Pausef or reflection

May 1, 1999
Picture this scenario. You`re moving along in your practice. "Things" are going pretty well. You`ve put money away for retirement, the kids may be in college, and your marriage is in order because you`ve grown together and made things work.

Steven A Ronis, DDS

Picture this scenario. You`re moving along in your practice. "Things" are going pretty well. You`ve put money away for retirement, the kids may be in college, and your marriage is in order because you`ve grown together and made things work.

The office is the "office." You`re pretty happy with your income. You have the usual management "stuff" to contend with, but you`re content with the cosmetic work you`re doing, and the "implant thing" is starting to pick up. You may not be knocking it out of the park at a McGuire-like pace, but you`re certainly getting your share of extra base hits.

Does this sound similar to your practice - a "mature" practice where the dentist is pushing his or her early fifties? Or, maybe, you`re 10, 15, or even 20 years younger with some of the aforementioned parameters being in slightly different stages of development. The point is that, with few exceptions on the high and low sides of income and age, I might be describing Joe or Jane Everybody`s practice. This is a nice scenario, one that certainly lends itself to complacency and the occasional griping about how things could be different or better.

We all talk about the intangibles of success (no matter what the job or profession), which invariably focuses us on the issue of health. Is there one among you who has not uttered the prophetic statement: "I don`t care how much you have; it all means nothing without good health." It`s almost the mantra of the ages. If we say it or think it often enough, we may ward off the evil spirits and live our lives in relatively good health.

So, now I`m on relative cruise control. I`ve been fortunate to save enough for my children`s college education; I bought my house "right" about 25 years ago, and have burned the mortgage. My wife is starting a new career as a college professor, having recently completed a PhD program. I`m well on my way to achieving a relatively worry-free retirement nest egg. Although I have gripes about my practice, I know that I have it real good.

Then, about two months ago, I started to notice a subtle change in my vision. I`ve always had 20-20 eyesight, but I`ve recently started to need reading glasses. (At first, I thought the newspapers were starting to print the stock prices in a smaller typeface. What was disturbing to me was that my visual field was blurred in a strange way. I could be reading a paragraph in a book, and suddenly several words would look as if they had been erased or smudged, while adjacent words remained clearly in focus.

Not being an alarmist by nature, I scheduled a routine examination with my opthalmologist. I explained my symptoms to him, and, after dilating my pupils, he thought I just needed a stronger -diopter reading prescription for my right eye. I really don`t know why he decided to take a closer look, but he redilated my pupils with a stronger solution. On re-examination, he told me that it looked as if I had a thrombosed vein in the retina of my right eye. He said he wanted me to see a retinal specialist. I asked how soon he would like me to make the appointment, and he responded, "today!"

I was fortunate that one of the finest retinal specialists had a satellite office about two minutes away from my doctor`s office. He didn`t have regular hours that day, but he was coming in on an emergency basis. The next few hours were - pardon the pun - a virtual blur. I went through a new series of tests, culminating in a fluorescent injectable-dye test called "Fluore-cine Angiography." In that test, you have about 40 pictures taken of your eyes, with a flash apparatus giving off a blinding flash of light every few seconds.

The moment of truth came during the consultation. The specialist, Dr. Liggett, confirmed the original diagnosis. I had suffered a central retinal vein occlusion in my right eye, accompanied by a good deal of hemorrhage into the retinal and macula area. I really could see the difference between the good eye (my left eye) and the affected eye. The specialist explained to me that no matter what I did, I had a 30 percent chance of losing complete vision in my right eye.

The treatment consisted of rest, relaxation, daily walks at a nonaerobic pace, and drops and medication to keep the intraocular pressure low. The walking was a must, because he believes in the therapeutic and relaxative benefits of walking. His office staff also compiled a series of essays as a handout concerning the peaceful and calming effect of walking.

I was advised not to work on patients that week, and was told I would be able to resume a limited schedule the following two weeks. The doctor explained that the stresses of practice could result in an arterial spasm that could cause me to lose all sight in my right eye. To rule out an underlying systemic cause, I had to undergo a complete blood workup, a carotid artery ultrasound, and an ECHOcardi-ograph. When all these tests came back negative, the doctor surmised that the causative agent might be stress.

Now, I think of myself as a pretty mellow guy, but I definitely could think of areas in my dental practice where hidden negative stressors could be a factor. Those areas include hopping from room to room, checking hygiene patients for two hygienists, running late from misfiguring or underbudgeting the time needed for a particular procedure that had gone awry, etc. That covers just the stressors from patient care, to say nothing of what is going on administratively in the practice, as well as stressors that come from patients and co-workers with personalities and agendas that differ from mine.

I made a decision the moment Dr. Liggett informed me of my condition and what could happen to my sight. I`ve been blessed with good health, and the only other scare that I`ve experienced occurred several years ago when I suffered a herniated disc in my cervical region.

However, this was altogether something different - the specter of losing vision in one eye! To me, this was a wake-up call of the highest magnitude! How could I modify my activities and my mental attitude to more adequately reflect the person I would like to be (and thought I had been)?

I always have been health- and fitness-oriented. I swam competitively in high school, college, and in the U.S. Master`s program. I had been working out aerobically three to four days a week, and I also was an avid cyclist. However, after initiating my moderate walking program for two months, I actually could "see" and "feel" a calming effect that I never experienced with an intense cardiovascular workout.

Without any blood-pressure medication, my pressure dropped to an average of 100/70. I actually began to "wake up and smell the roses." During my walks, I have begun to experience more serene thought processes, and I feel spiritually enriched. I don`t mean to trivialize or be maudlin about my sentiments, but this really has been an AHA experience in my life. I also have begun to take "cat naps" on my days off and the weekends, and I`m actually sleeping through the night, with the exception of nature calling.

In my office, I have informed the hygienists that I no longer will be a jack-in-the-box, hopping up at a moment`s notice to examine hygiene patients while in the middle of some procedure of my own. If my partner is unable to perform the exam, and the patient doesn`t have to be seen for current therapy, then we make a notation in the record that one of the doctors will examine this patient at the next recare appointment. If the patient doesn`t mind waiting and wants to be seen by a doctor, then we seat the patient in one of the doctor`s exam rooms. We do this so that the hygienist is not thrown off schedule, thereby eliminating another potential source of tension for the doctors and the hygienists.

I`ve begun to schedule slightly more time than I actually need for a procedure, to give me a little more of a buffer zone in the schedule and to be better able to communicate with my patients. Also, I`ve lessened what we call "middle columns" in my schedule to keep from getting into the roller-skate mentality and pace of practice. I`ve always prided myself on being a good communicator. I`ve come to realize, though, that, at times, I`ve been guilty of the "mañana syndrome" when dealing with employees and their problems. I now try to deal with these issues on a more timely basis, including patient complaints and returning phone calls. Dealing with these issues in the present is a lot healthier than letting them stew and churn inside you. I know, as with any behavior-modification changes, that there will be a certain amount of recidivism and backsliding. However, the key is to recognize what is happening to you in the present and to deal with it.

My most recent fluorescent dye test on my right eye showed a continued and remarkable change for the better. Dr. Liggett exclaimed, "See what you have done!" Without dwelling on the negative implications of my condition, I feel that I have made some real life changes for the better. I only can hope that this "pause for reflection" will be useful to you in your own daily lives and practice situations. Always appreciate and cherish what you have, instead of lamenting over what was and what might be in the future.

You are the master of your own destiny and the captain of your life!

Steven A. Ronis, DDS, has been a general dentist practicing in Fairfield, Conn., for the past 25 years. He and his partner operate a family-oriented practice, drawing patients from all socio-economic levels. Dr. Ronis is interested in esthetic dental procedures and is cultivating an implant-based restorative practice. He can be reached by phone at (203) 226-1770, by fax at (203) 227-9670, or by e-mail at [email protected].