Tuesday, August 31, 2010

Oh. Em. Gee.

I think this might be the cutest thing I've ever seen:

OR, is it cuter when he carries the kitty around?

 I don't know - I think it may be too close to call.

This monkey adopted this stray kitten in the Indonesian jungle, and made sure he was safe from harm. See, cats are good for everybody!

Read the rest of the story by clicking here.

Tuesday's Teeth: Cincinnati

Last week I went to Cincinnati to visit a pediatric residency program as an extern. Its like of like being an intern, but for a really short amount of time and you don't really do anything helpful for them. The whole point is that someone considering the program gets to visit and see how they like it, and in turn, the program can see if they like the extern. I'm really lucky that I got this externship, because Cincinnati is such an amazing program... and I'm glad I got to go before their program's application deadline.
Before I go any further, I should go ahead and admit this is kind of a cop out Tuesday's teeth... but this is what's on my mind, and its making it hard to discuss dental materials, as I had originally planned. (I know, how disappointing.)
Alright, all that being said, and moving on...
I was there just for a few days, and again, I was fortunate to meet residents that tolerated my awkward hovering and annoying questions. These residents? Amazing. I really, really liked them a lot. They were all really down to earth and normal. A lot of pediatric residents have a certain personality - like, super upbeat with kind of a Leave it to Beaver outlook on life. That's great and all, but I relate better to the kind of people  watch Bravo. (Does that make any sense, at all?) Well, anyway, these are Bravo people.
Well, these residents were extremely nice and friendly, but I don't know - somehow normal and relatable at the same time. They all get along really well too, which is such a good sign in a program. Its a really busy hospital based program, and these people work... but its not just that - they're so competent. This might seem like a given, but at this point of the year you have to figure that the first year residents are brand new, (they just started in mid-June,) and the second years have just barely started their second year. The people they used to ask for advice have graduated, and now they're the experienced ones... that the first years go to for advice...and they're really knowledgable about so much: certain rare syndromes and other health conditions their patients have, as well as the how-to's of pediatric dentistry, sedation, and running an OR case. I can't believe how independantly they can work as residents. I hope I'm like that someday.
So all in all, I loved Cincinnati. Its an extremely competitive program so I might not get an interview there, but I'm glad that I got to go ... no matter what.
That's my last externship - so now really, the wait is on to hear from programs. So you might remember that I also externed at Connecticut, and I also visited a couple of programs last year, including my alma mater, Baylor... which I also super loved. If I could hug an externship, I would have hugged my Baylor one.  Geez, hopefully these directors and residents don't think I'm totally weird.
I gave myself the deadline of today to apply to any additional programs, (and I'm not going to,) and since I probably won't hear anything for the month of September, I'm going to try to chill out and act like a normal person. I'm going to do my best not to check the student/doctor/forum whatever website to see who is getting interviews where and what rumors are swirling around about which programs. I'm extremely nervous, but I know that I've done the best I can do at this point to get in somewhere. I'll keep you all posted if I hear anything. Please keep your fingers crossed for me.

Monday, August 23, 2010

(Monday's)Tuesday's Teeth: the Night Guard

 I'm doing my first Tuesday's Teeth today since I'll be out of town this week, and after meager and easily given up upon attempts to figure out how to schedule this to post tomorrow, I'm just posting it today.
Today's teeth related post will be about my really wonderful patients at one of my offices, whose perfectionist tendencies necessitate the use of a night guard, but whose very analytical nature renders them too skeptical to believe they need it.
In one of my offices I enjoy a population of patients that is almost universally unknown outside of the little community in which our office is nestled... and that is the nearly 100% compliant, best
dental insurance carrying patients, who are willing to get all treatment needed. Almost all of our patients do what we recommend. We say they should get an electric toothbrush - done. Start flossing? (usually) done. They come to their appointments ten minutes early, and I usually have to make them tell me if something is uncomfortable. So to say that I love working in this office is an understatement. However, there is just one thing that I have a hard time conveying: their need for the night guard.

A night guard serves as a splint to protect the dentition from nocturnal bruxism, or clenching and grinding your teeth while you sleep. This is a maladaptive habit, born out of a normal growth and development occurance from childhood. As children, we would clench and grind our teeth, which directs mandibular, or lower jaw growth in a downward and forward direction... so it serves a purpose. As adults, we have achieved this development already, and while we won't see bone growth in this direction, we may see boney projections in the floor of our mouth or palate. These are harmless, and most people never realize they have them. (I should also point out that these projections, or "tori" are consistent with bruxism, evidence hasn't not definitively determined a causal relationship.)
 In this community of truly Type A people, it is extremely common for me to see signs of nocturnal bruxism, in other words, clenching and grinding unconsciously to deflect stress. Generally these signs are in the form of extreme wear on their dentition. Often the cusps of their posterior teeth are flattened, and front teeth appear shorter or fractured. Sometimes patients will chip front teeth, or shear entire cusps off of posterior teeth as a result.

There is wear through the external tissue layer of the tooth, the enamel, which is an otherwise protective layer that is not innervated, thus we can eat or drink cold things, brush our teeth, and chew without discomfort. When this layer is eroded, our teeth become sensitive to otherwise innocuous stimuli. What may even be worse, is the damage bruxism has on our temperomandibular joint, causing excess wear on the articular disc, which can cause clicking, popping, and pain in front of your ear when you chew, yawn, or talk. Furthermore, it is common to experience muscle pain in the masticatory muscles, or jaw opening and closing muscles, as a result of the slow sustained contraction exerted during bruxism.
Often our patients come in with sensitive teeth in areas that jump around. One week it was the lower left, another week it was the upper right. They may feel sensitive in their muscles in the morning after waking if they are nighttime bruxers, or at the end of the day if they clench while at work.
All of that being said, it is extremely difficult for me to convince most patients that their symptoms are a result of bruxism, and they need a night guard.  I think one of the first reasons is cost. Night guards are usually around $500 at the very least, and they are not covered by insurance. Also, most people haven't heard of night guards before, or bruxism, and its hard to fathom that they don't just need a filling, which is covered by insurance, in order to fix the problem. Second, as I mentioned before, these patients have gotten pretty far in their life as a result of their constant questioning and need for extensive, irrefutable evidence before coming to a conclusion. This means they often see the aforementioned signs as insufficient evidence of bruxism.
I explain to the patient what I see, and how common these findings are in this population. I explain my recommendation for the night guard, and then... I tell them how much it costs, and they're skeptical. So then we're at the part of the appointment where I feel like a car salesmen, and I don't like that.   I honestly do feel bad that it is so expensive, but the fact of the matter is, its fabricated by a good lab, and they're expensive to make. If they balk at the cost, I encourage them to try an over the counter night guard, which is significantly less expensive, usually around $25, but I know its a waste of that money because the quality is such that it makes nighttime use of the thing pretty unpleasant. So am I doing my patients a disservice by immediately recommending the OTC night guard? Should I emphasize their need for the prescription night guard even more? Its tricky when it becomes about money, when they're sitting in the chair that I perform treatment in. It starts to blur the line between business and health. Unfortunately, this is just the way it is. I don't have a private office where I discuss the treatment plan, and yes, perhaps that would be the most ideal and something I will do in my own office, but in a big group practice that just isn't practical. If the patient has a big treatment plan and wants to work out how to maximize their insurance benefits, they talk to our office manager or billing manager privately in their offices, and that works out pretty well... this is just the one area that's tough.  In any event, if you have any questions about bruxism or think you might benefit from a night guard I'd be happy to answer any questions for you in the comment section.
Have a great Monday, (and Tuesday) everyone!

Photo credit 1
Photo credit 2

Sunday, August 22, 2010

Born again

I used to be catty and sometimes sort of mean. Then I started reading blogs, and a lot of the girls that write them are really nice. So then I thought to myself, I'm going to try to be nice, and see people in a positive light.
Here I am, after reading a lot of Cupcakes and Cashmere:
I made Joey take this picture. And well, a few other ones almost just like it that didn't turn out as well.
This is my dress of Summer 2010. I wore to everything. I love it.
All that being said, I've tried on being nice, but well, it doesn't really fit that well. There's just so much trying, and I only have so much energy.
Yesterday I decided I can only be nice to so many people each day, and well, its just good sense that I'll have to spend that quota on Joey, then my patients. I'll still be nice to the nice people and people I already like, but maybe not the car repair people, for example.
The good news is, I think this can only help my blog.  Today I was my old self again, and it felt so good to be back. 

Saturday, August 21, 2010


I think Leon had a good day.

Saturday I do the laundry... and I will say, this was a terrific laundry day.  Aside from that, this has been the crappiest Saturday I've had in a long time. This morning I had to drop something off for Joey at his office early... and when I walked in the hygienest asked me if she could help me, with a concerned look on her face. As it turns out she didn't recognize me and wondered who the hell I was walking through the office and waiting for my own husband to be done with his patient so I could give him his scrubs. I mean, do I look THAT different without makeup on? Apparently so.
Then I got home and saw on my dining table a ticket for an expired inspection sticker. The ticket was written from the parking lot of the community health center where I work, in the most dangerous neighborhood in Boston. That's right, while I was inside the building seeing patients, a police officer took it upon him(or her)self to pass 3 condemned buildings and a small playground that are all frequently populated with loiterers and junkies and whoever else, and stood in our parking lot and wrote me a ticket. Yes, the thing expired 3 weeks ago, yes, that's my fault, but I mean, can't I get a break? The ticket was sent through the mail - he probably didn't want to put it on my windsheild for fear someone would steal it. I won't even comment on how this gross injustice relates to the socialsim that plagues Massachusetts.
So then I took a shower and blew out my hair, put on tons of makeup, since I otherwise frighten people, and went across the street to get the car inspected.
And, it failed. As soon as I pulled up, Jorge, the car inspector, said he could tell it was going to fail because of the way it sounded.  Awesome. Of course I didn't have the updated car registration, because I had previously filed it in my file cabinet. Genius. So then I got back in and rattled home to get it, just so that I could return to get a new sticker with a big R on it. For Rejected.
Its actually better to get the rejection sticker because then at least we have 60 days to fix it, versus getting more tickets. At least that's what the man that I had to pay 29 cash dollars to get it inspected said.
  I guess this is what I get for revelling in how financially savvy we've become, how good we are (or Joey is) with our money and how we're starting to really get a handle on things and be grown-ups.
So now what, do we take it back to the place where we picked it up two weeks ago after spending a fortune? I don't know. I'm sad. Alright then, well, its five o'clock now, time for a drink. Here's to hoping this is the only rejection I get before Match day.

Friday, August 20, 2010

Tuesday's Teeth

So I've neglected to mention much of my everyday life - that is, what I do at work, on the blog... because my tendency is to talk about things that have happened very recently on here - obviously it isn't that hard to figure out where I work, and it would be a breach of patient confidentiality to discuss daily cases as they happen on my blog...plus it might not be that interesting on a day to day basis. That being said, I feel like I leave out a big part of my life by not talking about my work, so once a week (Tuesdays) I want to (try) to bring up interesting cases or situations that I've experienced myself or through coworkers or friends who are dentists. I'll see how it goes, and if its boring and no one cares, well, that's OK, because this is my blog.
Alright then, what else?
Remember how I was acting like a better wife and not buying frivolous stuff like make-up? Well, that was then. Last weekend I went to Sephora (it was tax-free weekend afterall,) and bought the Lancome Artliner eyeliner. Fortunately for me, the store was empty because everyone was downstairs in line at the Apple store waiting to buy computers and hand-held portable electronics.  Anywho, I digress... this eyeliner is probably hands-down, my best make-up purchase... and brings me one step closer to my goal of looking like Kourtney Kardashian.

I'm still working on the hair. This morning I paired it up with the new Maybelline Falsies Mascara, because I saw that one of my favorite bloggers (who also has beautiful eyes) liked it. Well, I didn't love it. I had to separate my eyelashes with a safety-pin, and I like to save my hand skills for my workday.  I'll stick with the old Maybelline GreatLash, its pretty good, and well, if it ain't broke...

Well, all of that being said, I hope that everyone has a great weekend. Happy Friday!

Monday, August 16, 2010

More on cats

The day we adopted Leon, we actually wanted this other kitten that we saw on the internet. She was white and fluffy and her name was Mopsy. Then when we got there they told us that she had a "kitty cold" which we later found out is code for ringworm, but they had this one:

I have to admit, at first, I wasn't thrilled. I wanted the white girl one. Plus this one's name was Leland (after a kind of Christmas tree, it was Christmastime.) But then the lady brought him out and he literally ran into my arms, and I loved him, and the rest is history. Bonus that Joey thought his name was Leon, which is his favorite boys' name. As it turns out, he was a perfect fit... and now I don't have to name my son Leon.

ANYwho... I finally got my white cat last weekend! She has a moving tail and blinks and keeps perfect time! And Leon loves her!

Well, not that much.

Here's Joey trying to make Leon look like a cat clock.

It looks like we tortured him but he was fine. He got some treats afterwards and it was win-win for all. I love this clock so much. It really does keep perfect time, and it brings me joy each morning when I make the coffee. Of course I love my Leon too, I wouldn't trade him for a million Mopsies.

I hope everyone had a great Monday.

Friday, August 13, 2010

An Engineers Guide to Cats

May not be as enjoyable if you don't have cats. Have a great weekend!

Thursday, August 12, 2010

Family Ties

I struggled with work on Tuesday, but that was in part because I had such a great Monday... because...
my family came to visit!
My mom and dad and grandma came up from Connecticut basically just to have dinner with us. My parents are visiting CT from Texas, and they haven't seen our place yet - so they made the trek up.
It was so fun to see them, I had such a great time. After everyone came over to our apartment we went out to dinner at La Morra, then, even though it was late I sort of forced everyone into a car ride around Boston. I have a hard time letting go, and well, I had them all captive in the car.
Thanks Mom and Dad and Grandma! I can't wait to see you again soon.

Tuesday, August 10, 2010

Today's Blessing

What can I say government run workplace? Today, you have won. You drove me right over the brink of insanity. This morning, if I'd had an inflatable escape route perhaps I would have taken it, but I don't have these fancy supplies.

So what's a girl to do in order to camouflage losing her mind? Its easy! After your last morning patient duck out the back door and peel out of the parking lot to Dunkin Donuts, then get an ungodly amount of munchins for one person... and a coffee sort of for show.

Then come back and eat them at your makeshift desk in your operatory. Don't worry, its just a little bit gross.
Thank you Dunkin Donuts, you were today's blessing.

Thursday, August 5, 2010

Red Sox and Television

So as my self-doubt and self-pity over the application process continue to duke it out in the background, lets talk about something fun.

Like Red Sox games! Holla!
Joey and I went to a game about a month ago, and it was awesome.

Don't mind that I look like a boy here, I was trying to have carefree side french braids that met in the back and for some reason wore insufficient eyeliner, but that's alright.

Joey had never been to a game, and I hadn't been since college, which doesn't count because back then I just sacrilegiously waited for it to be over.

Maybe because I didn't have Joey to go with. Here he is with a Fenway Frank. Delicious!

Then it was time to sing Sweet Caroline, and Big Papi hit a homerun, and all was right in Boston. This is why I love living here.

In other news - why does Bravo torture me with these terrible women on these Real Housewives shows? I used to really like them, but now they're so terrible that I can't take it. That personality type - the entitled delusional confrontational type - is not good entertainment for me. I just get angry and want her to get a job and a grip. This is on my mind as the new DC one is on my TV at the moment, when I anticipated seeing the Bethenny Getting Married? episode from last week. That show is OK. Mercifully, Property Virgins is on at the same time. I love Sandra Rinomato!

Alright, what else - I spent a couple of days at UConn this week visiting their pediatric residency. The residents were so awesome and kindly tolerated my awkward hovering in their clinic. I was so impressed with the people in that program - their residents were really top notch and their attendings were so kind and knowledgeable.  One of the attendings thought my last name was LaPorta, and then I compulsively told her how much I love Designed to Sell. Fortunately, she does too... so it just got better and better. Plus I got to stay at a cute inn and I felt like I was on Gilmore Girls! 

Last but not least I got to see my parents and my grandma in Bridgeport last night! It made my heart feel good to have dinner with my family. Now I'm back and ready for one more day of work before the weekend. What a great week.

Monday, August 2, 2010

are you there baby jesus?

so I said in my last post that I'm applying to pediatric dental residencies like its no big thing - just a lot of paperwork and time... but its a pretty big deal in my life right now.
doing this is about 2 years in the making - debating back and forth if I should do it, the expense of applying, telling people about it, and then if I get in, we'll be moving... and maybe not to the most glamorous place. (hey, fine with me - at this point I'll sell my soul to whichever program will take me.)
its scary for a lot of reasons...what other people will think about me doing it for one. well - we don't care what other people think, right? yeah right. some people, even friends who probably don't want to feel this way - get some weird satisfaction of other people who try something and it doesn't work out. come on, we all know it, and we've all been that person. will people think I'm doing it for the money? because I'm not a good enough general dentist? well - the money IS good, and I'm not going to apologize for that, and there ARE days where I don't know if I'm a good dentist... but I think people who don't have those doubts are a-holes (sorry for the swear mom and grandma,) and unfortunately I won't be able to relate to them at happy hour.
anyway, I digress. I feel guilty for how expensive the application process is (did I really need to apply to so many schools?) and the time it takes while I'm at home writing cover letters and filling out applications each night.  
I also feel crazy apprehensive and fear rejection.
I just want to be a pediatric dentist - I have pretty big aspirations related to that but that's another story for another day. Can't somebody let me in? That would be just superb.
The residency coordinator at Indiana sent me the most courteous email so naturally now I love that program even more. Joey said if we move there we should probably get a farm, some blue heelers and maybe even a horse that we'll name Lightning. That would be so nice.
Today, (in other relatively unrelated news,) as I was getting on the train home after work I was thinking about how lucky I am that I have a husband that  has mentioned twice since being back from Belize that we should get horses someday because I loved them so much while we were there. He's pretty alright, that Joseph of mine.
Alright then, I'll draw this rambler to a close. Goodnight all, here's to waking up a little bit less neurotic tomorrow morning.

Sunday, August 1, 2010


So I've been delinquent with my posts lately... I'm applying to pediatric dental residencies and it has been pretty time consuming. I can see the light at the end of the tunnel with the application process, and I'll tell you more about it when I'm done. Please bear with me. I hope you all had a great weekend!

Cover letter writing and paperwork assembling station. Note my green binder/security blanket with all of the information about the programs, and 2x2 photos that I practically had to bully the CVS girl to sell me in bulk.

Supplemental materials awaiting quality control assessment prior to sealing up... ie did I write the correct name of the school in the beginning and closing paragraphs, and like, actually sign my name. Believe it or not, I have to do this at least three times and I'll still find obvious mistakes - like "Dear. Dr. Haney," I'm telling you... its pretty amazing.