Orr-al Habits

Orr-al Habits  (Timely messages from Dr. Orr)

May 4, 2017: A Big Announcement

Events have moved quite fast in the past 6 weeks. My son, Alex, graduates in a few days from Bentley University with a degree in Finance. I feel his excitement as he embarks on his career. As the “old man”, I have lately looked long and hard in the mirror and see flashes of my own mortality. I just today drafted a letter that I plan to mail to all active patients. I now share it here.

***

Dear Patient:

After 31 wonderful years of practicing in my home town of Belmont, I have just recently reached the emotional decision to retire from my periodontal office as of June 30th. It has been an absolute privilege to consider you as a patient in my practice, and I will always cherish the trust and the professional relationship that we have had.

I am pleased to announce that my former associate, Dr. Taraneh Naghieh, has agreed to take over the practice. Many of you have already met Dr. Naghieh, and are already aware that she brings outstanding credentials of experience and expertise to this office. I believe she will continue our legacy of excellence and compassion in periodontal care. I anticipate a near seamless transition in the practice.

I hope to have the opportunity to say goodbye to each of you in person. I can’t quite fathom where the years have gone, but I now look forward with excitement to the next chapter in my life.

Sincerely yours,

***

I can’t believe I’m doing this.

-RBO

October 18, 2016: Another Name on the Door

You may have noticed the new name on the office door. I am very pleased to announce that a new periodontist has joined our team at Belmont Periodontics. Dr. Taraneh Naghieh is a Tufts educated periodontist with many years of experience and numerous academic awards. She is also currently a part-time clinical instructor at Tufts University School of Dental Medicine. Her full biography is available on this website.

I am particularly excited to welcome Dr. Naghieh because I believe that she shares my concern for providing quality periodontal care in a personalized setting. Not only does she share my philosophy in treating patients, but she will bring new expertise in complex bone grafting and advanced regenerative technology. I am fortunate enough to say that this practice has grown to be larger than I am now comfortably able to service and I welcome the opportunity to have such a capable clinician shoulder some of the workload. Please help me in welcoming Dr. Naghieh to our practice.

June 30, 2016: An Ode to Diana’s Retirement

Diana’s last day as office manager is today. She started working with me in 1986 and was my second employee. We celebrated her retirement yesterday evening with a beautiful dinner attending by her husband and select people associated with the practice. I wrote and recited the following poem in her honor:

As we gather this evening to honor a milestone,
it’s hard to fathom where the time has flown,
for Diana has been with us for many years,
in fact, she has outlasted all of her peers.
We’ve orbited the sun just shy of thirty
this longevity earning status as a retiree.
I remember the innocent day in ’86,
when Diana threw her hat into the mix
and applied for the dental assistant position
with courage, guts, and plunk ambition.
Her two young daughters finally at school
that gave her freedom to join the work pool.
She was able to tolerate the blood and spit,
staunchly opposing the temptation to quit.
But soon the chairside role was not ideal,
and the front desk offered more appeal.
The billing, the scheduling, and the phone,
that became her forte, for which she became known.
Like a duck to water or an eagle aloft
she mastered the software, even Microsoft.
The ’93 move and office changes we endured,
if she had deficiencies, they were obscured.
Paperless we migrated, hi tech we became,
whatever format, she processed the claim.
EOB, attachment, or predetermination,
she was steady and sure at her workstation.
One couldn’t ask for more dedication and skill;
she became our GOAT, like Ali from Louisville.
Her head for numbers and innate common sense,
extended her worth to levels immense.
She embraced the technology and the computer
and on occasion became the office tutor.
Overwhelming adulation began to pour in
and Diana soon became the practice lynchpin…
by becoming indispensable in all different ways,
year after year and throughout the work days.
She had become the soul of the practice;
her steady hand has been to impact us…
to treat our patient’s with the highest care,
And to push us to excellence at levels unaware.
Patients complimented her on a daily basis,
for she has been the rock, the sublime oasis.
Instead of toiling with us further at 18 Moore
and enduring further computer screen eyesore,
this employment now comes to an end
for we could not convince her to extend.
But I ask: what does the future hold?
Every day a Saturday, a life uncontrolled?
Now Diana’s days will be spent with Jim,
yielding to his needs and his every whim.
They will putter at their homes in Arlington or Wells
or maybe Florida in some winter hotels,
Hanging with the grandkids on the ball field
and lathering up to avoid the skin peeled.
No matter where you roam in your retirement time,
make sure you hearken for the cell phone chime
because we will be calling you for advice
regarding payroll or insurance to be precise.
So Diana, you will be missed beyond measure.
You are our gem, our national treasure.
We will think of you daily and often
and hope retirement keeps you out of the coffin.

June 23, 2016: Slowing Down

On this blog, back in February of 2013, I reported that I had been awarded an endorsement from the Boston Consumers’ Checkbook (www.checkbook.org) in their “outstanding dental specialists” listing. I am pleased to report that I am once again listed in their latest Spring/Summer 2016 edition / Volume 6, No. 4. This unbiased and non-profit affiliation of the independent Consumer Reports is not an endorsement that can be bought or influenced. I am pleased and proud to be included in the list.

Other professional news to share includes my “retirement” from scheduled clinical teaching to the post-doctoral Periodontology students at Harvard. After 25 years of hands-on clinical teaching, as of June, I am going to spend all my Wednesday afternoons in my office. This schedule change will allow me to take Fridays off and work a four day week. I will still occasionally lecture to the Harvard students and hope to stay active with the school, but this change will reduce the frenetic pace that I have maintained for all these years.

Teaching has been a real joy. I have certainly got more out of it than I ever put in. Working closely with students has kept me on my toes and taught me much about the latest advancements and technology. It has allowed me to collaborate with innovative minds and forward thinking clinicians. As G.V. Black, the father of modern dentistry so famously stated, “The professional person has no right to be other than a continuous student.” When one considers that approximately 90% of what I currently do in my office was learned after I received my training, it becomes apparent that teaching has been in integral part of my own continuing education.

There are usually at least four new residents per year. It is amazing to consider that I have had even a small part in the education of over 100 periodontists from all over the world. When I go to national / international meetings, I see many former students doing well. It has been an honor.

April 6, 2016: An important article for the layman to read

https://www.sciencenews.org/article/gum-disease-opens-body-host-infections

February 5, 2016: Changing Times

Last month, after a two year associateship, Dr. Quinta departed our office for greener pastures. Simply put, the reality of the relationship never matched the expectations. On a positive note, Dr. Quinta provided excellent care to our patients and we parted company on good terms. I learned a lot from the experience and I am sure that he did as well. An Associateship is in some ways like a marriage, and we all know how tricky that can be.

Dentistry in America is undergoing a quiet revolution. This change is not unlike what has already transpired within the past few decades in other health care fields. I speak of a transition from the independent (often solo) private practice provider business model to large group practice corporate consolidation. At the Yankee Dental Congress last week, I spoke with a 3rd year orthodontic resident. While discussing her future plans after graduation, she told me that solo independent private practice was not a realistic option for her after graduation due to her substantial educational loan debt. She began her dental career as an assistant and worked her way up through hygiene school, dental school and then graduate orthodontics training. It was an incredible educational journey, but not without cost. She showed me on her smartphone app the exact dollar amount of her loans. I expected a high number, but was shocked to see a figure in excess of $830,000, and this number was increasing monthly from the accrued interest.

This amount of debt not only limits practice opportunities, but can also influence how one practices. This economic pressure can influence practitioner’s decision-making on what treatment approach is truly in the best interest of the patient. My educational debt in the late 1980’s was approximately $35,000, and I always felt it was manageable. With new dental graduates enduring near million dollar educational debt, the effect can be crippling. When newly minted dentists and specialists graduate with enormous debt, the delivery of dental care undergoes turmoil. Without mentioning names, search your browser for a PBS Frontline exposé on a certain dental chain owned by a private equity firm. I’ll let you draw your own conclusions.

September 9, 2015: Follow-up

I have made it a policy since the very beginning of my practice to call all post-operative patients the next day to inquire about how they are doing and if they have any questions or concerns. These phone calls have not only been sound policy to build practice goodwill, but also make good policy because next day follow-ups can also mitigate potential problems before they turn into time consuming events. Patients are usually very grateful to hear from me personally. I am often surprised when they tell me that I am the only doctor that has ever called them at home to check up on them.

Yesterday a patient was almost an hour late to her surgical appointment because a tractor trailer accident on Route 495 backed up traffic for many miles. We were able to accommodate the delay and told her by mobile connection to come to the office whenever she could. She came to the appointment accompanied by her son and was very stressed by the time she finally sat in my chair. The surgery was uneventful and went very well. When I called her this morning to check up on her, she told me that the commute to my office was the only unpleasant part of the entire process. That was gratifying feedback.

May 12, 2015: Perspective

As all Greater Boston residents know too well, this past winter was one for the record books. I would occasionally peer out my office window onto the parking lot and wonder where the snow plow driver was going to place the next snowfall. Our parking lot was rapidly diminishing in size after each snowstorm. It got so bad that the landscaper eventually had to bring in a front end loader and a dump truck to haul out the mountains of snow. I remember on many occasions, at the height of the winter, longing for hot hazy days of summer. This past Sunday, when the temperature flirted with 90 degrees, I imagined cooler weather. It’s hard to stay satisfied.

The American Academy of Periodontology is apparently not satisfied with the status quo. My professional governing body has embarked on a strategic initiative to consider augmenting the AAP’s name to better reflect the role of implant dentistry on our specialty practices. I’ll always be called a “periodontist,” but the AAP is looking for ways to reinforce the perception that the periodontist is the premier provider of surgical implant placements.

Our demand in the treatment of periodontal disease is certainly strong. The Federal government just released the latest National Health and Nutrition Examination Survey (NHANES) results. This comprehensive government study reported that the estimates for dentate non-institutionalized civilian adults aged 30 and older with periodontitis was 46%, with 8.9% having severe periodontitis.  This suggests that nearly half of US adults – roughly 65 million people – have periodontal disease. Hopefully you are among the fortunate half of Americans with healthy gums.

December 13, 2014: Prescription Pain Pill Dangers II

Just this week, as reported in the New York Times, the pharmacy benefits manager of Express Scripts, found that nearly half the people who took prescribed narcotic painkillers for over 30 days in the study’s first year were still using them three years later. This is an incredibility alarming statistic and a clear sign of potential abuse. Most experts now believe that while helpful in treating pain from injuries and surgery, opioids should be discontinued as quickly as possible.

The study’s author concluded that given opioid’s addicting potential,  “It’s our hope that physicians remain reluctant to start people on an opioid pain medication when they’re not necessary, and that there’s an increase in public awareness that people shouldn’t want to get involved with these medications if they don’t need them.”

The other day, I observed a post-doctoral student that I was supervising in the dental school offer a 10 day supply of narcotics to a young adult for what I felt was a relatively minor surgical procedure. He just offered the prescription as a matter of routine. His automated action became an opportunity for us to discuss prescribing alternatives.

A year and half ago, I blogged in this forum about the potential dangers of prescription narcotics. Fortunately, within the past year, I have noticed a tightening of the State and Federal regulations and oversight of opiate prescriptions.

I was very pleased to hear Governor-elect Charlie Baker’s announcement almost immediately after his election that he planned to address the state’s opiate addiction crisis early in his term. It will take concerted state and federal efforts to reshape the mindset about prescription narcotics.

How did we get into this mess? It is a combination of unrealistic patient’s expectations, doctor’s genuine desire to minimize pain and suffering, big pharma’s corporate greed, and a whole lot of naiveté.

July 31, 2014: Inter-specialty Competition

A general dentist colleague recently forwarded to me a letter received from a prominent endodontic group practice. It stated that they were pleased to announce that they have added surgical implant placement to their repertoire of procedures offered. The letter stated that the endodontic practice wishes to “provide the best possible service and care“ to their referral practices and that they have added computer guided implants as a provided service. They state that a single practitioner of the group will provide surgical implant placement in one of their five locations.

As my GP friend so succinctly stated, “Aren’t they supposed to be Limited to Endodontics?” I realize that the clinical range of treatment modalities sanctioned by the ADA for specialty practices in the United States is beyond the scope of this writing, but there are some interesting observations to be made.

Endodontists treat individual teeth. Computer guided surgery is rarely needed for single implants, especially if located in a bounded edentulous space. Surgical guides can add considerable cost to an already expensive procedure and the announcement of such technique does not lessen the complexity of the procedure. I submit that the best possible care is provided by a specialist that has been trained to perform such work and by someone who does this work on a consistent basis. I further submit that someone who specializes in complex prosthetics, deals with matters of prosthetic load and occlusion, anterior aesthetics, as well as bacterially-influenced alveolar bone loss is most well equipped to handle surgical implant placement.

In 2006, the Commission on Dental Accreditation (CODA) revised the endodontic standards for implants knowledge, increasing the level of knowledge from “familiarity” to “understanding.”1 Is this a sufficient skill set leap of mastery to best serve the public?

My cynical view is not unique. In a 2011 survey commissioned by endodontists themselves and entitled, Should endodontists place dental implants? A national survey of general dentists2, the authors concluded that the majority of respondents (general dentists) did not support implant placement by endodontists.

I’m not insecure about my profession as a periodontist. I encourage all practitioners to challenge themselves and expand the services offered in their practices, yet I worry about the dilution of the enviable success rate of implant placement. I have been placing implants for over 25 years and have rarely encountered an “easy” case. More often than not, bone grafting and soft tissue manipulation is an integral part of the case. I have invested considerable time and money in my profession, including a cone beam volumetric tomograph for my office to predictably manage surgical outcomes. In a recent large scale study involving 87 general practices, the authors concluded, “that implant survival and success rates in general dental practices may be lower than those reported in studies conducted in academic or specialty settings.3 Expertise matters and the phrase “practice limited to” should have validity as well.

Surgical implant placement is most often a considerable challenge and is always an exacting science. I sincerely hope that financial considerations are not taking precedence over doing what’s best for our patients.

References

  1. Commission on Dental Accreditation. Accreditation Standards for Advanced Specialty Education Programs in Endodontics. Chicago: American Dental Association; 2008.
  2. J Endod. 2011 Oct;37(10):1365-9. doi: 10.1016/j.joen.2011.06.002. Epub 2011 Jul 28.
  3. JADA. 2014 July, Vol 145 p. 704

March 17, 2014: Bleeding Edge

With Windows XP Pro SP3 no longer supported, it was time this week to migrate to a new operating system (and hardware) for many of the older office computers. I chose Windows 7 Professional, rather than the latest version of Windows 8. It is disconcerting how upgraded computers effect all the peripherals. The new computers won’t easily connect to the old printer or scanner, so I have to upgrade those devices as well.

I have been intrigued about computers since the mid 1970’s. I owned my first personal computer in 1984. It was a C/PM based machine with two large floppy disk drives and no hard drive (a very expensive option called a “Winchester”). I added a lone computer to this practice in the late 1980s, but it was only used for word processing. Computerized scheduling and ledger function was introduced to the practice in the early 1990s. (My office designer for Moore Street suggested big cutouts at the receptions area to accommodate the large CRT monitors; I am now very glad I resisted marring the countertops.)

Years later, I installed computers and flat panel monitors into the operatories and introduced computerization to clinical areas. This office has been “chartless” since the year 2000; this technological leap was way ahead of most of my peers. I still remember fondly when the paper shredder truck parked out front of the office and macerated thousands of patient charts. As of today, we are not completely paperless, but strive towards that goal and the electronic record has certainly streamlined how we practice. The Federal Government subsidizes medical offices to convert to the electronic medical record while the dentists are left to fend for themselves.

The good news is that over time technology prices tend to drop and the capability increases. The first flat panel monitors I bought were only 14 inches in diameter and cost $800 each. The two year-old cone beam volumetric tomography machine in my office, although still as expensive as my first house, would have cost over a million dollars a short decade earlier.

It is a delicate balance to be on the cutting edge of technology, while avoiding the bleeding edge.

March 7, 2014: A Clean Desk is the Sign of a Clean Mind

I performed an archaeological dig on my office desk today and stumbled upon some quotes from journal, newspaper and magazine clippings that I had saved over the years. I look at them occasionally and thought I would share some of them with this audience. I do not know the authors of these prose, but they especially apply to treatment planning in my profession.

“Vision without action is a daydream. But action without vision is a nightmare.“

“Because the main directive of the dental practitioner is “primum non nocere” (do no harm), saving natural tooth structure is always an important goal.”

“Dentists that work with their hands are laborers. Dentists that work with their hands and minds are craftsmen. Dentists that work with their hands, their minds, and their hearts are artists.”

Now that these quips are immortalized in the blog, I can finally throw out these yellowed clippings and more easily see my desktop.

November 26, 2013: Exciting Announcement

My 25 years of post-graduate teaching at Harvard has afforded me the opportunity to work with and assess many graduate students in the field of Periodontology. After a several year search, I am pleased to announce that Belmont Periodontics will have a new associate beginning in 2014. I look forward to working side-by-side with Dr. Anthony T. Quinta. Tony is an outstanding individual and he comes highly recommended. He graduated Summa Cum Laude from Tufts Dental, and was chief resident while a graduate student. His biography, soon to be listed on the web site, will detail his impressive credentials. Not gleaned from the words, however, are his easy going manner, excellent communication skills, and professional demeanor. Tony’s presence in the office will allow for extended hours, more flexible scheduling, and bring new energy to the practice.  Please join me in welcoming Tony to our practice!

November 22, 2013: A Remembrance

I remember vividly my dog getting run over and killed by the Hood milk truck when I was 4 years old. I remember as a 5 year old, getting stung on the hand by a bumblebee.

Friday, November 22, 1963. Those of us more than a few years older than 50 likely remember where we were when we heard the news that President Kennedy had been assassinated 50 years ago today. I heard the news as a second grader, hanging around after school at the Mary Lee Burbank playground in Belmont, when two older boys (fourth graders) boisterously announced that Kennedy had been shot. I was confused, but sensed that this was historic news. I was certainly naïve about what this meant to the nation and the world. I remember walking the half mile home with many questions and finding my mother in the kitchen, emotional and tearful. I remember asking why she was upset and what this meant for us as a family. She did her best to explain the significance of the Dallas tragedy to a 7 year old. About a week later, my parents drove me and my brother in the family station wagon to D.C. to visit the Kennedy grave site. I remember it was cold and rainy and the ground was muddy.

September 10, 2013: Shakespeare it Ain’t

As previously suggested, one of the most wonderful aspects of this profession is meeting interesting people as new patients to the practice. A gentleman recently referred to my office makes his livelihood by acquiring and reselling antique medical and dental textbooks. He was kind enough to leave me a copy of his last two catalogs outlining the books he had for sale. It is a collection of fascinating publications that span from the 1700’s to the 1900’s. I, of course, was most interested in the dental subject matter. He is selling a publication from 1833 by Solyman Brown entitled Dentologia: A Poem of the Diseases of the Teeth and their Proper Remedies. Imagine 80 pages of poetry concerning diseases of the teeth! I offer the following example from page 43 of his book as it relates to Periodontology:

If sloth or negligence the task forbear
Of making cleanliness a daily care;
If fresh ablution, with the morning sun,
Be quite forborne or negligently done;
In dark disguise insidious tartar comes,
Incrusts the teeth and irritates the gums,
Till vile deformity usurps the seat
Where smiles should play and winning graces meet,
And foul disease pollutes the fair domain,
Where health and purity should ever reign.

Feel free to print this poem and affix it to your bathroom mirror to remind you of your daily responsibility.

July 17, 2013: Lost in Translation

Last week, I presented a two hour lecture to 30 dentists from Japan for the 3rd Ivy- League Esthetic and Implant Course at Harvard University. Although I occasionally lecture, and have even done so outside the US, this was my first time utilizing direct language translation during a presentation. The format slowed me down quite a bit, but the Japanese dentists were attentive and engaged, and the overall experience was quite favorable.

The following evening was a graduation banquet at the Downtown Harvard Club, where each participant received a small certificate. I was involved during the presentations and offered individual congratulations to the Japanese dentists. Each dentist thanked me in their best English. Hoping to say, “you’re welcome” in their native tongue, I discreetly asked the translator for the Japanese equivalent. She quickly uttered the phrase, saw my confusion, and said, “Just say, ‘don’t touch my mustache’ as quickly as you can.” I did as she suggested, and it worked out fine.  If you have any doubts about this story, go to Google translate and listen for yourself!

April 5, 2013: Prescription Pain Pill Dangers

A fast growing problem in this country is drug overdose deaths due to addictive painkillers. The CDC recently reported that medicines, mostly prescription drugs, were involved in nearly 60% of overdose deaths in 2010, overshadowing deaths from illicit narcotics. Of those approximately 22,000 deaths in 2010 from prescription medication, three out of four were due to prescribed pain pills. When one thinks of fatal drug overdoses, one often imagines a heroin junkie, but in fact, it is more likely to be a young suburban adult addicted to opioid drugs such as Vicodin or Percocet. Most patients and even many doctors are unaware of how addictive these drugs can be. I am not opposed to prescribing narcotic pain prescriptions for my patients, but I often suggest non-addictive alternatives when appropriate.

As the father of a college student, I have heard from my son about several of his acquaintances that have gotten into trouble with narcotic prescriptions. They wrongly assumed that because these pills are pharmaceutical drugs, that they were safer than street drugs.  If you are a patient that one day may be prescribed such pain pills, please respect their danger and keep any leftover pills out of the hands of young adults.

February 19, 2013: Practice Ratings

I recently received notification that I have been awarded an endorsement from the Boston Consumers’ Checkbook (www.checkbook.org) in their Spring / Summer 2012, Volume 4, No. 4 edition. This is quite an honor because I was included in their listing of “outstanding dental specialists” (Periodontics) as voted by independent Boston area dentists. This research group asked almost all actively practicing dentists in the Boston area to name one or two specialists in six specialty fields they would consider most desirable for care of a loved one. The general dentists are certainly the guys that really know what’s going on. The Boston Consumers’ Checkbook is affiliated with the famously independent Consumer Reports. They accept no advertising and are completely unbiased and non-profit.

There are many reporting and rating services that are available to the consumer (patient). Some of these entities are not what they seem. A nationally renowned web site that rates professionals claims to be consumer based and impartial, but they are a for-profit business and accept substantial payments from “featured” clinicians. A local magazine asked me many times to be listed in their “Best Dentists” issue, but it would cost me many thousands of dollars in advertising to be included. Even worse, the Consumers Research Council of America, touted by a few area dentists, is a faux organization that was created for the sole purpose of allowing clinicians to claim themselves as the “Best of…”.

Some internet entities such as DoctorOogle.com, HealthGrades.com, Yelp, etc. (all sites where I fortunately have a very positive rating) are supposedly completely public based, but even they can be manipulated by professional internet reputation managers and savvy individuals.

Sometimes the best endorsements are from knowledgeable friends and your own instincts. Caveat emptor.

January 28, 2013: SteveO

Steven W. Orr (1954-2013)

My brother and best friend. The inspiration for Belmont Periodontics, P.C. to strive to be technologically on the cutting edge.

January 10, 2013: Advice

As I began designing and setting up my original web site, I agonized over the selection of the clinical photos, specifically, how much detail I should offer in my “before and after” photos. All clinical photos depict my own actual treatment, as I feel it is disingenuous to publish someone else’s work under my banner. A friend of mine offered some excellent advice in that one should never show the specifics of how the sausages are actually made.  Keeping in mind the audience’s appetite for unnecessary details, my clinical photos are devoid of any surgical-type images. I instead offer (non-Photoshop) magic wand depictions of successful treatment.

When I was in dental school back in the 1980s, we had a very elderly instructor who donated his retirement time to teaching us subtleties of periodontal care. After evaluating the student’s treatment, he consistently offered simplistic advice directly to our patients, “Now go ahead and just brush the hell out of that.” It was generally effective advice, if not a little vague. Today, we offer patients detailed instructions regarding a multitude of home care aids to assist in the post-operative regimen. I often think back to the uncluttered message favored by my former instructor.

December 18, 2012: Welcome

Welcome to the newly updated, 4th version of the Belmont Periodontics web site, launched yesterday. We are now sporting a fresh new look with modified logo, better graphics, updated clinical case examples, and this new section called Orr-al Habits. My plan is to update this somewhat obscure corner of the website with personal and professional musings, offer a compelling reason to occasionally revisit the site, and perhaps even satisfy my creative writing urges.

Speaking of the logo, I often wonder how many people understand the nuance of the logo. Here’s a hint: the “B” and the “P” are derived from the silhouette of something integral to this practice.

The cartoonist Charles M. Schulz wrote for Linus, “I love mankind, it’s people I can’t stand.” It is easy to fall into such sarcastic sentiment with any profession that deals with the public at large. Maybe after a challenging week, I too have shared such a view. Fortunately, my outlook is generally the opposite. I feel quite fortunate to devote my professional life to treating the great diversity of periodontal patients, also known as life’s rich pageantry. Meeting and (hopefully) helping as many people as I do provides for a very satisfying, stimulating, and fun vocation. I thank all my patients for making me a small part of their lives and making my professional life so interesting and fulfilling.

Have a great holiday season and hope you stay tuned for future postings.