Doc's Writing Refuge

Grades. We live and die by them throughout our academic journeys. And it starts right out of the gate during that tender time we call kindergarten. Yep, right then and there it happens: we’re labeled. By a combination of our peers and our teachers we’re either lumped into the smart kid group…or the other group…because of our grades. It’s really easy to be moved out of the smart kid group but it’s nearly impossible to ever move into the smart kid group. And once we are assigned to a group we all start to look at each other differently: “oh yeah, there go the smarty pants” and vice versa. Often the two groups find it hard to intermix and socialize together. The two groups usually remain segregated throughout their entire precollege journey right through to graduation from high school. And within the smart kid group we find competition.

And throughout our precollege years we are constantly reminded that grades are everything. Grades mean college. Better grades mean a better college. A better college means a better job. And a better job means a better income. And people with better incomes…well, you do the math. However, once in college some folks seem to finally relax just a little bit because they made it to college and they’re on their way to their career.

However, those who need college as a means to be accepted into graduate school, well, you probably already know the story. Better precollege grades mean a better college. Better college grades mean a better graduate program. Better graduate degrees mean a better income…and so on and so forth.

Dental students work damn forking hard to get into dental school. And making it into dental school is such an incredible accomplishment and reward for soooo many years of hard work and sacrifice. But right out of the gate starts the whole grade shit show again. People become segregated. People get labeled. People become competitive. People do silly things in the name of grades. And grades can lead folks down dark paths of horrible stress, anxiety, and depression (even to the point of suicide). Grades can and do make generations of emotionally scarred dentists. And to what end? Can there be a better way?

Dentistry and dental school can, in my opinion, do without segregation, labeling, and competition. I may be a bit of a socialist (yeah, more on that a different day) but we’re all training to do the very same things in order to serve the public. In other words, we are a profession: we’re not trying (or at least we shouldn’t be trying) to put our colleague down the street out of business. We are a profession: we are a group of professionals coming together with a common goal to serve (…and to try to earn an income). We are a profession: we should be somewhat united in our ambitions and beliefs when it comes to the ideals of the profession.

But, in my opinion, it doesn’t seem to run that way. Shouldn’t it be enough to be accepted into dental school and become a doctor working as a team with other doctors? Well, things get a bit murky. We have good folks who wish to specialize. Unfortunately those folks are judged by the very same thing that we’ve all been measured against since kindergarten: grades. Our system of grading forces those who wish to specialize to continue fighting for grades. And competition can be fierce. And competition can be polarizing. And competition can be segregating. And competition can make people act in ways…well, you do math.

I’m not a specialist so I want to make sure I’m not just doing a sour grapes thing here: I graduated with honors; I was going to be a pediatric specialist but withdrew my application right at match because of my having to attend to family needs. I even won the University of Minnesota Pediatric Dental Award…and I boycotted my awards ceremony. Why? I was disgusted by the competition fostered by my dental school (you know which one it is). I was disgusted by the lavish awards given to the grade getters in my class. I was disgusted by my dental school’s fostering a culture that promoted specialty over general dentistry. I was disgusted by HOW FORKING HARD my friends worked to just be able to graduate and they got NOTHING. It’s as if becoming a general dentist was a consolation prize.

Let me tell ya, our profession thrives because of general dentists. And being a general dentist ain’t a bad place to be (seen any recent US News & World Reports about forking good jobs to have?). And please don’t get me wrong: I’ve been around some great specialists and some great people who went on to become specialists. That said, the opposite is also true. And I think we need to remember that specialists work to SUPPORT general dentists. Specialists can not work unless given work by a general dentist (it’s called a referral). And the specialists that I have CHOSEN to work with have all been OUTSTANDING SUPPORT for my practice. That said, I have chosen to NOT work with some specialists who could or would not support my mission with MY patients. And it makes you wonder: what kind of people were those specialists before they were specialists? Did grades and competition play into anything related to the formative processes that led some specialists to their station in life? Specialists: doctors with magical dental super powers who can exercise those powers only in a supportive manner when called upon by a general dentist (it ain’t about the jerk with magical super powers cuz that docta ain’t gettin’ my bizness).

So, maybe there’s a better way. Maybe there’s a way that we can all play together nicely. Perhaps there’s a way that we can come together as a team for the greater good of society. Maybe there’s a way that we can support and reward hard work free from the debilitating, segregating, and down right nasty effects that arise from grades. Is it time to rid ourselves of grades? Is it time to recognize that it’s DAMN FORKING COOL TO BE A DENTIST AND WE DON’T NEED A FORKING GRADE TO SUPPORT THAT FEELING OF COOLNESS??? And remember: I HAVE NEVER HAD A PATIENT ASK ME ABOUT MY GRADES IN DENTAL SCHOOL!!!

DDS…’nuf said.

Dental students are, in my opinion, quite brilliant and have to be in order to survive the academic rigors of dental school. So much information and so many classes are thrown at students in rapid fashion and in a very short amount of time to help keep the financial burden (which is absolutely ridiculous) and the amount of time spent in school to a reasonable level. And with so much information in so little time I find that students tend to compartmentalize (“box”) information as a means of academic survival.

Often there are dental school courses with disparate information that have no connections to anything and contain nothing relatable. These classes tend to be the ones we slog through the most and sometimes have to rely on shear determination and plain old memorization in order to survive. On the other hand, there are several classes that stream together marvelously and build upon each other. For instance, the general dental sciences courses, which I help teach, are the very skills that students will use for the rest of their dental careers. We start very basic and then we add more and more elements that connect from one general dental sciences class to the next, from one semester to the next, and from one year to the next with the ultimate goal of graduating a practitioner that is empowered to safely, skillfully, and compassionately care for their fellow humans.

However, (in my opinion) disparate courses with no apparent connections to anything hijack student’s abilities to make necessary connections from one class to another and knowledge retention/connection and ultimately implementation becomes disrupted. So often students are forced to jam information into their minds, take a test, then push that information to the recesses of their minds in order to make room for more information. And switching gears between these different classes can be difficult especially when there may be extreme stress and a lack of proper sleep, nutrition, and physical fitness.

Disparate courses are a necessary part of the dental curriculum however those disparate courses can create some frustrations for we faculty. We faculty know exactly what’s been taught in each of our classes and we faculty expect that each student will be able to retain and use what’s been taught in each of our classes. And as we know that the students were physically present in each of our classes, frustration arises when we come to the realization that information given minutes earlier can not be recalled, accessed, and used properly by the students. In essence, we faculty can lose sight of the fact that students have way more going on than what meets the eye. Even though we faculty are ultra focused on the importance of that which we’re teaching at that moment students are having to prioritize twenty different items which are ALL high priorities to each faculty they’ve encountered within a 48 hour time span (hmm, which of my twenty #1 priorities is truly #1?). Ya think that might cause a little brain pain?

We faculty, as dentists, have to constantly be aware that we have dental information connections that differ from our students. We faculty have been exposed to dental information for a greater period of time compared to our students. And as practicing dentists we have necessarily been forced to creatively combine information from many sources in order to better accomplish tasks necessary to treat our patients. This naturally gives we faculty/dentists a much deeper and richer and more connected/integrated knowledge base. Unfortunately our students (out of sheer necessity for academic survival) look at each individual class they take as a “box” with information that goes into and stays in each individual box. As stated previously, I believe this to be necessary for academic survival. And, yes, we faculty were dental students once upon a time and have necessarily been through the exact same things our students currently experience.

So, there is hope for our students. And we faculty have to be cognizant of the struggles that we went through as students so that we can recognize and be sensitive to our student’s struggles with burdensome amounts of information that may be overwhelming their abilities to integrate, connect, and properly use knowledge. Therefore I feel that it’s important for me to explicitly connect information and concepts for my students. Daily my students may have extenuating circumstances that disrupt their ability to recall information much less connect it and/or use it properly in their simulated and real clinical experiences without deliberate prompting from me. Through daily huddles prior to simulated and real clinical experiences I can deliberately bring prior knowledge to the fore thereby helping students to recall concepts previously discussed. What’s more is I can then take that prior knowledge and connect it to the day’s new information thereby creating a richer and more creative experience for the students so that they have more tools at their disposal and a constant reminder that we are truly building knowledge upon knowledge. This way creative pathways can continually be created and strengthened between new information and old information.

I hope this posting was helpful. Please let me know whether or not you hated it. Maybe you might have even liked it? 😊

This is a bit of a tough blog entry for me but I somehow feel very compelled to write it. And I hope this entry doesn’t come across as self indulgent or self loathing or seeking pity, etc., etc., etc. I just wish to be brutally honest (especially with myself) and maybe, just maybe, some good, both for me and others, will come from my outpourings regarding this journey. So, please forgive me if this whole entry elicits a feeling of needing to projectile barf (you’ve been forewarned…stop reading right now, if you wish, before it’s too late!).

Going on two months ago a very horrible something was perpetrated against me. Many know what that horrible something was and I am not at liberty to discuss anything about that horrible something. But that horrible something triggered my suffering/struggling with uncontrollable, horrible, and debilitating panic attacks. With a combination of medications and, now, counseling I am beginning to gain some ground on my panic attacks. This is quite the journey, though, and time, patience, progress, set-backs, happiness, sadness, frustration, elation, discovery, etc., are all part of this journey (one does have to be brave in order to heal). And I am ever so grateful for the outpouring of support from my employer (I have been granted medical leave time for treatment), my colleagues, my students, my friends, my family, and my wife (Saint Kris).

So everyone has shit going on in their lives. I think that’s an unfortunate side effect of living. Sometimes that shit is shit we can live with fairly unscathed. Sometimes that shit can do weird shit to us. And sometimes I think we never realize some of the shit that’s going on in other people’s lives. For instance, a few people might say that I’m kind of an upbeat person every once in a while. Little do people know about the shit I have festering in the background. Huh? Many years ago I was inspired by two books: The Inner Game of Golf and The Inner Game of Music. Basically those books describe how we can deal with our shit and put our shit in the back of our minds so that we can get our shit together so as to perform at our very best. When I’m on stage (I use “stage” as a metaphor for life) I have to have my shit together and for the most part I think I do this fairly OK from time to time. But I’m learning that the horrible something that happened to me probably overwhelmed my coping systems. The horrible something was a trip wire that set off the bombs in my mind. And this is likely what led me into this journey with mental illness. And this same process happens to SOOOOO many people. And it is good and right to get help when this happens.

So what’s been going on in my life (bail out now if you haven’t done so already…here comes the self indulgent shit!)? Let’s go back a year in time (if you’re still reading you are brave!) and look at things in order.

Last year at this time my beautiful Jasmine kitty was still alive. She had significant kidney failure. Further, I needed to test her blood sugar twice daily and dose/administer insulin twice daily to help manage her diabetes (umm, yes, I had to prick her skin to get a blood sample and I had to inject the insulin). She was on a strict diet to keep her kidneys and diabetes in check so she had to be isolated from our other cat’s food. And daily I knew that Jasmine could have a really bad day that would necessitate my having to make a very difficult decision.

Last year at this time horrible body pain ultimately led to my having to become gluten free. Though I may seem upbeat about being gluten free this is sometimes a daily struggle. I have had to change SO many things in my life. And I have to be SO careful. Carefree eating is a thing of the past. Going out to eat on a whim can be daunting. Grocery shopping can be frightening/frustrating. And vacationing can be a downright nightmare when thinking about safe food options (thank God for Disney and their accommodations).

Last year at this time we were moving my wife into her new dental building. This was not without challenges. We were moving everything out of the old office. We were closing the entire practice for at least a week to move and get the new building up and running. We were worried about finances with the practice being closed for a time. We were worried about patients being able to make the transition to the new building. We had city inspection/occupancy issues that threatened to delay opening of the new building (it was silly stuff such as being short one 14 inch by 14 inch carpet tile that had to be ordered…what the fork?!). The bank bungled a bunch of loan paperwork right at closing. We had to cancel and reschedule the closing during the actual closing because we were missing x number of documents from the bank (it was, like, what the fork is this and what the fork are we signing?). We needed to close before December 31st and we were putting the final ink on the closing documents at 8PM on December 31st (Happy New Year).

A friend/colleague unexpectedly moved away.

Extensive and dangerous road construction have made for very long and stressful morning and evening commutes.

A very dear friend passed away. I held vigil at his bedside for days with his wife (also a dear friend) all while the polar vortex raged.

I grieved for my dear friend.

I helped my dear friend grieve/mourn the loss of her husband.

I helped my dear friend put her house and life together after the loss of her husband.

I helped in the planning and running of my dear friend’s life celebration (it was beautiful).

I have been helping my aging parents with their health struggles.

I went on a family vacation from Hell. For instance, due to traffic I almost missed the all aboard for my cruise out of Miami. There was a BIG family fight during the cruise. And the cruise line lost our luggage.

I had to say goodbye to my beautiful Jasmine kitty. To make matters worse, I had to make the decision to say goodbye to Jasmine while I was in the Miami airport waiting to fly home from the cruise from Hell (we boarded Jasmine during our vacation and while at the airport we got the call that her kidneys were in total failure). That was an awful flight home.

A musical group that I performed with since 1991 asked me and another one of my friends within said organization to fire (instruct to retire…but for all intents and purposes it was firing) one of my best friends/mentor who had been playing with said organization for MANY years. After very icky negotiations with said organization my friend and I decided that we would/should not be the people to fire our friend/mentor. Afterwards my friend/mentor was treated HORRIBLY by said organization which led to my decision to resign from said organization. Said organization was my mental rock through so many of my life’s changes and saying goodbye under said conditions was TOUGH and SUCKED!

Repeated asthma attacks led me to withdraw from running the Door County Half Marathon.

My Sulley kitty suffered a horrible bowel obstruction that required our administering multiple enemas (with subsequent HORRIBLE messes). Sulley was ultimately diagnosed with megacolon which means that his large intestine is ceasing to function. Twice daily Sulley receives three different medications to keep his large intestine working and he is on a strict diet. Eventually the medications will cease to work and we will have to decide whether to spend $10,000 on surgery to completely remove his large intestine or say goodbye to Sulley.

My place of employment is perennially short of faculty and I work myself to exhaustion daily. I get quite anxious when I see multitudes of students needing help and I am powerless to do more.

I did some extensive committee work for my place of employment which was very mentally challenging.

Played my last concert with my friend/mentor. Per usual, we drove together to rehearsals. After our last rehearsal together I dropped my friend off at his house and, while driving home, had to pull over as I could not see the road through my tears. I balled all night. My musical life would NEVER EVER be the same again.

I accepted my appointment as a Faculty Liaison to the MUSOD D1 class. This meant extra pressure/nervousness.

I accepted my appointment as an examiner for MUSOD Patient Based Skills Exams. These exams are required for graduation. This meant extra pressure/nervousness.

One of the courses that I help teach received a new course director which upended my ability to comfortably teach that class (tough transition).

I was hit with the sickness from Hell that required two separate rounds of antibiotics and LOTS of albuterol. Sleeping was difficult at best.

Another musical organization that I performed with since 1990 was no longer going to be rehearsing at Carroll University (where I did my undergrad). I’ve been performing in Shattuck Hall at Carroll since 1989 and losing my performing at Carroll was yet another blow to my musical life.

My little Reggie kitty suffered a knee injury and couldn’t walk (he’s better now).

My wife caught my sickness from Hell.

The sickness from Hell resulted in our cancelling two little weekend getaways to Wisconsin’s Door County (very sad…I really needed that time away).

My Hercules kitty fell ill and was wasting away. He was finally diagnosed with inflammatory bowel disease. He is now on two medications daily (one of which is prednisone) and has a very strict diet. We are waiting to see if there is underlying intestinal lymphoma which may require extensive surgery. But at least he’s eating, putting on weight, and generally looking healthy again.

And then there was the horrible thing perpetrated against me.

So, we all got shit going on. Sometimes we can handle it. Sometimes we can’t handle it (and that’s OK). Sometimes things happen that tip the scales toward not being able to handle it (and that’s OK too). Sometimes our actions toward others can take someone’s precarious situation and turn things in a bad direction. Maybe we just need to remember to be nice to people. Or maybe we just need to be respectful toward others. We don’t know the burdens that people carry. And our actions can make or break someone’s day. Kind words and a smile are healing gestures (at the very least they’re comforting). Even our body language can make or break someone’s day.

It’s OK to have shit going on. And it’s OK if the shit overwhelms us. There are really good people out there who can help us when the shit gets too deep. Reach out for help. Life is worth living well and we all can work together to achieve a life lived well.

If you’re still reading this, thank you.

I want to be really careful about jumping on the whole Thanksgiving “I am grateful for…” bullshit bandwagon. Don’t get me wrong, Thanksgiving is one of my favorite Holidays. But one culture’s Holiday is another culture’s Hell: not all folks celebrate Thanksgiving. For instance, many of our Native American sisters and brothers are diametrically opposed to Thanksgiving (and that’s a discussion for another day). But I do want to talk about a love affair that I’m currently in (and it’s not my love affair with my wife). I’m talking about my ongoing love affair with…Lake Michigan (which means I am grateful for Lake Michigan).

My love for Lake Michigan goes way back to when I was a little boy. As a boy I would beg my Dad to drive me down to the Lake. I loved sitting on the shore staring out at that big water. I loved seeing sailboats go by with big billowing colorful sails. And holy crap bonus points if I happened to see a big ship go by!

As I grew older I was eventually able to drive myself down to the lake. I found hiking trails (such as the Seven Bridges trail in Grant Park). I found biking trails. I explored beautiful parks and outstanding nature centers (such as the Schlitz Audubon Center). And I especially loved getting up early to watch sunrises over the big water.

My family even vacationed on the big water. Several summer vacations happened in Wisconsin’s Door County where the big water dominated pretty much everything we did (and to this day I try to get back to Door County with my wife as much as I can…have trailer will travel..and I argue that Door County is every bit as beautiful as, say, Bar Harbor/Acadia National Park in Maine).

And as I’ve grown my thoughts about the big water and my relationship with the big water have changed. Perhaps at one time in my life I didn’t realize how very important the big water was to my life. Perhaps at one time in my life I may have taken the big water for granted. Perhaps at one point in my life I may have even forgotten that the big water was even there (a lot of bullshit on the brain can make you forget the important things in life…at least that happens in my life). Leaving the big water for many years made me realize how big a part of my life the big water represented. I missed the big water. I longed for the big water. When you live near the big water life stops and starts at the big water’s shore. You can’t go any further East than the big water and then you turn around and begin again in another direction. Living away from the big water meant that life stretched on in all directions with no discernible end point.

And now I come to realize that just about all the liquid in my body is Lake Michigan. Lake Michigan gives me life. And Lake Michigan gives life to everyone along its shore. Life along Lake Michigan exists because of Lake Michigan. Could Milwaukee and Chicago be what they are without the life giving waters of Lake Michigan? Could Milwaukee have become brew town without Lake Michigan? And the big water is there everyday giving of itself and not asking for anything in return. It’s doing nothing but at the same time it’s doing everything.

And I argue that Lake Michigan has been doing its thing for a VERY long time. I am a bit of a geology nut. As such I have to subscribe to Earth/geologic time vs. Biblical time. And for those who subscribe to geologic time I argue that Lake Michigan may be one of the OLDEST bodies of water on the planet. Granted, all of the salt water is gone and the shape/depth of the big water has changed. However, all of Eastern Wisconsin was an ancient tropical ocean. And I’m talking billions of years ago. WAY before dinosaurs. I’m talking primitive times. But the evidence exists. All of the limestone around Milwaukee (and even the limestone of the Niagara Escarpment in Door County) exists because this was the bottom of the ocean. Even in the parking lot at Milwaukee’s baseball stadium (Miller Park soon to be AmFam Park) stand limestone bluffs that contain fossilized coral! I think that’s so cool!

But as I look around I am saddened by how easily and quickly we can mess things up. Yes, I took Lake Michigan for granted once upon a time and I am ashamed. And I wish to point out a few things now that I have awoken from my sleep. Invasive plants and animals threaten to destroy our beautiful big water (Asian Carp are at Lake Michigan’s doorstep and Zebra/Quagga mussels continue to wreak havoc). Continued dumping of sewage and industrial/agricultural effluent continue to degrade water quality (well, as most of me is Lake Michigan I guess I may literally have shit for brains!). Foreign ships entering Lake Michigan continue to dump bilge water containing biological stuff that was never ever meant to be here (such as Zebra mussels). Native fish populations such as Perch and Lake Trout continue to teeter on the brink of total collapse. And political/economic pressures make it nearly impossible to achieve any level of ongoing conservation. Why the fork is it so hard to do anything good for the environment especially when it means life or death for our own wellbeing?! Pisses me off!!!

But there is hope. For instance, researchers in Green Bay have been planting native mussel species in the Bay and have been watching those native mussel populations rebound. What’s more is the native mussels are outcompeting Zebra and Quagga mussels. How forking cool is that? As a keystone species mussels are the life of the big water and their survival (coupled with our providing them what’s needed for survival) may mean new life for the big water and subsequently…us.

We can do this. We have the knowledge and the tools to do good. Doing good is always harder than…well, you do the math. But doing good is…good…and the right thing to do. And I look forward to continuing a…healthy…love affair with Lake Michigan.

Thank you Lake Michigan for always being there for us. You always give and always ask for so little. I hope I can give back a little.

I am gluten free. And this didn’t come about because of some bullshit fad thing I had to try because some asshole talk show dumbass says it’s a good diet idea. No. Gluten makes me sick. How so? Think pain in my body and pain in my brain (and, surprisingly, not my gut). How long have I had this? Who knows. Probably a very long time. And it finally came to a head last year around this time (extreme pain can be such a powerful motivator). More on all that at a different time.

Bottom line: I can’t eat/drink anything containing wheat, barley, and rye. Everything I miss eating/drinking will be a conversation for another day. BUT, I most miss bread. And I used to make a lot of bread. In fact, one of the pick-up lines I used on my now wife was “I have a bread maker”. AND, my first all day date with my now wife started with a fresh loaf of bread that I baked (with my bread maker). So not having good bread was a huge loss for me. However, through some experimentation I developed a basic gluten free bread recipe that I find is awesome for my needs and palate (think beautiful comfy aroma filling the house as it bakes followed by a wonderful yeasty real bread taste and texture). Udi’s gluten free bread…sucks (barf)!!! So here’s my basic gluten free bread recipe:

**Basic Gluten Free Power Bread (This is a no-knead dutch oven recipe. This is also a good all purpose loaf that can be embellished with nuts, raisins, protein powders, etc.)**

-One cup Bob’s Red Mill GF (gluten free) Oat Flour

-One cup Bob’s Red Mill GF All Purpose Flour

-One cup Kodiak Cakes GF Pancake\Baking Mix (available on Amazon)

-1/2 cup GF Almond Flour

-1/2 cup GF Sorghum Flour

-Two tsps regular (not quick rise) yeast

-Two tsps salt

-2.5 tsps Bob’s Red Mill GF Xanthan Gum

-Two tsps Bob’s Red Mill GF Psyllium Powder

-Two Tbs brown sugar

-Two cups luke warm water

-1 tsp baking powder (optional)

-1/2 tsp baking soda (optional)

1. Mix/whisk all dry ingredients together in a large mixing bowl.

2. Add water to the dry ingredients and mix (with a big spoon) until all the dry ingredients are thoroughly wetted and you have a rustic looking sticky ball of dough (the more rustic looking the better). Dough can be transferred onto a piece of parchment paper inside another large mixing bowl if desired (my preferred method).

3. Let the dough “rise” in its mixing bowl (it doesn’t really rise much at all) for at least three hours. Cover the bowl with plastic wrap as the bread dough will dry out easily. Poke several air holes in the plastic wrap. Proof the dough in a warm environment (bread proof mode in an oven is great). DO NOT KNEAD THE DOUGH.

4. Preheat oven and a dutch oven to 400 degrees. Really allow the dutch oven adequate time to get REALLY hot.

5. Remove the REALLY hot dutch oven from the oven, place the dutch oven on a heat resistant surface, and transfer the dough into the dutch oven. The bread can be baked directly on the parchment paper in the dutch oven (my preferred method).

6. Bake for 45 minutes at 400 degrees with the dutch oven lid on.

7. Remove the dutch oven lid and bake for an additional 10 minutes.

8. Let the bread cool a little and then (hopefully) enjoy.

Panic attacks suck. Worse, they are very real. And we aren’t entirely sure what causes panic attacks. Trauma, genetics, stress, helplessness, hopelessness, fear? Perhaps certain individuals may even be predisposed to their effects? Yes to all of those. Debilitating? You bet your ass. How do I know this? I’ve seen their effects first hand. Even more…I suffer from them (and this isn’t easy for me to talk about but I feel I should talk about it). I will say as much as I am able to say right now but know this: as dentists MANY of our patients become panicky when even thinking about dental treatment and that can be a HUGE barrier to good dental care (more on that at a different time).

What is a panic attack? The Mayo Clinic describes a panic attack as “a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying“. Further, the Mayo Clinic states: “[p]anic attacks typically begin suddenly, without warning. They can strike at any time — when you’re driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently. Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides. Panic attacks typically include some of these signs or symptoms: [s]ense of impending doom or danger; [f]ear of loss of control or death; [r]apid, pounding heart rate; [s]weating; [t]rembling or shaking; [s]hortness of breath or tightness in your throat; [c]hills; [h]ot flashes; [n]ausea; [a]bdominal cramping; [c]hest pain; [h]eadache; [d]izziness, lightheadedness or faintness; [n]umbness or tingling sensation; [f]eeling of unreality or detachment. One of the worst things about panic attacks is the intense fear that you’ll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur” (thank you Mayoclinic.org).

Recently, a very horrible something was perpetrated against me. Within a few days of the horrible something I started suffering from some of the above mentioned symptoms. I have had panic attacks in the past. And in the past I chose to be stoic and “man” through it only to find that my life was eroding away because of my suffering. This time around I was brave enough early enough in my suffering to reach out for help. I went to my MD who immediately started me on some medication.

Am I feeling better? Yes. Or at least the medication is helping me to function. How so? Well, rather than wanting to throw up and cry and then stay home for the day I still want to throw up and cry but am able to work and exercise and do normal life things that, given time, will help get me closer and closer to feeling like me. I may still need to seek some cognitive therapy. But at the very least I am not a crying heap laying on the floor of my bedroom.

So why am I talking about all this and not just keeping it hush hush? Mental illness is an illness like any other illness that knocks us away from living life to its fullest. I go to my MD to get my asthma treated when it knocks me on my ass. And now I can say that I have the strength to go to my MD to have my panic attacks treated when they knock me on my ass. I should not be and I am not afraid/embarrassed to admit that I am suffering from a mental illness. And I wish that folks would not feel stigmatized by our society’s horrible views regarding mental health. I am Danish and Denmark is empirically the happiest country on the planet. Denmark’s happiness comes from many different sources but Denmark doesn’t stigmatize mental illness: Denmark embraces mental illness and treats it effectively and its people are empowered to live wonderful stigma free lives. We Danish Americans are arguably one of the smallest minorities in the USA because ya gotta be nutz to leave Denmark.

I wish to talk more about mental health another day. To wrap this up I encourage anyone who’s suffering from mental illness to seek help. I know how stressful dental school is. Practicing dentistry is also very stressful. And I have had to live through losing student dentists and colleagues to suicide. There’s a lot of life worth living. And it’s good and right to seek help and live to see beautiful todays and tomorrows.

SNAP. Ya know, that wacky crappy liquid shit we use to make temporary (provisional) crowns in dental school? Yeah, that crap. What can I say about SNAP? Umm…nothing good. Oh wait, it’s cheap (and you always get what you pay for!). SNAP, the horrible crap that’s a sadistic rite of passage for every student dentist past and present. SNAP, the stuff that shrinks before your very eyes. SNAP, the crap that develops open margins and interproximal contacts even though you never even touched said contacts and margins. SNAP, the stuff that gives me recurring nightmares and PTSD symptoms. And guess what? I get to teach student dentists how to use the crap (ARGHHH)! Why? Cuz it ain’t goin’ away any time soon (damn)! Students (and faculty) STILL need to suffer through the crap. Worse, students need to be COMPETENT in its use in order to graduate! Oh the fantastic temporary crown materials that await students after dental school: Integrity; ProTemp; CoolTemp; VersaTemp; LuxaTemp; etc.

So at least for now it’s here to stay. And I have experimented heavily with ways to make it work in MY hands. Perhaps a few of my techniques may be of some use to someone out there (I make no guarantees).

1. Thermoplastic matrix…We have to make working with SNAP extra hard so we always use those damn thermoplastic suck down matrices that really suck (but they’re really cheap). And then people cut corners in their constructing said matrices thinking that it will save time. WRONG!!! Thermoplastic matrices are single use pieces of junk. In other words, constructing several matching practice temporary crowns on the same crown prep requires SEVERAL thermoplastic matrices. And those matrices need to be made on a stone model made from an impression (or duplicated stone model) of the exact same tooth/typodont/mouth that you’re prepping. The stone model should be no more than 10-15mm tall from the base of the model to the free gingival margin and the tongue/palate need to be cut out of the model so that the vacuum forming machine can have a chance to make a somewhat adequately adapted matrix. Trying to use a big thick typodont, especially the wrong typodont (fixed vs. operative) will only result in an ill fitting thermoplastic matrix that will be HARDER to work with. Cut your matrix in such a way: that there are two teeth on either side of the tooth you’re prepping; that there’s matrix covering 2-3mm of gingiva.

2. Mixing SNAP…I keep adding more and more powder to the liquid with constant stirring so that I can get to a honey consistency as quick as possible. Adding too little powder will result in extra shrinkage. So, adding adding adding powder with stirring stirring stirring and quickly arriving at HONEY will help prevent some shrinkage.

3. Loading SNAP into the thermoplastic matrix…Just like using a swizzle stick to add honey to tea I will pick up honey consistency SNAP on the back end of a bend-a-brush (or something similar) and swizzle/drip a string of SNAP snot into the proper tooth slot within the thermoplastic matrix.

4. Smoosh the thermoplastic matrix/SNAP combo into place over the right teeth in the mouth…We have to start to work fast and smart. The SNAP will be starting to set up fairly quickly at this point. Keep in mind that SNAP goes from liquid shit to kind of gooey shit to honey shit to doughy shit to rubbery shit to set shit, in that order, fairly quickly if we mix the right amount of powder shit into the plain clear liquid shit. We want the thermoplastic matrix/SNAP combo going into the mouth and onto the teeth right in between the honey shit consistency and the doughy shit consistency so that the SNAP doesn’t flow everywhere.

5. Make a test piece of SNAP…Take all the extra SNAP that didn’t go into the thermoplastic matrix and roll it into a ball. As it turns into a doughier consistency roll it into a hot dog shape (cylinder). The SNAP will start to get rubbery. We want to remove the SNAP from the mouth when rubbery. How do we know when it’s rubbery enough? When we bend an end of the hot dog and it “snaps” back into the same hot dog shape. If we bend the hot dog and it doesn’t snap back then it’s still too doughy.

6. Take the thermoplastic matrix/SNAP combo out of the mouth…Take the matrix with adequately rubbery SNAP and give it just a little 0.5mm to 1.0mm push up (burp it) and then push it back down into place. That little burp will break any kind of seal that may have formed. Further, we don’t want to burp more than 0.5-1.0mm because any further lifting (and/or multiple lifts) could wreck the temporary crown’s margin. After we’ve reseated the matrix/crown we then lift the entire matrix/crown out of the mouth and place the matrix/crown in hot water (this will speed the final setting and help prevent more shrinkage).

7. Remove the fully set crown from the matrix and separate the crown from big pieces of flash/excess.

8. Remove big pieces of flash around the papillae/interproximal contact areas…We now try to remove big interproximal pieces of SNAP around the papillae and the interproximal contact areas (please don’t touch the actual interproximal contacts) that prevent seating of the crown. We won’t do much margin refinement yet and, once again, don’t touch the interproximal contacts. We just want to remove enough stuff to get the crown to seat.

9. Reline the provisional crown…We now remove a little bit of material (0.1-0.2mm) from the intaglio/inside of the crown with a small bur in a slow or high speed handpiece (try to limit the removal of material from the intaglio side of the incisal/occlusal as this area will eventually serve as a stop). Make sure that the crown fits back onto the tooth easily after reaming out the intaglio. Now, mix up some more honey consistency SNAP, swizzle the SNAP into the inside of the crown and smoosh it back onto the tooth (now is when that untouched intaglio side of the incisal/occlusal will give you that good firm stopping point). Take any excess SNAP that oozed out beyond the crown margin and pack it/shape it snug around the crown margin/finish line of the tooth with a cord packer/composite instrument. Remove the crown from the tooth when the SNAP becomes rubbery. Put the crown back in hot water to fully set.

10. Trim the crown…Mark the interproximal contacts with a sharpie and remember that those are “no fly zones”. Trim the margins in a vertical orientation parallel to the long axis of the tooth. We thin the margin areas in this orientation from the outside of the crown moving closer and closer to the actual margin until the flash surrounding the margin becomes paper thin and flakes off with a fingernail (this means that the bur or disk never actually makes any kind of contact with the margin). Then we can go around the remainder of the crown removing any remaining flash and shaping the interproximal areas with no touching/losing the contacts (“no fly zone”).

11. Polish with composite finishers/polishers (red and yellow stripe finishing carbides if needed, green sandpaper disks, pink sandpaper disks, pink rubber points, blue rubber points).

So what am I accomplishing? With the thermoplastic matrix I make a custom provisional crown and then I use the reamed out crown and reline to further customize my custom provisional. As SNAP shrinks SOOOOOO much I defeat that shrinkage with the reline. And that reline usually helps to cut down on open and/or short margins that require “salting and peppering”. Also, if I lose a proximal contact I can cut a hole through the crown at the contact area and use a reline to smoosh SNAP out that hole establishing a new proximal contact.

Hope this helps a little. I can’t make SNAP go away but I sure hope there’s a pearl somewhere in my writing. And hey, if one can master SNAP then making temporary crowns with the good stuff (expensive stuff) will be EASY!

This is so hard for me to write about as it conjures up such deep feelings of darkness and despair. I can only write so much about this at one time so I’m going to have to break this into parts and write about it only as I am able.

I believe it’s a well known fact that I hated dental school. I hated dental school with passion. Yes, when I was a damn, dirty, diseased University of Minnesota dental student I was admittedly a miserable person. It’s complex as to how I arrived at misery but misery was my constant companion. And misery can be so hard to overcome especially when everyone around you is miserable and for the same reasons.

Part of the problem was that I sold my soul to dental school. Perhaps I didn’t have a choice at the time but age and wisdom (which I likely lacked in dental school) tell me that we always have a choice. Needless to say, I lost all that made me who I was. And the misery feedback loop kept me blinded to all the things that made me, well, “me”. There was so much “me” that got me to dental school. What happened to “me”? I don’t know and I’m carefully/gently trying to figure that out. Stay tuned.

So, learning from my soul mistakes in dental school, what is an emergency thing that you can do NOW to give your soul a little break? I suggest that you try to remember one to three things that make your soul sing. And for anyone reading this post who is currently a student dentist PLEASE try not to say that being a dentist makes your soul sing as you’re not quite a dentist yet and I suggest that saying something like that is more like setting a goal. Goals help blaze a path. But what will nourish you on your path to a goal? The soul needs nourishment and attention. So, perhaps think back to being a child. Did you like to paint? Did you like to run around the backyard blowing bubbles? Did you like flying kites? Perhaps you liked to knit? Did you like sitting and watching the sun go down? Or, right now are you a pet parent and can’t wait to see your pet baby every day? It doesn’t matter what it is that makes your soul sing. And don’t try to say “ach, that was just a stupid little kid thing that’s just a waste of time”. The little kid thing gnawing at you is likely your soul screaming for help.

Once you relocate one to three very precious things that make your soul sing try to set aside some sacred time/space to do or focus on your precious thing(s). Set a goal that I WILL NOT LET ANYTHING invade my sacred time/space and I WILL lose myself in my precious thing(s) that makes my soul sing. If needed, set an alarm and let that alarm serve as a wall separating your precious sacred time/space from the rest of the world. I KNOW this takes great effort but I KNOW it may pay great dividends. Take it from a guy who forked up four years of his soul life and can never get those years back.

I have a feeling that most people don’t realize how much I love trains and model railroading. It all started when I was a very little boy. I don’t know if it was a Christmas or Birthday gift but my Mom and Dad got me my very first train set: Lionel O scale (O scale is pretty big in size and the locomotives can exceed a foot in length). It was big and it was beautiful. It had a classic Santa Fe locomotive (with that distinctive red war bonnet nose) and several different types of cars including a red caboose. I would sit on the floor for hours watching my train go by. The sound and that little whiff of ozone were pure kid heaven. And Dad and I always mused about how we’d make a train layout together (a layout is when you affix the tracks to a board and build scenery).

Well, O scale trains are really big and also really expensive. And as a kid I didn’t have much money and much space for my beautiful O scale Lionel train. I needed to think smaller. So early in high school I took all my bonus money from selling Boy Scout Christmas wreaths and started buying HO scale trains (which are smaller and less expensive than O scale trains). And now my Dad and I started to get really serious about a train layout because we could do a lot more for less money and in a smaller space. In fact, we’d go to all kinds of model train shows together and dream of the cool scenery we’d make. And in the interim I set up my HO scale trains on the floor in the upstairs of my Grandma and Grandpa’s house. That was my zone. I built little structures, I added more and more track, and, no matter what, if I was having a bad day I could always hang out with Grandma and Grandpa and run my train and dream that I was on that train going to new and beautiful places.

Time passes and life changes. Off to college. Grandma and Grandpa pass away. Mom and Dad move. And my trains and train dreams get packed away. And life continues to change. Go to dental school. Get married. Move around the country. Practice dentistry. Become a dental professor. And then something happens. Life events sometimes remind you of where you once were and what your most special dreams used to be.

Five years ago I had a life changing event. During that time I rediscovered model trains and immediately felt like I arrived back at a happy place. And unlike the past I’m not putting my trains and train dreams back in a box. Plus, I have a little more money and space than I did back in high school. So I have been collecting model trains like a mad man (I have such a patient and supportive wife). I started out by collecting N scale trains which are smaller than HO scale trains (N scale locomotives are 4 to 5 inches long). And this past spring (2019) I bought my first Z scale train which is the smallest scale of them all (locomotives are 3 inches long) but we don’t refer to them as cute!

So there you have it. I love trains (model and otherwise). I don’t have that layout yet but it’s in the works. Stay tuned. Oh, almost forgot: someday I’d love to take Amtrak’s Southwest Chief from Chicago to California and then take the California Zephyr back spending time seeing America the old fashioned way and taking pictures and writing music.

What does it mean to be a D2 (second year) dental student? Learning dentistry, right? Wrong! Well, somewhat wrong. But we need to step back and look at this from a different perspective (as we say in dispute resolution, get a 30,000 foot view). In other words, if we live with the belief that D2 year is just about individual dental skills, like an extension of D1 year, then we’ll sorely miss the point. And it’s been my experience that when we miss the point of it all then we become frustrated, lose hope, lose motivation, want to quit, want to beat on faculty, turn into zombies, need trips to Colorado every other weekend (soon it will be Illinois and Michigan), etc. D2 year is the same shit different year and everyone feels the same way about their D2 experiences.

So what exactly are you trying to say Doc? In D2 year we are pushing you in ways that undergrad never did or even could. In D2 year we are giving you a taste of stress and pressure, mixed in with some difficult dental skills, like you’ve never seen before and can, if allowed, melt you into a ball of goo OR EMPOWER YOU. BTW, having a successful dental career means overcoming a SHIT LOAD of stress and pressure DAILY and doing so PROFESSIONALLY without melting into a ball of goo. Who ever got that in undergrad?

So ya did good in undergrad. Yay (pat on the back)! That don’t mean jack for how good a dentist ya gonna be. Huh?! Ok, so ya took some tests, wrote some papers, and mixed some chemicals together without blowing your face off. What part of that has anything to do with dentistry? Not much! Say what?! Dentistry is about hand skills, interpersonal communication/relationships, and managing stressful situations. Who of us in undergrad had any time to: take a painting class; take a sculpting class; take a class on management; take a communication class focusing on interpersonal communication? Undergrad is usually about checking off just the right boxes and getting good grades and doing so in order to get the reward at the end. So what does solid undergraduate work mean to me? Perseverance! Being able to overcome challenges without melting into a ball of goo! Ya gonna need that shit to survive in dental school and thrive in a dental career!

D1 year is about working within the lines: take some gooey shit and put it in between the margins (lines) and then use the existing shape of the tooth to form the gooey shit you just placed. Seems hard at the time but it’s a relatively easy thing to do (given enough time and practice). In D2 year we’re forcing you to use your mind and vision and hands to mold and sculpt big difficult somethings from nothing using only wacky liquid and/or waxy shit. Then we throw in twenty different distractions and only give you enough time to do things once so it had better be done right on the first try.

Guess what? Welcome to a day of dentistry: stressful procedures on stressed out conscious patients all while managing a dental practice. In our practices we juggle ten to twenty things at any moment of any given day and they all have to get done and they have to get done well on the first try (SO OFTEN in dentistry there are NO SECOND CHANCES so we have to get it right…any questions?). For instance, you just get a purchase (grip) on a busted root tip and someone from your office (sometimes with attitude) barges into your op and is like: “Doc, I have been waiting ten minutes for you to (fill in the blank)!”. Immediate reaction internally is: “What the fork! Who the fork are you to talk to me like that?! Are you out of your forking mind?! Can’t you see I’m forking busy?! Who the fork pays your forking salary?! Get the fork out of my face you forking tarantula from Hell!”. And then our training immediately kicks in and we smile and say: “How about if we take just a little break. I’ll be right back. Is there anything we can do to help you feel more comfortable while I’m away for a few minutes?”. Want a stressful job in an incredibly calm environment (and make more money)? Be a heart surgeon (“whatever you do do not make any noise, move around, sneeze, cough, fart, belch, barf, interrupt and in any way shape or form bother the surgeon for the next five hours”).

So try to relax, enjoy the ride, learn all you can, get a few C grades, MAKE MISTAKES (it’s OK, they make you a better dentist), let your faculty help you learn from mistakes, pass your tests, let the learning and training take precedence over the grades, and please forget about the senseless quest for a grade. Patients want and deserve the best we can give them. And I have NEVER had a patient ask me about my grades. Topped ranked and lowest ranked people in each graduating class receive the same honor: DOCTOR!