The Second Banana Syndrome

by Anne Nugent Guignon, RDH, MPH

Before any of you even begin to think that I am not a team player or I'm out to bash dentists — please toss those thoughts right out of your head. But, during the past couple of weeks, I have received several disturbing phone calls from fellow hygienists. At the conclusion of each conversation, I felt very discouraged and sad.

Cathy was the first to phone me. We go way back. I used to be her hygienist more than 30 years ago. When she came in for an appointment, she would tell me how much she wanted to be a hygienist. My consistent reply was: Just do it! Apparently, my encouragement was important to her and she has been practicing dental hygiene ever since. She still laughs when she says Nike should be paying me for coining their most famous phrase — long before it was a glimmer in their ad agency's thought process.

At the beginning of the call, Cathy told me she was sorry to hear about my recent carpal tunnel surgery. I assured her that everything was going well and this was an opportunity for me to get some extra things done. When I thanked her for her concern, Cathy began telling me that she had been diagnosed with carpal tunnel syndrome in both wrists. Both her neurologist, who had done the nerve velocity conduction tests, and the hand surgeon told Cathy her condition was very advanced. They wondered how she was still practicing and both recommended surgery immediately.

As the conversation went on, Cathy told me about the years of pain, numbness, fatigue, and sleepless nights. When she started dropping things or had trouble opening jars, she began compensating with her left hand, but eventually it started giving her problems as well. She began sleeping with wrist splints but this strategy only gave her short-term symptomatic relief.

In the past few years, Cathy's employer began providing her with better ergonomic equipment but still the pain persisted. He was willing to purchase whatever she needed. Her schedule has always been bursting at the seams, but she tried to finish every patient, even when they arrived late. She felt an obligation to the patients and she felt that her doctor appreciated her efforts. Her wrists always told her a different story. She started taking medications, trying to reduce the unremitting pain. Her doctors are calling a halt to the prescription game. The medications aren't helping solve the situation ... they are only masking the problem.

The conversation took another turn. Cathy started firing questions at me. What did the surgery feel like? What was the recovery like? What kind of limitations would she have and would there be a lot of discomfort? My advice was based on my own experience and information I had gathered from other hygienists.

Both of Cathy's hands need surgery. Her doctors recommended she not do both at the same time but she was completely focused on how long she would be out of work, not on the problems she might experience having both hands operated on simultaneously. Cathy claimed that she wanted to get back to her dental hygiene practice as soon as possible — after all, it was summer, the busy season in her dental office.

I could not believe what I was hearing. Here was a woman — a dental hygienist that I had nurtured from the very beginning — putting the financial welfare of the office she had worked in for six years before her own personal health. She had hit one of my hot buttons. I told her the dental practice would survive. Her health was at stake. Her neurologist and hand surgeon had told her the truth but she did not want to hear. Her husband had been urging her to take care of herself but she did not understand his pleas. She was playing the "second banana." Where did she learn to think like this?

I went off on a tangent. Cathy was my friend and fellow professional. I felt like "The Mom" who needed to take a tough stand and let her know how distorted her thinking was. It was my turn to pepper her with questions. What was she thinking? Why was she willing to put the dental practice ahead of her health? Why was she willing to risk permanent damage to her body? Did she really understand how difficult it would be to perform even the simplest tasks for a period of time with both hands bandaged up — simple things like cutting her food, brushing her hair, or even using the toilet? The whole conversation was like a déjà vu experience. Here I was tell ing x0Cathy once more to just do it. When I hung up the phone, I was miserable, sad, discouraged, and totally depleted. Another dental hygienist was playing "second banana."

Last week, Karen called me. We do not go way back. She attended one of my continuing education courses several months ago but I didn't remember her. She started telling me her story, hoping that I could help. The more I listened, the more I knew Karen plays the "second banana" role as well. She was reaching out for help, trying any angle that she could think of to resolve her problems. Here is her story.

Karen has spent the last 11 years of her 20-plus-years career in a high-stress, full-tilt dental office, seeing nine to 10 patients per day. Most of her lunch hours were more like lunch minutes. The practice started demanding that Karen work faster and faster. Her doctor would constantly tap the face of her watch during the day to make sure that all of the staff was keeping on schedule. As long as the holes in the schedule were filled, no one cared how difficult the procedures were or what type of patients were plugged into these slots. High production was the goal.

Karen had never married. She lived alone with this stress for years, feeling that her benefits and pension were ample reimbursement for being treated this way. When Karen's mother became quite ill, Karen would work overtime. Then she could take enough time off to fly across the country to spend time with her mom, but only if she found another hygienist to cover for her. Still, she was content with her situation.

I forgot to mention that Karen is a very petite hygienist — 5-foot-2 at the most. For years she had been able to practice dental hygiene comfortably. Three years ago, everything changed. While she was on Christmas vacation, her doctor replaced the patient chair in Karen's room. This change was never discussed with Karen.

The new chair was in place when Karen returned from her holidays. It was bulky, wide, thick, and could not swivel. She knew immediately that this chair design would constantly force her body into a contorted position. Karen now had to bend forward just to reach the patient's mouth. Magnification loupes and auxiliary lighting would never be enough to resolve the situation. She was just too far from her target.

Karen loved her old patient chair. Her petite body could accommodate its design. Her old chair would swivel, allowing her to change positions as she needed, but it was gone. Her doctor thought the old chair looked dated to patients, so rather than replace the upholstery, the doctor replaced the chair. When Karen expressed concern, she was told to work in the 12 o'clock position; after all, the doctor had purchased an "ergonomic chair" for her. Karen could hardly feel grateful for this Christmas surprise that was causing her body more and more pain every day she practiced.

Karen's life was forever changed by this chair. She continued to address this problem but the subject was always ignored. At her last review, her doctor gave her excellent performance ratings in all categories. When Karen brought up the subject of the chair again, her employer dismissed the query with the comment that Karen should not expect the doctor to supply another new chair.

After nearly three years of working with this toxic chair, Karen had developed so much pain that she finally sought serious medical advice. That was August of 2002. She discussed her situation with her physician, went through some testing, sought physical therapy, and cut her clinical days in half. By the end of March, she could no longer continue. Her physician said she needed to quit dental hygiene practice for a period of time if she expected her body to ever heal. She has been diagnosed with right shoulder tears and calcium deposits, bilateral encroachment in the C5-6 area, carpel tunnel syndrome, pain in the lumbar area, radiating down her right leg, and numbness in the right foot. Karen's employer still did not understand how the "ergonomic chair" had created so much havoc with her body.

As I listened to her story, I wondered why she stayed in a practice that cared more about production than the health of the staff. I challenged Karen to think about what this situation had really cost her. I also asked her to think about the impact on the practice. At this point, Karen was still thinking in a "second banana" mode.

A couple of weeks later I phoned both Cathy and Karen. They had been on my mind and I was wondering how they were doing. Both of these women instinctively felt that the dental practices where they were employed were more important than their own health. The conversations were amazing.

Karen has lost close to $33,000 in income in 10 months. Her office has lost her valuable production. The doctor is now paying five dollars an hour more than he paid Karen for services of a temporary dental hygienist, and there are patients not willing to schedule until she returns. At this point, her medical bills are well over $4,000, and surgery may be in her future.

She is now trying to build a case for her worker's compensation claim — a task that is proving to be quite difficult. Karen was stunned to hear that her employer told the worker's compensation investigator that he provided ergonomic training along with the chair — training that Karen had never received. Later her employer said that he did not understand the questions on the worker's compensation form.

At this point it is not clear if she will ever be successful in receiving any benefits from worker's compensation. Her husband of less than two years is fully behind her but he longs for a partner that can fully participate in all of life's pleasures — one that is not too tired and sore from the practice of dental hygiene. Everyone has lost in this situation.

Cathy was stunned to learn that her employer was interviewing for a permanent position. He told her he would be happy to have her back for whatever days he could offer her after surgery. Is this legal? I'm not sure, but I am sure that it is a real slap in the face after six years of faithful full-time service. Cathy's engineer husband is urging her to consider her alternatives. If her wrists get fixed, what is the next thing that is going to happen to her body if she returns to dental hygiene practice?

Her story also has a whole new set of problems. When Cathy's carpal tunnel symptoms started several years ago, her dentist immediately dropped his worker's compensation coverage. Cathy practices in a state where doctors are not required to carry this type of insurance. Even though she suspected that she had CTS symptoms, she did not seek a formal diagnosis from a neurologist until three months ago. When Cathy questioned the worker's compensation case worker, she was told that if the diagnosis had made been made prior to her employer discontinuing the coverage Cathy's medical bills would have been covered. Now she is stuck!

Even though Cathy and her husband are in a comfortable financial position, this is still an unexpected blow to their finances. Many other hygienists are not so fortunate.

I wish I could tell you that Cathy and Karen's stories were not real but my imagination is not good enough to create horror stories like this. I don't have all the answers to their situations but I do know that no one is paying us enough to get hurt on the job.

Many hygienists are in denial. Many have tuned out their physical and psychological pain. They will pay a heavy price for ignoring the early symptoms and waiting for the pain to become so bad that it causes a massive disruption in their lives — physically, mentally, and financially.

Unfortunately, dental hygienists are disposable in the eyes of some employers. That point of view is so shortsighted. Superb hygienists are not hanging out on every corner, but then, superb, serene dental practices are not at every stop sign either. However you must analyze your own situation, I hope that you will fight tooth and nail before you ever put your physical and emotional well being in the "second banana" position.

Common sense tells me you should save your bananas for pancakes, bread, Bananas Foster, and fertilizing your roses.

Last week Cathy phoned with good news. She thanked me for giving her another dose of tough love. Here is her advice to all hygienists in pain:

"You told me to forget everything and go as fast as I can for carpal tunnel ligament release surgery. This was the best advice one professional can give another. Everyone I have met since my surgery eight days ago is putting it off too. If you wait too long, the damage may become permanent. Act now.

"Garfield recall cards say, 'You can run but you can not hide.' How many of you are hiding in denial? Over time, we learn to live with the discomfort and pain from CTS. We do exercises. We wear splints and can't sleep at night without them. The unrelenting pain, throbbing, numbness, icy-hot burning, and knots in the scapular muscles can be misdiagnosed as cardiac pain. Why do we put up with all this? Fear! Many of us are afraid. It is our hands for goodness sakes — our caring hands that caress, bake, shake, and golf.

"If you suspect that you are having any type of physical problems that might be related to workplace activities, please seek the opinion of a physician immediately. In addition, it is advisable to contact your state to find out if your employer carries worker's compensation. Save yourself from yourself. Get the proper neurological testing and heed my advice. You must become the patient.

"Twenty-four hours after CTS surgery, I was pain-free for the first time in many years. No more suppressed pain. My energy and spirit are refreshed. My brain doesn't have to conquer and override the never ending pain any more. In a short time, I'll be able to drive again and my hand will get stronger with strengthening exercises. Soon I'll be able to have surgery on my left hand. I am looking forward to that day.

"My employer has shown me a side that I never saw in six years. He has not called to see how I felt. I offered to work at the front desk for administrative wages while another employee was on vacation. I know all of the patients and knew this would help reduce office stress and keep me busy. My feelings were hurt when he declined, saying that they'd just get along as they always had when someone was out. Will I return to this practice after my next surgery? It's getting hard to feel good about going back.

"Rethink your situation now if you are putting up with lousy insurance, or none at all, or your employer does not carry worker's compensation, and you have put in plenty of unpaid overtime with few benefits. Do not allow yourself to be injured for life because you were too afraid of an employer — an employer who may not be thinking of you, even if you doubled or tripled their practice over the past few years. Whatever your situation, deal with it now rather than later. The stakes are just too high."