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gordonwilliamsweb · 4 years ago

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Why Your Dentist Might Seem Pushy

In 1993, Dr. David Silber, a dentist now practicing in Plano, Texas, was fired from the first dental clinic he worked for. He’d been assigned to a patient another dentist had scheduled for a crown preparation — a metal or porcelain cap for a broken or decayed tooth. However, Silber found nothing wrong with the tooth, so he sent the patient home.

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He was fired later the same day. “Never send a patient away who’s willing to pay the clinic money,” he was told.

Silber said what happened to him then still happens today, that some dentists who don’t think they receive enough from insurance reimbursement — whether private insurance or Medicaid — have figured out ways to boost their bottom lines. They push products and procedures a patient doesn’t need or recommend higher-cost treatment plans when less expensive options might accomplish the same thing.

The pressure is more intense now since the covid pandemic cut traffic into dentists’ offices. But while most dentists are ethical, the practice of going with more profitable procedures, materials or appliances is not new. In 2013, a Washington dentist writing in an American Dental Association publication lamented a pattern of “creative diagnosis.” A 2019 study of dental costs found wide differences in the price of certain services. It said teeth whitening at the dentist’s office, for example, is no more effective than whitening strips one buys at the drugstore — and at least 10 times more expensive.

But sometimes dentists escalate to outright fraud. A recent article in the Journal of Insurance Fraud in America put it plainly: “Medicaid fraud is the most lucrative business model in U.S. dentistry today.”

Indeed, the ADA sees a problem. Dr. Dave Preble, senior vice president of the American Dental Association’s Practice Institute, said, “Hundreds of thousands of dental procedures are performed safely and effectively on a daily basis.” But he cited a study from the National Health Care Anti-Fraud Association that says between 3% and 10% of the $3.6 trillion Americans spend annually on health care is lost to fraud each year. That’s as much as $13 billion of the $136 billion Americans spend annually on dental care lost to dental fraud.

Silber said he saw the X-rays of one patient after she’d seen another dentist and was shocked to learn she’d had two crowns put in when she needed only one minor filling. She was told the first crown was necessary to treat decay in one tooth, and the second crown was needed to make the first crown fit better. “She only needed one small filling. It should have cost her $100 or so,” Silber said. “Instead, the dentist convinced her to replace two perfectly good teeth just so he could make $2,400 from her insurance company.”

The absorption of small private practices by corporations, private-equity buyouts or group practices over the past two decades has increased the emphasis on higher profits. “The executive at the top tells the dentists working for them which procedures to push, like a chef tells their team of waiters to push the daily special,” Silber said. “If a dentist refuses to comply, they’re shown the door.”

One treatment patients are commonly pressured to undergo in corporate dental chains is quadrant scaling: an invasive teeth-cleaning procedure along the gum line, usually done over three or four visits. While the procedure can be helpful if a patient suffers from severe gum disease, it can erode gum tissue that cannot grow back. Dentists can charge between $800 and $1,200 for each procedure, while a standard cleaning nets them only about $100.

Dr. Michael Davis, a dentist practicing in Santa Fe, New Mexico, said some dentists look for procedures for which Medicaid pays more. He explained that Medicaid pays three to six times more for nickel-chromium steel crowns than for standard fillings, so some dentists recommend those more profitable and invasive treatments to unsuspecting patients. “The fit of premanufactured steel crowns is unfavorable and can show gaps,” Davis said, “so unethical dentists target little children who won’t notice the misshapen fit until their permanent teeth come in.”

Children who still have their baby teeth are prime targets for pulpotomies — the removal of the pulp of a tooth — whether they need them or not.

Unethical dentists also perform shortcut versions of otherwise covered procedures for a patient, while billing the insurer for the full amount — a practice known as upcoding.

Mini-implants, for example, can be easily upcoded. A standard dental implant is an artificial tooth root that dentists install to anchor a dental crown or bridge. A mini-implant, by contrast, is like “a thumbtack compared to a bolt,” said Dr. David Weinman, a dentist practicing in Buffalo, New York. In the past, mini-implants were used only to hold dentures in place, but because they are so much quicker to install and cost the dentist as much as 60% less than a regular implant, more dentists have been recommending them as a long-term solution.

“We in the dental community see a high failure rate when mini-implants are used where a regular implant is needed,” Weinman said, “but that hasn’t stopped some dentists from pushing them on patients who don’t know better.”

Then there are horror stories of dentists gone bad. In March, Dr. Mouhab Rizkallah, a Massachusetts orthodontist, was sued by the state’s attorney general for deliberately keeping his patients in braces longer than medically necessary and for deceptive billing for mouthguards. The complaint against him alleges he instructed his staff to buy plastic mouthguards at a discount store even though he knew they wouldn’t fit the patients’ teeth properly. Rizkallah then billed Medicaid $75 to $85 more than the retail price for each one and was reimbursed more than $1 million for the mouthguards alone, according to the lawsuit.

Other dental practitioners have done far worse. After a video of Dr. Seth Lookhart, an Alaska dentist, riding a hoverboard during a dental procedure went viral, intrigued authorities found he’d been sedating nearly all his patients to cash in on the reimbursements Medicaid pays for general anesthesia. He was sentenced last year to 12 years in prison.

The Texas Dental Board revoked the license of Bethaniel Jefferson, a dentist who was practicing in Houston, after she was found to be endangering her patients by needlessly administering general anesthesia to take advantage of the same insurance payments. She left one patient in an oxygen-deprived state for so long the child suffered severe brain damage.

Dr. Scott Charmoli, a Wisconsin dentist, was charged with fraud after he was found to be using his drill to intentionally break patients’ teeth so he could bill the insurance company for crowns instead of fillings. The indictment alleges that he performed more than $2 million worth of crown procedures between Jan. 1, 2018, and Aug. 7, 2019 — amounting to more than 80 fraudulent crown procedures a month.

Weinman said patients can always seek a second opinion — especially for expensive treatments — and that a dentist who seems hesitant when you say you want a second opinion is worrisome. “A dentist who is confident in his or her abilities won’t have a problem with you checking a diagnosis or treatment plan elsewhere,” he said.

Other red flags: Weinman said to be wary of any dentist who seems to be reading from a script, or who pushes a treatment plan too hard or refuses to explain treatment options. “There may be several scientifically sound, evidence-based treatment plans available to a patient,” Weinman said, “and a good dentist is willing to explain your options — even the ones that may not be as profitable.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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ezatluba · 4 years ago

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Alligators make terrible pets: 'You're basically dealing with a dinosaur.'

New Mexico officials seized this seven-foot American alligator (seen here at his new home, the ABQ BioPark Zoo) from a private home, where he'd been kept illegally for a decade.

A rise in the abandoned reptiles around the United States—including two recently found in a Kansas creek—has raised concern among experts.

JULY 31, 2020

Something unusual was lurking in Wildcat Creek, in Manhattan, Kansas, a small college town on the prairie. In June, townsfolk spotted two American alligators swimming in a body of water better known for reptiles such as garter snakes and painted turtles.

Further investigation revealed that a thief—still at large—had stolen the gators from a local pet shop and released them into the creek. Rescuers set humane traps to catch the animals, but the female, Pebbles, died after falling into the water inside one of these traps. The male, Beauregard, eluded capture until late July, when a construction worker caught and returned him to his owners at Manhattan Reptile World, according to their Facebook page.

The two gators, kept at Manhattan Reptile World under a state zoo permit, had previously been illegal pets, living in a pool and a bathtub in Manhattan and Kansas City, according to a news release. (Learn more about why people want exotic pets.)

The incident—particularly the female’s untimely death—highlights the often problematic, yet not widely known, phenomenon of keeping pet American alligators, which are native to the U.S. Southeast, experts say. (Read more about the exotic pet trade.)

Formerly endangered, American alligators reached their nadir in the 1950s because of overhunting and habitat loss, but conservation efforts returned the species to healthy numbers by the mid-1980s. Weighing up to a thousand pounds, these behemoths live in wetlands, rivers, lakes, and swamps, feeding primarily on fish, turtles, snakes, and small mammals. (Watch alligators on the hunt.)

Official numbers on how many American alligators are kept as pets don’t exist, but some states have estimates. There are likely 5,000 in Michigan; at least 50 in Phoenix, Arizona; and as many as 52 of the prehistoric reptiles are surrendered to the city of Chicago each year.

American Alligator, Alligator mississippiensis

TYPE: Reptile

DIET: Carnivore

GROUP NAME: Congregation

AVERAGE LIFE SPAN IN THE WILD: 35-50 years

SIZE: 10-15 feet

WEIGHT: 1,000#

In recent years, wildlife officials across the nation have noticed an uptick in alligators abandoned in parks, creeks, and other public places. In 2019, six pet alligators went on the loose in Detroit (one was shot to death), and in August, the New Mexico Department of Game and Fish seized an alligator from a Santa Fe man who had kept the animal illegally for 10 years.

Gator laws

Ownership laws for alligators vary by state and municipality. While keeping them is legal in Michigan, parts of Detroit ban private ownership. In other states, such as New Mexico, pet gators are illegal without a permit, and in Arizona and New York, private ownership is banned.

Such regulations don’t faze many collectors who covet palm-size baby gators. A quick search for pet alligators turns up dozens of websites that sell juvenile alligators for anywhere from $150 to $15,000 (for an albino animal). Most of these young reptiles come from legal alligator breeders in the Southeast who sell the animals wholesale to vendors.

The black market trade of these animals has long been “a big problem,” according to Matt Eschenbrenner, director of animal care and conservation at the Great Plains Zoo and Delbridge Museum of Natural History, in Sioux Falls, South Dakota. It’s likely that most of these animals originate in Florida, says Russ Johnson, president of the Phoenix Herpetological Society.

Florida has strict alligator farming laws and inspection protocols, but not all breeders play by the rules. In 2018, the state reported 21 active alligator farms that produced legal hides and meat. Not present on this list are unlicensed operations that illegally breed gators as pets. (Read about the largest seizure to date of illegally caught reptiles.)

Bone breakers

Most gator pet owners are unprepared to care for an adult animal that can reach 14 feet and live 80 years, Johnson says. When that cute baby gets bigger and less manageable, the owner faces a real conundrum. “It’s not like owning a cat or dog that will return love,” he adds. “You’re basically dealing with a dinosaur.”

To capture their prey, alligators are armed with strong jaws lined with up to 80 teeth. If captive gators don’t get enough food—a common problem—they can get cranky and bite, easily breaking through human bone. “It’s not the alligator’s fault,” Johnson says. “The alligator was just being an alligator.”

This happens, he says, because feeding an alligator is expensive. Adults need nourishment such as whole chickens or pork with the bone, and Johnson says he pays about $150 a month to feed each adult alligator at his rescue facility.

Alligators also need a large pool of water to thrive. Bathtubs and kiddie pools, preferred by many pet owners, aren’t good enough, Eschenbrenner says. Buoyancy relieves the weight of an alligator’s internal organs, and if the water isn’t deep enough for a gator to float, it can suffer pain and even die from the pressure of its own internal weight. Plentiful water helps alligators feel safe and calm in their environment, he adds.

The right temperature is a requirement too. As natives of the U.S. Southeast, alligators are used to living in a warm-to-hot environment, and pet owners may need to use several heat lamps to keep the cold-blooded animals warm, Eschenbrenner says.

Health woes

Because many people keep pet alligators illegally, the animals miss out on routine veterinary care. As a result, serious health problems may go unchecked for years.

Eschenbrenner recalls one alligator rescued from a home in New Mexico that had been kept in a kiddie pool for a decade. The animal was obese, but even so, poor nutrition had stunted its growth and caused dental problems—it was unable to fully close its mouth because the top and bottom jaws were misaligned.

Many pet alligators develop weakened bones because of a nutrient-poor diet, such as hamburger meat or deboned chicken. One alligator rescued in Arizona was so low on calcium that its jaws were “like a rubber band,” Johnson says. Another was so malnourished that it broke its back leg while trying to escape rescuers.

Unnatural surfaces can be harmful: One alligator raised on a glass platform had a disfigured skeleton because of improperly settled bones.

Considering the difficulties of keeping an alligator, much less a healthy one, it’s no surprise that when the animals become too difficult to care for, their owners abandon or kill them—or surrender them to the authorities, Johnson says.

Good homes for gators

There are people trying to make life better for abandoned alligators. For example, the Phoenix Herpetological Society, in Arizona, provides a natural, semi-wild habitat for 15 rescued alligators at its 2.5-acre sanctuary—along with a number of other abandoned, abused, and confiscated reptiles. The facility, which has an on-site reptile clinic and research center, aims to find permanent homes for many of its animals, often sending them to other reputable sanctuaries around the country.

Female crocs lay their eggs in clutches of 20 to 60. After the eggs have incubated for about three months, the mother opens the nest and helps her young out of their shells.

Alligators' heads are shorter and wider than crocodiles'. Although heavy and slow on land, they can ambush their prey from the water by lunging at speeds of 30 miles (48 kilometers) per hour.

Nile crocodiles are the largest crocodilians in Africa, sometimes reaching 20 feet (6 meters) long.

Saved from the brink of extinction, the American alligator now thrives in its native habitat: the swamps and wetlands of the southeastern United States.

Critically endangered, the prehistoric-looking American crocodile struggles to survive in pockets of shrinking habitat.

The largest crocodilians on Earth, saltwater crocs, or "salties," are excellent swimmers and have often been spotted far out at sea.

American alligators are found in freshwater coastal wetlands across the southeastern United States, from Louisiana to the Carolinas.

Mother Nile crocodiles lay their eggs in a buried nest, opening it when high-pitched squeaks are heard from within. The sex of baby crocs is dependent upon the temperature of the nest rather than genetics.

The best solution, Eschenbrenner says, is not to own an alligator in the first place. “I would never have an animal like this as a pet, period.”

A good option for alligator enthusiasts is to appreciate them from a distance by supporting conservation groups or a certified zoo that keeps the animals properly for public education, he says.

Owning one is “doing an injustice to this animal,” Eschenbrenner says. “You’re causing it more harm than good.”

Wildlife Watch is an investigative reporting project between National Geographic Society and National Geographic Partners focusing on wildlife crime and exploitation. Read more Wildlife Watch stories here, and learn more about National Geographic Society’s nonprofit mission at nationalgeographic.org. Send tips, feedback, and story ideas to [email protected].

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addictionrecoveryassistance · 6 years ago

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itsfinancethings · 5 years ago

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March 29, 2020 at 11:41AM

SANTA FE, N.M. — As the coronavirus rages across the United States, mainly in large urban areas, more than a third of U.S. counties have yet to report a single positive test result for COVID-19 infections, an analysis by The Associated Press shows.

Data compiled by John Hopkins University shows that 1,297 counties have no confirmed cases of COVID-19 out of 3,142 counties nationwide. Of the counties without positive tests, 85% are in rural areas — from predominantly white communities in Appalachia and the Great Plains to majority Hispanic and Native American stretches of the American Southwest — that generally have less everyday contact between people that can help transmit the virus.

At the same time, counties with zero positive tests for COVID-19 have a higher median age and higher proportion of people older than 60 — the most vulnerable to severe effects of the virus — and far fewer intensive care beds should they fall sick. Median household income is lower too, potentially limiting health care options.

The demographics of these counties hold major implications as the Trump administration develops guidelines to rate counties by risk of the virus spreading, empowering local officials to revise social distancing orders that have sent much of the U.S. economy into freefall. President Donald Trump has targeted a return to a semblance of normalcy for the economy by Easter Sunday, April 12.

Experts in infectious disease see an opportunity in slowing the spread of coronavirus in remote areas of the country that benefit from “natural” social distancing and isolation, if initial cases are detected and quarantined aggressively. That can buy rural health care networks time to provide robust care and reduce mortality.

But they also worry that sporadic testing for coronavirus could be masking outbreaks that — left unattended — might overwhelm rural health networks.

“They’ll be later to get the infection, they’ll be later to have their epidemics,” said Christine K. Johnson, a professor of epidemiology at the University of California, Davis. “But I don’t think they’re going to be protected because there’s nowhere in the U.S. that’s isolated.”

Counties that have zero confirmed COVID-19 cases could raise a red flag about inadequate testing, she said.

“I hope the zeros are really zeros — I worry that they’re not doing enough testing in those regions because they’re not thinking they’re at risk,” she said.

In New Mexico, a state with 2 million residents spanning an area the size of Italy, Democratic Gov. Michelle Lujan Grisham has moved aggressively to contain the coronavirus’ spread with a statewide school shutdown and prohibition on most gatherings of over five people.

Nearly half of the state’s 33 counties are free of any positive coronavirus cases. New Mexico is among the top five states in coronavirus testing per capita, though some virus-free counties aren’t yet equipped with specialized testing sites beyond samplings by a handful of doctor offices.

Torrance County Manager Wayne Johnson said plans are being prepared for the first three dedicated COVID-19 testing sites, in the high-desert county of 15,000 residents that spans an area three times the size of Rhode Island.

A statewide stay-at-home order is keeping many residents from commuting to jobs in adjacent Bernalillo County, the epicenter of the state’s COVID-19 infections, with 93 confirmed cases out of a state government tally of 208 as of Saturday night.

“We don’t have any test sites open, and part of that is that we don’t have any needs for the test yet,” Johnson said. Still, Johnson said he worries that an outbreak could overwhelm the county’s sole local medical clinic and an all-volunteer corps of emergency medical technicians.

The state´s first of two coronavirus-related deaths occurred last Sunday within a southern oil-producing region in Eddy County, where two other positive tests have surfaced. A man in his late-70s died shortly after arriving at a hospital in Artesia, and tested positive postmortem. He had previously visited two health clinics, and at the hospital five staff were quarantined for possible exposure even though they wore face masks.

State Deputy Epidemiologist Chad Smelser said health officials have continued to painstakingly retrace the steps of infected patients and notify people who came into contact with them. There are dozens of connections per infection on average.

“We know the details of his prior visits in the health care system,” Smelser said of the deceased Eddy County patient. “We’ve worked with those physicians to assess their exposure. And we do not believe that he acquired it in the health care setting.”

State health officials say it is unclear how many people have been tested for coronavirus in each county.

Medical experts say uneven testing patterns across the country make it difficult to gauge whether remote areas are really better off.

“It’s a fundamental unknown,” said Benjamin Neuman, a virologist at Texas A&M University in Texarkana. “I think there is some truth to that notion that there are lower infection rates out there” in rural areas.

He said he fears for homeless populations and undocumented migrants.

¨We hope they stay safe. Those would be hard places to get rid of the coronavirus,¨ Neuman said.

Complaints that testing is not readily available extend to the crossroads town of Crossett in southern Arkansas, where surrounding Ashley County has no confirmed coronavirus cases.

Disabled veteran Marty Zollman, 42, of Crossett says his wife, a clothing store clerk, and teenage daughter sought coronavirus testing this week for fever and flu-like symptoms at a local health clinic and were turned away.

“We might be contagious, but no one will test her,” Zollman said of his wife, Janet, who was awaiting surgery for breast cancer. “They keep turning her down. They don’t have a source of testing.”

He lashed out at Trump for indicating that testing is readily available. “Now it’s time for me to call his bluff. If he’s got the equipment … he’s got to provide it,” Zollman said.

In New Mexico, along the southernmost finger of the Rocky Mountains, Mora Valley Community Health Services and a companion agency attend to elderly patients living in extreme poverty in Mora County, where there have been no confirmed COVID-19 infections and few if any people tested.

With a population of 4,500 that is more than 80% Latino, the county is among the economically poorest in the nation. Average combined household income is $27,000.

“There’s elderly out there that have dementia, who don’t have a family … who eat out of cans,” said Julián Barela, CEO of Community Health Services, which ordinarily serves a steady stream of Medicaid and Medicare patients with health, dental and behavior health services.

Under new state directives, the clinic has scuttled all non-emergency appointments — most of its caseload — to comply with a measure designed to conserve dwindling protective gear such as masks, gloves and gowns for health care workers, Barela said. The clinic has yet to see a patient with telltale symptoms of coronavirus worth testing.

Barela said it has been alarming to turn away patients who feel they need attention as new federal grant money arrives.

“We don’t have an emergency backlog, it doesn’t seem reasonable that we’re just shut down,” he said. “We should not operate the same as New York. There is no reason for it.”

#IFTTT #Blogger

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mollyjoycupcake · 6 years ago

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9/3/2018

Things have been quite a ride since I last wrote here.

I did manage to survive the spring semester, if that is what you are wondering. I had to drop calc and physics, and take a medical withdrawal for linear algebra, but I ended up passing intro to engineering, engineering success, computer science, and latin sol immersion. Although I did make it through the semester, I am afraid it was to my detriment. Forcing myself to go through that simply wasn’t worth the sacrifice of my mental health. I’m fairly certain that I walked away with some trauma, both from specific events but also as a general effect of the constant, drawn out stress. I never quite got used to the noise at the apartment (I found out why, which is what I’ll talk about later), and I never quite made any friends, with the exception of Taksha. Although I was somewhat proud to finish my classes, I was much too drained to really appreciate that I had made it. And, of course, any positive emotion I would have felt was taken away by the unexpected news that VR wouldn’t cover rent during the summer (which I wasn’t aware of, nor was prepared for). So, because I couldn’t come up with $1,000 in rent in two weeks, I went back to Santa Fe to stay with Shawn.

Although our relationship had almost completely fallen apart over the spring semester, returning to Santa Fe was an attractive (and probably my only) option at the time. My parents had moved out of their house to a campsite in June, rendering themselves technically homeless. I was at a negative balance both emotionally and financially, so I figured a familiar and low-key place would do me good. To this day, I’m not certain if it was really the best choice, because these past few months have been incredibly difficult. But, I guess it makes no sense to dwell on it. Just need to find a solution and move on.

In June, after we took a trip to Florida and Disney World, I started modeling by being a part of Santa Fe Fashion Week’s runway show. I simply sent the director a DM and he put me in the show. It was a great experience and I learned a lot. After that, in late June through July, I then began working in background for television shows in New Mexico. I was featured background as a “cheerleader” and “high school student” for the new netflix show Chambers, background for Midnight Texas, and background for Messiah. I also had a small acting role in Midnight Texas as a ghost witch. I think I may get IMDB credit for it. In late July/early August I began a 4 week job as a stand in for the main actress in a movie for Netflix called Walk Ride Rodeo. I also appeared in the background in several scenes as a nurse, a patient, and rodeo-goer. The hours were long and hard and I struggled to get through it. It was 5 days a week, for about 14 hours a day. I made decent money, but the exhaustion and the lack of free time made it hard to be worth it. Once that movie was over, I moved on to some more modeling with the RD3 Elite fashion show, and then I attended two casting calls. On one casting call, I was hired on the spot to do photos for the covers of romance novels. I am still waiting to hear back on the other one, so cross your fingers. If I get it, I will be part of a traveling fashion show out of LA (and it’s paid). Although all these experiences would be exciting for anyone, I have a hard time even feeling anything due to my mental state. It’s frustrating because I would like to appreciate it, but I can’t seem to right now.

Aside from those activities, my summer has been relatively uneventful. I have struggled to get through every day. It has been hard to process all the traumas from the spring semester. Things with Shawn have been rocky, which is both a cause and effect of my perpetuated mood issues. I finally decided to seek help during the last week of August, when I couldn’t stop crying all week. I think the long hours on the movie finally broke me down. I decided to go to the ER to be evaluated. They had me stay overnight and I spoke to a few counselors and psychiatrists. We agreed that a likely cause for my symptoms was the Nexplanon implant, so we made a plan to get it removed at the women’s clinic the following week. The doctor also got me in to see a reputable psychiatrist the next week, who formally diagnosed me with PTSD (as opposed to the typical depression/anxiety diagnosis I was given previously). I started two new medications that are supposed to address PTSD specifically, so I am hopeful that it will be effective. I also did get my Nexplanon removed, but because I was so anxious and the implant was very deep, I had to be given Xanax and Oxycodone to get through the procedure. I think seeing that finally seeing that bloody thing in the tweezers in the doctor’s hand was one of the most relieving moments of my life! It is still too soon to tell if the removal of the nexplanon plus the addition of the drugs has helped me very much (its been less than a week), but statistical information has me hopeful.

The biggest thing on my plate right now (aside from healing from PTSD) is now deciding whether or not to return to ASU or become a resident of New Mexico. Both situations have ample pros and cons. At ASU I would be closer to my family, and I would have the climate that I want. I also have a nagging suspicion that if my symptoms get under control, a lot of personal growth could occur there (at least, in the way I want it to). Also, there is something to be said about the youthful and vibrant culture that surrounds Tempe. However, staying in New Mexico could be good as well. There are several schools to choose from that are all reputable and more affordable than ASU. It is also less populated and therefore more peaceful out here. I would also remain close to Shawn, which is good if we decide to remain together. New Mexico also has a lot of modeling and film industry, as well as two national labs, so if I want, I do have a successful double life as a STEM person as well as an entertainment person. Additionally, the medicare in New Mexico has much better coverage and includes dental and vision (which AZ medicare lacks), so if I get medicare here, I can get my broken tooth fixed, which could save me a few thousand dollars. As you can see, both options seem fairly attractive. There are many cons to each option, however. For ASU, they are kind of obvious: if I can’t get my symptoms under control, I will end up overwhelmed just like the spring semester. It is also very busy and chaotic, which may simply may not be the best for me, regardless of mental health. I would also be far away from Shawn, which would really strain the relationship, as well as my emotional state, and could end up forcing us to split. I would also need to know exactly which major to pursue in order to secure VR funding, and there is no guarantee that the funding will be enough to guarantee a comfortable existence, due to the rising costs and the lowering funds available from VR. As far as New Mexico goes, by staying here I would be far away from my family. Although my family does stress me out sometimes, I do like to be close to them so that we can be there for each other (especially now, as things are stressful for all of us). I am also not entirely sure if I like UNM or Albuquerque yet. There is also the fact that if I get residency here (in order to get medicaid and such) I would lose my AZ residency and VR funding, which would make it very difficult to return to ASU if I change my mind. I am not quite sure if I am comfortable with cutting the AZ ties just yet. Another fear I have about staying in NM is, what if Shawn and I end up splitting anyway? It would be extremely difficult to live in the same town if we were no longer together. Just the thought of potentially seeing him with someone else tears me apart.

In general, this is a very huge decision. I would be lying if I said I felt equipped to handle such a major life decision. I have a difficult enough time deciding what drink to order at Starbucks (even though I always get the same thing), so deciding where I want to live and study for the next two years is extremely overwhelming. I am very distressed by it. Part of me just wants to be a kid again so I don’t have to be burdened by all these thoughts. I am far too aware, and worried of, all the implications that come with each possible route. All of this, combined with the fact that I don’t have much money, makes things seem impossible. I can’t even pay rent right now, so how could I possibly decide where to settle in for school? Do I even want to go to school any more? Do I even have a choice? Maybe I should run away and travel the world. But without money? Maybe I should just drop out and work and make lots of money. But how? And with what mental health? I guess the only place I can start is by listing my basic needs, which would need to be fulfilled regardless of location, and then selecting location based on what would be best suited for my needs.

As far as I know my needs include: healthcare coverage, adequate mental health/psychiatric support, friends, access to high calibur dance training, proximity to family, proximity to shawn, access to further STEM exploration and employment, a low stress living environment, quiet home, either living alone or with good roommates, a degree program that is fun and not too stressful, opportunities in modeling and entertainment, a structured schedule that allows for creative expression and self care. I would type more, but my brain fog is starting to set in (along with a headache).

Hopefully I will be able to reach a decision soon. Perhaps I am struggling because I am attempting to intuit a decision instead of making hard, conscious choices for myself. I’ve always preferred going with my gut, because I am terrified of making a conscious decision that ends up going wrong. I would rather blame god than blame myself.

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dentistinsantafe-blog · 7 years ago

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Thank you for the opportunity to meet and talk about your dental needs. Please download, print and complete the new patient forms and bring them to your next appointment.

#Dental Health Forms

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lustfulrosy · 8 years ago

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US company creates dental tourism to Mexico

A company created just last June in New Mexico offers US dental service packages at a cost that is 50 to 80 percent cheaper than in the United States. Beyond Borders Dental was formed to help residents of Santa Fe and Albuquerque, New Mexico, and now also in other parts of the country, get affordable dental care in the border community of Palomas, in the Mexican border state of Chihuahua. The company, which is promoted as the nation's first personal dental assistant service, offers its clients a transportation package to Mexico, lodging and dental treatment. Ralph Grosswald, president and CEO of Beyond Borders Dental, explained that the service takes care of all the programming and work necessary for clients to visit the dentist expeditiously. Customers can expect to have everything under control, including treatment, round trips from Santa Fe and Albuquerque to Palomas, escort to the dental clinic and lodging. The company offers a directory of dentists who speak English and who provide affordable prices on almost all dental services, from cleanings to root canals. Grosswald said that the clinics have been carefully examined, prior to being chosen, so they are safe. "We evaluate our clinics very carefully with periodic visits, and we know the dentists as well as their staff. We continuously monitor our clients' satisfaction," he said. Customers travel in a 12-passenger van and usually spend a night at the Deming motel in New Mexico before heading to Columbus, where they cross the border into Palomas. Patients are accompanied to clinics and picked up after their appointments. Once the person concludes with his dental session, he has time to visit shops and restaurants on the Mexican side before returning. The cost of the service fluctuates between 200 and 250 dollars, not including the hotel, meals and dental appointment. The idea of creating the company came out earlier this year, after considering that about one million Americans travel each year out of the country to get dental care. Beyond Borders Dental offers two trips per week, but the frequency may increase after the company has recently partnered with several dental clinics in Chicago, Illinois, so their patients who can not afford the treatment receive care in Mexico. Through this partnership, US clinics will be able to collect a portion of the money the patient spends at clinics in Mexico. Under this modality, American dentists provide the patient with the exams, diagnosis and recommendation of the services he needs. Beyond Borders Dental receives the dental treatment plan for patients, schedules care with a dentist in Mexico and arranges accommodation and transportation. With this plan the patients of the Chicago area fly to Alburquerque and from there they are transported to Palomas. "This program is the first of its kind and helps American clinics participate in the revenue generated by dental tourism services," Grosswald explained. Do you need transportation? Cancun Airport Transfers is your major option for tours in the vacation in Cancun

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