CONTACTS 

SUBJECTS
Cleaning Water Jet Dental Instrument Extremely Painful
Xrays Full Set 18 Pictures

0404 -
0404 -    ..
0405 - Summary/Objective
0406 -
040601 - Follow up ref SDS 8 0000, ref SDS 6 0000.
040602 -
040603 - Steve took xrays and did a preliminary cleaning. ref SDS 0 FB6L  Xrays
040604 - show infection that will require root canal on tooth #19, where the
040605 - crown fell out. ref SDS 0 FB7Y  He proposed a comprehensive scope of
040606 - work in addition to repairing the failed crown that led to the meeting
040607 - today. ref SDS 0 FB83  Was great to see Russ again, who has now become
040608 - a doctor.  He performed deep cleaning to complement the initial
040609 - standard cleaning. ref SDS 0 FB93  Lyn presented a work plan prepared
040610 - by Steve. ref SDS 0 F85G  Lyn estimated the cost will run about $10K.
040611 - ref SDS 0 I43J  We cannot afford this scope, and so will need to think
040612 - through a priority that fits our budget of $4K.
040613 -
040614 -     [On 050519 Doctor Allen Hasse performed root canal on #19.
040615 -     ref SDS 9 9G6M
040617 -      ..
040618 -     [On 050525 Lyn scheduled work on the 2 crowns to be performed on
040619 -     050615. ref SDS 12 0001
040620 -
040621 -
040622 -
040623 -
040625 -  ..
0407 -
0408 -
0409 - Progress
0410 -
041001 - Primary reason for the meeting today is to repair the crown on #19,
041002 - which failed on 050516. ref SDS 8 QT5I
041004 -  ..
041005 - Arrived late about 1130.
041007 -  ..
041008 - Signed in and was seated in a patient examination and treatment chair.
041010 -  ..
041011 - Steve recommended taking a full set of xrays to evaluate all
041012 - conditions, since dental work has not been done for several years,
041013 - which impacts preventive maintenance.  A technician took the xrays,
041014 - which seemed like about 20 separate pictures.
041016 -  ..
041017 - Steve examined records on prior work, and found that he had not done
041018 - the crown for #19.  This aligns with SDS showing Steve worked on #31
041019 - beginning on 980304, ref SDS 2 0001, and that work was completed by
041020 - Russ a month later on 980414. ref SDS 3 1888
041022 -  ..
041023 - During the meeting today, asked about treatment for cancer patients.
041024 - Steve indicated that his practice offers more frequent dental cleaning
041025 - that reduces risk to cancer patients of compounding small infections,
041026 - as discovered this morning in my case, ref SDS 0 FB7Y, into serious
041027 - problems due to reduced immune strength caused by chemotherapy, as
041028 - occurred with Mil on 041202. ref SDS 7 S96L
041029 -
041030 -     [On 050520 primary care physician in Oconolgy Department at Kaiser
041031 -     approves dental examination to avoid infection. ref SDS 10 YU8N
041032 -
041033 -
041035 -  ..
041036 - Cleaning Maintenance Predicate to Repair Failed Crown
041037 -
041038 - Today, Steve did a standard cleaning using ultrasonic scaler equipment
041039 - that is extremely painful.  Unfortunately, work today was more
041040 - difficult to tolerate than last time Steve used an ultrasound scaler
041041 - tool, reported on 980827 1100. ref SDS 4 4522   Work today caused
041042 - problems similar to the report on 980217 1100. ref SDS 1 7378
041044 -  ..
041045 - Not sure how we got through this.  Steve suggested gripping the arms
041046 - of the chair to express pain.  Hopefully, we didn't damage the chair,
041047 - because there was a lot of gripping, and unfortunately some turning
041048 - away of the head, grimacing, etc.  Must have been frustrating for
041049 - Steve to have a patient so intolerant of pain, which others readily
041050 - accept in order to benefit from advanced dental care.
041051 -
041052 -     [...see below Russ used novicane that reduces pain, but ultimately
041053 -     switched to a standard dental pick that reduces the amount of
041054 -     water to maintain, which is a separate significant issue for
041055 -     patients with digestion problems. ref SDS 0 GD69
041057 -  ..
041058 - Going forward, if this method is used again, will have to pay
041059 - additional for novicane, which was effective for deep cleaning,
041060 - performed later in the day. ref SDS 0 GD69
041062 -  ..
041063 - Had to sit up because of digestion issues from aclasia problem.  Steve
041064 - was considerate of this problem, even though it made his work more
041065 - difficult.
041066 -
041067 -     [On 050519 Doctor Hasse also accomodated the aclasia problem.
041068 -     ref SDS 9 MO6N
041070 -      ..
041071 -     [On 090306 0800 Doctor Harris and assistant, Todd, accomodated
041072 -     aclasia problem. ref SDS 14 V38S
041073 -
041074 -
041075 -
041076 -
0411 -

SUBJECTS
Xrays Full Set 18 Pictures Diagnosis Scope of Work

0503 -
050401 -  ..
050402 - Xrays Show Infection Many Problems Determine Scope of Work
050403 - Scope of Work Determined from Xrays Showing Infection Many Problems
050404 -
050405 - When standard cleaning was completed, Steve showed the xrays taken
050406 - earlier this morning. ref SDS 0 286O
050408 -  ..
050409 - Steve pointed to a darkened area between the roots of tooth #19 and an
050410 - adjacent tooth.  Steve explained this slight coloration identifies
050411 - infection, and recommends repair with a root canal procedure is needed
050412 - to clear the infection.
050414 -  ..
050415 - There seemed to be slight difference in coloration at this location.
050416 - To the untrained eye, difference in coloration at tooth #19 compared
050417 - with other locations was hard to appreciate from the xray alone.
050418 -
050419 -        [On 050519 Doctor Allen Hasse performed root canal on #19.
050420 -        ref SDS 9 9G6M
050422 -         ..
050423 -        [On 050519 doctor explains xray of the treated tooth shows
050424 -        infection removed. ref SDS 9 MM8V
050426 -  ..
050427 - Steve used a hand held dental mirror to show significant decay on the
050428 - broken surface of #19 which requires immediate action.  Decay
050429 - previously hidden below a crown likely explains unexpected findings of
050430 - infection, and further why this crown suddenly came loose, without any
050431 - evident provocation or trauma from biting a hard object such as a
050432 - peanut, meat, etc., in that it appears decay erroded the tooth from
050433 - below the crown, and so without a stable foundation, very minor
050434 - pressure finally caused the crown to fail by breaking loose from the
050435 - structural connection into the jaw bone.
050436 -
050437 -        [On 090303 2053 tooth #2 experienced similar problems with
050438 -        possible infection, reported in a letter to the dental team.
050439 -        ref SDS 13 0T8Q
050441 -  ..
050442 - Hidden infection may further explain sudden loss of energy the past
050443 - month, that has significantly reduced productivity.
050445 -  ..
050446 - Steve proposes the following scope of work, based on the xrays...
050447 -
050448 -        1.  Deep cleaning (Root planing)
050449 -        2.  Periodontal exam for deep pockets.
050450 -        3.  Root canal remove existing infection for the
050451 -            tooth on the lower left, probably #19
050452 -        4.  Crowns - 4
050453 -        5.  Fillings replace - 5
050454 -        6.  Periodontal exam - deep pockets
050456 -  ..
050457 - Thanked Steve for comprehensive review, and noted we probably cannot
050458 - afford this entire scope in the near term, but will shoot for a
050459 - program that addresses the most urgent needs at this time.
050461 -  ..
050462 - Steve was unsure about cost.  We discussed payment in light of no
050463 - insurance coverage and no revenue base.
050465 -  ..
050466 - Discussed cost savings by restoring the gold crown that fell out on
050467 - 050516, leading to the meeting today. ref SDS 8 QT5I
050469 -  ..
050470 - Steve took the gold crown, and advised that his practice cannot
050471 - achieve savings to the customer by restoring the prior crown.  He will
050472 - ask his finance coordinator to work up some numbers, and submit a
050473 - quotation after completion of the work today.
050474 -
050475 -
050476 -
050477 -
050478 -
050479 -
050480 -
0505 -

SUBJECTS
Deep Cleaning Left Side Prepare for Root Canal and Crown Replacement

0603 -
060401 -  ..
060402 - Deep Cleaning Left Side Prepare for Root Canal and Crown Replacement
060403 -
060404 - We decided to perform the deep cleaning on the left side today, which
060405 - is needed to repair the crown on #19 that presents the most urgent
060406 - requirement.
060408 -  ..
060409 - Russ performed deep cleaning on the left side.  He did a great job,
060410 - particularly switching to a manual cleaning instrument.  Before
060411 - starting, Russ numbed the work area with Novocaine.  This solved the
060412 - problem of physical discomfort that plagued the initial cleaning
060413 - operation, per above. ref SDS 0 FB6L
060415 -  ..
060416 - During this procedure, Russ checked for pockets and reported a few 3s,
060417 - some 4s, and maybe a 6.  Not sure if the attendant recorded this part
060418 - of the work.
060419 -
060420 -     [On 090306 0800 Russell reported no findings of "pockets" during
060421 -     examination and teeth cleaning; and Doctor Meyer made no findings
060422 -     of pockets during extraction of tooth #2. ref SDS 14 1X4K
060424 -  ..
060425 - Russ started deep cleaning using an ultrasonic scaler instrument,
060426 - similar to the tools used for the primary, standard cleaning, per
060427 - above. ref SDS 0 FB6L  Numbing with novocaine injection was effective
060428 - eliminating pain, however, the water employed with the instrument,
060429 - caused continual breathing difficulty due to the esophagus problem.
060430 - Russ initially offered a choice between water and mint flavored
060431 - liquid.  We chose water, but this still proved problematic.  The aide
060432 - using a vacuum tube instrument was unable to prevent water from
060433 - flowing down the throat, and this led to continual burping, which
060434 - interuppted the work, causing slow productivity, and frustration by
060435 - everyone.
060436 -
060437 -     [On 050519 Doctor Allen Hasse used a shield that avoided the
060438 -     problem today. ref SDS 9 C49K
060440 -  ..
060441 - Russ eventually asked the aide to stand down, and switched to a
060442 - standard dental pick, or possibly one designed specifically for deep
060443 - cleaning, which requires more vigorous physical effort to clean
060444 - beneath the gum line.
060446 -  ..
060447 - This work took about an hour.
060449 -  ..
060450 - Thanked Russ for consideration of patient infirmities.  Like Steve,
060451 - Russ has excellent communication skills that are calming while
060452 - reporting progress throughout the procedure.  He was kind to indulge
060453 - some discussion on tranformation to a culture of knowledge, cited in
060454 - POIMS, ref OF 4 J26O, and indicated plans to examine welchco.com...
060455 -
060456 -              http://www.welchco.com
060457 -
060458 - ...where he can find POIMS by clicking on "Publications."
060459 -
060460 -              http://www.welchco.com/03/00050/01/09/01/02/00030.HTM#0001
060461 -
060462 -
060463 -
0605 -

SUBJECTS
Scope of Work Priority Payments Work Plan to Fit Budget

0703 -
0704 - 1430
070501 -  ..
070502 - Payment and Budget to Prioritize Work Plan
070503 -
070504 - Met Steve's payments manager, Lyn.
070505 -
070506 - Lyn submitted a Treatment Plan and Cost Estimate showing...
070507 -
070508 -        1.  Cleaning....................$   95     Steve
070509 -        2.  Xray........................   125
070510 -        3.  Examination.................    80     Steve
070511 -        4.  Root Planning UR............   319     Russ
070512 -        5.  Root Planning LR............   319     Russ
070514 -               ..
070515 -              Daily total..........................$  938
070517 -  ..
070518 - We discussed insurance company practices on approving payment of $640
070519 - for the root planning task, which took about an hour, per above.
070520 - ref SDS 0 GD69
070522 -  ..
070523 - Lyn seemed to indicate there is often some negotiation on medical
070524 - standard pricing.
070526 -  ..
070527 - Lyn showed the next page in the estimate...
070528 -
070529 -        6.  Root canal #19..............$1,300     Allen
070530 -        7.  Build-up #19................   300     Allen
070531 -        8.  Xray to apraise quality.....    45
070532 -
070533 -              Daily total..........................$1,645
070535 -               ..
070536 -              Subtotal initial stabalization................$2,583
070537 -
070539 -             ..
070540 -        9.  Root Planning UL............   319     Russ
070541 -       10.  Root Planning LL............   319     Russ
070543 -             ..
070544 -       11.  Crown #14................... 1,185     Steve
070545 -       12.  Crown #18................... 1,185     Steve
070546 -       13.  Crown #19................... 1,185     Steve
070547 -       14.  Crown #31................... 1,185     Steve
070548 -       15.  Filling #11.................   220     Steve
070549 -       16.  Filling #12.................   260     Steve
070550 -       17.  Filling #22.................   280     Steve
070551 -       18.  Filling #10.................   240     Steve
070552 -       19.  Filling #25.................   280     Steve
070553 -       20.  Periodontal Exam............   160     Kashani
070555 -               ..
070556 -              Subtotal remaining work.......................$6,818
070558 -               ..
070559 -              Total project.................................$9,401
070561 -      ..
070562 -     [On 050519 meeting with Steve to prirotize work based on a budget
070563 -     of about $4K. ref SDS 9 QT5I
070565 -      ..
070566 -     [On 050520 Lyn indicated that Steve concurs with limiting initial
070567 -     next steps to repairing 2 crowns, making total cost of $5K, and
070568 -     final payment in the July payables cycle. ref SDS 11 5Q9O
070569 -
070570 -
070571 -
070572 -
070573 -
070574 -
070575 -
070576 -
0706 -