Wednesday, December 7, 2011

Pain in the Neck

Hey all,

Oh my gosh! It has been so long since we talked and I have so much to tell you. I don't even know where to begin. Sorry about last week. The AGD had a major computer issue and they spent most of the week rebuilding their servers. I have to admit that I liked the break, but I missed you all. I hope you missed me.

I hope you had a great Thanksgiving. I hope there were no major fights with the family and lots of food and football. That reminds me: I took a little boys’ weekend Thanksgiving weekend. It all started because my 12-year-old loves the Minnesota Vikings (don't ask, it is a long story). We were talking about when we would be able to see them. They didn't play the Bucs or Jags in Florida, so the closest place was Atlanta.

Well, if we are going to be in Atlanta on Sunday, why don't we see if there is a college football game on Saturday? My friend was in the room and he is a South Carolina grad. You guessed it: South Carolina vs Clemson was the day before.

We got the green light from the wife and we bought all the tickets (the college game tickets were twice as expensive). The time for the Clemson vs USC game was TBA (they announced the 8pm game time one week before the game).

My friend said, "Me and my boys are going to the game too, but we are going to our hunting property for the previous week. Why don't you meet us and we will go hunting Friday night and Saturday morning, and then we will all go the game?"

Now, here is the thing. I have shot a gun ONCE in my whole life. I have no idea how to shoot or gun or hunt. But it sounds really manly and was perfect for our boys’ weekend.

We left at 8:30am from Orlando to Kingstree, SC. We rolled up to the camp at about 3:30pm and they were ready to go. He showed us the guns. We all got gun lessons and we all got one shot at a target. Then he announced, "Well, I guess we are ready."

So within 30 minutes of us pulling up to the camp, I was in a tree stand with a rifle and instructions. "If anything that looks like a deer comes out of the woods and starts eating that grass, well, you know what to do". There I sat until it got pitch black and nothing ever came into my sight (well, except a bunny rabbit, but I let him live).

Then the fun started. We all came down off our stands. The one dude’s family came and there were about 13 of us around the fire. We cooked out (venison with bacon wrapped around it and potatoes they had over the fire all day), drank beer and smoked cigars while the boys played and had a ball.

Five o’clock came around way too fast the next morning, and we were up in the stand again waiting for any movement. Nothing again. The only difference was that it was 5am and 34 degrees outside (I am from Florida, where it will be 81 today). But not killing anything didn't mean we couldn't feast again. Eggs, hashbrowns, bacon, juice. It was awesome.

This was as close to roughing it as I have ever known. I basically slept on the floor of a barn. We brushed our teeth with water from a pump and this Ritz-Carlton boy didn't do so well. My friend had family close by and we all were able to shower before the next leg of the trip.

Then we were off to Columbia, South Carolina to tailgate for the USC vs Clemson game. We got to the parking lot at about 3pm and the game was at 8pm. That meant more eating, drinking, smoking cigars and a lot of watching games and throwing the football.

The game was great. My friend was really happy because USC whooped up on Clemson. We fought traffic to get out of there and pulled into his parents’ place in Greenville at 1:30am (are we having fun yet?). We slept in a bed this time but were up at 8 to eat and get out to Atlanta for our 1pm Vikings vs Falcons game.

The game was great. Very loud, high energy, fun football. After the game, it was right into the car to drive 440 miles back home. We got home at midnight. Wow, I am tired just thinking about it that trip. My son had a blast and he was up for school the next morning like nothing. I was dragging all week. It was great.

I got tons of pictures. Here are a couple.

Today’s topic is pain. I am sure that I am not alone in this, but pain could be the #1 frustration I have in my office.

Post-operative pain: "These teeth never hurt before."

Phantom pain: "I was eating and I hurt this tooth. It hurt for a couple of days, I made the appointment, and now it doesn't hurt."

Real pain: “This tooth has been throbbing for 4 days and I have this pimple on my gums."

Nondescript pain: "The right side of my face hurts."

I want to talk to you about a patient I had. He came in with some fillings that were breaking down. One had a pulp exposure. After the procedure, I sat him up and told him that there may be issues with this tooth. Now, I do a lot of deep fillings and I do get pulp exposures and I rarely have people in pain. If I had more than five in a year, I would be surprised.

Let me rephrase that. I get post-op sensitivity all the time, but I adjust the occlusion and it is done. So I get less than five "This tooth you did a filling on hurts and has been hurting for 2 months and now is throbbing" cases a year. I get so few that I start to forget to tell people that there may be some post-op sensitivity.

A couple of months ago I did a few fillings on this guy. One of them had a pulp exposure. I did however warn him of problems. About two weeks later, he called with some pain. I told him that 99% of these issues will get better after an occlusal adjustment. But after the occlusal adjustment, I knew from his pain that this was going to be a 1% kind of thing.

Of course, three days later, we were doing a root canal on this tooth. It was #29. It was a by-the-book root canal. I told him I hoped to never see him again. Sure enough, the next day he called asking me if he should be in pain. I explained that he did have a root canal done and some post-op tenderness is normal. A couple days later, we were adjusting his occlusion again. I know you are all feeling my pain right now. Again, a couple of days later, he called saying he is still in pain.
I asked him if he was taking anything. He said he was taking ibuprofen and it was helping, but because he doesn’t like to take meds, he was only taking one tab every six hours, and it was helping.

Do you all know what is going on here? This guy is a total sissy. I have just walked this guy through this whole process, holding his hand all the way, and it turns out it is because he is a total sissy. One ibuprofen is like telling me you drank some water and it made it feel better.

Now I have a pain: a pain in my neck from this guy. It is one thing to deal with people in pain but to deal with patients that are sissies makes it worse for all the other people.

Hey I am so glad to be back.



Anonymous said...

About the endo, and I'm not a specialist, but I routinely inject 4mg of Dexamethasone into the vestibule after I've given the local. This greatly helps with the post-op inflammation from a 1-shot endo. I find I get people calling the next day thanking me rather than complaining to me. I don't know what it costs me but I'd say it's priceless. G

Anonymous said...

Yeah, I'm the 1%, too. Big sissy. Kept going to my endodontist, telling them the pain wasn't getting better. Over and over. Called or visited 10 times. Asked to see another oral surgeon in the practice. Finally referred myself to an ENT. Then on to a neurologist. Then to pain clinic. Tried this and that, until a combination of 4 drugs gives some relief. Yep, I'm the big sissy. Too bad no one listened.

Listen. Sometimes your patients DO tell the truth.

Anonymous said...

You must be a great dentist, oh how I wish I could visit your office!

gatordmd said...

I appreciate all your comments.
And from the sound of them I must have sounded like a pompous a!#$%^ to the casual observer. I reread it and yeah I would tend to agree.
Hey look, I can't be all cheery and great all the time. Sometimes I just have an edge.

I do listen to my patients and I do care but as a dentist you always have to have your radar up. This radar helps tell when someone is a drug addict. This radar helps when someone is taking advantage. This radar helps when something is wrong.

And lastly this blog is mainly for dentists. So I write these things to make other dentists feel like they are not the only ones who deal, and get frustrated, with post operative sensitivity.

I am happy with the public reading this. But you can't read one thread and judge.

I hope you went shopping this weekend.

Anonymous said...

You might be surprised to know that I am the "general public" you mention. I've learned a lot reading your blogs about the dentistry world, and I haven't read only one. But I am a gentle reminder to you and all the other dentists that your comments will be read and judged by the "general public", since that is where your blogs are accessed. I hope that dentists don't get their guard up so much that they fail to recognize the subtle signs a patient has that may indicate something is wrong, wrong, wrong. And I also hope that your blogs don't include enough information that a "real" patient of yours could be identified, or that a patient could identify himself.

gatordmd said...

I hear you and no, no one would ever be able to identify themselves. I change the story enough to make it almost a fictitious person.

Listen, I know how it sounds. But it is not that I put my guard up. I continue to care for my patients as they were my family. But you know how dealing with family gets.

Some times people feel taken advantage of, or hurt....both ways.

I appreciate your comments.
Thank you for reading.

Anonymous said...

Fracture,a habit (eg chewing on pen) or prematurity when going into cuspid rise?
Doesn't like pain killers?- ask what alternatives he has used previously.
Sometimes constructing a small anterior splint (out of acrylic temporary material- quick and easy) to be worn for just a 2 or 3 nights helps.

Elysse Parsons said...

I'm not a dentist too but I love researching and this site specifically because of the honesty. It's interesting to know how a dentist feels about the different types of persons and cases he encounters. I enjoy reading the posts here so I'll keep on coming back. Thanks again for sharing your thoughts.


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