Friday, March 19, 2010

THE DENTAL TANGO

"Life is a shipwreck but we must not to
forget to sing in the life boats"

-- Voltaire

The dance between the dentist and the patient is unpredictable. Each person's style requires a unique choreography. Some take the Two-Step, others require the Waltz, but with Tanya it was definitely the Tango.

She lay reclined in a motorized wheelchair; bellowing cheeks, bright eyes, curly, muddy-red-blond hair, huge lips, exaggerated make-up, no neck, hands that appeared to be plastic and a dress wrapped around a small ovoid body. A mouth stick was attached to the wheelchair near her chin as she gasped rhythmically for air.

Polio had affected Tanya's spinal column at a level of C-3 at a young age in the 1950s. Her lungs were not involved, but the intercostals muscles of her chest, abdomen and diaphragm were paralyzed.

Most people in this condition are confined to an iron lung, but Tanya was an exception. She skilled herself in getting people to do what she couldn’t. And for routine dental care without hospitalization, she taught me to perform the "Dental Tango."

Our procedure worked between Tanya's breathing for air and my brief invasive interruptions. Tanya would gulp, gulp, gulp, then I would drill for five seconds and get out. Gulp, gulp, gulp. Drill five seconds. Get out. The routine became second nature. Sometimes she would speak between gulps, and the pattern continued for the whole time she was in the chair. I was particularly proud of myself when we restored a maxillary second molar. On prior visits I feared that Tanya become overly dependant on our office for her care, ironically I now realized that Tanya had just trained me well.

Sometimes I'd go to her high-rise condo in downtown St. Paul to clean her teeth with a portable hand piece and conduct a limited visual exam. She was on state assistance but the high technical quality of her home was surprising. Her iron lung had a life-depending back-up generator, and this was not the easiest item to locate in the housing market.

Tanya also required a personal attendant to feed, bath, move her and perform all daily activities, and it was apparent their special relationship was built on intimate trust.

Tanya was a dictator. She learned early that if she did not demand the care she needed, she would not survive. She was driven to manipulate, insist, coerce and just plain bully. She did not exclude herself.

Tanya's body was forced into a new form. Her cheeks were huge because she bellowed them to swallow the maximum amount of air. Her neck was wide allowing an expanded airway from base of her skull to her shoulders. The shape of her head was altered by the face masks and elastics to maintain an air-tight seal. Her mouth had developed a big anterior open bite from the wooden mouth stick to operate her computer.

The lack of a working diaphragm and chest muscles affected her ability to clear her lungs. The secretions can act as glue preventing the lungs from proper inflation and causing collapse (atelectasia) resulting in upper respiratory infections and pneumonia. Several doctors told her that she would not survive this condition, but she outlived many of them.

She miraculously learned to mentally control her epiglottis because a ventilator hook-up would have limited her mobility. Fewer than twenty people in the world have learned the art of "pharyngeal breathing."

Tanya was personally affected by the meddling of the legislature over benefits and program cuts. She lobbied successfully on behalf of the disabled, and she was elected ‘Miss Wheelchair Minnesota.’

Tanya was our dental patient for more than fifteen years and she never had a bad day. She was a fighter who showed us that attitude can do it all. If we can’t control what knocks us down, we can choose how we react to it.

For Tanya, it was the dance.


--Patrick J. Foy, DDS, Minneapolis

Monday, March 8, 2010

CHOOSING TO LIVE

"If standard of living is your major objective,
quality of life almost never improves; but if quality of life is
your number one objective, your standard of living
almost always improves.”

-- Zig Ziglar, Author and Motivational Speaker


"I used to eat sheet rock,” the patient confessed, "They call it pica.”

He was a small Hispanic man whose boyish, olive-brown face was coarsely scarred and framed with neatly-trimmed jet-black hair. As I filled out his medical history forms, he peered at me with jaundiced eyes, hoping to catch my response.

“I suffered from severe depression and almost died several times,” he said, as if he had often shared this story. “But now I’m trying to get my act together for a kidney transplant. I want to live."

He resided in a nursing home; his kidneys had shut down and he was dependent on dialysis three times a week. Blood chemistry issues also compromised his ability to heal. The downward spiral of mental health had left his general health in shambles.

The patient had been referred by "Donated Dental Service," a volunteer program to treat people who are medically compromised. This man had destroyed most of his dentition with a combination of depression, neglect and the assault of chewing abrasive sheet rock.

The name pica comes from the Latin word for Magpie, a bird that will eat almost anything. The condition is world-wide, but because of patient’s shame and low incidence, pica often goes undetected. Causes may be cultural, physical (malnutrition and mineral deficiencies), and mental (developmental and psychological).

The erosion to this man’s maxillary anterior teeth was remarkable; they were worn down to the alveolar bone exposing unprotected nerves and dentin. His mouth was riddled with worn, fractured, decayed and abscessed teeth. Paired with poor oral hygiene, his dental state was catastrophic. A treatment plan was challenging because pica relapse is not uncommon. His fervent will to live became our motivator in helping him.

Many of his teeth were extracted and replaced with removable upper and lower dental prosthetics. Now he could eat and speak properly, and with his body rid of future dental infection risks, he was a better candidate for a kidney transplant to help satisfy his goal.

He said, "Everybody has been complimenting me on my new smile. I’ve never had straight teeth before. I can’t believe it."

It would be a pleasure to report that this man has received his kidney transplant, but he is not there yet. Despite several setbacks requiring hospitalization, he is slowly improving.

The interconnection of dental, mental and medical problems was clearly apparent in this extreme case of pica. However, these relationships cannot be as neatly separated as we formerly believed.

Medical pathology needs to be evaluated with a differential of possible mental health causes. People tend to ignore their dental health from stress, depression, low self-esteem, physical pain and other conditions. Anti-cholinergic medications, poor diets, poor hygiene and lack of preventive dental services also contribute.

"I want to live."

That was the mantra for our dedicated response.


-- Patrick J Foy, DDS

Monday, February 8, 2010

THE STAR OF DAVID

"Question with boldness even the existence of a God;
because, if there be one, he must more approve of
the homage of reason, than that of blind-folded fear."

-- Thomas Jefferson


His shiny black boots were laced up to his knees. Dressed in black, sporting Nazi swastikas on two arm bands, hair slicked back, Larry Trapp was a self-professed Nazi who wore the uniform daily and without apology. He boldly leaned on the wall waiting for his appointment at the University of Nebraska Dental School.

The "Nazi guy" visited so often, I assumed he had a lot of dental needs. Severe diabetes would later account for his frequent appearances. With his inability to fight off infections, he was prone to severe gum disease.

Trapp’s racist antics and hate crimes were often described in the Lincoln press. He was anti-Semitic, anti-Catholic and rumored to be Grand Dragon in the Ku Klux Klan. He preached bigotry on his own cable access channel and a criminal rap sheet reflected his hateful behavior.

In 1994, I was driving to work in Minneapolis listening to public radio and heard that a play about Larry Trapp was being performed at the local Heart of Beast Puppet and Mask Theater. The title was “Befriended by the Enemy,” a remarkable story of conversion and faith.

In 1991, Trapp had besieged a Jewish cantor Michael Weisser and his wife, Julie, with obscene phone calls in Lincoln, Nebraska. One day, the cantor responded that he’d heard Trapp had a foot amputated from diabetes. If he needed help with getting groceries, Weisser would stop by his house to get a list and go to the store. Trapp agreed and before he left, Michael told Julie that if he did not return home, to call the police.

When Weisser arrived at Trapp’s apartment, he was surprised to see how small it was. Firearms were spread throughout the room and Nazi flags were hanging on the walls. The cantor and his wife began routinely bringing groceries to Trapp, talking with him and helping him out. Somehow their kindness got through to the man. Trapp eventually begged for their forgiveness and actually converted to Judaism. In 1992, he spent the last two months of his life at home with the Weissers and their two small children.
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I waited until my twenty-fifth class reunion at the University of Nebraska to share this story with my colleagues, who remembered Trapp well from the dental school.

Before hearing the Weisser story one classmate sheepishly shared, “You know, I was working on the Nazi Guy and he needed a gold crown on his tooth. Right before cementing it, I carved the Star of David inside.”

May wonders never cease. By Patrick J Foy, DDS Jan. 2010

Monday, January 25, 2010

DOWN AND OUT

DOWN AND OUT
By Patrick J. Foy, DDS

“People are like stained-glass windows.
They sparkle and shine when the sun is out,
but when the darkness sets in their
true beauty is revealed only
if there is light from within.”

~Elisabeth Kübler-Ross

A bush of kinky dishwater-blonde hair masked the woman’s face with total disarray as she trembled like a newly-trapped animal. She dropped her head, trying to hide a face scaled with white patches and randomly sliced with reddened, shallow incisions. She glared at her feet with empty sullen eyes. Cat-scratched hands shook, clasping open and closed. In contrast, the drab-green, oversized hospital gown she wore carried a freshly-laundered, light fragrance.

Jane’s medical chart revealed that she was a middle-aged woman who had been found homeless in a back alley of downtown Minneapolis. She was dirty and cold, incapable of responding to simple questions, mumbling in a state of catatonic depression. After being taken to the E. R. for psychological evaluation, she was admitted to Station #22 where they attended to her basic needs.

Medication and electro-shock therapy soon re-fired her conscious state and brought on the agonizing dental pain caused from long neglect and an abusive boyfriend.

Before dealing with it, we had to work on stranger-anxiety as with a small child or any frightened creature.

Upon entering the room, to respect her personal space, I moved to the foot of the dental chair until she reached a state of acceptance.

“Jane, I appreciate that you’re a little nervous. I was deathly afraid of the dentist as a teenager. Your chart indicates that you have been having some tooth pain?” She nodded and cupped her jaw.

“Does the lower-left side hurt today?” She nodded again. “Can you point at which tooth is hurting you?” Her body shuddered as she opened her mouth and pointed to the back. From a distance, I could see her hollow, brown molars on red, swollen gums.

Sensing humiliation, I said, “My mother lost her teeth when she was twenty-seven and my father lost his at fifty. Both were good people.” She stopped writhing and for the first time relaxed with a calm that appeared to be trust.

We took a Panorex, a full x-ray of her upper and lower jaw, which showed that only two teeth were salvageable. Over the long term, they, too, would be of little value.
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I gently explained that most of her teeth were beyond repair, but today we would attempt to relieve her pain. We discussed options for short and long-term future care, and she asked excellent questions. Later, she told us that she’d worked as a dental-lab technician.

In preparation for complete upper and lower immediate dentures, Jane returned for several visits and became comfortable in our office. During each encounter we were building a relationship while alleviating her suffering, along with the hospital mental health treatments and medications.

The day of reckoning arrived when I extracted all her remaining teeth and inserted the new dentures. The results were beyond her wildest dreams. The dentures not only fit well but gave her a beautiful smile.

The next time Jane came into our office, she walked with radiant grace. Her hair was styled, her eyes bright, chin lifted with pride and her face revealed a natural inner light.

A few months later, the psychiatrist sought me out at a staff meeting. He reported that Jane’s dentures had drastically reduced her hospital stay by several weeks, and lifted her self-esteem to a new height that no mental science could measure.

Our work was done.

© 2009 Patrick J Foy, DDS

Friday, January 15, 2010

HAITIAN DENTIST

“Good judgment comes from experience, and experience comes from bad judgment.” Rita Mae Brown


Destiny serendipitously pushed me onto an empty stool for lunch, as I sat down the lady next to me began to chuckle at my expense. It was a hurried sports bar and grill on an unusually steamy hot fall day in San Francisco. She appeared to be a petite Hispanic in her mid-thirties with gold-rimmed glasses with an ADA “Dentist” name tag from The American Dental Association’s annual meeting. “You don’t know what you just did” she giggled. “What” I asked.” “You see that line of people. All those people have been waiting in line to order food and after they get their food they wait and look for a seat. You just walked in, sat down and ordered with out waiting in line.” “I came from the hotel.” I was pointing at the back door. “I didn’t mean to cut in line, but I thought if there was an empty stool available, then there would be nothing wrong with me sitting down. So, I guess I am with you today.” I chuckle.


She had already received her food order and was eating as we curiously continued our conversation. She was from Haiti and I was from Minnesota. She was here for the convention to improve her dental education, see what’s new in dentistry and escape. We mutually shared our ignorance’s of each other geography. We both had misconceptions of each others worlds, cultures, and life styles. I must admit I was a bit arrogant about my United States’ training and my perceived prosperous quality of life. I attempted to get a flavor of her world by asking a ton of questions and she likewise was curios about life in a colder climate. Like most things in life we shared more commonalities than differences. We talked on and on describing and comparing our strange worlds.


She shared that she was afraid to go back home after the convention. There was an epidemic of murders that were occurring in her country. The servants of the wealthy were killing their bosses and absconding with their processions. The current government was unstable and the police were infiltrated with corruption. She said that she has several domestic servants, for example, she does not own a wash machine and clothes dryer at home. If she did have automated appliances at home she would be putting several people out of work. The poverty was so great that they employ people to do all kinds of menial domestic work.


Her family wealth was from a family owned rum distillery. It had recently lost its profitability, but with increase in popularity of rum in the Caribbean region the family was trying to re-invest in the distillery. Her family was able to afford her advanced education. She had lived a privileged life in an uncertain part of the world. Her practice was not that much different than mine. She was in a solo practice in a metropolitan area and she worked 34 hours a week.


I was aware of the extreme poverty, aids epidemic and rampant poor healthcare services so I asked her “What type dental care do you do for the poor?” She abruptly answered “I do not do any dentistry unless I get paid.” As she said this I was stunned; “How callused she seemed to her own people”. The fact that she didn’t seem to care about the poor was not how I was raised. I didn’t have a very good poker face. I must have been looking down my nose at her, she sensed my judgment.

She immediately replied” You do not understand, as a professional woman, I advocate for women rights in Haiti. Women are second class citizens in Haiti. I feel it is a better use of my time and talents in this area. I hope to make a bigger impact in my country as an advocate for women than trying to solve every little dental problem.” I was handed my smugness with her revelation. I had no right to judge her. My values, in my world did not make sense in her world.

Altruism is personal. PATRICK J FOY, DDS

Thursday, December 31, 2009

HAPPY NEW YEAR!

I am happy to share with everyone that we are adding more hours to our dental hygiene schedule. This will open our practice to accepting and welcoming new patients into our practice. Our current hygienists both have requested to add more hours to their current schedules, so we our inviting new patients and referrals to fill her expanding schedule.

Dr. Foy and staff have been practicing in the Riverside Professional Building Suite #806 since 1981 and we accept most dental insurance plans. We have enjoyed being part of the Riverside Campus and hope you will keep us in mind for you and your families dental care in 2008.

We want you to have a healthier new year, but we also want to make it a little brighter. As a small token of appreciation for all new patients scheduling for a “New Patient Intake” will offer a free professional strength Crest Supreme White Strips.

Please ask for your complimentary kit after you get your teeth cleaned.


We look forward to meeting you and your friends, making it a happier and healthier New Year.

Happy New Year
Patrick J Foy DDS

Wednesday, December 9, 2009

END OF THE YEAR PLANNING

Did you know that each year insurance companies make millions of dollars off patients who forego necessary and preventive dental care? Many individuals who are paying for dental insurance do not realize that their plans provide coverage up to a certain dollar amount annually. Consequently, some patients are not scheduling the dental treatment they need, deserve, and have insurance to cover. Thus, the insurance revenues allocated to pay dental claims on many patients are never used, and, unfortunately, those dollars cannot be carried over year-to-year. The bottom line: what the patient does not use they lose.