Course Correction

Nov 14, 2018 No Comments by

What I Learned After a Brain Tumor Diagnosis.

I was recently at a continuing education dental seminar with the Dr. Dick Barnes Group when the conversation shifted to course corrections—the events that have the power to change the direction of your entire life. ‘Yes, I know what that means,’ I thought. In my life, I’ve had a course correction. So I decided to share my story.

One afternoon in January 2017, two hours before I was supposed to finish my work day, I was suddenly overcome by horrible vertigo. I decided to sit down, so I walked slowly to my office. I missed the door handle when I tried to open the door, and then I nearly missed the chair. I’d been fighting a cold, so I thought it was likely due to an inner ear problem, and in 15 minutes the dizziness went completely away. Later that evening, I barely mentioned it to my wife.

I reasoned that the appointment was more for my peace of mind, to confirm that I didn’t have a big problem.


It happened again in April 2017, but this time it was much more serious: my left leg and arm got really clumsy, and the episode lasted 12 hours—long enough that I started worrying about a stroke. Strangely, the next day I felt completely normal. Fortunately my friend, a neurologist, told me I needed to see a doctor.

It took two and a half months to get into a neurologist, but I wasn’t in a hurry, even though my friend kept pressuring me. I hadn’t experienced any further symptoms, so what could be wrong? I reasoned that the appointment was more for my peace of mind, to confirm that I didn’t have a big problem.

At the appointment, I specifically asked the doctor if he thought it might be a brain tumor, and he said no, because symptoms almost never go away. Nonetheless, we decided to do an MRI. My medical insurance had to pre-approve the procedure, and it seemed like wasted effort to push for it, but for some reason we persisted. A month later, I had the MRI.
(Above) An MRI showing Dr. Richins’ tumor.

I asked for a copy of the images. As soon as I looked at them, it was obvious that there was a big difference between the left and right sides of my brain. I don’t know much about the inner workings of the brain, but I knew they should be symmetrical.

The doctor called the next day to confirm that something was growing. He specifically said he didn’t think it was malignant—the borders of the tumor and its rate of growth weren’t consistent with that—but he said that I needed to have surgery to remove it right away.

Later, I met with a surgical oncologist, who presented a grim diagnosis. Judging from the scans, she said it was likely a grade-three glioma, a cancer which is always fatal; average life expectancy from diagnosis is three years. I was 34 years old at the time.

Brain Surgery
The surgery lasted nine hours, and I was awake during most of it so the doctors could test the effects and determine how far to go. But that was the easy part. Next I had to deal with the immediate aftermath. The hospital staff had me standing up and trying to walk the very next day. It was excruciating.
(Above) Dr. Richins’ scalp after surgery.

The entire left side of my body was affected. I still had motor control, but the neural feedback and sensory perception were harmed, so I had no spatial recognition; I couldn’t tell where my left foot and arm were, and I couldn’t judge how much weight I was putting on my leg. It was more difficult than you could possibly imagine.

I was an in-patient for ten days, doing intense physical therapy for seven of those days. For the next few months, I kept doing physical therapy—four times a week, then three, then twice a week. (I still do physical therapy once a week.) I took walks with my wife, and I felt lucky to take 150 steps.

My first day home from the hospital, I fell six times. During physical therapy, I spent five to seven hours a day practicing basic tasks, things that used to be effortless: buttoning a shirt, tying a shoe. It was the most difficult period of my life, physically and emotionally.

Before surgery, the surgeon and I had talked about the best approach, and I told her not to be conservative, but to get everything she could. Fortunately, she was able to remove the entire tumor.

She reaffirmed the value of something that I’ve always tried to do in my own dental practice: under-promise and over-deliver.


Later, we discovered that the tumor had a mutation that makes it slow-growing and less aggressive than originally anticipated. She reaffirmed the value of something that I’ve always tried to do in my own dental practice: under-promise and over-deliver.

I went into the surgery thinking that I might have two years to live—never seeing my children grow up, never having the long marriage I had envisioned, not having the experiences I’d always dreamed of—and suddenly I was looking at 15 or 20 years, based on current science. It was great to have a measure of hope.

Effects on Dentistry
I experienced this difficult trial as a husband, father, and individual—and also as a dentist. There was so much to grapple with. I’ve caught a few lucky breaks throughout this process, and now I’m determined to share some of those lessons.

Looking back, I would have done a few things differently had I known that I would face mortality head-on when I was 34 years old. I’m lucky that I already recognized how important my family was and already had a fairly good work-life balance, so I didn’t have to do a lot of reprioritizing.

But I was young and healthy—a competitive mountain biker, a physically active person in the best shape of my life. And like most young and healthy people, I thought I had all the time in the world to prepare for “the worst,” whatever that might be.

There are a few things that I now recommend all dentists take a look at, regardless of age or health, because I am living proof that it’s never too soon to prepare for the unexpected. Here are five important ways to prepare:
1. Have as much insurance as you can afford (life, disability, practice overhead).
2. Have systems in place with your team.
3. Establish a network with local dentists.
4. Evaluate your priorities before you’re forced to.
5. Have goals and a larger purpose outside of your professional aspirations.

Disability Insurance
Having good insurance is the best, most practical advice I could ever give anybody. Most dentists think about disability and life insurance, but it’s important to get disability insurance early. Most policies require a physical exam to ensure that you’re in good health and don’t pose an undue risk to the insurance company. Needless to say, the older you get, the more health problems tend to crop up, and the insurance companies may exclude coverage for specific issues.

For example, if you don’t have problems when you are examined, but you injure your dominant hand, they will probably cover it. If, however, you have arthritis in that hand and then apply for insurance, the insurance companies may add a rider excluding coverage for problems with that hand.

Disability insurance is based on income, so when dentists start working and income is lower, they don’t need as much coverage. I got a policy through the American Dental Association that allows an increase as my income goes up. There’s a window of time every six months when I can review my policy and increase the amount. In the past, I missed a couple of opportunities to increase my benefits because at the time I didn’t think it was critical.

I wasn’t as oblivious as I might have been, however. Five years before the brain tumor, I had a wake-up call. One night I slipped in freezing rain and broke my left arm. While I was in the emergency room, I reevaluated a couple of things. I had been considering setting up a solo practice or joining with a partner, and that night I decided to make the partnership happen. Because of my broken arm, I realized it was a good idea to have backup plan, such as a dental partner. I also realized how much I needed a good disability policy. In hindsight, I’m really grateful that I broke my arm.

Practice Overhead Insurance
Another type of insurance to consider is business overhead insurance. At the time of my diagnosis my partner and I had recently started our practice, so when I was out of commission, he was able to take over my workload without missing a beat. However, in a sole practitioner’s case, it wouldn’t be so easy.

I wasn’t able to practice dentistry for three months, and then I started with simple things, like doing a filling for a friend, and ramped up slowly. Six months after surgery, I finally had a regular patient schedule again.

If only one dentist brings in revenue and he or she can’t practice, the money stops coming in completely—but your bills don’t.


Without a partner or insurance, I would have been forced to sell my practice. If only one dentist brings in revenue and he or she can’t practice, the money stops coming in completely—but your bills don’t.

Business overhead insurance can cover your lease, utilities, loan payments, taxes, and even your payroll, which is critical because your team members’ bills don’t stop either. And if they can’t get paid, they’re going to find other jobs.

Having Systems in Place
The importance of having systems in place is easiest to explain if you think about it in terms of wanting to franchise your practice. To do so, you need employee handbooks with descriptions of each position and clarifications of office policies.
For example, if a team member has a relative come in, what do you charge? With a handbook, you have a resource to refer back to, rather than trying to remember or decide in the moment.

I also recommend describing in detail the segregation of duties. The office manager is in charge of X, Y, and Z; the front office team member is in charge of A, B, and C. It’s also important to have redundancy, so that if a team member gets hurt or has to take time off, his or her duties can be covered.

We have found it particularly helpful to have redundancy on the financial side of the practice. Business owners often worry about embezzlement, but more common than that is simple mistakes or clerical errors. Having more than one person reviewing the accounts cuts down on the risk of both mistakes and anything nefarious.

Again, prepare for the worst: if something happens to the financial coordinator, and no one else knows the ins and outs of that side of your business, you’ll have more problems than you would if you had some redundancy in place.

Ergonomics
Another important system deals with the desired procedures for the clinical team. Before my tumor, I had certain preferences in terms of how the instruments were set up and handed to me, but it didn’t do me any harm if I had to twist or bend to get something.

After my surgery, it was imperative that the ergonomics be correct. I went through a lot of physical therapy to strengthen my muscles and to ease neck and shoulder pain, so I couldn’t afford to exacerbate the problems.

When I returned from surgery, I realized that I had poor chairside positioning, with my left leg out in no-man’s land, for example. I had to position myself better, which required me to get comfortable asking for help and setting expectations. Now I proactively communicate how things should be laid out and handed to me, and if needed, I can offer a gentle correction to a team member. I had to adjust certain procedures so that we could continue to offer quality care to our patients without doing further damage to my body.

Networking
Because I had a practice partner who was willing to cover my workload, I didn’t use a lot of temporary dentists to help out. However, because we had just opened our practice, my partner and I were still working part-time at other offices. In order for him to cover my workload, the dentists at his other office had to shift their schedules.

I also referred some of the cases that I was working on to other doctors. That was key in ensuring continuity of care for those patients. For dentists not working in a group practice or working without a partner, having good relationships and a network of other local dentists is critical.

Priorities
I am happy to say that I already loved spending time with my wife and my young kids, and I didn’t need to have a brain tumor to know that it’s important to give them a lot of time and attention. Nonetheless, after my experience, it’s more important than ever for me to establish more clearly when work ends and family time begins.

It’s great to have a job and make a living, but life is so much fuller if you have more of a purpose than a paycheck. Putting people first—family and team and patients—just makes you a better dentist.


Another shift my wife and I have made is that material things have decreased in priority. Experiences and memories are what matter most. For Christmas last year, we didn’t exchange material gifts. Instead, we took our kids to Disneyland. It’s a memory we will have for the rest of our lives—time spent as a family doing something fun, enjoying each other’s company, and sharing a new experience.

Personal Goals
As I mentioned, my family is extremely important to me. I also have a deep faith in God. I think these two things were instrumental in getting me through this difficult experience. Finding a bigger purpose, whatever that may be, is something everyone should consider.

One of my favorite things to do is to work with an organization that provides free dentistry to less-fortunate people. It’s great to have a job and make a living, but life is so much fuller if you have more of a purpose than a paycheck. Putting people first—family and dental team and patients—just makes you a better dentist.

Patients and team members can sense if they’re important to you, or if they represent dollar signs. If they feel important, they’re more likely to trust you, feel comfortable in your office, and have confidence that you will work according to their best interests. Any dentist can drill and fill, but I think a lot of patients gravitate toward those dentists who consider them to be individuals, rather than just patients.

Reflections
I have learned much from this challenging episode of my life. I was lucky in many ways: I have an awesome partner, a fantastic team, and an amazing wife and family.
My classmates from dental school were also wonderful; I heard from nearly every one of them, along with other dentists in the area. I received encouraging letters and messages on social media on a daily basis. Patients expressed their gratitude and told me they wanted me back as their dentist. It was so gratifying—and fortifying—to realize the impact that we as dentists can have on people’s lives.

I went into dentistry to help people, and I absolutely love my job because I’m able to affect patients’ lives in a positive way. I intend to continue doing that as long as I possibly can. I also hope to strengthen my community and help my colleagues. I have learned how important it is to be prepared for difficulties. Prepare for the worst (and hope for the best), and you’ll be better able to deal with your practice, your life, and the curveballs as they come.

Fall 2018, Issues, Perspective

About the author

Brett Richins, D.M.D. has been practicing dentistry since 2012. In 2015, he opened Aspen Heights Dental in Lehi, UT, with a business partner. He practices most aspects of general and family dentistry, including implants and cosmetics. He is also the founder of SureClaim dental billing. When not practicing dentistry, he loves to spend time with his wife and four kids or go mountain biking. He is constantly pursuing opportunities to further his training, including completing the New Dentist Program at Arrowhead Dental Lab. Dr. Richins graduated from the University of Pittsburgh School of Dental Medicine in Pennsylvania.
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