PATIENT CLOSE TO DEATH

I had a patient come in to our office the other day who had constant headaches and TMJ pain.  At first brush, it seemed that this was going to be a routine TMJ patient with migraine headaches.  Fortunately for her, we spent approximately two-and-a-half hours with each of our new patients to fully understand all the contributing factors associated with their facial pain.  In doing so, she revealed to me that she had numbness along the side of the face coming out of the neck region.  Upon inquiry, I asked her when this started and she stated it started this weekend when she was dancing with her nephew.  As she was dancing, she creaked her neck.  She had a pain in her neck and then numbness.

 

I asked her she has had this area imaged.  She said that the neurologist was going to watch and wait and see if it resolves itself.  My response was that any patient that comes into my office with any type of facial numbness, I always take an MRI, so therefore I sent her over to the hospital for an MRI.

 

Later on that afternoon, the radiologist gave me a call and said that she had a dissection of the vertebral artery that goes in the brain.  He is very concerned that a clot will form, which will give her either a stroke or death.  I called the neurologist and had her admitted right away.

 

It is not often in a practice that one gets the opportunity to make an impact in somebody’s life like this.  It is equally rare that a patient shows an incredible amount of appreciation as she did afterwards.  She came by our office and gave everybody in the staff a gift.  There was a lot crying involved of joy and with both her, her husband, and our staff and I have to admit, myself.  She is a truly precious lady and I was honored to be able to be part of her care.

 

Situations like these always seem to be a deep well to drawn on, when days get long and arduous.  People who respond such a way seem to make everything worthwhile.  It is like God sent to me “you are doing the right thing and here is a little window of appreciation I want you to feel.”

 

Dr. Prehn

A Young Girl With A Brain Tumor

Last year we had a patient come in who was in college.  She had a headache that had started four months previous to this day that came out of nowhere.  She has never had a headache before and it has never stopped since then.  She has been to three neurologists who have treated her for muscle tension headache and migraine with no response to their treatment.

 

I have a hard and set rule in my practice life, which was given to me by an old neurologist friend of mine.  He said he always wanted to the image the “worst or the first headache.”  This was both for her, so I decided to take an MRI.

 

I got the report back from the radiologist and she had a schwannoma of the acoustic nerve (brain tumor).  It was approximately 2.5 mm in size.  I called her father to notify him of the results and that he needs to get to a neurosurgeon immediately.  The size of the schwannoma is largely dependent on how much brain tissue is damaged trying to getting it out… larger the schwannoma …the more damage and permanent damage can be done during the operation to remove this brain tumor.

 

You would think that the story would end here, but it does not.  The father responded with a question “do you think insurance will pay for that?”  I almost dropped the phone when he asked me that.  I told him it did not make any difference because your child has a brain tumor and whatever it takes you need to get that out of there.  Then he followed up with a question “she is going back to college on Monday; do you think we can take care of this next summer?”  This time, I did drop the phone and picked it back up again I said you need to do whatever you think is best but in my opinion everyday makes a difference in how much brain damage is going to be done.  I told him that she may never go back to college and become a vegetable if he does not get this taken care of as soon as possible!

 

Unlike other situations that have happened to me like that through the years, this one ended sort of odd.  I never heard back from the father or mother or the patient again.  We may have saved her life or at least the quality of life by diagnosing this brain tumor when we did, however I have never heard an ounce or a single word of appreciation.  Please note that I do not do what I do and expect appreciation or thankfulness, because what I am doing what I am doing because I feel that is what God wants me to do and is the right thing to do.  However the reaction of gratitude is a normal human reaction to a situation like this and the lack of it in this situation was concerning to me because I hope that they had the situation taken care of.  I never heard back and I do not know if she ever did have it taken care of.

 

God bless,

Dr Prehn

Masters Meeting

Master Meeting Thoughts

 

The first week of May, I have been asked to teach a course at the Master’s meeting for sleep dentists in Dallas.  This is headed up by Dr. Keith Thornton who I have to say has become a friend of mine.  We have been working together on developing custom masks and custom interfaces for the CPAP machine.  While he has invented these devices, I have been working with him to help develop protocols for dentists to use once it becomes commercially available.  The section I am teaching, will be on how to take a face impression and construct a custom mask, which is the ultimate mask for a CPAP machine.  We are able to take an impression of the face and fabricate an acrylic mask that will have no leaking and a near perfect seal so that there is an excellent interface between CPAP machine and the airway.  This is attached to a mouth splint, which will give it security without any straps and also there will be no movement.

 

When I started my career in dentistry, I never dreamt that I would be teaching other dentists new procedures like this.  I have come to believe that no matter what one’s occupation or profession is, if they choose to do it for the right reason… because they love it and because they want to help other people, and in the end represent God and all that they say and do… the blessings will come, because that is just the way God is.  That is the purpose of what I do and as a result I have pursued excellence in the high standard of care in my practice and in professional life, and this pursuit has lead me to the cutting edge of a new subspecialty of dentistry once again.

 

Dr. Prehn