Rough Night at the Hospital, Entry # 2

*Please note that newer entries for my personal blog are published in reverse order (newer posts are published at a later date), so that the true story of my family can be told in chronological order. The real date of this post is August 16th, 2011*

After getting off the phone with my wife, I had my patients cancelled for the rest of that Tuesday and all of the next day, Wednesday. I let my office manager know to keep the Thursday scheduled for our patients in order to offset for the other closed days. I then headed straight home to pick up the over-night hospital bags for my wife and myself.

That late afternoon on Tuesday, I was finally at my wife’s bedside. I remember stepping into her labor room for the first time and seeing her in her light blue hospital nighty sitting on her bed wrapped in a blanket, watching TV. Something about that moment still sticks with me. Her skin had a golden shine and face was beaming – delighted that I was finally here. I felt relieved and happy that she was doing “okay” and that we were finally getting ready for that big day at the hospital. I walked over to her bed gave her a light kiss on the cheek and sat next to her.

After about 14 hours of labor, my wife was still only 3 centimeters dilated. Her doctor informed us, that it would be at least another 9 hours before she would be dilated enough to give birth. Because of the pain from her contractions, my wife asked for an epidural so that she could get some rest. I could still remember the hospital recliner that I was trying to sleep/rest in next to my wife. You would think that for $10,000 a night, such a highly rated five star hospital  would be able to provide more comfortable accommodations. Let’s just say I think I’ve slept better in my college years on the floor of the bathroom next to a toilet after a USC party.

I think my wife could hear me tossing and turning. At around 3:30 am, I remember her opening her tired eyes and telling me to just go home for a few hours to get some rest so that I could be back bright and early. Knowing that I would need my strength and not really wanting to argue with my wife, I somehow made it back home around 4 a.m. As soon as I got home, I hit the shower and fell flat on my bed asleep.

I woke up around 6:30 a.m. to the sounds of my dog barking. Mochi, my shit-poo dog (Shihtzu/Poodle) was pretty angry because I had forgot to feed and give her water the night before. Somehow that didn’t stop her from laying a nice large dark pickle in the hallway. I quickly cleaned up her mess and gave her enough food and liquids to last the next few days. Moments later, I rushed back to the hospital.

When I arrived at the Huntington Memorial Hospital, my wife didn’t look so great, She looked very pale and her eyes were blood shot – yet she still managed a weak smile as I entered her room. The pitocin didn’t seem to be helping her dilate – she was at around 5 centimeters dilated after about 21 hours of labor. In order to try to induce the dilation further we walked around the hospital so many times, that I became an expert at counting the number of dings and cracks on the hallway walls – 92 not including the dark scuff marks which would put it at 112.

After about 25 hours of labor, our doctor informed us that my wife was still only 5 centimeters dilated and would therefore have to go through a caesarean. At that point my wife received her 2nd epidural in preparation for surgery. Just as we finished packing up our things and was ready to check-into the surgery room, the head nurse came in and said all the surgery rooms were full and that we would have to wait till one was available. Two hours later, we were informed again that a room was still not available. To this day I’m not sure why they didn’t let us know earlier, so that my wife could at least rest on her hospital bed. My nine months pregnant wife was about to burst and basically had to stand around or sit on the edge of the chair because we had to be ready at the snap of the fingers, to admit her into surgery. I kept thinking in my head at that time that we had done our research and Huntington Memorial was one of the highest rated hospitals in our area – it was hard to imagine how it could have been worse at any other hospital. My train of thought was broken when the nurse finally came in and said a surgery suite was available … my wife had suffered another 3 hours of labor waiting for that room, putting the grand total at 28 hours of labor.

* Too be continued on the next post titled "The Happiest and Saddest Day of our Lives" *

The Happiest and Saddest Day of our Lives, Entry # 3

*Please note that newer entries for my personal blog are published in reverse order (newer posts are published at a later date), so that the true story of my family can be told in chronological order. The real date of this post is September 25th, 2011*

I was lead to a hallway area near the surgical room to wait, while my wife was being prepped for surgery. Sitting there, I could feel excitement of welcoming a new family member into our world and at the same time a sense of relief that my wife’s pregnancy and long labor will soon finally be over. After about 15 minutes, the nurse escorted me into the surgical suite. My wife was on the table in her hospital gown. They sat me next to my wife on the right side near her head and allowed me to hold her hand.

I could not see what was happening because they had her mid section covered by a barrier – I’m sure this was to protect the eyes of the average husband. I’ve heard of grown men vomiting all over their wife or even passing out on the floor from watching this type of surgery.

I nearly jumped out of my chair as the terrifying screams of my wife interrupted my muse. A few minutes into the surgery had passed and my wife was screaming as if she was being butchered alive. Her face turned a ghastly white and her body was jolting in pain. Her right hand was squeezing the life out of my hand; the deathly grip was so intense, that I thought the bones in my hands would break. The nurses ran to her side in preparation to hold her down and I tried my best to console her. Apparently the epidural and anesthetic was not working, most likely because the length of her labor had lasted too long and her body was building a resistance to the medicine. So she could feel everything during he caesarian. At this point they could do nothing but press on with the torturous surgery…

A few minutes seemed to last a life time as the cries of agony from my wife filled the room.  Moments later our baby girl was born and the screaming from my wife settled. Our baby girl, Hanna weighed a whopping 9 pounds and 2 ounces and was 23.25 inches tall.  Please keep in mind that my wife is by no means heavy set – at least for now! Prior to her pregnancy, she was 112 lbs. The average baby weight in the United States is usually 6-7 lbs. After I cut the umbillical cord and Hanna was cleaned up, I brought her over to my wife. The touch of her baby seemed to calm my wife down some more and she managed a faint smile.

After they closed up my wife she was carted away and I was brought into a room, while they checked the condition of our baby girl. A feeling of happiness rushed through me as I was holding baby Hanna, I still could not believe I was finally a proud father. When everything finally checked out, they told me I would have to release our baby to the neonatal nursery so that they could continue her care while I visited my wife.  I watched from the nursery window as our daughter laid in her hospital crib. She was the biggest baby in that nursery. Next to her, the other newborn babies seemed like little dwarfs. Seeing that Hanna would be okay, I went to see my wife in her recovery room. My wife, Cisca was laying in the hospital bed with an IV flushing fluid and pain-killers through her sore body. I went over and gave her a kiss on her forehead and gave her an update about our beautiful baby. An hour passed and I asked the nurse when our baby would be able to join us in our room. She said it should be soon. Another hour passed and my mother and sisters met with my wife and I. At this point, I got up and went over to the neonatal nursery to see how our baby was doing. When I got to the nursery window, Hanna was nowhere to be found. I started conversing with some people next to me by the window overlooking the nursery. They were visiting and watching their newborn grandchild. When I asked if they saw a large Asian baby in the crib near the corner, they informed me that not too long ago there were about 4 doctors and a group of nurses hovering over our baby. Moments later they said Hanna was carted away.

Something did not feel right. I quickly tracked down a nurse and asked where my daughter was. They directed me to the neonatal emergency center. I immediately rushed into that department to talk with one of the doctors. One of the specialists explained that our daughter had a problem with her heart.  When, I asked if it was a heart murmur or a hole in the heart, they said no it wasn’t, but that someone would explain everything to my wife and I in a few moments. I tried to squeeze more information out of them, but they just brushed me off, and told me it would be better if I waited for a pediatric cardiologist to go over the information with us.

About another hour passed before a doctor came into our room to talk with my wife and I. Our daughter was diagnosed with a rare congenital heart disease, Hypoplastic Right Ventricle, Tricuspid Valve Dysplasia with Pulmonary Atresia. Basically the right side of our daughter’s heart did not develop properly and she was not getting oxygen delivered to her body. They informed us that Hanna would have to be immediately transported to Children’s Hospital Los Angeles for her survival and proper care. We were also informed that there were surgeries that could be preformed to prolong the life of our child. They would not be too specific about the surgeries or her long term outcome. We asked if we could at least see our daughter one last time before she was transported away. They said time was of essence, but that they would allow us to see our baby.  Minutes later, Hanna was carted into our room trapped in a clear polycarbonate enclosure with tubes and wires inserted all over her innocent little body. The sight of our beautiful baby in that condition brought an overwhelming sense of helpless despair and heavy sadness in the bleak hospital room. I could not help but think how this might be the last time we saw our precious baby. My mother and sisters broke down into tears. Cisca, my wife, who had just lost a lot of blood from a dreadful caesarian seemed like she was dazed in perhaps the worst nightmare of her life. We were able to put our fingers through a small hole in the enclosure to touch Hanna’s little hands. My wife offered some words of comfort to our baby and told Hanna to be strong. I wanted to show confidence in the survival of our baby and so it took every ounce of energy to hold  back the tears welling up in the back of my eyes as we watched our first and only baby transported away.

* Too be continued *

Children’s Hospital Los Angeles CTICU, Entry #4

*Please note that newer entries for my personal blog are published in reverse order (newer posts are published at a later date), so that the true story of my family can be told in chronological order. The real date of this post is October 31th, 2011*

To no surprise, I did not sleep well that night … it didn’t seem to help the fact that I had to go to work on that next day. I remember going through the motions of my daily routine and going to the office. Everything felt so surreal almost like I was living a really bad dream. Walking around like a zombie with a numbness crawling up my brain and down my fingertips. Just waiting … or rather, hoping for someone - anyone to pinch me and wake me up.  All I could think of was getting through the day so that I could go over to Children’s Hospital after work to see my baby girl.

By the time I got out, it was a little past 7 o’clock. My wife had called me; she was in pain from her cesarean and wanted me to come see her at Huntington Memorial. So I quickly jumped into the car and drove straight to the hospital. I arrived to see my wife in bed, looking very haggardly – I’m sure my tired body didn’t look much better. She was in pain and had a hard time trying to do daily activities. The nurses at this so called 5 star hospital were of little help – they would make my wife try and do things on her own, even though every step she took her stitches would open and fluid would hemorrhage out of her incision. I remember my wife looking at me- we were both really tired, I was torn between leaving my wife alone here and running off to see my sick daughter. I could tell my wife was concerned with how tired I was and afraid that I would fall asleep and get in a car accident on the way to see my daughter. I called the cardiothoracic intensive care unit and children’s hospital in Los Angeles.  The nurse there said Hanna was stable and that my sisters and mother had visited her that day. I think the nurse could tell how tired I was; she recommended that perhaps it would be better that I came early in the morning since it was already getting late. I finally succumbed to my weariness and the advice of my wife and the nurse, I would get some rest that evening and head out early morning to see Hanna.

I was up early the next day. Had some breakfast at the hospital, made sure my wife was okay and was off to Children’s Hospital LA. Upon arriving at the hospital, I checked in at the front and had them look up where my daughter was. The receptionist said she was in CTICU and made a call up there to verify that I was authorized to go up. Apparently they only allow 2 people up in that unit. Once I got the okay, I walked through and up the elevator. The place was rather large, lots of signs and different departments. There were many pictures on the wall with children experiencing various congenital heart problems. They had their birth dates … and their demise date. Some only lived a few weeks, many only a few years and others passed away at their teenage years. I could feel a pit starting to form in my stomach and refused to read any further. I immediately went up to the cardiology department counter and asked to see my daughter. They asked me to wait in the waiting area because one of the cardiology specialists wanted to speak with me.

Fifteen minutes later, I was escorted into one of the exam rooms to the side and met with Dr. Ahdoot. He was very patient with my flurry of questions. Currently Hanna was on PGE1 to keep her PDA open and she was on back up life support. Normally he would not have gone into so much detail because most parents would not understand the extensiveness of the surgeries and or the complications of my daughter's heart condition: hypoplastic right ventricle with tricuspid valve dysplasia.

Once I understood the severity and risks of my daughters defect, everything that I experienced from the past few days finally crushed me like a ton of bricks. I could not bear the weight and ramifications of my daughter's condition ... of the fact that our daughter may not live past her first surgery … and that IF she survived the first, there would be many more major surgeries to follow … after which I feared she would never be that healthy, bright and happy girl that I had always imagined. I kept thinking how it was so terribly unfair for a parent to out live their child. Unable to hold back the wave of emotions, I crumbled down, a flood of tears washed down my face as I somberly cried for perhaps the first time in 18 years.

Dr. Ahdoot handed me some tissue and offered some words of encouragement. He told me a story about a good friend of his, who was also a pediatric cardiologist. That doctor was born with a similar congenital heart defect. His friend was in his late forties and continues to treat children with similar congenital heart defects like Hanna’s. He also pulled out a picture in his email, showing a family who moved up North, who had a daughter also with a similar heart defect. She was currently doing well at the age of seven. More importantly he showed me that the couple had three other healthy children in their family. I realized that life still goes on and that there was still hope for my daughter.

After my meeting with Dr. Ahdoot, I was then escorted to CTICU to the room where Hanna was resting …

* Too be continued *

The Truth about White Fillings

On a weekly basis, I seem to always have at least one conversation with one of my patients in regards to white fillings. Just recently in July, I had someone ask me why their old white fillings done by their prior dentist were failing. Meanwhile some of their old silver fillings that were done during their childhood were still going strong. In order to address the questions that many people may have in regards to white fillings, I have decided to compose a brief explanation:

White fillings in general have a life expectancy of 2 to 25 years, while silver fillings will usually last anywhere from 15 to 30 years. The reason there is such a wide discrepancy between white fillings is because these fillings are very technique sensitive. In addition there are also many types of white filling materials and bonding agents that may be used by the dentist. Silver fillings on the other hand, are far less technique sensitive and there is basically only one type of silver filling material.

When determining the life expectancy of white fillings, the hand skill and technique level of a dentist are typically an unknown and always a changing variable. The patient has no real control over the proficiency of the dentist at the time of service. However the type of white filling and bonding agent is a constant and more controllable variable because of the vigorous lab and in-vitro testing done in order to get these dental materials on the market.

The longevity and strength of a white filling material is determined by numerous factors. However in order to simplify, I have listed two very important attributes: Polymerization shrinkage and Compressive Strength. Please keep in mind that each white filling material will measure up differently for each category. Better numbers in shrinkage rate will not always result in better numbers in compressive strength and vice versa. It is up to the dentist to determine the best material with the attributes that will provide the best results for each individual case.

The polymerization shrinkage rate is measured by a percentage. The lower the shrinkage rate, the lower the chance of a cavity developing under the white filling. Basically a lower shrinkage rate translates into a longer lasting white filling. The shrinkage percentage can range from as low as 1.4 percent to as high as 5 percent. Again the lower the percentage the better the material.

The compressive strength measures the ability of the white filling to withstand the forces of mastication and grinding. The higher the compressive strength, the less likely the white filling will be crushed when chewing and grinding with the teeth. This attribute is measured in MPa and can range from 100 to 500 MPa. The higher the number, the better the material.

Now the type of bonding agent will determine how well the white filling bonds to a tooth. The stronger the bond, the longer the white filling will last. This bond strength is also measured in MPa. The bonding strength to enamel can range from 10 to 38 MPa. While the bonding strength to dentin (the inside portion of a tooth) can range from 5 to 44 Mpa. Again the higher the MPa, the better the bonding agent. However, just because a bonding agent has a stronger enamel bond, may not mean it will have a strong dentin bond and vice versa – it is up to the dentist to determine which agent will work best in each case.

There are over a hundred different kinds of composite material and over fifty different kinds of bonding agents. Typically the better the material, the higher the cost. In addition every few years new materials and bonding agents are introduced – so a dentist must keep up to date, if they wish to provide the best level of care.

That being said, I typically will explain to patients that we use the best bonding agents and white filling materials on the market and we will constantly change these out for better products regardless of the cost on a regular basis. We also use a variety of different bonding agents and filling materials depending on the type of cavity or tooth we are working with. We always try and choose the best material for each case. I spend hundreds of hours every year doing research on all our dental materials. Most dentists have no clue as to how their material rates up against others. There are some dentists who will only use the dental material that gets them the best bang for their buck or the material that they had used long ago in dental school – this in essence will lead to more failed white fillings.

As of today, the white filling material that we use at our dental office has a polymerization shrinkage rate of 1.48 % and a compressive strength of 500 MPa. Our bonding agent has an enamel bonding strength of 35 MPa and a dentin bonding strength of 44 MPa.

Memories about Children Dentistry

In early June, my staff and I attended a continuing education course on treating children who have extreme fears of dentistry. It was titled “Little People, Big Problems.” Because I see a lot of children in my practice, I thought this course would be excellent for learning new tips. Sitting in that course brought back some memories from the past. As part of the staff at the USC dental mobile clinic in 1999, I did charity work for under-privileged children all over California. I remember we would have to sterilize and set up treatment rooms in make-shift clinics – most of which were cafeterias or auditoriums and elementary schools. We would then  have to  treat over 500 kids in one day. At the end of those busy days, I always felt exhausted both mentally and physically, but just seeing those happy innocent smiles on so many children made it all worth it. At the end of the course, my staff had commented that they felt as if they learned “nothing.” I explained to them that because of my extensive experience with sedation and working with children, I had trained them on many techniques for working with kids. Apparently, the course was geared towards those dentists who were having “Big Problems” with children – which did not apply to my staff and I. Even though we may not have learned anything new, I still feel that it is important for my staff and I to attend these types of courses. Without sitting through these lectures, there is no real way of knowing if new information would have helped our practice. As dental professionals, in order to provide the best level of patient care, I feel we must continuously make every attempt to learn and improve ourselves in all aspects of dentistry.