True Healing of Pain

There is more than just physical pain in what the patients have when they come to this office.  Yes, they are in physical pain and that needs to be #1 in the way we treat our patients.  We look for the sources of the pain, things that are driving the pain, and where they are in their degenerative issues concerning the joint and other structures.  This is based on scientific evidence and baseline knowledge of human anatomy and physiology.

 But there are two other types of pains that a patient has when they come to this office.  First is physical pain, then there is emotion pain, and finally there is spiritual pain. 

 Emotional pain comes from the effect that this physical pain has on people.  People get stressed and the pain usually gets worse.  When people have been abused in their past or when they are hurting from emotional issues such as financial disaster or death in the family of a loved one or certain circumstances that are tragic to people; this would drive their physical pain to be worse.  There will also be something that needs to be addressed when we are treating her physical pain.  If the emotional pain is severe enough, then the stress of that emotional pain will frustrate a treating doctor’s ability to treat the physical pain.  Sometimes emotional pain is transient and will pass when the physical pain has been reduced.  Because often times the physical pain alone creates emotional pain.

 The third type of pain people have is spiritual pain.  These are the people who have been disconnected from God and are lonely and alone.  Often times, they are angry at God for the physical pain that they have or they are angry at God for the emotional pain that they have.  Sometimes they do not even know who God is and do not even realize that there is a God who loves them and cares for them.  This type of pain I explore very gingerly and compassionately.  I do not push the subject.  However, I do raise faith flags as I explain to people that there is empirical evidence that people who pray or who are being prayed over have a higher success rate and healing from cancer and from the pain of cancer.  If the patient wants to discuss this spiritual pain further, I try to make myself available to address that pain.  This is a very touchy subject and something that has to be approached with sensitivity and love.  There are those who want nothing to do with this aspect of the pain and that must be respected.

So, therefore, all three types of pain need to be dealt with at some level by the person in pain and depending on the severity and the complexity of the pain, needs to be dealt with by the treating health care provider.

God Bless,

Dr. Ron Prehn

Constitutional Rights

I guess I had no interest in guns until our right to own one was threatened by our current administration. It is sad in this country how a criminal can break into your home and threaten your family with death and how your life will be a train wreck if you survive! It will cost 20-25,000 just defend your  self, not to mention the liberal media and some people will call you a murderer for killing that father of 2 kids!  We need tort reform in this country.

 Instead, since November elections (2008), the numbers of gun owners have grown exponentially. I guess I am not only one who feels our right to bear arms is not only threatened, but necessary to keep our country free. Everyone at the shooting range and in guns shows have said that in the last 6 months, sales have been better than the last 30 years combined!!!  I am certain that is all over the country.

 This country has many freedoms and they are all designed to maintain our freedom. It is the right to bear arms that will keep our gov’t serving the people instead of us serving them. History has shown that to be true every time. Our forefathers were geniuses and I believe divinely inspired. The right to bear arms is the most important freedom we have because with out it, we would lose all the others. It is not that the people will revolt and over throw the gov’t! Rather it is that the gov’t knows that they can not go against the people. There are many more guns in private hands than the military by far.

 Even at the threat of limiting this right has caused a huge backlash and people everywhere are now interested in owning and learning about guns. In the attempt to limit that right, those who want to eliminate guns from society have caused the opposite to happen.

God Bless,

Ron Prehn

Speaker’s Responsibility

I just returned from presenting at the national sleep meeting in Seattle in June 2009.  I had the opportunity to observe many different types of speakers and many types of presentations.  Some were good and some were excellent.  What I observed as far as excellence is that the speaker has several responsibilities when it comes to presenting to an audience.  He has the responsibility to make his presentation logical and clear.  He should take the issues involved and clearly define them, and try to present a logical solution to problems or explanations of phenomena that are noted.

 But beyond that, I believe a speaker has to have humility in order to connect with his audience.  The speakers who are pride of the prestige they think they are getting may be interesting on the surface.  However, they fail to really connect with the audience.  It is my belief that it is God who provides opportunities for speaking.  I do not deserve to be speaking in front of any audiences based on my own skills and intellect.  Everything that I have and ability to speak comes from God who has gifted me with certain talents and gifts.  I try to honor Him when I speak by being excellent at what I do.  I understand that a teacher and a speaker is under a greater judgment because many people will either rise or fall based on the information of the subject he is presenting as well as to the character that he is.  When a person is put in the position of authority either in a subject or as a leader in an area, that person is given greater responsibility and is under greater judgment by God or those who are over him.  Therefore, it is incumbent upon this person who was speaking or teaching to do diligence in his subject matter and to present in a clear and thoughtful way.  This is what motivates me when I speak knowing that I need to validate what I say with science and to present in a humble way so as to make it clear that what I am saying is either based on scientific fact or things that I have figured out.  If they are scientific fact, they are fact, but if they are things I figured out I believe that it should be presented in a way for those who are listening to consider as a possibility.  Humility is the key to effective communication and to motivate change.

God bless,

Dr. Ron Prehn

Business friends

As I was returned from the National Sleep Meeting in Seattle in June 2009, I am reflecting on a business friendship that I have.  My lab technician who has been with me for over 10 years was at the meeting with me.  We have been in many meetings together.  He has been at my side since I limited my practice as only TMD here in Houston many years ago.  We have been through thick and thin, good times and bad times, but it seems that no matter what, we enjoy each other’s presence.  We have a business relationship, but more than that, a friendship.  When business gets rocky it seems that our friendship gets us through.

 What value is this to a business?  I believe it is like icing on a cake.  I count myself one of the fortunate few to have a friend such as this in a business relationship.  His technical ability is creating splints for my practice.  This has been key through the years to the success of the practice.  Not only is he part of the team, but he is also instrumental in providing excellent quality care in the southeast Texas area.  Our friendship within the context of this business relationship has provided greater purpose for what each of us do.  We both realize that God has blessed us with this relationship during this season of our lives.  He has come alongside with what God is doing here in Houston and has become a critical part of God’s plan.

 I too am part of that plan and together during this season of our lives we are working to advance God’s kingdom as we care for these patients in pain with competence, character, and compassion.

Purpose of Work

Today, I just delivered a custom face mask that I fabricated for the patient who has significant health problems and in dire need of a CPAP machine in order to maintain his airway at night.  His current CPAP mask has to be put on so tight, is causing permanent marks on his face and is not working because of leakage.  He is unable to tolerate any more pressures higher than it is right now.  So the custom mask is based on a face impression that I take and I attach a mask made out of acrylic to an oral appliance.  It attaches to a post that sticks out from the oral appliance and therefore no straps are needed in order to keep this mask on the face.  It is secured to the skull base via the upper the teeth and there is no leakage.  This mask is extremely efficient so we are able turn the CPAP pressure down which makes the whole experience more comfortable.

 However, the great satisfaction and purpose in making this mask is the dramatic changes in health that he is going to be experiencing soon.  As this mask settles down and we are able to get the pressures correct, he will experience deep uninterrupted sleep, which will enable his body to heal at night and therefore help him have a better overall health.  His cardiac problems will start to level out and his obesity will also be easy to deal with now that he is getting the deep sleep.

 Reason why I came in to this profession to begin with was to help people.  In circumstances like this, the help is so dramatic that it underscores and emphasizes the purpose by which I started in the dental profession.  It gives great satisfaction to make a dramatic effect on somebody’s health and hopefully prolong his life and more importantly the quality of his life.  I believe that is why God let me enter this profession and I praise him for allowing me to fulfill that purpose.

God Bless,

Ron Prehn

Dangers of Snoring

Snoring Defined: “vibrating noise coming from oropharyngeal structures that are most notably the vibration of the soft palate, uvula and pharygeal walls as a result of the collapse of the airway.”                                                          Dr. Ronald S. Prehn

 The Danger of snoring is the last few words of the definition “as a result of the collapse of the airway.” There are several principles of flow dynamics at play in this dynamic process, but the one to understand is the Bernoulli’s principle.

 “As the speed of a moving fluid (liquid or gas) increases, the pressure within the fluid decreases.”   Wikipedia

 Like a shower curtain that collapses into you (from decrease pressure) as you turn on the shower (increased velocity).

Therefore the dangers of snoring are related to the fact that snoring may be an early indication of obstructive sleep apnea (OSA). The following conditions are known to either be caused by OSA or aggravated by OSA:

• Heart disease
• High blood pressure
• Cardiac hypertension
• Pulmonary hypertension
• Stroke
• Type 2 diabetes
• Insomnia
• Fatigue
• Loss of concentration
• Weight gain
• Acid reflux
• Bruxing (grinding of teeth)
• Sleepiness and drossiness leading to car accidents

 Q: How do you know if you are at risk for these medical problems?

A: Need an evaluation by a Dental Sleep Specialist

Big Responsibility

 

With the new Medicare rulings that are coming down it will put a great responsibility on the General Dentist to educate themselves as to the nature of sleep disorder breathing.  It has upped to the bar for responsibility both medically and bioethically.  If the Dentist is in charge of the patient’s care of their sleep disorder breathing he will have responsibility to understand the disease and to treat all aspects of it.  Just with any other dental disease that Dentists are trying to deal with, sleep disorder breathing has its medical side of things too.  The Dentist needs to learn the medical side and be able to refer all aspects of sleep disorders not treated by the Dentist, at the appropriate time just as he does now treating other dental diseases.  This will be a natural extension of a dental practice; however, it will put a large responsibility on the Dentist for additional training in order to treat this disorder.  This is going to open up a whole new avenue of teaching in both the dental schools and out in the continued education environment.  I look forward to be in part of that aspect of the growth of this profession, and I am committed to keeping the standard of the profession at the high as possible level. The future is bright for not only the profession, but for all the patients under the care of competent dentist.

 

God Bless,

Ron Prehn

Impact of Medicare Ruling

 

There is a new Medicare ruling coming down the pipe that may put dentistry at the forefront of sleep medicine.  There is no other profession in existence that is better equipped to deal with the airway as a Dentist.  The training and education of the Dentist has been on the head and neck so this is just a natural extension of dentistry.  We are able to manipulate the jaw, the tongue, and all the major contributors to the sleep disorder breathing.  It is something that is we have been trained for to start and now we are able to bring it to bear on this concern.  Medicare is starting to see this and understand the role of Dentist and thereby the new ruling validates the Dentist’s role in this sleeping disorder.  If this ruling turns out to be the final ruling it will have profound impacts and ripples through this entire sleep medicine community both in the dentistry and medical side of things.  With this ruling, home unattended sleep study will be an accepted diagnostic modality thereby enabling Dentist to diagnose sleep disorder breathing without using a sleep lab.  This will have profound the effect on medical doctors who have started all the sleep labs around the country and who have decided to avoid utilizing Dentist in their treatment plan.  However, the medical doctors who have been wise enough to seek out a Dentist to work with their team may be able to survive. The future is just starting and it will be interesting to follow the progress of these aspects of dental sleep medicine in the future.

 

God Bless,

Dr. Ron Prehn

Dr. Keith Thornton’s Contribution

 

There are some new Medicare rulings that are being released as I pen this blog.  It will address the fact that Medicare will pay for the oral appliances as well as home unattended sleep studies.  This is a shocking and incredibly significant ruling if this ends up to be Medicare’s final position on this matter.  The ruling will propel the dental sleep profession into the forefront of dentistry as it starts to deal with all the aspects of sleep as it relates to oral disease as a whole and the deterioration of dental apparatus through time.  I will write more on this later.  At this point, I need to pay homage to Dr. Keith Thornton, who has been on the forefront of this profession since the beginning.  He has spent his career for the last 25 years in trying to obtain this type of status for the dental sleep profession.  He has worked diligently with lawmakers, with policy makers, with Medicare, insurance companies, and other industry professionals in order to convince them of the essential role of the Dentist in treating sleep disorders.  The Dentist is well equipped to deal with every aspect of sleep disorder breathing at the base of the diagnosis up to every aspect of the care of the airway.  This is what Dentists were trained to do from the very beginning and now we have been able to bring every aspect of our profession to bear on this critical problem in society and hopefully many patients will not only have their lives saved, but also have their entire general health improved.

 

Dr. Thornton is to be commended for all his hours and years of work that he has not had any pay for, nor has he had the recognition he deserves.  He is not only the inventor of one of the best mandibular advancement appliances for sleep medicine, but also the father of Dental Sleep medicine in my mind.  So, I dedicate the future of the dental sleep profession to Dr. Keith Thornton.  Thank you Dr. Thornton for all you have done for not only the profession, but for all the patients that will have better overall health and the lives you have saved, for your lifetime efforts.  I look forward to your continued contribution to the profession as we dive into all the different aspects of sleep disorder breathing as it affects the general dental health of all our patients.

 

God Bless,

Dr. Ron Prehn

Diplomate of the American Board of Orofacial Pain

Diplomate of the American Board of Dental Sleep Medicine  

 

Hebrew and Facial Pain

  

I have had the incredible opportunity to attend seminary at Dallas Theological Seminary.  I am near the end of my work for a masters of the Theology degree and all I have remaining at this time is to learn the language of Hebrew.  As I am learning this language, I find it fascinating by the versatility of this language.  When I learned Greek, every word had an exact definition and endings were very accurate as to how are they used in vocabulary and grammar.  Hebrew on the other hand is very fluent and very versatile.  One word may have many different meanings, often at times four or five meanings.  Therefore, it is from a western point of view a very difficult language to learn.  However, from the Semitic mind, this language fits the way the mind works.

 

The meaning of a Hebrew word is entirely contextual.  Context determinants the meaning not just the nuances, but the actual meaning of the word.  Therefore, a word cannot stand on its own, has no meaning until it is put into a context of a thought in sentences or paragraph.

 

When it comes to pain, the same principle applies.  Pain without context is almost unimaginable.  There is always a context to pain. Pain is in the context of anxiety or an experience or a physical harm or punishment or many other things that frame the context of the pain.  If the context of a painful event is in a life-threatening situation, the mind often times puts the pain aside and ignores it completely.  However, if the pain is in the context of secondary gain where the person would receive sympathy and attention, then the pain becomes highly exaggerated and center of the patient’s life.  I often see this in mothers who are raising children.  They very often put their pain aside because their children are of high priority than they themselves.  They have contextualized the pain and put it in a place of low priority.

 

Therefore as I am learning Hebrew and its vocabulary, I am reminded how people contextualize pain and that as a treating medical professional that we have to understand the context in order to understand the patient’s pain.  Then we are able to address the pain and to treat it properly.

 

God Bless,

Dr. Ron Prehn