A New Understanding
Ronald C. Auvenshine, DDS, PhD
On March 14, I was involved in an incident with a golf cart. One of my playing partners inadvertently hit me in the shoulder with his golf cart as I was walking back to my cart. He did not see me, I did not see him, and, as accidents go, that resulted in my shoulder problem. The golf cart struck me on the head of the Humerus (shoulder bone). The pain was excruciating. I thought at first it was a dislocation, separation or a broken collarbone. An x-ray at the emergency room revealed that it was none of the above. I then thought that it was only a muscle injury and that I could rehabilitate it myself. After attempting rehab for three weeks, the injury felt somewhat better; however, not enough to avoid seeing an orthopedic surgeon. I made an appointment with the surgeon and an MRI was performed. The MRI showed a 3 cm tear in the rotator cuff. Once the surgeon entered the joint, he found more damage than was originally predicted and it took him an extra hour of surgery just to repair it. The procedure was performed on April 16.
I have several friends who have gone through rotator cuff surgery. But until you experience it yourself, you don’t have a true appreciation for the pain and difficulty of recovering from this type of surgery. I can safely say that no matter how complete my preparation, my attention, and my compliance to the instructions provided by the surgeon and physical therapist, I was not prepared for the first month of post-surgical care.
It all began the Saturday night following the surgery. The local anesthetic in my neuroaxial block ran out 12 hours early. I was not prepared for the event because I had not loaded up on ibuprofen and pain medicine, since the nerve block was so efficient. Needless to say, the pain was excruciating. I did not get any sleep that night and it wasn’t until about five o’clock on Sunday morning that I was able to doze off. I truly learned in that short time what level 9 pain (VAS) was all about. I thought I had experienced severe pain when I broke my knee playing football in middle school. However, the pain following my shoulder surgery was literally breathtaking.
It has now been six weeks since the surgery. The physical therapy is progressing extremely well. My range of motion has markedly increased. I no longer have to sleep in my arm sling, nor am I required to wear it everywhere I go. I still have minimum strength in the arm, but I am building more strength through exercising with the physical therapy instructions. I continue to rely on ibuprofen for pain relief and supplements for repairing the damaged tissue.
What have I learned from this experience? The lessons are many, almost too numerous to count. But the most important thing that I have learned is that God placed this accident in my path of life to teach me how to be a better doctor. For the past 44 years I have dedicated myself to the treatment of chronic pain. I lecture and write articles explaining the mechanism of pain and the care and management of pain. But this experience has enabled me to feel what it is like to be in severe pain. Now I find myself more understanding when my patients talk about their pain. Having gone through a painful experience myself, I can truly say that my passion for relieving pain is at an all-time high.
Had it not been for my wonderful associate, Dr. Pettit, I would have had to close my practice for at least three weeks. His presence here and adequate training to assume the responsibility of patient care has allowed us to continue to see patients without a single delay. I also want to thank my magnificent staff for their care and attention during this trying time. They have been remarkably helpful in allowing me to recover without placing demands on me which required additional movement of my arm. God works in mysterious ways. We don’t understand His ways, but it is the wisdom He places in us which allows us to see His hand in everything we do. I thank not only my partner and my staff, but also you, our patients, for being so kind and caring to me during this time
My surgeon feels that I will make 100% recovery, but it will take 3 to 6 months to achieve. I thank you in advance for your continued patience, and I can assure you that our care here at MedCenter TMJ will never be anything but of the highest level. You are our greatest asset and will continue to be the main focus of this practice.
Ronald C. Auvenshine, DDS, PhD
Dr. Pettit’s Tips for Healthy Living
Nathan J. Pettit, DMD, MSD
As a feature of the MedCenter TMJ newsletter, we want to include a short and practical tip of the month for optimizing nutrition. An important element of healthy living is healthy eating. We have said before: we are what we eat. With summer at our doorstep, it is important to remember: we are also what we drink!
Our bodies are composed of more than 60% water. Our muscles are 75% water. The liquid we drink can hydrate and nourish, or it can dehydrate and malnourish. Our bodies can go a month or so without food, but only a week without water. Sufficient hydration is important to each aspect of our health. How much water is enough?
We often hear the general rule to drink about 8 glasses of water a day. The truth is that the need for water will vary greatly, depending on your age, weight, physical activity and climate. The Institute of Medicine recommends a higher level of fluid intake, up to about 15 glasses a day for some men. In Houston, the weather can be hot and humid, leading to perspiration and the need for more water.
It is important to listen to our bodies. If we were to drink whenever we were thirsty, most of us would be just fine. The problem arises when we get so busy that we don’t stop and our body is not heard. When deadlines are approaching and tasks are stacked high, we get to the end of the day without even knowing our fluid balance is compromised. What’s worse, we frequently replace water with coffee or soda. These beverages are typically high in caffeine, a diuretic that can further dehydrate our system. The result may be fatigue, mood swings, jaw pain, dry skin or mouth, and headaches.
How do we know if we are drinking enough? One of the most effective ways to gauge your fluid intake is to note the color of your urine. Aim to drink enough water to cause your urine to be light yellow in color. This, along with listening to your thirst, will help prevent dehydration. Keep in mind that advanced age, physical exertion, illness, temperature, pregnancy and breastfeeding also increase the need for more water.
Take water with you on the go. Make water accessible at work. Drink water before and after you exercise. Have water at home. Don’t forget to pause and listen to your body’s requests. This will go a long way in optimizing your health.
Nathan J. Pettit, DMD, MSD
Happy Father’s Day!
This month we’re publishing a blog post that explains what Juvenile Idopathic Arthritis (JIA) is and how the vast majority of children who have JIA also develop TMJ arthritis as well. It reminded us of how much our parents watched over us as kids. How our fathers took care of us and protected us at every turn, making sure we grew up healthy and happy.
Dads are tough guys who help us take on everything that life throws our way. They are wise men who always seem to have pearls of wisdom hidden in their stories. They are a support system that’s always there when you need them.
Dads do all this and rarely ask for anything in return. In this sense they are like police officers, firefighters and health professionals. It’s their job to make sure you’re taken care of when you need it most. Dr. Auvenshine and Dr. Pettit are dads themselves. But in addition to taking care of their own children, they care for other people’s sons and daughters every day.
Being a dad is one of the most important jobs a person can have. It’s 24/7, there are no promotions or awards, and you won’t get paid for it. But fatherhood is the most rewarding job in the world for dads and their kids!
Celebrating Fruit and Vegetable Month
June is the perfect time for Fruit and Vegetable Month because there are so many ripe options to choose from that are easy for everyone to eat – even people with TMJ disorders. No matter which produce you prefer, these are the three must-do fruit and veggie rules:
• Go fresh
• Go local
• Know what makes a serving size
Both fruits and vegetables also make great BBQ foods. Try a combination of your favorites skewered on a kebab over the open flame. We also recommend sautéing a blend of squash, zucchini, broccoli and tomato with rich butter. It’s a fantastic side, whether you’re eating indoors or al fresco.
If you or a dinner guest has TMD, it’s best to cut fruit up into bite-sized pieces. You may also want to avoid fruits that have hard seeds hidden inside. For a delicious way to add a serving or two of fresh fruits to your diet, check out our recipe of the month.
RECIPE OF THE MONTH
This cold, refreshing dessert incorporates everything there is to love about summer. Semifreddo is an Italian dish that has the rich flavor of ice cream and the light texture of mousse. It will take a little extra time to prepare in advance, but on Father’s Day your dad deserves a slice (or two) of this incredible TMJ-friendly treat.
Lemon Semifreddo with Summer Berries
• 1/2 cup sliced almonds (optional)
• 1 3/4 cups heavy whipping cream, chilled
• 1 1/4 cups + 2 tablespoons sugar
• 7 large egg yolks
• 1/2 cup fresh lemon juice
• 1 tablespoon + 2 teaspoons finely grated lemon peel
• 1/4 teaspoon salt
• 4 cups fresh berry mix (your choice of raspberries, blackberries, blueberries, and quartered hulled strawberries)
1. Line a 9x5x3-inch metal loaf pan with plastic wrap, including enough left over to completely cover the top.
2. If adding almonds, sprinkle them evenly in the bottom of pan.
3. Using a mixer, beat the cream in a large bowl until soft. Refrigerate.
4. For the custard: in a large metal bowl whisk together 1 1/4 cups sugar, egg yolks, lemon juice, lemon peel and salt.
5. Set water to simmer in a large saucepan, then sit the custard bowl over the saucepan. Whisk constantly until the mixture is fluffy and thick. If using a thermometer, it should register 170°F. This should take approx. 4 minutes.
6. Remove from simmering water and beat the mixture until it doubles in volume. This should take approximately 6 minutes.
7. Fold the chilled cream into the mixture. Transfer everything to the loaf pan and smooth out. Tap the pan on the work surface to remove air pockets.
8. Fold plastic wrap over the top of the pan.
9. Freeze until firm, at least 8 hours.
10. Up to 3 hours before serving, gently mix the berries and remaining 2 tablespoons sugar together in large bowl.
11. After chilling unwrap the semifreddo and invert the dessert onto a platter.
Dip a large knife into hot water before cutting the semifreddo crosswise into 1-inch-thick slices. Transfer to plates and spoon the berry mixture alongside the semifreddo on the side opposite of the almonds. It’s a sweet counterpoint to spicy, savory BBQ on Father’s Day!