LAST WEEK OF CLINIC!

I'm going out with a bang...I have 3 clinic sessions in a row!  I would have had four if I had been able to come to clinic on Friday, but I have a wedding.  Tuesday, I saw Jennifer K-Z  and Marco.  Jennifer was fun...I knew her from my credit union days.  She was cake.  Marco has been a class 3 in the past and the poor soul still has 10mm pockets between his 2nd and 3rd molars, but he presented with marked improvement over the last time I saw him and I was able to complete him in one appt, so I called him a class V.  He was one of my favorite patients so I was glad I was able to finish my WSU clinic days with him as a patient.  Today Im a CA at VA and tomorrow I come to VA for my last clinic day of the semester!  Of ever!  Oh my lan!  I picked up my cap and gown yesterday...crazy!  I am so excited to have reached this time and I'm grateful for the support of those who have encouraged me through the years.  I am stronger and better because of you. 

The Mind is Willing But the Body is Weak.

Well my body is screaming, "I'VE HAD IT!", right in my face.  And it's manifesting in all sorts of fun ways.

Plague #1:  Esophagitis.  I woke up at 12:30am, a month or so ago, with a dull ache (much like the sensation of swallowing your food before you have a chance to chew it appropriately) that spread from my neck to my diaphragm and jetted to my left arm.  Initially, I was concerned that it was a heart thing so I saw the school physician.  After applying pressure at various areas along my chest her brow furrowed and she innocently asked, "Have you been experiencing any stress lately?"  Haha!  Huh, well, lets see.  Is it possible that in some realm of my life, I have been experiencing some smidgeon of stress? (short pause, as if pondering...then KAPOWEE!)  ANY STRESS???  That sweet doctor had posed the question in such a tone as if to suggest that I would have to rake my brain in order to come up with something.  Of course I was experiencing some stress...I was in the thick of Boards!!!  My body was drunk on stress!  She put me on a medication commonly used for GERD, and the sensitivity went away within the week.

Plague #2:  Random loss of appetite, with accompanying nausea.  Throwing up for no reason.  Not fun.

Plague #3:  A "pretty" little boil made its debut on my side, right along my bra-line.  A boil.  Really?  Who gets boils?  Missionaries in Brazil, maybe??  I only mention its precise location because the constant abrasion makes it particularly bothersome.  Ever-present, it serves as a reminder that my body desires to punish me for the stress I put it through during my Board exams.  It's finally gotten to a stage where it isn't irritating to the touch, but it needs to be looked at I think because it's still erythemic, indurated, and raised (what's the cool word for raised?).  As far as I know it's taken up permanent residence.  Soon it will be receiving its own mail.

Plague #4: My retromolar pads started throbbing!  (That sounds funny).  I felt like I had popcorn kernels stuck between the pads and my second molars for weeks.  Man, that hurt.

Plague #5: A flood of cankers (apthus ulcers, professor ;) ) perused my mouth for those same two weeks.  Oddly enough, they only manifested on the right side.  I can't figure that one out. I think plagues 4&5 were linked to my toothpaste moreso than my stress response.  Has anyone else experienced a similar effect with Crest tp (the type with baking soda)?

Plague #6:  An insatiable appetite for sugary beverages, particularly sodas.  That's **no-no-number-one** in my world.  What is my deal?

Plague #7:   A painful little sore on the tip of my tongue that I can't stop playing with.

Plague #8:  A cold sore in my right commisure.  Why is all this crap happening on my right?  I can't remember the last time I had a cold sore, but in all fairness, I assumed one would be coming at some point.  I just didn't know when.

Plague #9:  A full-on cold, with slight temperature increase.  Not miserable enough to keep me from typing this painfully long blog entry (sorry readers) but enough to keep me from seeing my patients in clinic today, which I'm not happy about.  I've met all my requirements, so I'm grateful I don't have to worry about that, but I'm really trying to build my speed.  I had three people scheduled today and I strongly suspected my afternoon patient would have some thick deposits (I was secretly hoping for some fun quality time with my triplebend).  Alas, it was not to be.

So in retrospect, these really can't be considered plagues.  I know this.  I also know that there are those among us that have experienced worse, and my heart goes out to those individuals.  But this is my sob story, and I hope that it humors you to some end.  I'm chuckling my way through it.

I have to say, though, my body and I have a pretty good relationship.  It carried me through when I needed it most.  I wasn't worrying about all this stuff while I took my exams (with the exception of plague #1).  My body was kind enough to find a notch of time between boards and graduation to release the tension its been feeling.  I guess I can't blame her.  I put her through a lot of grief the last couple months.  She deserves a rest.  You did good body...You did good. 

Welp, I planned on using the day more efficiently

Today my goal was to work on my speed.  I intended to schedule 4 ppl for one day...and I had 3, but one cancelled so I was left with two 1Bs.  Bummer.  I still urged myself to hurry and I had my second patient out the door in an hour!  Exciting!  My morning patient was my brother in law!  I was able to complete my last sealant experience requirement on him, which was nice.  Today has been super chill and I wish I could have been busier but it is what it is.  You know what sounds grand?  A smoothie.  I cant wait to go home! 

BOARD EXAMS

Let me list, in proper order, the exams of which have given me the most amount of stress and anxiety.  1 represents the most stressful.
1.  National Board Written Exam
2.  Process of Care
3.  WREB Local Anesthesia Written
4.  WREB Local Anesthesia Clinical
5.  WREB Clinical Dental Hygiene Exam

I am anticipating the results of my National Board Written this week and I'm reasonably confident that I passed.  I hope that is safe to assume.  The first half of the exam was a little scary and I didn't like that there were so many pharmacology questions but the case study portion of the exam saved my tucus, I think.  That was pretty straightforward.

Process of Care sucked.  I really don't know what to anticipate.  I feel there is a 50/50 chance of passing it.  I didn't like the format and how subjective the test seemed to be.  The huge annoyance with this exam is that we have to wait until we have taken the WREB clinical to get our results for POC.  So I have 30 more days to wait on my stupid results.  At least I know that this is the least important Board to pass on the first shot.  If I fail, I just pay $25 and take it immediately again.  It would be no fun, but pretty atraumatic.

Of all my exams, I felt the most confident coming out of LA written...and I passed.  I was grateful that this exam ended up being fairly stress-free.

LA Clinical went really well, as well...but I was really nervous going into it after failing my mockboard.  I passed on my first go, though, so I was pretty excited.  I left immediately for the airport to pick up my brother-in-law from his mission.  After the adrenaline wore off, I was seriously in shock.  I couldn't believe I was through with one clinical and that I had done so well.  I kept telling my family, "I passed!  I can't believe I've taken my first clinical board!!!"  I'm sure they were sick of me by the end of the night.

Once I found my patient, I had zero stress about taking my clinical board.  I probably should have been stressing a little more because I was 10 minutes from having to submit my patient for his scale check and I was still scraping calculus off his molars.  I would have much rather spent a solid half hour finding nothing, but I guess it was what it was.  I PRAY I passed this.  It would be such a holy annoyance to have to take this exam out of state.  Please oh please oh please say I passed.

In other news, I saw Linda this morning and cleaned her UL class IV quad and her LL class III quad.  No errors...felt good!  She didnt like the ultrasonic much, so I went light on that.  It has been a good day, so far.

THANK THE ROYAL HEAVENS

I found a patient for my clinical board exam last friday during screenings.  I was so grateful to Emily for looking him over while I finished up my previous patient.  We were concerned that his pocket measurements were too deep so I ran to the store to purchase him antiseptic mouthrinse and some good toothpaste.  I very thoroughly described the methods I wanted him to use to brush over the next week and we scheduled him for today to look for improvement.  This patient is amazing.  He came early to his appointment (which makes me hopeful that he will be dependable the day of boards) and his mouth looked 75% better than at the screening.  His gums were less inflammed, there was less bleeding on probing, his PFI had decreased considerably, and he was in the perfect position to be an ideal board patient.  We took forever on his xrays because try as we may, we couldnt keep an UL molar PA from looking elongated...and this was with Professor Alexanders help!  Oh well, it wasnt too extreme.  Hopefully it wont come back to bite me.  He was perfectly comfortable with me cleaning his UR quad, even without LA.  Another plus!  He stayed wide open the entire time and was super cooperative.  No errors!  I am set!  Hooray!

Linda cancelled with the front desk and I never got the message so I was without a patient for the afternoon.  I ended up putting Tori in the chair and cleaning her up.  Professor Alexander asked me if I thought she needed to do a scale check.  I said no and she was alright with that!  What a complement to Tori and me.

Next week...Boards and lots of hair falling out.

1B Day

Today I knew it was going to be a light morning. My friend Rachel came in for a cleaning.  She was my first patient in the program last year and I remember her coming back three times in order for me to finish her.  Today I finished her in 20 min.  Haha.  I'm glad she was able to see my improvement.  I was hoping my afternoon patient would be a class III or board worthy.  She hadn't seen a hygienist in years.  Unfortunately, she too, was a 1B.  If I would have known I would have scheduled them together in the morning!  Oh well, easy day.  I need to remember to give my explorer an extra twist on LL premolar mesials. 

Tri-Mockboard

I was surprisingly calm when my patient tried to back out of his appointment for today.  I reminded him of the significance of this exam and he agreed to make it work, thank goodness.  Unfortunately, he still came late.  I was planning to take a couple PAs before sending him to the front to meet with the student examiners, but I I had to throw that out the window.  Fortunately, I was able to get through his HHX super quickly and didn't lose any scaling time.  I don't think Maren was as lucky, poor thing!  She was in a similar situation, but her patient never showed.  Stupid undependables.  Anyway, scaling went smoothly, thank heavens!!  No errors, and only a few probe readings that didn't mesh (which is actually quite peculiar for me...usually I'm spot on with probe readings.  Curious.).  I was pleased with the day, overall!  Heather and Ashley, who evaluated my patient pre and post tx commended me for the challenge my patient posed.  I'm really grateful to have increased my skill level.  I've passed all my clinical mockboards and I feel ready for Clinicals...if I manage to find a patient ever!

Happy Valentines...Im going to sleep.

Well I managed to get myself sick last Thursday and it carried through the weekend.  No fun.  Today I was groggy and a little hesitant to come in but I had to finish my Class IV patient so I made it.  Sad story though.  His blood pressure has risen each time he's visited the clinic.  The first time he was only prehypertensive.  The second time he was hypertensive because he had drinken an energy drink (ww?).  This time he came in, he assured me that he stopped drinking energy drinks because "I had scared him" into watching his B/P.  This time, even without the drink, his B/P was in the Stage II Hypertensive state and we had to dismiss him.  I still have to follow up with him to make sure the doctor thinks he is okay.  I was worried for him and his wife.  They are a nice couple.  Whitney wasn't able to find an afternoon patient and my energy was kaput, so she was willing to take the patient so that I could go home.  So...no patient treatment this week.  Oh well.  Happy Valentines all!  I hope you didn't have to spend your day like me! 

LA MOCKBOARD

Kristen, my peerpal, volunteered to be my LA mockboard patient.  She makes for a great patient because she can open so wide and she's super cooperative!  I was grateful for her help!  I remember being Ashley's patient last year and thinking how amazingly awesome she was.  That girl always seemed to have it together...she was always so chill and confident.  Observing her made me feel as though I could expect to feel the same in the coming year.  I hope I have played some reassuring role for the juniors this year.  With hard work, you really can be successful at this stuff.  Anyway, I didn't pass the Mockboard, but I was kinda glad I didnt.  A lot of us failed actually, and I think we learned a ton from eachothers mistakes.  I was never really worried that I had failed...I think it provided my teachers the opportunity to target some small areas that I could improve on and I know Ill go into my board much more confident.  My IA was slightly too high.  I was a little surprised at this.  Every time I've recieved direction on my IA, I have been told to go higher...I think I played it a little too safe this time, haha.  Good to know for next time.  Oh, and I got used to putting the barrel of my syringe to the crest of the lip (dang I forget the right term...you know, where the upper lip and lower lip meet??) because that landmark is usually where the premolars are.  Well I didnt watch her dentition specifically, so because she could open her mouth so wide I was actually a little too far posteriorly.   The injection was still overall effective...she was numb and all, but my technique needed polishing.  For my PSA, I had the same issue everyone else was facing.  I needed to increase my lateral angle.  Lesson learned.  If I ask the patient to relax thier jaw and to move it toward the side I am giving their injection, it allows for more buccal displacement so I can get the correct angle.  Good information.  I will try to get lots of experience with these injections before clinicals. 

Lisa came in as my afternoon patient.  Shes a cute one.  There have been two times as a DH student that I have felt nausious.  My first experience occurred at VA last week when I smelled my Class IV patient's perio breath.  The second experience was today with Lisa.  In August of last year, she had 13&14 removed.  There is a cavernous area in her alveolar bonewhere those teeth used to ly.   Covering this 5X12mm hole was a yellow "sheet" of something gross.  It was soft, but of a thick consistency and it held together really well as I peeled it off the hole.  I couldn't even tell you for sure what this filmy bandage-like layer was composed of but it made me want to hit the floor.  I was so disgusted.  The rest of the appointment went really well though, and she was a Class III so that was good. 

Not my best day at VA...but hey, we learn!

The morning went well.  All our patients decided to cancel, no show, or show up really late.  Adrienne learned that I haven't treated any 1Bs this semester and spent her morning trying to make sure I got a 1B.  I thought it was so cute...she's so kind.  Despite her best efforts, I ended up treating a Class V.  I was a little disappointed because the patients xrays were most definitely Class III material in the past...Class IIIs are very much appreciated by us all right now...but when I look at the big picture, its really great that this person has been able to take care of his mouth so well and that his periodontal disease is managed.  We all went to lunch (which is so nice...I love having downtime with the girls) and then the afternoon turned into a nightmare.  My patient had 11 teeth so even though he was Class IV material, I expected the appointment to go relatively quickly, without many complications.  Boy, I called that one wrong.  I pulled out all the tools in my VA arsenal and it wasn't nearly enough.  This man needed serious root planing.  When I observed Professor Bossenberger's lateral pressure against those teeth, my jaw almost dropped in awe.  Her arm was kinda shaking!  My injections weren't taking effect due to his level of infection and PB didn't seem all that impressed with my technique.  It was all in all a pretty sucky afternoon.  But, in the end, the patient was taken care of, I finally got out of there and I learned a few things so I can't really consider it a failure.  Note to self:  don't suck so much next time ;)

Moving right along...

Today I was able to complete 4 quads of a Class III/IV; take intraoral photos of my class IV patient for my project; pass off 3 PEs; get 10 LA experiences; it was a great day! 

I learned how difficult it can be to clean a maxillary quadrant!  Holy majelin!  Thank goodness Joy was there to assist me.  His deposits were among the stubbornest Ive ever seen.  I was grateful that even with that, I missed only two areas when scale check came around.  Good day I would say!

Heather M = Ms. Congeniality

Heather just saved my tail feathers...again!!!  This girl is the sweetest thing on two legs.  I was hopeful that my morning patient would classify as a class III in at least 2 quadrants but as I probed and looked at her xrays, I quickly realized that she had started taking care of her teeth and that she was only a class V.  That is FANTASTIC for her, but I was bummed.  Heather, by contrast, found yet another stunningly difficult patient and because she already has 3 class IVs on her wrap sheet she offered to switch places with me so that I could use him for my class IV project.  Is that not the kindest, most charitable thing to do for a person?  I was super grateful and it gave me the opportunity to get 2 more local anesthesia experiences.  I haven't had anesthesia patients since last semester (which is strange, because last semester I was giving injections left and right).  Apparently, my craft needs a little fine tuning.  This was the first time I had to adjust my approach...but in all fairness, his anatomy was much less distinguished than other patients I have treated.  He was a very cooperative patient, however.  He has never had a cleaning and he was told to have a cleaning before he has some needed extractions.  There were a number of teeth that were so mobile that I was genuinely concerned I would pull them out with my scaler.  I learned last year to use a finger to secure the occlusal plane as I instrument mobile teeth so I did that.  It helped.  I was super happy that I missed zero areas! 

My afternoon patient was a class III...I was super excited.  He has calculus deposits on nearly every tooth surface.  I am using him as my backup for mockboards if I don't find a patient that is a little less challenging before then.  After taking 11 PAs (!!) on the poor man, I brought him back to have him assessed by Dr Hanson.  We agreed that he would be a very challenging patient but she assured me that she was confident that I could definitely pull it off.  We were 45 minutes away from walkout but she asked if I felt I could get through a quadrant of cleaning so that I could evaluate how easily his calculus deposits could be removed.  I decided to give it gusto and to try.  I zoomed and I was pleased with the turnout.  I had to throw in the towel there at the end because we have to absolutely have our patients out by 330.  I would have finished him by using my slimline and afterward, doing a ultra fine exploratory look around, but even without these things I only missed 4 places...and they were miniscule easily picked up with an explorer.  I had debrided all of the deeper root surfaces and the only deposits left were along the margins.  I did learn that its okay to use a nevi along the distal surface of a third molar.  That was surprising and helpful.

Funny story (insert later)

Caught Up in the Moments

This week it hit me that I'm not going to be a dental hygiene student forever.
There are a lot of exciting things that I look forward to experiencing as a licensed hygienist but I will genuinely miss being with my peers and mentors in this program!

I've loved listening to Karlie W's way of teaching her patients about their oral conditions, etc.  There's so much cheerfulness and enthusiasm inflected in her voice.  I've loved being around as Adrienne and Kelsey bring out the craziest sides of themselves together.  It's been nice having Michelle and Karen around to share their years and years of experiences in the dental field.  There's probably no dental mystery out there that could elude them.  Jamie and Jodie have the best comedic timing and their funny comments ALWAYS get a laugh.  I've admired that Heather M puts so much thought into others and making sure their needs are met.  I've loved knowing that if I ever have a question about the material we are studying, Kristie is just a text away.  Brooke leaves the most thoughtful comments on our blogs.  She always makes certain that we know that we are not alone in our frustrations (or in the celebrating of our successes!).  Stefanie has the sweetest smile of all of us I think.  She's so approachable and friendly.  Love it.  Maren is so good-natured...I love how easily she laughs at herself, and its fun to watch her and Karlie N together.  MeChel fears noone and says exactly what she's thinking and I LOVE it, and there have been numerous times I've appreciated Marianne's "lets-get-to-it-iveness."   Tori is so down to earth, and she has the answers for everything clinic-related.  Sarah says the things we all want to say but fear to say...thanks for that!  Leigh's always the one to catch the comments that are drowned out by the class and right when you decide no one heard you, she makes sure to let you know someone was paying attention to you.  Kayla is great about that too!  Gosh, how I could go on...I love reading dental hygiene blogs and knowing that I'm not alone in whatever is going on that week.  I love having 29 other people to keep me in check. I've appreciated how we always take care of one another.  I've loved having the professors that we do.  We know, above anything else, that they are an advocate for us, and I think that goes a long way.  I love that we can laugh with them, learn from them, dance with them, party with them, share our concerns with them, joke with them, etc etc etc.    I've appreciated having friends that understand my lingo.  I try to explain the craziness of my life to my friends and family and if I'm lucky they'll understand maybe 30% of the things I'm talking about.  Its just so much better getting to class and being able to vent to my peers.  I love how we have type A written all over us.  I love being able to call over my shoulder for Dr. Naylor when I know my patient has caries but I'm too chicken to say it out loud.  It's going to be a whole different ball game when we can't second guess ourselves anymore!

Today I paused to watch all of us go about our busy routines in clinic...each of us has come so far.  Boards are upon us and I guess we're to that point where we have to be ready...I imagine we all are, but it's going to feel very foreign when we are on the other side of graduation and we don't have the power of what? 38 (or so) individuals on our side, reassuring us and making us feel like a thousand bucks each day? 

Everyone, thanks for making me feel like a thousand bucks each day.  This program has been a blessing in many ways.  It, of course, gives me the knowledge and skills necessary to make dental hygiene a lucrative career.  It also enables me to utilize my strengths in such a way I can meaningfully help others.  It gives me a strong network of friends that I can resource throughout my career.  This program possesses so many qualities that I have come to value and I look forward to every day I have left here.

2nd Mockboard

I feel so much gratitude for today.  We had our second mockboard and it couldn't have gone better, to be honest.  Heather found me a great, cooperative patient who was really fun to talk with during the appointment.  In the morning I was an examiner and my findings were more in line with our professors' findings than last time...by mucho!  I was glad about that.  During our downtime we were asked to take a mock written LA board and it that exam is any representation of what the real board will be like, I realize that I have little to worry about.  I got an 88/100.  I did learn some things that are going to help me in the future.  Then came mock clinical board in the afternoon.  My patient was on time and patient and wonderful.  I felt bad for the girls that had more difficult patients to manage...I hear some of their patients were super sensitive and heavy bleeders, etc.  That was what my last mockboard patient was like and I know how difficult that was.  My heart goes out to them.  Today went smoothly, I felt so calm it was creepy almost, and I just jabbered and cleaned the whole time.  I finished a half hour early and decided there wasnt anything else I could do so I sent him for his check.  NO ERRORS!  except that I supposed one tooth had recession when, in fact, it was just abfraction.  In the future, I was told that I can state on my form that I measured a tooth from its level of abfraction, but because I didnt write that, I was docked the 2.5 pts...no matter.  That left me at 97.5!!!!!!!  Not too shabby!  and you know what, ILL TAKE IT!!!  Bring it on Boards!

Moving right along

Today I was lucky and got to treat a Class III patient.  He had various depths of pockets varying from 3-11mm!  His lateral incisors were positioned directly behind his centrals and cuspids on his maxillary arch.  It took a lot of time and extra careful exploring to make sure I cleared out all of the deposit but in the end I was successful!  I completed three quadrants and missed nothing!  He had third molars (all but one was fully erupted) and Prof Alexander explained that by adjusting my fulcrum just a bit I could reach that buccal surfaces of his maxillary 3rds a whole lot easier.  I was grateful for the help. 

Tender Mercies are fun to see and today I experienced one firsthand.  My afternoon patients cancelled while I was cleaning my morning patient.  During lunch I called people from the resource list and from my planner but noone could come in this afternoon.  I really wanted to utilize my day the best I could.  That is when Kristie dropped by and told me to talk to Mr soloman about scheduling a lady named "sylvia".  She couldnt remember her last name but Mr Soloman thought about it for a second and finally remembered that her name was actually Sonia and I called to see if she was available.  No answer.  Then a lady drops by and wants to talk to MR Soloman and wouldn't you know it...it was HER!  She came in hoping to be seen and I was able to treat her!  That was such a neat experience.

Oh and I need to remind myself to treat Heather McKay to something extra special.  She found me a Mockboard patient for next Tuesday.  Thanks Heather!  You are super sweet and I truly appreciate you. 

Great day.

...and Weeee're back!!!

MY LAST SEMESTER OF COLLEGE STARTS TODAY! 

Today I learned an important lesson about patient positioning.
My morning patient was a cute young girl who was referred to me as a possible board patient by a former graduate of my program.  Unfortunately, she had a probe reading of 7mm, which exceeds what we are allowed, and her calculus was not tenacious enough.  Even more unfortunate was the fact that I bombed in calculus removal today on the lower molars, but Dr Hanson helped me to realize why.  She said she was having difficulty reaching the areas that I missed because of my patients head position.  Due to her thick ponytail, her chin was down throughout the appt and it made it harder for me to scale those places thoroughly.  I will not allow that mistake to occur again.

I paid more attention to my patients positioning in the afternoon and while this patient had calculus that was a thousand times more diffuse and tenacious than my morning patient, I missed ZERO spots!  I was able to pass off a root debridement PE on this patient.  That felt nice!

At least I ended well!  Great lesson to re-learn on the first day of Spring Semester 2012!