Sleep breathing is a dynamic problem

When starting to understand sleep-disordered breathing, it is imperative that the medical practitioner understands that this is a dynamic problem.  The collapsing of the airway at night is a problem that occurs with changes in the pressures of the esophagus.  This is not something that can be imaged, although imaging does suggest a narrow airway and the possibility of this happening.  There is no exam for this problem that can be done without invasive techniques.  The medical problem can be brought to light by history and examination of the various effects of sleep-disordered breathing.  Once the case has been made, then the only way to diagnose this dynamic situation is with a nocturnal polysomnograph (NPSG).  This sleep study would then measure the various parameters of sleep-disordered breathing such as airflow and effort to come up with a proper diagnosis of sleep-disordered breathing.

Therefore, the examination process is basically good enough evidence that this problem exists to the point, which a NPSG will be ordered.  The goal-up of this evidence may have several purposes one of which might be to convince the patient that this problem actually exists.  The other purpose is to determine the severity.

It is impossible to guess the severity of sleep-disordered breathing by the examination history alone.

God bless,

Ron Prehn

Competency, Character, and Compassion – Part Three: Compassion

As I reflect on the third part of our core values of the practice compassion is a very easy concept to think about.  Compassion is what draws people into this business, and it is a compassion for others who are in pain.  The ability to help others and to make a difference in their lives is what satisfies people such as myself who are in this business.  My staff are all very compassionate people and most of the people that I teach and speak to are also very compassionate people.  It seems compassion is what brought people into the field of dentistry to begin with.

Compassion means to empathize with the person’s issues in their life and to help them intervene in these issues so that they are better off either their pain or in the effect of pain in their lives.  This pain of course can be more than just physical pain as we address the spiritual and emotional pain as well.  We try to address all those features in a practice such as this in order to be compassionate with them.  It means to connect with them on a personal level not just as a patient.

Dr. Mayo once said medicine is about knowing the person who has a disease and not the disease that the person has.

Competency, Character, and Compassion Part Two: Character

As I reflect on the second part of our core values and the fact is I realize that this is probably the most difficult value and the one that reaches into the core of what a person is.  The character of a human is greatly influenced by the sin that we are.  It is not the sins that we do, but we have a core sin nature that seeks out rebellion against God.  It is this sin nature that drives us to do selfish things and to put ourselves above others and to do things our own way.  This greatly affects our character if that is the mode by which we live by.  However, as a Christian, one has other options and that is to ask God for His character, which is provided by the Holy Spirit.  This character that represents God is available to all those who believe in God’s Son Jesus Christ.  Once that happens, it is a lifetime transformation to be transformed into a person of good character to represent God better in this world by reaching out and allowing mercy to others.  This character that I am speaking is based on self-sacrifice for the betterment of other people lives rather than your own.  The ego or the sin nature in us is very strong and everybody desires to put themselves over other people.  However,   the character of God is that we will sacrifice ourselves for the betterment of others.

This character of self-sacrifice and helping others is what I am talking about in the core value of this practice.  I have come to know that the work that God has put me into to represent Him to other people is based on His character.  There is a lot of sacrifice that is going on in the work of helping people in pain.

Competent, Character, Compassion – Part One:Competency

As I reflect on the core values of our practice what comes to mind today is competency.  This means that God has called me to and anybody who is desiring to advance His kingdom, to be the most competent person in the job that he is doing.  It does not matter what the job is.  To work in this world is to work alongside God in what He is doing.  God has called people to work with Him in order to rule over His creation and this is a privilege and an honor to do that.  Therefore, this calling is, while it is universal, it is also very personal.  In order to since we are called to represent God in creation with the work that we do, it is important that this work is done with a high degree of competency.  Since we are representing God who is all perfect in all things, we must be competent in the job that we are doing.  This competency will not only represent God, but will also draw others to Him as they see you as a competent person.  For example, if you have a heart problem I am certain you will not be looking for a Christian doctor, but you will be looking for the very best heart surgeon in the world.  You want a competent doctor before you want a Christian doctor.  Therefore, it is the competency of what you do, that will draw people into your sphere of influence to begin with. This is the first step in representing God to the world through the work that you do.

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