Hiding My Hair Loss

Lifestyle, Uncategorized

This next post has been a long time coming. On this site, I have written about my astounding student loan debt, my parenting faux pas, my time as president of an organization, and even a disconcerting medical condition that occurred to me fairly recently. Perhaps the reason I have been so reluctant to write this next post is because I have spent so much time, effort and money over the years trying to conceal this problem in the first place. Well, without further ado, here is a little tale about my struggles with hair loss.

In my early 20’s, I started noticing a few hairs on my head started to go scraggly. Even more distressing were the ones that would shed outright; usually discovered to my dismay while shampooing in the shower. Certain, close family members of mine (i.e. uncles) had an early history of hair loss; but my father retained a healthy mane well into fifties and sixties, and my mother (while thin) didn’t have any appreciable alopecic areas on her head. Please note, there can be genetic (e.g. family history, male sex hormones) and/or environmental (e.g. stress, nutritional deficiencies, thyroid conditions, etc.) causes to hair loss – I would strongly encourage everyone to seek the true etiology before starting on any particular treatments and therapies.

I just knew mine was not your normal ‘ordinary day’ hair loss. I started noticing discernable areas of my scalp in the mirror. By 23 years old, I took it upon myself to start visiting dermatologists and hair-transplant consultants to see what my options are. My form of hair loss, as best as I can tell, is the typical male pattern baldness known as androgenic alopecia. Back then (and perhaps even now?), the Norwood Scale was used to gauge the various patterns and stages of balding.

The Norwood Scale

Fortunately for much of my twenties and thirties, I fell under a Norwood stage I classification – where, especially when styled just right, there was not much noticeable change in the hairline or elsewhere. Now, in my forties, I have progressed to a stage III/IV where the hairs on my vertex/crown have more appreciably thinned and there is more generalized loss within my front and mid-scalp sections.

The dermatologist I saw in my twenties (and who has since retired) was a family friend of ours. With great reluctance, he prescribed me Propecia to help slow my hair loss. I say “reluctance” because, however rare, it may have sexual and other adverse side effects. He also made me promise that, when my wife and I decide to start a family, I stop taking the medication for several weeks (preferably months) prior to trying to conceive in case it may cause some unintended birth defects in our unborn child. Again, please consult a health care professional before starting any particular treatment; but personally I credit this medicine for retaining much of what I have left on my head today.

As I’m sure we all do in times of weakness and vulnerability, I turned to the Internet for answers. Forums like Hairlosstalk.com became my obsession, and I was constantly seeking other cocktails, potions, elixirs, “cures”, what have you to supplement and help stop (or better yet, reverse) my hair loss. Let me assure you, men’s hair loss is a multi-billion dollar (and growing) industry and there is no shortage of ‘strand-restoring’ products out there. Perhaps it was the recommendation of strangers online, or simply succumbing to the brilliant advertising and the promises of “stimulating regrowth” and “reactivating hair follicles” on the Rogaine packaging; but soon after starting Propecia – I found myself also applying 5% Minoxidil topically 2x a day.

Propecia and Minoxidil was my hair loss treatment regimen for over a decade, with relatively decent results. The scraggly hairs were no longer an issue, and hairs would still fall out in the shower, but in what seemed like more stable, ordinary amounts. I purchased expensive shampoo’s (e.g. Revita Hair Growth Stimulating Shampoo), tried vitamins (e.g. Viviscal Pro), used a micro-needling roller a few times a week, and even bought a laser helmet (e.g. Theradome EVO Laser Hair Growth Device) – but nothing really helped to any significantly appreciable degree.

About a year or so ago, I started noticing my hair receding in more substantive amounts again. I don’t know if there was elevated stress from the whole Covid-19 time period, I don’t know if maybe the tolerance or the efficacy for the medications I have been taking has started to reach its limit, it’s impossible to say. Nonetheless, it has concerned me enough that I have again started up consultations with dermatologists and hair-transplant specialists.

So far, the consensus among the three or four doctors (some dermatologists, some surgeons) I have met with (in-person or virtually) is that I am still not an ideal candidate for a hair-transplant (either FUT or FUE) procedure. While, in some strange way, that feels reassuring to hear – I am constantly paranoid about this problem progressing. My most recent research into hair loss remedies has introduced me to PRP (Platlet-Rich Plasma) Injections – which seems to be gaining popularity for this and other health conditions. Pricing and the recommendation on frequency seems to vary among providers, but I am resolved that this will be the next logical therapy in my desperate attempt to slow/stop my hair from falling out.

I would be remiss if I did not mention the psychological ramifications in all of this. While I recognize (and appreciate) that I am a lot better off than some male men in their forties, I can’t help but feel down, depressed, and distraught about my decrepit appearance. I already know my facial type is not fortunate enough to look good with a bald head, like the Bruce Willis or Dwayne Johnson’s of the world. I hate being so vain, and already struggle emphatically with aging and my fleeting youth. I spend SO much time trying to hide and disguise the problem; time I could spend with my kids, reading, exercising, just all-around bettering myself. So much expended energy worrying about how many strands I have waiting on the shower floor or in my comb. While I didn’t experience any erectile disfunction (thankfully), it is hard to pinpoint the hormonal changes that happen when you’re on medications (especially, electively) and the negative effects it may have on testosterone production and energy levels. I wish I could come to terms with it, accept and embrace it, age gracefully and focus on what really matters in life. For me (and many others suffering a similar fate), having hair is very much integrated into our identity, our self-esteem and our self-confidence; it a symbol of our youth, virility and feeling of attractiveness – and not so easy to let go of.

So, on that propounder-ing note, I thank you for reading this latest post. As with so many other topics, I wish I had better photographic documentation to incorporate in this post. Please feel free to contact me or leave any comments to discuss your own personal story and struggles.

Investing and Gambling(?)

Lifestyle, Uncategorized

Being born and raised in Las Vegas, growing up around slot machines and poker/blackjack tables, perhaps helped desensitize me a bit to the appeal of gambling. In my early twenties, I worked as a web developer and programmer for a local gaming company and it helped solidify in my head the notion that ‘the house always wins.’ As much as I love the idea of getting rich quickly, I knew that – at least in casinos, the cards were stacked against me.

After we paid off our student loans, I started to take some of that monthly income and began investing. Fortunately, I had already been reading content from The White Coat Investor for years; and his philosophy on refinancing, saving, investing – it was ingrained deeply within me. Now, there is A LOT to investing – certainly too much to cover for a mere post where the author tends to write extemporaneously i.e. here. There are countless books, websites, blogs, podcasts and forums in which to educate yourself and start the journey.

As always, I am happy to share with you the little information I have gleaned over the years. For starters, I subscribe to a FIRE (financial independence, retire early) movement; in which adopting a certain disciplined lifestyle and setting financial goals helps someone achieve freedom from the workforce. Of course raising your annual income, lowering your expenses, increase your saving/investing rate, maximize retirement accounts, reducing your tax liabilities, living below your means, etc. – it all feeds into successfully reaching this goal. Also, familiarize yourself with the 4% rule. In order to sustain a 30-year time horizon in retirement (adjusted for inflation), your nest egg should have about 25x what you expect to spend annually stored away.

Which brings me to my next point – calculate your savings rate and track your monthly/annual expenses. In addition to using our Mint account to budget and track expenditures, I also use an Excel spreadsheet to simply monitor our overall finances (monthly income, account balances, investment gains/losses, etc.). Consciously (and maybe, subconsciously?) seeing these numbers regularly not only keeps us organized and informed, but (for me at least) motivates me to improve/correct some spending habits. Generally my family stays within a 30-50% savings rate every month. Depends how early you start, but I have read a 20-25% rate (at least) is typically what you want to shoot for.

In order to start investing, I created an account (brokerage and retirement) with Vanguard. I love the story of Jack Bogle, the founder of The Vanguard Group – which was really my only deciding factor to open my accounts with them. I imagine Fidelity, TD Ameritrade, Charles Schwab, etc. have just as good (if not better) platforms set up as well. All my ‘long-term’ investing is done in Vanguard. There is some ‘uncompensated risk’ that goes along with investing in individual stocks and specific companies. Theoretically, a company can go bankrupt and you stand to lose everything. My distribution or asset allocation in my Vanguard account looks something like this: 1/3 Vanguard Total Stock Market Fund, 1/3 Vanguard Total International Stock Market Fund and 1/3 Vanguard Total Bond Market Fund. Every month, whatever I can contribute, gets split evenly amongst these three. The growth has been steady enough over the years, and there is a certain serenity in knowing my risk is drastically minimized because index funds are highly diversified. Another reason I have come to love Vanguard is because their fees and expenses to purchase and own these funds are so low compared to some other companies.

About a couple of years ago, I opened up a Robinhood account as well. All my ‘short-term’, active trading takes place there. Every month, a very small percentage of the money I set aside for investing purposes gets deposited here. Honestly, I consider this ‘play’ money – it affords me an opportunity to invest in companies I like (i.e. Apple [ticker: AAPL], Tesla [TSLA], Costco [COST], Netflix [NFLX], Berkshire Hathaway [BRK.A – which I can’t afford, and BRK.B]), and dabble in speculative stocks like GameStop (GME) if I so desire.

It has been interesting to see how my Vanguard (i.e. long-term, passive trading) compares against my Robinhood (i.e. short-term, more actively traded) account performs. The Robinhood app makes it super easy to execute trades; and within that simplicity, I think a lot of people succumb to their emotions and either 1) sell in a panic when the market or stock price is down or 2) buy in big on hyped-up meme stocks that are supposedly ‘going to the moon.’ Investing 101 teaches you either of these can be dangerous and really cut into your long-term gains. Timing the market is impossible. In my own experience, giving myself a fixed allowance every month to ‘dabble’ with has worked well; it allows me to keep myself in check and not get too carried away. If I happen to randomly pick some winners, great! However, in my mind, every single dollar I have placed into that Robinhood account is mentally money I have come to terms with completely losing. And just FYI, my Vanguard account is currently well out-performing my Robinhood gains.

The same appeal, and that ‘rush’ people get in casinos by putting it all on red (a reference to the game roulette in case it was missed) – that is a similar adrenaline high I get when putting a purchase order in on the Robinhood app. It can certainly be addictive, and really get you into some trouble. Which is partially the reason that I have not ventured into cryptocurrency trading, I do not feel I understand that investment vehicle well enough yet.

Arguably one of the most famous investors of all time, Warren Buffett, said quite a few things pertinent to my topic today. He said:

On Earning: “Never depend on single income. Make investment to create a second source.”

On Spending: “If you buy things you do not need, soon you will have to sell things you need.”

On Savings: “Do not save what is left after spending, but spend what is left after saving.”

On Taking Risk: “Never test the depth of river with both the feet.”

On Investing: “In the business world, the rearview mirror is always clearer than the windshield.”

Of course we all want to maximize our returns while minimizing our risks. However, there will be investment fees and expenses, market corrections/depressions, and asset classes that underperform just to name a few. Most investments just need TIME. The concept of compounding interest works; and for those individuals passionate enough to educate yourself, responsible enough to control your lifestyle, relentless and patient enough to withstand (and minimize) the failures along the way – I think they will earn the right to FIRE.

Thanks for taking the time to read this post! As a full disclaimer, I do not possess a business degree, have no formal financial training, do not stand to benefit any monetary gain from the companies mentioned above, and – for some – would recommend you seek assistance from a financial consultant or trained professional before beginning this endeavor. As always, feel free to ask any questions or leave any comments for me!

Figuring out Fatherhood

Dentistry, Lifestyle, Uncategorized

Colleagues in the dental field, upon discovering I do pediatrics, always squeeze in the phrase “it takes a special kind of person” somewhere into the conversation. I have also heard the words “thank God for people like you” on more than one occasion. If you have read any of my previous posts, I almost never miss an opportunity to gloat about how lucky I am to do what I do. Sure, there are stressful moments mixed into each work day – the deafening loud screamers, the biters, the pukers, and my personal favorite, the parents that tell me how to do my job. However, I would not trade my profession for any other, ever, period.

I imagine that the “special kind of person” comment implies there is a certain degree of patience and compassion for these little patients that those individuals maybe do not have a want or willingness to exert. Mind you, I do not say that judgmentally. I recognize that everyone on Earth has different skills, talents, and abilities – and what suits me may not befit someone else. I already established in my last post that I certainly do not have what it takes to be a Chippendales dancer.

Nevertheless, this notion that I may somehow possess a special amount of patience is an interesting one. At work, I am proud to say, I always try and maintain the utmost professionalism. I treat children with low-functioning autism, with attention deficit hyperactivity disorder (ADHD), and with various other medical and behavioral conditions. The truth is, throughout most of my brief appointment – whenever I have an unruly child in the chair – I think to myself how demanding and taxing it must be for the parent to take this on day in and day out. Really, kudos to them.

At home however, unfortunately, my parenting style does not always feature that same calmness and composure.

When I was younger, well before my children were born, I was driving down the street, stopped at a traffic light, with my window rolled down. At the same street corner, waiting to cross, was a father and his young boy (probably no more than around 7 or 8 years old). I caught only a brief portion of their altercation before I had to resume driving, but the dad was berating his son about his bike, either ruining it…not riding it properly, something to that effect. I remember thinking to myself, how could any material object be worth laying into your kid like that?

Little did I know back then that I would have progeny of my own one day. As recently as yesterday, I chastised my younger son for 20 minutes about being too distracted/not concentrating and doing ‘poor quality work’ on his Kumon (a math and reading tutoring program) assignments. (Ironically, he’s eight.) It is a lecture I have given to him time and time again. A few months ago, at a park, he left his tennis racket unattended somewhere and it was stolen. The drive home was filled with my reprimanding him about being more responsible with his things. I guess, so much for my ‘material objects’ memory huh?

I wish every moment could be remembered like this one above.

For the record, I am not proud of these outbursts and punitive moments of mine. All too often, I ultimately regret the vehement way in which I handled the situation. My biggest fear is the emotional scar and substantiality of the memory it creates in their mind. Although for me, disciplinary moments like these seem infrequent and tend to occur far and few between; in the mind of a child, I imagine it carries immense weight and detracts from the many jocund times we share together. And that is sad to me; because I truly do make concerted efforts to play with them, talk with them, take them places, and provide them things that I was bereft of as a kid.

The reasons for (and root cause of) my overly aggressive outbursts are probably outside of the scope of this blog post. But like so many other things in my life, in an effort to right wrongs, I try and self-reflect on shortcomings and character flaws within myself. I need to work harder at managing my expectations for my kids. While (I think that) I am trying to instill a good work ethic in both of my boys; I feel I am also setting myself up for disappointment and frustration when they aren’t delivering on things I myself believe to be important. I have to learn to exercise more patience and tolerance to the simple fact that they are children; and mistakes, and messes, and imperfections in all forms will help them learn, cope, and even correct certain behavior in the future.

When I think about the miracle of childbirth; and how even from the point of conception, we need so so so many countless processes to go right before we’re given a beautiful, healthy baby – I almost feel ashamed of myself that I let petty things like messy handwriting or a stolen tennis racket ruin a moment and a memory in time I have with my two young boys. Don’t get me wrong, disciplining and punishments have their place. I am just going to make more of a conscious effort to handle their foibles and failures with a tad bit more of tranquility. Every child is a blessing; I have to work harder to appreciate that fact not only at work but within my own home.

Really, thanks for taking the time to visit this blog and read through some of these posts. I can always use help in the parenting space, so please feel free to send any comments and questions my way!

My Exercise Expedition (Part I)

Lifestyle, Uncategorized

I suppose before I get into this next post, I should probably apologize in advance to all the parents and/or patients that I provide dental care for; this post will likely feature way more about your dentist than you ever wanted to know or see. Now that the disclaimer is out of the way…I wanted to dedicate this post to one of my (few) hobbies and pastimes, physical fitness.

I started working out probably in my late teens, early twenties. In fact, in my early twenties – a time when my body actually knew how to properly metabolize food – I remember getting a free body fat percentage check and it was pretty much in the range of where male athletes typically fall (i.e. 6-13%). Of course, I had youth on my side, no family at the time (i.e. less responsibilities, arguably less stress), a strict vegetarian diet, and I recall going at least three to four times a week (immediately after work) to the gym. I looked and felt great.

Unfortunately, you will have to take my word for it. You see, back then, smart phones had not yet been invented and I am pretty sure the term ‘selfie’ wasn’t even coined yet. Even if it was, it would have been such a pain to take regular 35mm film photos of my shirtless self, hope to God they weren’t blurry, drop them off to be processed, pick up the prints in the typical 7 to 10 day window, put them into my super slow flatbed color scanner, and all that – for what? To place them onto social media websites and dating apps that hadn’t even been invented yet? No thanks.

We obviously live in an age of information overload. We have so many fitness diets and workout programs, P90X’s and Pelotons, and a slew of Youtube training videos all guaranteeing 10-minute abs. CrossFit is all the craze, tons of Zumba zealots, and people are quite passionate for Pilates and of course Yoga routines. I wish I could tell you that I have tried a number of these programs; and offer you a list of the ones that have been most effective for me. The truth is, my family and work schedule are not conducive to my attending many of these classes, and frankly I am too cheap to subscribe to anything I cannot fully commit to.

In that same vein, let me take a moment to caution my readers that I am by no means a fitness expert. I have never recruited the help of a personal trainer, have no professional education in physical fitness, have never met or spoken with a nutritionist and/or dietitian, and essentially possess a basic understanding of the anatomy and physiology of our body.

2018 – Not a Chippendales dancer

Temporarily ignoring the messy counter-top, the filthy residue on the bathroom mirror, and the stack of laundry on the tub behind me…that was my body in late 2018. Back then, of course, there was no such thing as COVID-19 and therefore, I was not hyper-paranoid about avoiding the gym. Honestly, I never controlled my diet; but I exercised routinely, drank WHEY protein shakes on occasion, and would try my hardest to power through a good workout session.

2021 – Still not a Chippendales dancer

Fast-forward to 2021. Interestingly enough, three years later, and the nasty mirror residue and messy counter tops are still there! The big difference being, I am now quite noticeably way more gray up top. Anyways, since COVID is still very much a threat, I have invested in a small home weight rack (from Costco), and I work out to Youtubers like Heather Robertson and Midas. Also, lately, I have been making a conscious effort to cut back on processed foods and minimize my sugar intake. Finally, I try to be careful to drink plenty of water and get solid sleep every night.

My workout goals right now are to get more definition in my core region, rid myself of that stubborn belly fat (i.e. lose the love handles), and build muscle (without bulking up too much).

I am only a few weeks into a regular workout regimen. Three or four times a week, I wake up early and try and work either back/biceps, chest/triceps, shoulders, legs, and/or core and abdominal muscles. Already though I feel a boost in my self-confidence and mood, I feel more energetic throughout my day, and I feel overall just healthier. Ugh, I love that rush of endorphins at the end of a good workout!

The pain you feel today is the strength you feel tomorrow.

– Unknown

For anyone starting to exercise and get fit (again, I am no expert); I would encourage you to set achievable goals for yourself, simultaneously control your diet and calorie intake, and be sure to watch your form so you avoid injuries. For me personally, the hardest part is just starting a routine after a long hiatus of not exercising; overcoming that initial laziness, doubt, and mental fatigue. It definitely requires self-determination, hard work, discipline and sacrifice.

Thank you for taking the time to read this post. I am not afraid to admit there is still so much I need to learn, and welcome any advice you are willing to share. If you have any specific questions about my own routine, I am always happy to share. I will continue to keep you all posted about my progress on this journey, and hopefully I will get around to cleaning that bathroom counter and mirror!

Enabling vs supporting

Dentistry, Lifestyle

Today, I attempted to do some fillings on a highly anxious nine-year-old girl. She was sobbing practically non-stop, grasped tightly to her stuffed animal, and basically blocked/ignored all of my various behavior management techniques. Mentally she did not succumb to the oral sedative, she could not care less for my tell-show-do spiel, and she could not bring herself to stop crying well enough to tell me what was frightening her. The mother denied any past emotionally-distressing dental visits and claimed she behaved perfectly fine with her other medical doctors. Needless to say, I accomplished nothing in the office and her parents were made aware she will likely need to go under general anesthesia to get her dental treatment done.

Very few of my appointments are completely aborted like this one was. In fact, the rarity of it is probably why I am so heavily bothered right now; and I only wish I could have more effectively understood this patient’s disposition. In a child with a learning disability or mental health issue, (at least to my aberrant mind) there is more of a justification to why that individual may not be able to tolerate such a procedure. However, a supposedly healthy, ‘normal’ nine-year-old (with a stuffed animal?) without any previously traumatic dental appointments acting with such resistance really makes me question her resilience and coping skills for other difficult situations in her life.

There are some psychology concepts we briefly discuss in pediatrics such as (B.F. Skinner’s) operant conditioning, and positive/negative reinforcement and how each influences desired behavior. I also try to stay mindful of the developmental milestones children should be achieving, and try to raise awareness and arrange appropriate consultations when they are clearly not being met. The patient I had today clearly exhibited extremely fearful behavior (i.e. crying uncontrollably), still relied on comfort objects (i.e. stuffed animals), and willfully refused to be verbally interactive. Let’s assume she is not developmentally delayed; when someone exhibits such uncooperative misconduct, and realizes it provided her the outcome she desired (i.e. not getting dental work done) – my concern is, could that moment reaffirm in her mind that poor behavior rescues her from all circumstances she deems uncomfortable? What is the lesson she took away from today’s visit?

It begs the question though, where does parenting style play a part in all of this? In the few moments I was in the room with her, this parent met the criteria of a stereotypical “helicopter mom”; in that she hovered closely over the child the entire time (never once out of reach) and a bit overly involved in trying to pacify her daughter throughout the process.

Now, by no means do I profess to be the perfect parent. Far from it in fact. As you may know, I have two young boys. One has a borderline addiction to Minecraft and the other has a very unhealthy affinity for watching scary YouTube videos featuring Slender man. One tends to be clueless about his surroundings, messy and irresponsible with his belongings; while the other can have uncontrollable temper tantrums, often times is quite passive-aggressive, and (no joke) may one day turn out to be a kleptomaniac. At eleven and eight years of age – they already seem to know the full catalog of curse words, they consistently stay up past their bed time by at least an hour, and disobediently raid our pantry in search of sugary snacks.

In retrospect, I am starting to realize just how often I inadvertently enabled my children’s undesired behaviors over the years; all under the guise of trying to be ‘supportive’. Like when my son forgot to turn in multiple assignments throughout the school year, and my wife and I pleaded with their teachers to accept their work late. Even with minute challenges, like tying their shoe laces for them or cutting up their meals into bite-size pieces – these were obstacles they could have easily overcome and a great opportunity to build up their confidence.

It is perfectly natural to want to protect our children from difficult situations, or experiencing failure, or enduring pain, or undergoing embarrassment. Before we know it though, they’re older – and if we have shielded them from all of their struggles, I feel we may have deprived them of developing essential coping skills and the ability to build up resilience.

“We don’t grow when things are easy, we grow when we face challenges.” ─ Unknown Author

Within my own life, I know conflict has always helped me be more confident and grow as an individual. There is a sense of empowerment when we face fears and overcome obstacles. Lately, I not only ask my children to exercise perseverance and more independence through the problems they face within their own lives; but also, allow them to suffer more consequences and tackle some relatively uncomfortable situations without parental intervention.

I wish every child I treat in my clinic could have a pleasant and pain-free dental experience. Many kids unfortunately are overwhelmed with fear and anxiety before they even step foot into our office. “We are a sum total of all our experiences.” (BJ Neblett). I do not presume to be able to correct the behavior of every child within my one-hour appointment. Their past dental experiences, their environmental influences, their parent’s parenting style, and much more are all considerable factors. Fortunately we have various treatment modalities, and perhaps with time and enough positive experiences, even the nine-year-old with the stuffed animal can one day feel comfortable getting work done in the dental chair.

Thank you so much for taking the time to read this post. Please feel free to express your own thoughts and feelings on this matter, I love to hear various point’s of view.

Vacations vs burnout

Dentistry, Lifestyle

Contractually, I get ZERO paid vacation days a year. That is not to say I cannot take time off. In fact, my employer is quite accommodating of my vacation requests. However, when I am not in the office and not seeing patients, I am forfeiting any and all income for that period of time. Needless to say, that causes some internal conflict.

When I was younger, I remember someone telling me about the concept of ‘opportunity costs.’ They pointed out an example of how because Bill Gates’ net worth is worth so many several billions of dollars; that it literally would not be worth his time to pick up a $100 bill if he were to drop it on the ground. In fact, he called it a ‘poor investment’ of his time.

In the early part of my dental career, that same decision-making process always stirred in the back of my mind. Essentially, when I go on vacations, not only do I not bring in an income but I am also spending money on restaurants, hotels and flights. The other thing that weighs on me is that I work in pediatrics – so the times when it is usually most convenient to go on a trip (i.e. summer time, spring break, winter session) we are usually the busiest and therefore, the most productive. For these reasons, in my first few years of employment, I practically took no time off.

As time has progressed; I am settling into my career, my kids are getting older, and, more recently, with my health issues – I realize more and more how finite my life and time with my family really is.

I have said it before and I will say it again – I feel blessed to practice pediatric dentistry. Truly, I do not think any other profession could have brought me this level of satisfaction in my life. However, I work in a heavy Medicaid office where I am constantly surrounded by patients in pain from rampant decay, frequently get grief from parents about appointment wait times, and unfortunately, am often times immersed with a sense of hopelessness on whether we are even making an impact. Honestly, it can all start to wear on you a bit.

My family took a week long vacation last week to Yosemite National Park and a quick trip up to San Francisco. On our way back to Las Vegas, we drove along a small stretch of the Pacific Coast Highway. Lots of beautiful sites!

In the weeks leading up to the trip, I couldn’t help but feel a little more pep in my step. Just planning for it, packing for it, and the anticipation of it made me excited and really gave me something to look forward to. Since coming back (a week ago), I have put in a request for even more vacation days.

My goal from here on out is to find that right balance between work and play. Admittedly, going in to work every day feels quite repetitious and mundane. However, it is hard for me to say that I have truly felt burned out by it. I never dread going in. I look forward to conversing with the families and my co-workers. Conversely, I do want more time with my family, and want to get out and explore the world.

I wish I was rich enough to leave $100 bill on the ground. Heck, I would pick it up even at the risk of my back giving out. Seriously though, I feel fortunate that I am now stable enough financially, settled enough professionally, and (thankfully) healthy enough physically to take some time off of work and enjoy life a little more with the ones I love.

I am always interested in what others experiences are, please feel free to agree/disagree and give me your take on things! Thanks for taking the time to read this post.

Cystoscopy and medical clemency

Lifestyle

It’s funny…when I started this blog, it was supposed to be my mechanism of blowing off steam for my days doing dentistry, or a way to tell a tale about repairing something around the house for the first time. It was certainly not my intention to discuss urinating blood and getting a cystoscopy for the first time. Yeah, you heard me right, a cystoscopy – the procedure where the urologist shoves a little camera lens up the urethra to evaluate the bladder.

It is hard to say exactly what my favorite part of the procedure was. Perhaps it was when I was asked to wait – “naked from the waist down” – for the doctor to arrive. Or was it when not one, but two nurses (one teaching, one training) entered the room to place local anesthetic up ‘there’ – in preparation for the procedure. No, it was definitely the grand finale, when the doctor came in (about 30 minutes later) and inserted a tube up my penis. Ah, good times.

As I mentioned in my last post, I suddenly started to see blood in my urine several months back. After numerous visits to the urgent care and ER, multiple blood tests, and all the financial costs that come with those appointment (on a high-deductible insurance plan mind you); I am happy to say so far the problem seems to have resolved without incident. With a family history of prostate cancer, suffice it to say, I was relieved when my PSA (prostate-specific antigen) levels came back within normal limits.

The cystoscopy was just like, the cherry on top, so to speak. The hematuria thankfully has not returned in well over a month; and the urologist seemed to suggest what the ER doctor speculated – and that is, perhaps a small kidney stone may have came and went, and tore up some of the lining along the way. I have heard personal accounts, from friends and family members, of how unfathomably painful kidney stones can be and I just want to say for the record – I just feel so blessed to have been spared any cognizance of that whole ‘passage’ experience, if in fact that is what happened to me.

I do still have a slight, unexplained, lingering lower left abdominal discomfort from time to time. Both the urologist and gastrointestinal doctor I visited do not seem to think anything of it. At least for the time being, I am enjoying having normal-colored urine again and pray to God to never again have to endure a camera scope my bladder.

I write this post…with some, almost scary degree of coincidence; because a dear friend of mine, her husband actually recently had routine bloodwork done and discovered a largely elevated PSA and got the diagnosis (from the same urology office in fact) of (prostate) cancer. :::sigh::: I do not know his family history of such disease. But I do know he is not much older than me, and I know he has a daughter the same age as my oldest son. I know his CT scan had some lymphadenopathy involved and that means he has a very scary road ahead of him.

Even though my cystoscopy took place several weeks ago, I still vividly remember the feeling I had laying half-naked on the urology operatory bed. Besides feeling embarrassed and vulnerable; worst of all, there was still this terrifying anticipation and uncertainty about what results would come of this procedure. I partially joke about having medical bills piling up on me, shrinkage when the nurses put the lidocaine up in me, etc. – but the reality is, I was incredibly fortunate to be given clearance and another chance in my life. I have countless reasons to feel relieved, thankful, hopeful, optimistic, what have you. I am not so quickly dismissive, and now feel a thousand times more empathetic, to struggles and health issues like the one my friend’s husband is having.

Alright, thank you so kindly for taking the time to read this. I am glad to give more details about my cystoscopy to anyone that wants it, and please feel free to share your own stories with me. Take care!

Hematuria and an Uncertain state of Health

Lifestyle

Every weekday morning I tend to start my day basically the same way. I do my morning routine in the bathroom, and simultaneously peruse through the days headlines in my News apps and check in on the stock market performance. Then, I head downstairs for breakfast, make myself some oatmeal while I Youtube last nights Stephen Colbert monologue. I sort through some left-overs in the refrigerator to take for lunch. I pour the kids a bowl of cereal before I wake them up. And then I am off to work. I love those mundane, predictable, uneventful moments in life.

So on March 1st of this year, imagine my surprise when I am standing over the urinal in the men’s restroom at work and peeing out blood. An hour or so passes, I go again and regrettably have the same outcome. Panicked, I start hydrating like crazy, and fortunately it appears to have resolved.

I told my wife later that afternoon about the concerning occurrence(s) and she immediately forced me to schedule an appointment with a urologist – whose soonest availability was 3 weeks out. Beggars can’t be choosers, I took what I could get.

Two weeks later, however, the horrifying hematuria returned with a vengeance. That day – almost every time I ‘went’ and despite how much water I drank – the toilet bowl appeared like it was filled with blood. My wife encouraged me to go to the Urgent Care.

At the UC, I provided a urine sample and blood to run some diagnostic tests. The physicians assistant (PA) that was examining me wanted to help rule out any sexually transmitted diseases, urinary tract infections, etc. The blood work thankfully all appeared within normal limits and the urine culture results also looked good once they came in a few days later. The PA was impressed (relieved?) to know I had already lined up an appointment with a urologist for the following week, and deferred to him for a more thorough and absolute diagnosis. That was Monday.

As before, a plethora of water consumption seemed to really help eliminate the hematuria. Throughout the week, things appeared again back to normal. However, my wife and I – both with a foot in the medical field – knew the underlying cause of this issue needed to be investigated. We couldn’t help but to Google search causes of visible (non-symptomatic) hematuria, inquire with some close friends and family that are physicians, and honestly just prayed it was not anything too serious.

By Friday of that week – with only a mere 5 days and counting until my scheduled (and long-awaited) urology appointment – to my dismay, the blood came back yet again. This time, my radiologist brother and pharmacist wife insisted I just go to the hospital ER and get some imaging done. The ER doctor ordered a CT scan of my abdomen and pelvis with contrast.

After receiving my CT scan, I must have waited in the ER waiting room for at least a couple of hours before my doctor came out to give me the results. Let me tell you, those couple of hours were daunting. The mind has a cruel way of playing out all the worst-case scenarios in dire detail. However, perhaps those hours were the rude awakening I needed to re-evaluate my life. A time to reconsider the things (and people) I tend to take for granted. A time to count all the blessings that were bestowed on me throughout my life.

I thought about how my wife has been so worried about me; and in that moment truly appreciated what her unconditional love meant to me. I thought about not being able to see my two boys grow up; and wondered to myself what great things they would do in their lives. I wondered how I would break the news to my beloved office staff; how I might phase myself out of my professional career and contemplated if patients would even notice my absence.

The ER doctor eventually came out, and apologized for the long delay and stated she had been called away on a code. She stated that the CT scan did reveal a left-side small kidney stone, but everything else imaging and blood work wise appeared remarkable. As for the blood in the urine, her theory was that I may have already had a small stone pass and that it could have damaged my ureter along its pathway. However, she too was pleased to discover that I had an upcoming urology appointment.

As of this posting, my urologist appointment was two days ago. While they concurred that there does in fact seem to be a small kidney stone present; they want to do additional testing to include a cystoscopy of my bladder and a prostate-specific antigen (PSA) level check.

Knock on wood, the bleeding has stopped since the day of my ER visit last week. Unfortunately, no sign (or really, pain for that matter) of a kidney stone passing. But I wake up every day now feeling different. I have a rejuvenated attitude about my life. I feel genuinely lucky to be here each day. I put my phone away when my kids talk to me; they get my undivided attention. I appreciate and take the time to notice the trees and the sky and the world around me.

I no longer read news headlines and stock reports, now my mornings are spent perusing my photo albums. However, still turn on Stephen Colbert – he’s too wonderful! I wake my kids up before I pour their cereal…just to get a few extra minutes in with them each morning.

I still have a lot of stuff to figure out with my health. I actually try not to think about it too much. I am trying to live in the moment and not worry quite as much about what the future holds. I will surely keep everyone posted. Thank you for taking the time to read this blog post, and please always feel free to share your own experiences! Until next time…

Annual Meetings

Dentistry, Lifestyle

There is a certain sense of euphoria and absolution I am feeling right now. It is the complete anthesis to the doubt and trepidation I was suffering from this morning; especially just minutes before our virtual meeting went live.

By the way, I have officially relinquished my duties as the President of the Nevada Academy of Pediatric Dentistry (NVAPD). My one year term ended earlier this month.

I have written about taking on that position in a previous post. COVID-19 created challenges this year no other president in our organization has ever had to face. I say that not to gloat; but the truth is the advocacy efforts increased tremendously, communication became far more critical, and good leadership in general becomes exponentially more difficult in times of crisis.

NVAPD annual meetings historically take place within the first few weeks of January. If you are lucky, planning that event could potentially be the ONLY responsibility the presidency title may call for. My year though, fugetaboutit. State budget cuts, PPE (personal protective equipment) shortages, disastrous legislative policies, dental office closures, the list goes on. This past year, MY year, was ridden with issues that needed to be addressed.

I do not want to insinuate that I handled these matters on my own. I had an incredibly helpful executive committee, I coalitioned (if that’s even a word) with other local dental societies, and I basically did my best to raise awareness and garner support from our members against policies that could have devastated (I mean devastated) dental coverage for underprivileged children in Nevada. That effort took a plethora of emails, some conference calls, drafting letters, making public commentaries, and conducting surveys.

So luckily for me, around October 2020, my advocacy efforts started to stabilize. Dental practices had pretty much found their footing and figured out how to stay safe opening up their office for patient care. It afforded me a chance to begin planning that upcoming NVAPD Annual Meeting I was still responsible for.

Historically, our meeting is a two-day event. Day one is generally a Basic Life Support (BLS) /Pediatric Advanced Life Support (PALS) course in the morning, and an Infection Control class in the afternoon. Day two is typically a one-hour business meeting in the morning, followed by a full day lecture by a keynote speaker.

My to-do list was as follows: 1) find a venue 2) find speakers for each event 3) find sponsors 4) promote the event to our members and 5) host the event.

Finding “a venue” was probably the easiest item on my agenda. In the past, we have rented a small classroom at our UNLV Dental School campus for day 1’s events, and a grand ballroom at a local casino for day 2. Each year there are generally about 50-60 attendees. We normally cater breakfast and lunch both days, with snacks kind of strewn in there somewhere. In this age of social-distancing, I had but to find a virtual platform to utilize and that was it. This past year, Zoom (no financial disclosure to declare) became a household name. Although I have been an occasional attendee, I had never actually ‘hosted’ a Zoom meeting – let alone held a conference on their platform. After some perusing, researching, reading tutorials and watching demos – I signed up for their Zoom Video Webinar package, allowing up to 100 attendees. It was a little confusing at first learning the lingo (co-hosts, panelists, etc.); but once you play around with it enough, it is remarkably simple yet powerful! The invitation and registration process, branding and marketing…there really was an impressive array of features available. Other state dental societies had made their CE free this year for their members as kind of a good faith gesture; I wanted for us to be able to do the same. Fortunately, purchasing this package for a month (or two) was reasonably priced ($55/month at the time of this post) and was a cost our organization could afford to absorb (especially considering casino ballrooms can set you back upwards of 10 grand).

Finding a speaker was a little more of a challenge. For most of the courses (BLS/PALS and Infection Control), I recruited the speakers from last year and fortunately they were available to help us again this year. However, I could not just as easily reuse the keynote speaker and topic. But perhaps I put too much pressure on myself about for finding one. We are relatively limited in pediatric dentistry for the subjects we discuss (behavior management, sedation, pulp therapy, etc.). Initially I was bent on finding someone that had some notoriety in the industry and maybe even a big social media presence. The harder I looked, the more discouraged I became – especially to find many of the topics and/or speakers had already presented recently (or were about to be presenting) at other state’s conferences. To make matters worse, I spoke to two individuals prior to the end of October that ultimately ended up declining my invitation to headline our conference. My confidence shattered, I was contemplating canceling that component of our meeting. Lucky for me, in early November, a pediatric dentist in our community just happened to check in on me, and ultimately put me in touch with a friend of his from Texas that does a lot of orthodontics in his practice. Perfect!

The year 2020 surely must have been a brutal financial year for many companies. In the past, companies welcomed a chance to set up their booth in the back of our conference hall and promote their products to everyone. But we were going virtual this year. I had to get creative. I took some initiative, wrote a carefully worded letter, and created a tier for our potential sponsors; in exchange for their financial support, I tried enticing them with their company logo on our website and on our advertising emails, and even a short video of theirs played during our virtual meeting. I reached out to many of the organizations that have supported us in the past – only a small fraction of those even bothered to respond to my email, and all that did informed me they were suspending such activity this year. So, that was a fruitless effort. I did manage to secure one dental anesthesiologist that recently moved back to Nevada and wanted to introduce herself to the community. Yay!

For the advertising portion, I was able to return to my graphic design roots for this meeting. I Google searched attractive event fliers, found one that I thought was visually pleasing, and fired up Photoshop to design a similar one for our event.

From October 2020 until basically the date of the event, I was sending out email reminders to our members about registering. Around December 2020, I started to feel my blood pressure rise in anticipation of this upcoming meeting. I learned to operate Zoom fairly proficiently; held several practice sessions with my executive committee and guest speakers. We wanted to make sure polls, Q&A, chat, etc. were all being displayed properly, as well as any PowerPoint presentations and videos we needed to broadcast.

After tuning into another state’s annual meeting, I decided to contact the president that orchestrated it and asked how I could mimic it. She was incredibly kind, probably spent a couple hours on the phone with me answering my questions, and ultimately I was able to assemble it. The best part of pre-recording the video (which, mind you, took long hours and several weekends to construct) was that I was able to time it perfectly to the hour I had available.

I initially purchased and downloaded Animotica from the Microsoft Store for my movie editing, but that had very basic/limited features and I found it difficult to use. After a little more investigating, I wandered upon HitFilm Express (no financial disclosures to declare). Let me tell you, AMAZING piece of FREE software! It had tons of transitions, some built-in text effects, sound-editing features, you name it. Highly recommend it!

So, there you have it. I apologize for disappearing for so long from this blog. I got tunnel vision on this project for the past several months, and any and all free time I had was devoted to this. Honestly, the past year was filled with a constant stress of tending to something or another NVAPD related. But overall, I would say the event went well, as did my year as president. I am however, looking forward to a little time off to just read, learn Spanish, play tennis with the kids, and try and clear my plate of responsibilities for a minute.

If you need any help planning a similar event, or have your own experiences you wish to share, I’m all ears! Thanks for taking the time to read this post!

On-line Reviews

Dentistry, Lifestyle

I work as a pediatric dentist in a heavy (and I mean heavy) Medicaid office. Generally speaking, these types of offices have high cancellation rates, low fee reimbursements, and occasionally long wait times. One facet is not independent from all of the others. When the office receives such low reimbursement and has a high no-show rate, we are forced to double book patients in anticipation some patient, and occasionally entire families, may not keep their appointment(s). It is a necessary evil. Thankfully, I have the help of a well-trained staff, and together we have learned to tough through those overwhelming moments when everybody decides to show up. We understand everyone’s time is valuable and we try and respect it by staying on schedule whenever possible.

Usually, if our office receives a negative review, it almost always is not directed directly at me. Someone will leave disgruntled remarks about an insurance issue they faced or, like the other day, voice their frustration about our office policy on needing to perform a ‘consultation’ before we are able to schedule a new patient for any dental treatment. The irony is that the lady had enough time to leave a lengthy 1-star review for an office she had never visited yet claimed we tried to “waist” her time and gas by making her drive to our office so we could properly evaluate her child’s behavior and treatment needs.

I do not know if it is because I take pride in my chair-side manner, and the fact that I thoroughly try to explain my thought process in developing my diagnoses and treatment plans to each and every parent; but when I received a negative Yelp review the other day, I couldn’t help but take it hard. We had an anxious 6-year-old girl come in last week, brand new to a dental setting, who had multiple decayed teeth, an abscess and has been in pain for the last month. The mom, who was in the room initially, was very pleasant and seemed to understand the options I had presented. I recommended we try and save some baby teeth with cavities, while the abscessed one was better off being extracted. I also informed her that because the patient is new to a dentist, perhaps giving an oral sedative to relax her a bit may offer her a better experience. She completely agreed and went up front to schedule. Just moments after they left for the waiting room, the grandmother of the child comes in and adamantly proclaims she wants all the infected teeth extracted, stating they are “just baby teeth” and that she knows what [baby] “root canals” are like and she does not want her [grand-daughter] going through that. Oh, yeah, and she wanted it done right away versus scheduling for a conscious sedation like I had recommended.

5-Stars for those two smiles!

A quick side-note if I may: Baby teeth are IMPORTANT! They save space for the adult teeth to erupt into, they keep bone in the jaw stimulated and strong, and they can potentially spread their infection along to the adult teeth.

I am used to parents minimizing and misunderstanding how important baby teeth are. Heck, I did before I specialized. Now it is my job to educate them on not only how best to keep them clean and healthy; but also explain the duration of time we naturally need to have them around for in our mouths. Most are receptive and appreciative to get that information – and start to see some value in the baby dentition. This grandparent, however, had already made up her mind that those teeth should be pulled. After I started to get the sense that she could care less about my recommendations; I basically told her I do not feel that [extractions] is in the best interest of the child, I cannot allow her (who, mind you, was not even the legal guardian) to dictate the treatment that I provide, and I encouraged her to seek care elsewhere. Keep in mind, at no point did I change my tone or demeanor, I simply said something she did not like hearing. Sure enough, shortly after this encounter, a Yelp review appears saying how “rude” I was for stating she was trying to dictate my treatment and how she did not understand how I deal with kids all day.

I am pleased to report MOST on-line reviews about our practice are positive. In spite of our mildly lengthy wait times, people usually find the service we provide efficient yet thorough. In fact, that is the most common source of new patients coming into our office – beating out word-of-mouth, pediatrician and general dentist referrals. Luckily this ladies complaint will fade into the abyss of compliments and praise we receive from most people that visit us. And as I have said before, I try to be empathetic, the sweet girl has been having pain and that is never easy for a loved one to witness. Nonetheless, the sheer audacity of coming into a dentist’s office and telling them how to do their job is a bit overly brazen if you ask me.

Look, I get that everyone is entitled to their own opinion. I strongly believe that. God knows I have left my share of positive and negative reviews. For the few negative ones that I have been inclined to leave, I always appreciate when a business owner responds and goes out of their way to contact me to make things right. But this is not a ‘Taco Bell screwed up my order so let’s give them a 1-star review,’ kind-of scenario. In other industries too, but especially in health-care, you should put the majority of trust and treatment decisions on the person that went to school for it.

I will admit, I love getting positive reviews. I check at least a couple times a day to see if we have any new postings. I think it is human nature to feel that sense of accolade and approval from the people you work hard to serve. And while I have little concern that the recent negative review will damage my clinics overall stellar reputation in any significant way; I cannot help but feel a little outraged at the temerity some people have. I am used to the occasional snipe about our wait-times, and understand our office policies may piss some people off; but I draw the line when people can come into their friendly neighborhood pediatric dental office and treat it as if it is their local fast food joint – order whatever they want and have it done immediately at their beck and call.

This post feels like a bad review about bad reviews. Thanks for letting me have this rant and get this off my chest. I do not think anything changes for me, I still plan to leave both good and bad reviews for other businesses; overall I still find them useful and effective. Personally, before I post the bad ones, I think maybe sleeping on it and letting emotions settle down first is always a good idea. Maybe the less bridges we burn, the better sometimes. Anyways, as always, let me know your thoughts! Thanks for visiting!