and as drug addicts are, didn't give a shit about anyone but herself. I know it is the worst kind of disease but when they bring others into the world and they don't shape up, they are giving that disease to someone else. She was in a bad place. It was taking over her life and she was bring it home.

This kid loved his mother, as most kids do. He would be all torn up when his mother would tell everyone she was going to go out and get milk and disappear for 5 days.
One time, one the mothers many boyfriends went to jail because he brought Billy with him to burglarize a house. This is how bad it was.
It was bad, real bad. My friends (rich white kids) were finding out things about Billy that they never knew happened to kids.
Now our friends through the years saw all this playing out. But it was just getting worse and worse.
It was the worst kind of child abuse. The kind that leaves scars so deep.
They realized they had to do something about it. And as they would say later, "anyone of us would do it if they saw a kid get abused like their nephew".
So our friends pitched a solution to Billy's mother. "How about we take the kid for 6 months so you can get your life back together?"
They told the mother, "Its seems simple, you are drug addict and your son needs some consistency. He needs to have an education. Your son needs to go to the doctor and the dentist." "Help us help you".
She does what is in her blood and disappears. She was gone for three days. In the meantime our friends had drawn up a contract that gave temporary custody to the aunt and uncle, giving them permission to take him to the hospital and/or get medical attention when necessary.
The mother finally relented and signed the papers.

Just so you know that six months turned into 7 years.
As I said this kid should have been in kindergarten but had never been to school (at least on a consistent basis). The aunt immediately got the kid in school.
The beginning was pretty tough. He obviously didn't just pick up school like it was nothing.
He had never been around other kids in his life. He had to learn how to interact with other kids without hitting or biting.
My friends were both working professionals so they had the money to take care of the things he needed. And he had a lot of needs.
The got him in counseling and got him tutors.
Speaking from experience, when you raise a kid from birth there is a bond built between you and your kid. Trust is built. The authority is established. My kids know right from wrong. They know that dad and mom are the ones that tell me what to do. They are training me up to be an adult.
Billy came with none of this. They had to start from scratch.
They were doing the best they could with the help of their pediatrician who was a friend of theirs.
My friend told me once that when Billy was 8 one of his counselors said there was 98% chance that Billy was going to be a deliquent when he gets older.
He says genes are so much stronger than the environment.
They were hell bent on being the 2%.

Things started to settle. At the beginning, the mom was AWOL and it was easier.
Then she started to reappear. Then she would tell Billy that she was coming to get him.
Now I remember our friends telling us that his mother would tell him this constantly.
And never do it.
Not only is this tearing Billy up, but it is never letting him settle down in the home that my friends were trying to build around him. He was never able to root himself in their home.
He would never feel like he could do this for the long run because, "My mom is coming to get me."
Now how can you tell a 6 or 7 or 8 or 9 year old boy that his mom is a drug addict and is not coming to get him.
I remember talking to my friend when he was so frustrated and he told me that Billy acts so much better when his mom doesn't call. Months would go by and she wouldn't call, things were good.
But Billy's behavior changed when mom called. He would get in trouble and he would tell him mother. Of course the mother's MO is not to encourage discipline but to be his BEST friend. So she wouldn't say, "Listen, Billy if you do what they say...if you obey the rules, you don't get in trouble. So obey the rules and don't come to me with your stories." No she would say, "That sounds horrible Billy, let me talk to them and see what I can do for you."
Now my friends have a kid that thinks he is leaving in the summer time (every summer) and also doesn't respect their authority.
Time went on... he did everything a kid did. Pee Wee football. Baseball teams, private schools. Church. He was a real likable kid. Smart, witty, handsome, but I would think to myself that this his life could be a whole psychiatric text book.
There was so much shit going on in his head that it was like a spider web.

In the meantime my friends started to have their own family. They had two kids of their own. They had a nice little family and they really thought Billy would be with them forever. They tried many times to get Billy's mother to give up custody. They talked to attorneys about getting somethings down on paper. But much to there dismay the attorneys always said the same thing. The mother has all the rights.
If she signs over her custody and then wants him back then she probably could get it back. One attorney went as far to say that the mother could be a crack whore and most judges would give the kid back to her. So keep you thousands of dollars and hold on to him and hope the mother never comes wanting him.

When Billy was about 11, mom started to really be a nuisance. Also, I never told you about Billy's dad. Well he was in jail for awhile and was now out. Oh No, you say. Well, yes. He started to resurface too.
Now Billy's mom started to call and start saying things like, "it is time for you and I to be together."
I am going to come get you this summer.
Now she didn't have a job, she didn't have a place of her own (she was still living with her mother and grandmother). She didn't have any money. (now I am not saying you need all these things to be with your kid, but for her it would be a good start)
She kept saying, "it was time for her and Billy to be together.

My friends held on like troopers. Things might have been unravelling but they were trying to keep it together.

That summer Billy's mom came to get him.

This is where I am going to stop.
This is probably going to take three day because Billy has just resurfaced in our friends life.
He is 17 years old now.
It is not a happy ending.

Talk to you Friday,
john

Monday, June 2, 2008

Top 10 (plus story)

Hey how was everyones weekend?

Mine was very eventful.
As you know Luke's B-Day was yesterday.
So instead of 25 kids over in the pool and bounce house, we have evolved to having three friends over for a "sleep over".
So I was in charge of the boys on Saturday.
So at 2pm the four boys and I went to the G0-Karts (oh, Lukes sister and brother went also).
Now if you thought getting a root canal was expensive try going go-carting.
$4 each for 8 laps. But if you buy a bunch of them you get it for $3.
I bought 16 tickets for $48. Me and Noah raced my Madison on the slow cars.
While the boys went on the medium fast track.
I let the boys go three times and me and the little ones went twice.

I thought this was going to be an all afternoon gig. Not exactly, we got back in the car all excited and laughing, but it was only 32 minutes later.

So we were back at the house and we looked up movies. The movie we wanted to see was playing at 4:10 right up the road.
So we loaded up the mini-van again and went to see Prince Caspian. This time Madison took a friend and all of us journeyed to the theater.
Now picture this...
Me and 6 kids (9 and under).
We bought tickets (don't even ask how much) and got in line for popcorn.
"Get over here"
"Don't touch that"
"No you can't have Jumbo Milk Duds"
"No I don't have quarters for the game room"
So I get a Large Popcorn and two large drinks (dont ask) but...
FREE REFILLS.
I pay $30 bucks for that and they give me a free refill that costs them $.50.
And somehow I am suppose to feel like I got a deal.
I got extra bags and little cups, for everyone and got into the theater. The boys wanted no part of the girls so they sat in the row behind us.
I start our personal concession stand and pour popcorn into each bag and filled all their drink cups.
Okay, the popcorn is empty and one and a half of the jumbo cups were empty.
Then I am going to go get the refill. But the issue is now, do I leave 6 kids in the theater to go get free stuff. Do I leave the 6 innocent children vulnerable to the sickos of the world to get FREE REFILLS? You bet I did.
So I tell them, "Sit here, no one move, I will be right back".
I run to the counter. Wouldn't you know it there is a line. I try to go straight to the counter and ask a dude to fill them up. He says I have to stand in line. I wanted to jump over the counter and strangle this 16 year old pimply faced kid but I restrained.
I got in line... I was second. Behind a woman who was ordering for her softball team. She ordered so much stuff she had to have an employee help her bring all her stuff to her seats.
I got the stuff and ran back to the kids. 1-6 I counted and they were all safe.
Now, one of the girls pipes up, "I have to go to the bathroom."
WHAT?!!!
Now my daughter is 7 and her friend is 8. What the heck do I do?
I can't bring them into the mens bathroom (It is a disgusting place. Trust me ladies. And I am not having my daughter anywhere near those seats) and I can't let them go to the bathroom by themselves. Can I?
What the heck?
I let them go together with strict orders.
While they are gone the movie starts while I am doing the second fill up on all the drinks and popcorn.
They safely return and I can sit and relax for a minute.
The movie was 2 hours and 20 minutes.
It was pretty good. In the Lion, the Witch and the Wardrobe there was symbolism that I got. There was redemption. I got that.
In this one I didn't get it. I kept waiting for the thing that led me to the Bible story but there was nothing there.
It was just a kids movie and a pretty violent kids movie at that.
Then we got home, safely a little before 7pm.
Then it was swimming time.
Swimming for 2 and a half straight hours until pizza. I looked like a prune and so did all the kids.
Next was pajamas and brushing of teeth (one kid didn't bring a toothbrush, can you imagine not bringing a toothbrush to a dentist's house).
I dropped them in front of a movie at about 10pm and they went to bed without many issues.
It was great. I think Luke had a great party.
We spent way more than if we had the 25 kids and the bounce house, but it was worth it.

Sunday is always reserved for the family party. But a funny thing is we have a great family that are friends. The mother and one of the sons have the same birthday as Luke, so now it is a family and friends party. 21 people to be exact.
We finished at 10pm.
I was pooped last night.

But, enough about me...
Lets talk about some products

Where was I....
Top 10.

Next on the list is...
Burs.
You know how much I like doing fillings.
Well to me, in order to do a filling that looks like a tooth it involves a specific bur.
If I want to do a crown prep that is similar to Dr. G.V. Black, you need a specific bur.
If you are doing a lot of veneers you have to have the right bur.
When you are cementing a porcelain onlay, you need the correct bur to smooth and polish.
Easy, but it took a long time for me to find the right ones. In fact, I am always looking for something better.

#7
An intraoral camera.
I do not have the biggest baddest most expensive one. I have a decent one. I have one that the pictures can be loaded directly into the persons chart.
I use the camera all the time.
I use it on New Patient Exams. I show people what I see. I am not talking to them in a language they can't understand. I take the trust factor out of it.
They see a broken filling. They see a crack. "WOW!! That looks bad, when can we schedule to get this problem taken care of.
I also use it during a procedure.
"This is what the tooth looks like after I have taken the old filling out". I leave the stained dentin for effect. This is where they usually cuss.
"Holy S!@#$$#%t"
Then I show them a picture after I put the caries detector in it.
Then I show the finished prep and how clean and yellow it is.
Then I show the final restoration.
This is where they cuss again. I get alot of WOWs.
A couple of seconds more. Yes, it can be a pain in the butt. But it is worth it to me. For a patient to see his or her problem and watch us fix it.

Next.
Monitors mounted on the ceiling.
In my rooms I decided to place monitors above the patients head.
I wanted to be able to communicate to the patient without bringing them back up.
I take an xray with them back. I do an exam with them back. I am doing a restoration when they are back. I hated sitting them up.
I leave them back and communicate with them.
I LOVE IT.
And the best is this monitor can be used for movies. I purchased all my computers with DVD players in them and I have a stash of about 60 movies and they can choose from. I have wireless
headsets that they put on and lala land it is.
I decided not to have the 12 o'clock monitor and use this one instead. So I have a 7pm monitor and a ceiling mounted.


In this picture you can see one of my rooms and everything in it.
Take note of the...
Ceiling monitors
Wireless headsets
Intraoral camera
Electrosurge unit (under the counter)
Aquariums for ambiance
Windows that lookout to my atrium (foliage and a pond outside).
Listen, I don't mean to sound like I am bragging.
I love my rooms. These are years and years of adding more and more stuff on.
If you don't have all of this stuff, think about it. You don't have to run out and go into to hauk to get it.


Last thing for the day.

My DEMI LED Curing light.
Have you guys seen this yet.
OMG. It is out of this world.
I went from a halogen light (I used for 11 years) to a cordless LED light (the LEDemitron II).
It was decent but had all these battery problems that couldn't be resolved. I was literally recharging a battery after every procedure. What the heck do I do now? I had already thrown all the other lights I had out. I was in a pinch.
So I talked to the rep and he told me to try these (yeah, try these for $1000 a pop). So I did. Since then I have bought four.
What he ended up doing for me is letting me trade in old LE others.
But this thing reads about a 1300 on my light meter (just as a reference, my dad is using the Demitron 501 halogen light and it reading about 400). It is small and light weight and the battery lasts about a MONTH.

Are you kidding me?



I have to stop here.
It is too long, but I had to tell you about the party and I didn't want to wait to tell you about the other products.
Talk to you Wednesday.
john
Ps Don't forget to double clip on the picture to make it big

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