#and leave myself a note to call the CPAP equipment people…

[firebirdsdaughter]

Random Writing Guess What…

… New fandom???

I’m gonna actually holding off on tagging this as Hakuoki atm bc… I dunno. I’m scared of bringing my particular brand of odd to the tag (I say, about an apparently incredibly historically accurate yet fictional dating visual novel about samurai vampires…), but… Here we are.

Look, this is Sunagawa’s fault, if the man weren’t so goddamned good at acting, I wouldn’t be here.

Or maybe I would. Who knows.

Actually, @fluttering-by, bc this is also your fault (affectionate/grateful).

~I’m trying desperately to find a replacement for the horizontal line and failing~

“You lied to me.”

The words aren’t so much angry as hurt, trembling slightly—Miki’s shoulders were taut, but more in the way of nerves, huddling into himself rather than readying for a fight. He hovered by the end of the table, one hand by his side, anxiously pulling at the hems of his sleeves absently, the other fidgeting on the hilt of his sword. He was looking more at his boots than Koudou, an odd appearance on one as tall as he was, with a katana in his sash—and yet, when he felt the doctor’s gaze on him, he looked even further down, biting his lip.

Koudou sighed deeply, straightening up from the table, setting the bottles he was had been looking through aside and wiping his hands off before turning to face the young man. “It wasn’t a lie. It is merely a process.” Miki said nothing in reply, his hands merely tensing even more, teeth sinking further into his lip. He truly was so easy to read.

In a few measured steps, the doctor came level with the young man and reached out, tucking his hand under Miki’s chin gently to tip the young man’s face back up. The very first time they had met, when he had reached out like this, Miki had jerked away with a proud glare—now the young man didn’t move back at all, allowing Koudou to lift his head up to reveal unguarded, confused, and wounded eyes beneath his bangs. The nights spent tending to the Miki’s transition into a Fury, wiping the blood from his mouth when needed had apparently won him over. He had taken miraculously well to the basic kindness, combined with honest praise for being such a successful test—where Miki had once maintained a brash and arrogant veneer, Koudou was now privy to the gaze of an insecure, innocent young man filled with desperate pleading. Underneath the spiky shell, he was such a simple soul, longing for worth and guidance—when dangled before him, he scrambled eagerly for them like an abandoned puppy.

When Koudou smiled at him with practiced warmth, that naive eagerness blossomed, waiting to be reassured. The doctor remained silent for another moment, gaze flickering over Miki’s face for a little longer. “… Have your injuries healed completely?” He didn’t need to feign the concern in the question—the young man was the most successful, responsive specimen he had ever had; losing him would be a significant setback he could not afford.

Miki hesitated for a moment, put off by the change in subject, but eventually nodded slightly, chin bumping against Koudou’s hand. The doctor gave him a quick once over just in case, slowly lowering his arm—although the young man hadn’t been one for deceit even before letting his guard down, it was best to be sure—and was satisfied with the response. There were a few remnant marks from mostly-healed wounds, but no actual damage. Good; what he needed to do today was going to be rather… Invasive, and he preferred that Miki be in full health for the procedure.

The young man’s gaze turned curious. “… Why?”

“Like I said, it’s a process.” He made certain to hold Miki’s wide-eyed gaze the entire time. “Thanks to you, I’ve already found a method of mitigating the energy consumption.”

The young man watched him with more uncertainty than he had before—but not enough for concern. “… What is it?”

The question wasn’t new, either, and he was already giving another smile of studied reassurance before the words had finished leaving Miki’s lips. “There now,” When the young man looked away nervously, Koudou brought his hand back up to hold Miki’s chin once more, gently turning his face back forward. In a last second addition, he brushed his thumb over the young man’s cheek briefly, noting how Miki’s head tilted slightly into the touch, eyes darting back to the doctor’s face, “You trust me, don’t you, Saburo?”

The silence that followed was longer than it had ever been before, but Koudou wasn’t terribly concerned—he could still plainly track every thought that ran through the young man’s head, displayed clearly on his face. There was some hesitation, but nothing strong enough to make him think Miki would refuse. The young man was desperate, both for worth and for the means to avenge his family—a raw, determined, consuming rage fuelled by grief that Koudou easily recognised as kin to his own. They were like spirits, in some ways—enough that he knew Miki would never back down from the promise of a chance to achieve his goal. One of the things besides his uniqueness as a test subject that made the doctor almost… Fond of him.

At last, the conflict in Miki’s eyes dissipated, and the telltale nod came, the young man’s chin tapping against Koudou’s fingers once more. The doctor gave him another soft smile, releasing his face and turning back towards the table. “Put that aside, please.” He instructed, lightly gesturing to Miki’s katana. He heard the sound of cloth and motion behind the sounds of him readying supplies. Turning back with the appropriate cloth and bottle in hand, he was unsurprised to find the young man had obeyed, the sword leaning against the wall. Yet another pleasant trait—finding a cooperative subject was almost as rare as finding one that took to the procedure as well as Miki. “And you should sit down.” He didn’t look up from the precious task of pouring the liquid onto the fabric, but again he heard the rustle of silk as the young man sank down onto the straw mat covering the corner of the room, next to the futon. Another good thing—it would be best to not have to move him too far. He really needed to see about finding a new exam table.

Putting away the closed bottle, he took the soaked cloth in his hand, crossing the room in measured steps to kneel behind the young man’s shoulder. Miki was staring either at the floor or his hands in his lap from lowered lids, biting his lip slightly, still a bit tense. Well, in a fashion, this would help with that. As a forewarning, he reached up and gently smoothed his free hand over the young man’s hair, noting the instinctive start at the sudden touch. Lingering for a moment to be sure Miki was calm, Koudou’s hand drifted to the back of the young man’s head, fingers tangling slightly in his hair for grip. Then he raised his other hand to set the cloth over Miki’s nose and mouth.

The young man stiffened immediately, resisting on impulse, but the doctor’s hand tightened on his hair, pulling Miki against him to keep the cloth over his face. “Shh… It’s alright… It’s alright…” He doubted the words were understood, but that didn’t matter—what was most important was a level tone, “Just breathe… Take deep breaths…” He positioned his arms around the young man to contain him, combing his fingers through the small tangles in Miki’s hair as if to sooth a panicky animal, continuing to murmur softly. The young man continued twisting a bit, hands grasping instinctively at the doctor’s arm, but he managed to maintain enough control to not actually pull hard enough to dislodge the cloth from his face. It took effort—Koudou could feel him trembling, and tears began to well in his eyes, catching in the lashes.

The doctor drew him even closer, folding over him a bit, counting silently as the young man struggled to take slow, heavy breaths. “Do not be afraid, Miki Saburo,” He whispered, smoothing his hand over Miki’s hair in a steady, constant rhythm, in time with each inhale and exhale, “You are my greatest success—I would never cause you unnecessary pain.”

At long last, Miki blearily mumbled something, and his eyes finally closed over the tears brimming in them. The word was muffled by the fabric, and the way his head lolled sideways as his body went fully limp, pressing his face into Koudou’s chest, but… It sounded like ‘aniki.’

Koudou held him for a little longer, running a hand over his hair a few more times, more slowly, until the young man’s breathing levelled out completely. Once he was satisfied Miki was completely under, he slowly unwrapped his arms from around the thin shoulders, tossing the fabric he’d used into the laundry. In the next moment, he guided the unconscious form in his hold over to the futon, cushioning the young man’s head on the pillow carefully, with the same attention he had bequeathed to injured animals in the past.

Under anaesthesia, all the anger and frown lines in Miki’s face smoothed out, easing the weariness that the rage and grief had added to his appearance. The tears that had been partially formed in his eyes were smeared across his cheeks, dripping onto the bedding, leaving small stains in the cloth. When not standing tense like a tightly coiled spring, his body was slender, delicate—all awkward angles and youthful softness.

He looked… He was… So young. He couldn’t be much older than Chizuru—two or three years, at most. Barely more than a boy.

Somebody’s child, whispered a voice in the back of Koudou’s mind, as he watched Miki’s tear streaked face, somebody’s son.

A softness he hadn’t felt in years gathered in his chest as he watched the young man—the boy—sleep. Under the influence of the chemicals, there were no twitches or movement—if not for the languid rise and fall of Miki’s chest and the fact that he wasn’t quite pale enough, he could have passed for a corpse. Another child caught up in a conflict that had been brewing for long before he was born, one that would likely destroy him.

Koudou sighed, closing his eyes for a moment to collect himself. There was no purpose to these lingering emotions—he had no use for them, they served no purpose to his goal. He might not savour using as innocent a soul as Miki, but he didn’t have a choice. Not when the boy was the foremost amongst all his attempts. A pity, yes, but he couldn’t lose so precious a specimen.

Opening his eyes, he took one last deep breath, then reached out to brush the wayward strands of hair away from Miki’s face. He’d wasted enough time—he needed to get to work. He had been able to brew a brand of chloroform that was sufficiently effective on Furies, but it didn’t last forever, and there was much to do. His posture shifting back into professionalism, he leaned further forward to arrange both the boy’s arms straight at his sides before getting to his feet and turning back towards the rest of the lab, to fetch his bag. It was time to get to work.

~I’m trying desperately to find a replacement for the horizontal line and failing~

Yeah, have I mentioned I MISS THE HORIZONTAL LINE BRING IT BACK TUMBLR I SUFFER.

Anyway. I. Uh. I finished a thing.

Bc by the by I love this musical/game/thing now. It has soothed my frustrations so much. I’m gonna now go and listen again bc I’m starting to get kinda salty and it is like the magical ‘Detox the Fire’ button. Or maybe that’s just Sunagawa singing.

[ellymackay]

Finding Focus in Dental Sleep Medicine: Rosemarie Rohatgi, DMD

Finding Focus in Dental Sleep Medicine: Rosemarie Rohatgi, DMD is available on https://www.ellymackay.com

Why Rosemarie Rohatgi, DMD, left general dentistry to open San Diego Sleep Therapy, where she exclusively works with patients who have obstructive sleep apnea.

By Greg Thompson | Photography by Susan Magre

Many people advised Rosemarie Rohatgi, DMD, that a dental sleep medicine-only practice would not succeed. But San Diego Sleep Therapy is now a thriving dental practice in which most patients are physician referrals.

General dentists often start with making a few oral appliances “here and there” when opportunity presents itself as a complement to their traditional practices. Far rarer is a dentist who jettisons the safety net of a traditional practice altogether to focus exclusively on dental sleep medicine.

Rosemarie Rohatgi, DMD, is one of those trailblazers. After almost two decades as a general dentist, she went looking for a new space to ply her trade. While she had no equipment, no physical location, and could not take any patients with her, she made it a point to lay a strong educational foundation, earning Diplomate status with three separate boards, the American Board of Dental Sleep Medicine, the American Sleep and Breathing Academy, and the American Board of Craniofacial Dental Sleep Medicine. Rohatgi previously had completed her undergraduate training at University of Oregon, Eugene, and graduate work at Oregon Health Sciences University School of Dentistry, Portland. She also completed a sleep medicine residency at the University of California, Los Angeles.

Rohatgi eventually took the bold step of opening the 1,300-sq-ft San Diego Sleep Therapy in San Diego, Calif, from scratch. At first, Rohatgi did everything herself. She answered phones, saw patients, and even handled the billing for a while before turning that over to experts. “The practice has grown significantly,” Rohatgi says, “so much so that a majority of my patients are physician referrals.”

It’s been a challenging road, and many colleagues, particularly at the beginning, discouraged the move. “A colleague even told me that a sleep only practice would never work, and I needed an existing [general] dental practice,” says Rohatgi. “Even my supporters were skeptical. It was too risky for them. Yet I took a loan out and pressed forward.”

Rohatgi’s plan to focus full time on oral appliance therapy in the treatment of sleep apnea began to crystallize during a dental sleep medicine seminar about 10 years ago in Irvine, Calif. She remembers: “I was pregnant at the time and ready to deliver at any moment. However, I drove up from San Diego for a 2-day weekend course. The instructor, Kent Smith, DDS, was impactful, and I was moved by the patient need. At the end of that session, I told myself, ‘I have to do this.’”

Many years before this epiphany, Rohatgi traced the first seeds of her interest in dental sleep medicine to a return trip home after completing dental school. “I visited my parents one weekend and I couldn’t believe my ears,” she remembers. “I started researching this undefined area [loud snoring] and found a simple device to fabricate for my dad. His experience of better sleep, and a restful night for my mother, was enough for me to become a believer in the field of dental sleep medicine. This is where it all originally began.”

While Rohatgi liked dentistry in the intervening years, she needed a new purpose. “I enjoyed some dental procedures such as extracting teeth, but I did not love dentistry,” she says with a chuckle. “I feel like dental sleep medicine is my calling. It gave me a purpose and revitalized my meaning of practice.”

Alternative to Gold Standard

Rohatgi and a medical office assistant review notes in the modern-styled reception area.

For people with obstructive sleep apnea (OSA), Rohatgi readily agrees that CPAP is remarkably effective. “CPAP is certainly the gold standard if patients are compliant,” she says. “Oftentimes, we see patients are more compliant with oral devices due to comfort. We can now personalize oral devices and make them smaller to allow for more tongue space.”

Medical providers who routinely treat patients with CPAP are willing to refer people who fail or refuse CPAP to Rohatgi because they know she is committed to patients. They know because she has communicated with many of them, often face to face. “There are no shortcuts in establishing referrals,” she says. “I spoke with many of my referring providers in person. I was persistent. I educated sleep labs and sleep physicians and informed them that oral appliances work effectively by showing them results and [having them] hear our patient testimonials, often directly from patients who attest that we are improving outcomes.”

Patients tell sleep physicians how they feel better with oral appliances, and their personal stories also build referrals. “Quite often we hear, ‘This is definitely working better than CPAP,’” Rohatgi says.

Rohatgi’s patient-first philosophy, along with her willingness to steer clear of turf wars, means that referrals are often a two-way street that can take unexpected detours. As an example, Rohatgi recalls the case of a stay-at-home mom who was referred by a sleep physician. She’d been diagnosed with OSA several years prior via in-lab polysomnography (PSG), but Rohatgi observed that another disorder might also coexist. “She would come in with injuries, and she was accumulating them while she was asleep,” she explains. “Naturally we tend to think of domestic violence, but she spoke of her husband highly and I was not sure what was going on.” 

Documenting the injuries in S.O.A.P. (subjective, objective, assessment, and plan) notes led to additional discussions with physicians during hospital sleep rounds. “I eventually referred her to a neurologist because we knew she was sleep walking, and her injuries were getting more serious,” says Rohatgi, who by then suspected REM sleep behavior disorder. “She did not want to go see another doctor and have another in-lab PSG, so I had to cajole her. He ordered an in-lab PSG.

“She was diagnosed with nocturnal epilepsy,” Rohatgi continues. “She had a seizure during the sleep study. We were fortunate to obtain this data during her study because it did not happen every night. They eventually found a hemangioma. When I came back for another sleep round, a colleague said: ‘Well of all people, it’s a dentist who found it.’” Rohatgi takes pride in getting patients such as this mother into the proper hands and in following up. In addition to having a network of sleep physicians to refer to, Rohatgi also maintains relationships with general dentists in her area to refer patients who need dental services that she no longer does herself.

Rohatgi laments that the broader medical profession still lacks respect for the full breadth of available sleep apnea treatments. Within her specialty of oral appliances, the biggest misconception is that they don’t work, she says. “But they do work,” counters Rohatgi. “I have data on hundreds of patients. I know oral appliance therapy works, and there is supporting literature. It’s a big disappointment when we are unable to get sleep labs or sleep physicians on board with us. We need to give patients the alternatives they deserve.”

Despite exponential growth in sleep apnea awareness over the last decade, there is a large population of potential patients who still have never even heard of oral appliance therapy. Rohatgi thinks reasons include that patients “are not informed about the oral appliance alternative” and that some sleep physicians lack the confidence in oral appliance efficacy.

Modern Technology

Rohatgi eschews polyvinyl siloxane impressions in favor of a Carestream intraoral scanner, which she demonstrates on a medical office assistant.

Patients who eventually find their way into Rohatgi’s office appreciate the practice’s modern architectural feel that gives a hint of what is to come; namely, the latest technology. Rohatgi counts herself as an early adopter of new technology, even if that means larger capital expenditures.

Rohatgi says, “We digitally scan patients’ mouths, so we are able to capture a three-dimensional image for CAD/CAM [computer-aided design/computer-aided manufacturing] technology. We use a Carestream scanner; it’s quick, accurate, and efficient. Everything is sent digitally to the manufacturers, so there is nothing to package and the order is sent out electronically, which means more efficiency and less room for error. I utilize oral appliance manufacturers that accept digital information, such as ProSomnus, Narval, and [Whole You] Respire, among others.”

Rohatgi demonstrates proper patient positioning for usage of the Orthophos SL 3D cone beam computed tomography imaging system.

  Rohatgi uses a Dentsply Sirona cone beam computed tomography system (an Orthophos SL 3D) in addition to the Carestream scanner. “I realize that view is captured while [patients] are awake, but it’s more of an educational tool for patients,” she says. “I’m not diagnosing with the cone beam, but at least they can see the area that is most constricted. A lot of people are visual, so when you show them, they see that the airway is not perfectly circular.”

Rohatgi uses CBCT as an educational tool, particularly since not all patients realize the airway isn’t perfectly circular.

With two young children (a 4-year-old girl and 6-year-old boy), Rohatgi and her husband are all too familiar with the challenges of getting enough sleep. Being a wife, mother, and full-time clinician/business owner is not easy and admittedly leaves little time for old pastimes such as playing the piano, travel, tennis, remodeling homes, and wine tasting. “The balance is the biggest challenge in my life. It is difficult and a constant ‘work in progress’ with trying to make time for everything,” she says.

And yet, Rohatgi is adamant that her bold career decision was the right move. That decision is repeatedly affirmed when new patients come through the doors, sometimes at their wit’s end. Whether it’s a new patient, or one who has put away his CPAP a decade ago and is still seeking alternatives, the possibility to make a positive influence remains a gratifying part of the job.

“One patient recently said he had a ‘new and extended lease on life’ and added that this ‘has been one of the best investments of time and money I’ve made in my lifetime. I wish I would have done it sooner,’” says Rohatgi. “It’s amazing how this small object, this custom-fitted device, can be such a life-changer for people. Their outlook can completely change for the better, and that’s a really satisfying part of my job.” 

Greg Thompson is a Fort Collins, Colo-based freelance writer.

from Sleep Review http://www.sleepreviewmag.com/2018/05/dental-sleep-rohatgi/

from Elly Mackay - Feed https://www.ellymackay.com/2018/05/10/finding-focus-in-dental-sleep-medicine-rosemarie-rohatgi-dmd/

[marclefrancois1]

Finding Focus in Dental Sleep Medicine: Rosemarie Rohatgi, DMD

The blog article e0a9e1e9e6412908cf53cee25f32209b62d23d03e119cd2df63e6855e8fc22eee0a9e1e9e6412908cf53cee25f32209b62d23d03e119cd2df63e6855e8fc22eepostlinke0a9e1e9e6412908cf53cee25f32209b62d23d03e119cd2df63e6855e8fc22eee0a9e1e9e6412908cf53cee25f32209b62d23d03e119cd2df63e6855e8fc22ee is republished from https://www.marclefrancois.net

Why Rosemarie Rohatgi, DMD, left general dentistry to open San Diego Sleep Therapy, where she exclusively works with patients who have obstructive sleep apnea.

By Greg Thompson | Photography by Susan Magre

Many people advised Rosemarie Rohatgi, DMD, that a dental sleep medicine-only practice would not succeed. But San Diego Sleep Therapy is now a thriving dental practice in which most patients are physician referrals.

General dentists often start with making a few oral appliances “here and there” when opportunity presents itself as a complement to their traditional practices. Far rarer is a dentist who jettisons the safety net of a traditional practice altogether to focus exclusively on dental sleep medicine.

Rosemarie Rohatgi, DMD, is one of those trailblazers. After almost two decades as a general dentist, she went looking for a new space to ply her trade. While she had no equipment, no physical location, and could not take any patients with her, she made it a point to lay a strong educational foundation, earning Diplomate status with three separate boards, the American Board of Dental Sleep Medicine, the American Sleep and Breathing Academy, and the American Board of Craniofacial Dental Sleep Medicine. Rohatgi previously had completed her undergraduate training at University of Oregon, Eugene, and graduate work at Oregon Health Sciences University School of Dentistry, Portland. She also completed a sleep medicine residency at the University of California, Los Angeles.

Rohatgi eventually took the bold step of opening the 1,300-sq-ft San Diego Sleep Therapy in San Diego, Calif, from scratch. At first, Rohatgi did everything herself. She answered phones, saw patients, and even handled the billing for a while before turning that over to experts. “The practice has grown significantly,” Rohatgi says, “so much so that a majority of my patients are physician referrals.”

It’s been a challenging road, and many colleagues, particularly at the beginning, discouraged the move. “A colleague even told me that a sleep only practice would never work, and I needed an existing [general] dental practice,” says Rohatgi. “Even my supporters were skeptical. It was too risky for them. Yet I took a loan out and pressed forward.”

Rohatgi’s plan to focus full time on oral appliance therapy in the treatment of sleep apnea began to crystallize during a dental sleep medicine seminar about 10 years ago in Irvine, Calif. She remembers: “I was pregnant at the time and ready to deliver at any moment. However, I drove up from San Diego for a 2-day weekend course. The instructor, Kent Smith, DDS, was impactful, and I was moved by the patient need. At the end of that session, I told myself, ‘I have to do this.’”

Many years before this epiphany, Rohatgi traced the first seeds of her interest in dental sleep medicine to a return trip home after completing dental school. “I visited my parents one weekend and I couldn’t believe my ears,” she remembers. “I started researching this undefined area [loud snoring] and found a simple device to fabricate for my dad. His experience of better sleep, and a restful night for my mother, was enough for me to become a believer in the field of dental sleep medicine. This is where it all originally began.”

While Rohatgi liked dentistry in the intervening years, she needed a new purpose. “I enjoyed some dental procedures such as extracting teeth, but I did not love dentistry,” she says with a chuckle. “I feel like dental sleep medicine is my calling. It gave me a purpose and revitalized my meaning of practice.”

Alternative to Gold Standard

Rohatgi and a medical office assistant review notes in the modern-styled reception area.

For people with obstructive sleep apnea (OSA), Rohatgi readily agrees that CPAP is remarkably effective. “CPAP is certainly the gold standard if patients are compliant,” she says. “Oftentimes, we see patients are more compliant with oral devices due to comfort. We can now personalize oral devices and make them smaller to allow for more tongue space.”

Medical providers who routinely treat patients with CPAP are willing to refer people who fail or refuse CPAP to Rohatgi because they know she is committed to patients. They know because she has communicated with many of them, often face to face. “There are no shortcuts in establishing referrals,” she says. “I spoke with many of my referring providers in person. I was persistent. I educated sleep labs and sleep physicians and informed them that oral appliances work effectively by showing them results and [having them] hear our patient testimonials, often directly from patients who attest that we are improving outcomes.”

Patients tell sleep physicians how they feel better with oral appliances, and their personal stories also build referrals. “Quite often we hear, ‘This is definitely working better than CPAP,’” Rohatgi says.

Rohatgi’s patient-first philosophy, along with her willingness to steer clear of turf wars, means that referrals are often a two-way street that can take unexpected detours. As an example, Rohatgi recalls the case of a stay-at-home mom who was referred by a sleep physician. She’d been diagnosed with OSA several years prior via in-lab polysomnography (PSG), but Rohatgi observed that another disorder might also coexist. “She would come in with injuries, and she was accumulating them while she was asleep,” she explains. “Naturally we tend to think of domestic violence, but she spoke of her husband highly and I was not sure what was going on.” 

Documenting the injuries in S.O.A.P. (subjective, objective, assessment, and plan) notes led to additional discussions with physicians during hospital sleep rounds. “I eventually referred her to a neurologist because we knew she was sleep walking, and her injuries were getting more serious,” says Rohatgi, who by then suspected REM sleep behavior disorder. “She did not want to go see another doctor and have another in-lab PSG, so I had to cajole her. He ordered an in-lab PSG.

“She was diagnosed with nocturnal epilepsy,” Rohatgi continues. “She had a seizure during the sleep study. We were fortunate to obtain this data during her study because it did not happen every night. They eventually found a hemangioma. When I came back for another sleep round, a colleague said: ‘Well of all people, it’s a dentist who found it.’” Rohatgi takes pride in getting patients such as this mother into the proper hands and in following up. In addition to having a network of sleep physicians to refer to, Rohatgi also maintains relationships with general dentists in her area to refer patients who need dental services that she no longer does herself.

Rohatgi laments that the broader medical profession still lacks respect for the full breadth of available sleep apnea treatments. Within her specialty of oral appliances, the biggest misconception is that they don’t work, she says. “But they do work,” counters Rohatgi. “I have data on hundreds of patients. I know oral appliance therapy works, and there is supporting literature. It’s a big disappointment when we are unable to get sleep labs or sleep physicians on board with us. We need to give patients the alternatives they deserve.”

Despite exponential growth in sleep apnea awareness over the last decade, there is a large population of potential patients who still have never even heard of oral appliance therapy. Rohatgi thinks reasons include that patients “are not informed about the oral appliance alternative” and that some sleep physicians lack the confidence in oral appliance efficacy.

Modern Technology

Rohatgi eschews polyvinyl siloxane impressions in favor of a Carestream intraoral scanner, which she demonstrates on a medical office assistant.

Patients who eventually find their way into Rohatgi’s office appreciate the practice’s modern architectural feel that gives a hint of what is to come; namely, the latest technology. Rohatgi counts herself as an early adopter of new technology, even if that means larger capital expenditures.

Rohatgi says, “We digitally scan patients’ mouths, so we are able to capture a three-dimensional image for CAD/CAM [computer-aided design/computer-aided manufacturing] technology. We use a Carestream scanner; it’s quick, accurate, and efficient. Everything is sent digitally to the manufacturers, so there is nothing to package and the order is sent out electronically, which means more efficiency and less room for error. I utilize oral appliance manufacturers that accept digital information, such as ProSomnus, Narval, and [Whole You] Respire, among others.”

Rohatgi demonstrates proper patient positioning for usage of the Orthophos SL 3D cone beam computed tomography imaging system.

  Rohatgi uses a Dentsply Sirona cone beam computed tomography system (an Orthophos SL 3D) in addition to the Carestream scanner. “I realize that view is captured while [patients] are awake, but it’s more of an educational tool for patients,” she says. “I’m not diagnosing with the cone beam, but at least they can see the area that is most constricted. A lot of people are visual, so when you show them, they see that the airway is not perfectly circular.”

Rohatgi uses CBCT as an educational tool, particularly since not all patients realize the airway isn’t perfectly circular.

With two young children (a 4-year-old girl and 6-year-old boy), Rohatgi and her husband are all too familiar with the challenges of getting enough sleep. Being a wife, mother, and full-time clinician/business owner is not easy and admittedly leaves little time for old pastimes such as playing the piano, travel, tennis, remodeling homes, and wine tasting. “The balance is the biggest challenge in my life. It is difficult and a constant ‘work in progress’ with trying to make time for everything,” she says.

And yet, Rohatgi is adamant that her bold career decision was the right move. That decision is repeatedly affirmed when new patients come through the doors, sometimes at their wit’s end. Whether it’s a new patient, or one who has put away his CPAP a decade ago and is still seeking alternatives, the possibility to make a positive influence remains a gratifying part of the job.

“One patient recently said he had a ‘new and extended lease on life’ and added that this ‘has been one of the best investments of time and money I’ve made in my lifetime. I wish I would have done it sooner,’” says Rohatgi. “It’s amazing how this small object, this custom-fitted device, can be such a life-changer for people. Their outlook can completely change for the better, and that’s a really satisfying part of my job.” 

Greg Thompson is a Fort Collins, Colo-based freelance writer.

from Sleep Review http://www.sleepreviewmag.com/2018/05/dental-sleep-rohatgi/

from https://www.marclefrancois.net/2018/05/10/finding-focus-in-dental-sleep-medicine-rosemarie-rohatgi-dmd/