Archive for the ‘Uncategorized’ Category

The other day was Memorial Day in Afghanistan. This is the day we honor our fallen colleagues who have made the ultimate sacrifice for our nation.

In my unit, we chose this day to have our Combat Patch Ceremony. The ceremony honors all of those serving in a designated combat zone by awarding what is known as the SSI-FWTS (Shoulder Sleeve Insignia-Former War Time Service). In day-to-day life back in the states, all soldiers in the Army wear the patch of their unit on their uniform’s left shoulder. Those who have served in combat with a unit are awarded the SSI-FWTS – and are authorized to wear the patch of their unit on their right shoulder as well. This is more commonly known as the “combat patch.”

Today, many soldiers in our unit join the ranks of soldiers before us who are authorized to wear a “combat patch.” For many of the soldiers in the unit this is their second, third, fourth, and even fifth yearlong deployment to Iraq or Afghanistan. I am really honored and humbled to serve here and to add my name to the ranks of those authorized to wear a combat patch.

Version 2.0

Posted: May 29, 2011 in Uncategorized

As an officer I have certain responsibilities to the public. One of those is to be a representative of the US Army and the Dental Corps and not make disparaging comments about either.

The last month or so before my deployment I lost track of those responsibilities. Despite my desire to deploy, I became very upset about the impacts on my family of my looming year away.

In the mornings I put on my game face and hid my sadness and anger well but I began using this blog to air the misdirected anger I was experiencing. I was blaming the Army and the Dental Corps for putting me in this position and just wrote out my thoughts. My personal existential dilemma went online for all to see…

That was a mistake. I want this blog to serve as an accurate depiction of life in the Army Dental Corps as a general dentist and as a brigade dentist. There will be both good and bad experiences, but I now recognize that I should not just wantonly air my personal grievances in such a public forum. That defeats the real purpose of writing and tarnishes my credibility.

I have removed the previous posts that I considered inflammatory towards the Army and the Dental Corps not because I take back what I said, but because they don’t belong in this public venue. Any personal issues I have with either will remain just that…personal.

So I hope with a second chance at this blog I can get back on track with my goals of sharing my experience and of making the Army Dental Corps better. I also hope that by sharing my regular observations of life downrange that I can help prepare those in our corps facing future deployments, while also helping educate all those others supporting us from back home. I hope all of you will give this blog a second chance.

The boot saga continues…

Posted: May 11, 2011 in Uncategorized

So now that pretty much everyone in my company who can has stopped wearing the combat hiker, other random boots are popping up all over the place. Our company supply sgt actually acquired a whole bunch of these boots. These are the ASOLO Moran GTX. They’re Italian and cost $250 a pair.  THANKFULLY these boots are lightweight, comfortable, have a speed-lace (!!!) system, are breathable, and look super sexy awesome. Most of the time I still wear my old school Wellco Panama Sole hot weather boots that I have had since OBC, but the soles on them are taking a beating from all the rocks here.

So hopefully these new boots will pass the test. The guys we replaced were wearing these and had some good things to say about them. With any luck they will serve us just as well.

So…what is it like here as a dentist in a deployed environment? It is a little rough. This is by no means the most miserable I have ever been, but its a little rough. The living conditions aren’t bad at all. I live in a plywood room that is pretty cool (although the cells at Ft Leavenworth are bigger). The clinic is a little difficult though. It is small and was an absolute mess when I took over. The place doesn’t seem to have been cleaned often and much of the equipment is not functioning properly. Im pulling garbage and food wrappers and food and shaving cream and other personal hygiene items out of the same drawers that they kept dental supplies in. Its really gross. We are still cleaning it up and we have been here almost a month.

Practicing dentistry here is frustrating. I am the only dentist around for a very large number of soldiers, sailors, marines, airmen, civilians, and “other governmental agencies.” None of those units brought a dentist with them. That means I work 24/7 with no real time off. The PA-C/MD do one day on, one day off. Thats a pretty good deal! People come in all hours of the day wanting to be seen for dental.

When Im not in the clinic, I have plenty of downtime. This is a nice FOB so there is stuff to do. We have an MWR and USO facility with internet and  phones. We have a little movie theater and two gyms. The dining facility is open 24 hours a day so you can go get ice cream whenever you want.

On the evenings when we are all available we like to go up on the roof and smoke cigars and drink near beer. Its not as nice as Club Habana in Charleston, but its relaxing. I also get to hit the gym almost every day.

So that is what life as a deployed brigade dentist has been like so far. This is going to be a long year. I hope the time goes by fast.

Here it is. The much anticipated “downrange review” of the Danner Combat Hiker. The overall consensus is in: These boots suck. I will caveat this by saying that Im no Tora Bora mountain climbing SF dude who is wearing these things in the middle of winter. But unlike many reading this, Ive actually worn these boots for several weeks- both in garrison and in Afghanistan.

So a little background…We were all required to wear them post RFI for several weeks back in garrison. That means I wore them every day in the new multicam duds. I wore them on a short 6 mile ruck march and I wore them on the flights over here and I wore them in Kyrgyzstan. I gave them all the benefits of the doubt. My initial thoughts when putting them on were that they were stiff and heavy, but relatively comfortable and not too hot.  Then on the trip over here people started complaining. It seemed like EVERYONE was complaining about them. Peoples feet were aching. The lacing system became a nightmare – they wouldnt get tight, they came undone, the laces wouldnt stay tucked in. As soon as our flights took off – off came everyones boots. Mine included. Originally I thought these boots might just turn out awesome. I was wrong.

So once we got here to Afghanistan the CSM authorized us to wear our old tan boots. Why? I have no idea. But as soon as that was put out the combat hikers disappeared. A few people are still wearing them but the one individual I talked to said the only reason she is still wearing them is because she didnt bring her tan ones. So the army spent $310 per pair and bought two pair per soldier in my brigade. Thats $310 x 2= $620 per soldier. $620 x 3,500 soldiers = $2,170,000 of boots just for my brigade!!!

Afghanistan!

Posted: April 19, 2011 in Uncategorized

I finally arrived in Afghanistan a few days ago. It took the better part of a week to get here and took some of the craziest routes one could imagine. Lets just say flying from Alaska to Germany nonstop in the back of a plane full of soldiers is a heck of a flight.

Things here are decent. The dental clinic is dirty and small, but has almost everything I could need. So far we haven’t been too busy.

Living arrangements are sparse but I have my privacy which is nice. Being around the same people 24/7 can drive a guy crazy. It is nice to be able to go sleep in a room by myself.

This is going to be a loooooonnng year. I miss my family and my friends back in Hawaii but am honored to be here. I’ll write more later and as soon as I can figure out a way, I’ll be posting photos as well.

Finally, there is a code for a PRR! I do a lot of these so called “preventive resins” in the Army. For those who dont know what it is it is something between a sealant and a filling. So many young soldiers come to see me with early carious lesions on occlusal surfaces that I find myself in the dilemma of choosing to code the procedure as D1351 (sealant) or D2391 (one surface posterior composite) all the time. Most of the time my rationale was this: if decay was present, even if it was limited to enamel, then it was not a preventive therapy and I coded it as a one surface occlusal. If I was doing this to prevent caries from forming in “deep pits and fissures” then I coded it as a sealant. The procedures are virtually the same in my practice: rubber dam, fissurotomy, etch, bond, some type of flowable resin, finish, polish, check the occlusion. Sometimes I throw in GLUMA or chlorhexidine prior to etching depending on the situation.

I hated finding myself in those predicaments. And with 18-24 year olds with moderate to high caries risk, I found myself in that situation quite often. In private practice (or dental school) there are some ethical dilemmas that pop up here. First, the previous definitions required that for it to be coded as a filling it had to go all the way into dentin. If you’re in private practice that gives you incentive to go “just a little further” into the dentin to guarantee your reimbursement from insurance. Same thing in dental school when you’re desperately trying to get credit for composite procedures in a school that may be very pro amalgam just so you can graduate.

I have only one issue which is Dr Blairs statement: “The code will probably be reimbursable for PRR on children and patients up to 16 years old, especially on newly erupted molars.” I would say to him and those at the ADA that limiting reimbursement to those under 16 is a mistake. Adults are susceptible to caries as well and should be given the best and most conservative treatment available for those in their situation – be it a sealant, a PRR, or a 1 surface occlusal composite. Insurance should neither discriminate on age nor dictate care.

So I applaud the ADA for realizing the problem with this and coming up with a solution. To all the naysayers concerned about potential fraud, I say relax and realize this is a step in the right direction.

So it is officially released and public knowledge – my unit is getting ready to deploy to Afghanistan. For those who haven’t heard, they have changed the camouflage pattern for Operation Enduring Freedom from the digital gravel-esque ACU pattern to the new super-sexy Multicam! Since this pattern is new and only for use in theater, we all had to get issued brand new everything. I’m talking everything – new uniforms, new equipment, new camelbacks, new rucks, boots, etc. Its a lot of stuff.

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The process of getting all this wonderfulness to the soldiers is called RFI – Rapid Fielding Initiative. They basically fill a warehouse with all of the required gear and the soldiers spend the better part of a day going through stations in which we try on and are issued said piece of equipment. It was really exciting – like Christmas morning exciting.

All this new gear appears to be really high quality. Phenomenally expensive however. I asked one of the civilians who seemed to be in charge of the RFI process how much all this cost? His answer: Between $10 and $13,000 per soldier. The new boots – which are just Danner hiking boots – retail for over $300 a pair. They are surprisingly comfortable and breathable. I wore them around for an hour the other day here in Hawaii and was quite impressed.

It blows my mind how much money the Army has just for gear. They spare no expense when it comes to taking care of soldiers. I would say about 1/3 of this stuff I will never use. The boots are awesome, but do I really need two pair? Especially since the old boots are rumored to be authorized for wear in the Multicam uniform as well. How about the $800 dollar Level 7 Parka top? This is for -40 degrees! I don’t even think it gets this cold in the region of Afghanistan we are going to. But better to have and not need than need and not have, I suppose.

Dental Benefits for Veterans

Posted: February 7, 2011 in Uncategorized

I see a lot of patients who ask whether then can finish their dental treatment at the VA when they separate from the military. Here is the official answer:

Cost free VA dental benefits are available:

  • You must have served 90 days or more, and;
  • Your DD214 must not show that you received all your needed dental service at least 90 days prior to your separation.

You must apply to VA for this dental care within 180 days (6 months) of separation from active duty.

If you experienced “dental trauma” while in an active duty status, you may be eligible for lifelong dental care associated with this trauma and receive a service connected disability.

Click here for more information on dental benefits for veterans.

Dentists assigned to a brigade will no doubt get the opportunity to do one of two rotations – NTC or JRTC . These rotations are approximately one month long and are designed to simulate being deployed to either Iraq or Afghanistan. My brigade just completed a month-long rotation at NTC and I was privileged enough to go along for the whole ride. I heard all these horror stories from folks about NTC so I was a little concerned going into it. It really wasnt that bad.

Here is my NTC story: We left Hawaii on a chartered Delta 747. It was just like a normal 747 except it was full of soldiers and guns. They took everyone E-7 and above and flew us first class. That was awesome. We flew straight from Hickam AFB to this tiny desolate place called Victorville, CA. It used to be George AFB back in the day but was closed in 1992 as a result of the BRAC.  We landed just before midnight. They wheeled a staircase up the side of this giant aircraft in the desert and we just deplaned right there. It was a little weird hanging out underneath the wings of this giant craft that just ferried us across the ocean. They gave us 15 minutes to smoke and use the latrine then herded us on to busses for the journey to Ft Irwin. We arrived at LSA Warrior AKA the Rotational Unit Bivouac Area (RUBA) around 0200.  We stood around outside for about 45 minutes while they unloaded our bags, gave us briefings on where we were, and told us where we would be staying – giant tents that held about 150 people.

We spent about a week in the RUBA. The living conditions weren’t really that bad. We had a PX, Burger King, laundry facilities, and the infamous “Gut Trucks” that served the cheapest and most delicious coffee on post. There were showers, flushing toilets, and a dining facility that served hot food even though it was outdoors and standing room only.

Our soldiers spent the week getting weapons and vehicles ready for the rotation. The docs ran sick call out of a trailer and I had to take any dental patients to the main clinic on post to treat them since we didnt have a field clinic set up yet. The Ft Irwin DENTAC was very accommodating and they were all extremely helpful and friendly. I saw about three patients that week. The rest of the week was spent sitting on my rear. After the week in the RUBA we convoyed out to “the box” for our two weeks of training.

The Box is a training area roughly the size of Rhode Island. It is designed to look and operate just like Afghanistan or Iraq. There are multiple Forward Operating Bases (FOBs) scattered about as well as multiple little villages. During those two weeks the brigade conducted full spectrum operations. They ran convoys, attacked insurgents, got attacked, etc…Our job at the clinic was to run a level two medical facility to treat all real world and “notional” casualties. When we got to the FOB that first night we had four hours to go from tent with dirt floor to fully operational medical facility. The living conditions were austere – no real toilets, no running water, no PX. It took three days to get the shower tents up and running. We ate a lot of MREs those two weeks. You aren’t allowed to take cell phones into the box (although I did) and there is no internet access. Verizon gets good service but nothing from AT&T.

The soldiers at the other FOBs would get attacked by fake insurgents. They would then be flown to our facility for “treatment.” We would triage them, treat them, and evacuate them. We saw 305 pretend casualties those two weeks. The cadre at NTC employs amputees to play wounded soldiers and they do a pretty damn good job acting the part. It was  a real eye opener for our new medics – most of whom have never actually seen any blood or trauma.

After two weeks of life in the box we headed back to the RUBA – convoy style. We convoyed several hundred vehicles about 6.5 miles back over a period of HOURS. You can’t head west at sunset very fast through the desert. We got in late at  night and moved back into the tents we were originally in. We spent the week doing pretty much nothing. Our soldiers stayed busy cleaning weapons and vehicles. The officers, however, were relegated to wander the main post of Ft Irwin like vagrants. We spent hours loitering at the PX, bowling alley, and library. I really felt homeless. After a week of that we headed back to Hawaii.

So overall NTC wasn’t the worst experience I have ever had. It sucked being away from the family but I really think it was a great learning experience for everyone in the unit.