Caring for Face Pain and Sleep Apnea
Rich Hirschinger, DDS, MBA
Diplomate American Board of Orofacial Pain
9615 Brighton Way, Suite 323
Beverly Hills, CA 90210
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Archive for the ‘Life Lessons’ Category

How to Do a Quick Brain Concussion Assessment

Posted on: March 31st, 2017 by Dr. Rich Hirschinger No Comments

After a head injury, such as those that occur after being involved in a bike accident, any layman can do a quick assessment of the injured person to check for a sign of a possible brain concussion.

It is not important that you remember all the information below. If you only remember some of these questions, and you get responses that seem abnormal, you should get the person emergency medical care as soon as possible.

The first step is to determine if they are “alert and oriented times four” by asking them the following questions:

  1. What is their name?
  2. Where are they?
  3. What are the time and date?
  4. What just happened?

Then ask them some or all of the following questions and observe their responses.

  • Ask them to repeat back to you, and remember, three simple words such as, “dog, boat, and orange.” Then have a 5-minute conversation with them. At the end of the conversation, ask them to repeat the three words you told them to remember.
  • Ask them to spell the word “world” backwards.
  • Have them follow your finger with just their eyes. Move your fingers up and down and make an “X.” Both eyes should be able to track the movement of your fingers.
  • Ask they dizzy, nauseous, or do they have a headache?
  • Is their speech is normal?
  • Is their behavior normal?
  • Are their pupils the same size?
  • Are they sensitive to light and/or sound?
  • Are they getting more and more confused, restless, or agitated with your questions?
  • Do they have any weakness, numbness, or decreased coordination?

Again, it is not critical that you remember everything listed on this page. This is a quick assessment to check for a brain concussion, and it is always better to error on the side of caution and have the injured party evaluated by a medical professional if you get any sense that something is not normal.

It is also important that you stay with someone who was injured until professional help arrives. Just think if the roles were reversed and your head was involved in the accident, or even if your head was fine but you were injured. Wouldn’t you want someone to stay with you?

My Last Road Bike Ride

Posted on: May 30th, 2015 by Dr. Rich Hirschinger 10 Comments
This was taken last week at the start of the NOW ride. I'm easy to spot. I'm wearing the Camelbak

This was taken last week at the start of the NOW ride. I’m easy to spot. I’m wearing the Camelbak

This blog post is about my last road bike ride. Yes, my last ride. The post was inspired by a fellow cyclist who approached me after a very fast road bike ride with a group of about 50-60 cyclists. It was the weekly NOW ride, which stands for “No Opportunity Wasted” The ride is on Saturday’s and it leaves from a local coffee shop in Santa Monica, California, and it rolls out to Trancas in Malibu on Pacific Coast Highway, which the locals call PCH. The ride is very fast, and you need to keep pace by staying within a few inches of the rider in front of you or you lose the draft effect. If you don’t keep pace you sometimes get called out by other riders for not holding the wheel of the rider in front of you. It is a ride for experienced cyclists only, due to the speed and intensity.

About halfway to Trancas is Pepperdine Hill, which is a hill that tends to split the group since not everyone is a strong climber. I was riding very strong today, and was able to stay with the lead group. I was helped by a traffic light at the top of the hill, and caught up with the very fast riders at the light. I was then able to ride with the main group over the undulating road along the Southern California coast all the way to the gas station at Trancas, which is about 20 miles from the start. We rest, hydrate, and refuel at the gas station for about 15 minutes before heading back along the coast to Santa Monica. The initial pace on the return to Santa Monica was very reasonable until we reached PCH after leaving the Malibu Colony, and then pace was increased again. And, again, I was able to ride with the lead group all the way to the parking lot at Temescal Canyon in Santa Monica. The fast part of the ride was done, and then we crossed under PCH via a tunnel, and climbed a short hill to get up to Ocean Avenue, which overlooks the Pacific Ocean in Santa Monica.

The left side shows the herniation of L4-L5, and the collapse of L5-S1. The middle and right images are the spinal fusion screws.

This is my double spinal fusion. The left side shows the herniation of L4-L5, and the collapse of L5-S1. The middle and right images are the spinal fusion screws.

I was on Ocean Avenue when a cyclist approached me, and blatantly told me that I should not be riding a road bike with a Camelbak. I asked him why, and he said because it makes the other riders nervous. I asked why. He said it was because Camelbaks are only for mountain biking, and it is a sign to other riders that I don’t belong on the road. He told me I should only use water bottles like all other road cyclists. He asked me if it is “that hard to bend a little bit down and grab a road bottle?” He then started to repeatedly reach down,  and remove and replace his water bottle from the bottle cage. I responded, “actually, yes, that is difficult for me since I have had a double spinal fusion in my lower back.” When most people hear this, they make some type of comment that it is great that I’m out riding my bike, and they also usually ask if I ride with pain. But, no, not this person, whom I will hereinafter refer to as the Judge. The Judge, after hearing I had a double spinal fusion, said, “then you should not be riding a road bike.” I asked him if he ever saw me make a bicycle move that was dangerous and put others in jeopardy? The Judge responded, “no but I will pay attention to you next week.”

A Camelbak is safer than a water bottle. I don’t have to reach down and take a bottle out of a holder at 30 miles per hour, take a sip and then reach down and replace the bottle into its cage. A water bottle occasionally comes out of its cage and falls into the roadway, which is then a dangerous hazard that can cause a whole group of cyclists to crash and injure themselves. I drink more with a Camelbak than my friends who use water bottles since it is more convenient to sip from a hose, which is a few inches from my face, than to reach down and grab a bottle. And, for me, a Camelbak is painless whereas a water bottle causes pain. I like pain but only pain from the soreness that comes from a good workout.

The Judge’s attitude offended me for several reasons. The Judge did not accept the fact that I was different than him. The Judge did not accept the fact that I did not conform to the norm. The Judge was judging me based on my appearance, and not my performance. When you really think about it, it is a form of discrimination, and I was offended. Several other people heard the exchange and told me to “consider the source” but I want to try to turn this into a life lesson. A teaching moment.

What is it about some people that they cannot accept others who are different than the norm? What is it about some people who judge people based on how they look, how they dress, who they love, who they identify with? Who are they to be judge and jury to say what is socially acceptable? Would the Judge reject his child if his child was gay, lesbian, transgender, bisexual, asexual, etc? My guess is yes since that is not the norm. If someone like the Judge can’t understand why I have to be different, why I don’t use what the pros use, why I have to accommodate to my personal situation even after hearing a very valid and reasonable explanation, then the Judge and people who think like him need psychological help since it is they who are the source of any problem instead of the person who is different.

Be different. Be yourself. Do what makes you happy. Be your own person. Don’t let people like the Judge change who you are.

And, yes, I’m still going to ride my road bike. My next road ride is tomorrow. This blog post simply refers to my “last ride” as in my “most recent” ride. It’s all about semantics. See you on the road.

Here is the link to the ride on Strava. You can see I set several PR’s (personal records) for me, which means that I was riding fast compared to my past rides. You can follow me on Strava by clicking this link

*And don’t let a dentist ever grind or adjust your teeth, or have you wear a dental appliance 24 hours a day for several months since it is not part of any accepted treatment protocol for chronic head and neck pain. This has nothing to do with this post but it is good to remember since many dentists think otherwise. See an orofacial pain specialist by finding one at

Rich Hirschinger, DDS, MBA
Diplomate American Board of Orofacial Pain
Fellow American Academy of Orofacial Pain
Clinic Director UCLA Orofacial Pain and Dental Sleep Medicine

An Apology Followed by “But” is Not an Apology

Posted on: August 10th, 2014 by Dr. Rich Hirschinger No Comments

We all make mistakes. If you aren’t making mistakes you are probably not trying hard enough. If you make a mistake, and others agree it is a mistake, nothing is more rewarding than making an apology to those impacted by the mistake. However, if your apology is followed by the word “but” and a whole bunch of other words, it disqualifies the apology since you are now making excuses or qualifying the apology, which is never good. The following are three short stories of apologies offered to me this week.

As regular readers know,  I am a cyclist. Some cyclists ride their bike, and some cyclists race their bike. Personally, I am a rider and I have never competed in a bike race with the exception of the 2000 Malibu Triathlon, which I raced as a three person relay team with two friends from business school who raced the swim and run portions of the triathlon. I don’t race since it is not important for me to compete in sanctioned events to try to win trophies, medals, or money. Racing also adds an element of risk to cycling that I don’t want to take.

Road rash from a bike crash.

Road rash from a bike crash.

I was involved in my first ever bike crash that involved another cyclist this past Thursday. I was on a regular club ride on the streets that surround the Riviera Country Club. I was with a small group that had made a traffic light, and the large group stayed behind. As a result, I was ahead of most of the stronger riders in the group. Near the top of the climb, the stronger riders came quickly up on my left, which is the proper place to pass. One rider came on my right. He bumped my shoulder since there was a Corvette parked in front of us and he had to make room to pass me. He moved left, and when he did, my front wheel and his back wheel touched, and I went down. As with all crashes, everything moves in slow motion. I hit the pavement, and saw a rider behind me come over the top of me. The rider that caused the crash stopped, and tried to help me up but I needed a minute to collect myself and assess my injuries. My right elbow took the biggest hit followed by my right knee, both of which you can see, as well as my right hip and left hand. Yes, I’m left handed but my cycling glove looks worse than my hand. He then apologized for being too aggressive on a club ride and felt bad that I was injured. If I was a soccer player, I would probably still be laying on the ground slithering in pain. As a cyclist, I got back on my bike and started to ride. My front wheel was out of true but I was able to ride it, and complete the remaining 2.5 laps of the club ride but I was feeling something strange on my inner thigh. When I went down, I must have stretched the right adductor magnus, which is the inner thigh muscle. After stopping for my usual Matcha Green Tea Latte at Peet’s Coffee in Brentwood, I then rode 10 miles to get home, cleaned my wounds, stopped at the drug store to get Tegaderm patches, and then went to my office to see patients. Fortunately, my wife and daughter were out of town since they could not stand to hear the construction noises from our neighbors house, which is described below. My point is that the apology I received was very sincere, and I consider what happened an unintentional accident, and there are no hard feelings.

Earlier in the week, I watched a video that was a very public apology by Laura Weintraub, who previously made a video blog about why she hated cyclists, which ended up going viral. Her video was the reason I was interviewed by the local Los Angeles NBC News, and it was part of the subject for a previous blog of why I felt she was so wrong. I did not mention her by name in my previous post since I did not want to give her more attention. So why am I using her name now? Laura made a new video, which you can watch below.

I reached out to her on Twitter and Facebook to tell her I appreciated the new video she made, and we are now Facebook friends, and I hope to personally meet her someday. Why would I want to be friends with someone who made a video that put a bounty on drivers hitting cyclists? After watching the video above, and hearing Laura sincerely admit that her video blog about hating cyclists was a mistake, I wanted to commend her for admitting her mistake, and making a public apology. We all make mistakes but Laura’s was very public. My point is that the apology I watched in the video was very sincere, and I consider what happened a mistake, and there are no hard feelings.

My neighbor's driveway under construction...again.

My neighbor’s driveway under construction…again.

Lastly, my neighbor was redoing his driveway for the fourth time. We share the bottom part of the driveway, and his portion is long and steep up to his house. His previous attempts to patch it failed so he was finally doing it the right way, which involved lots of jackhammering, and lots of concrete, and lots of noise. Last Sunday, he had construction workers at his house using concrete saws to cut the driveway but he skipped out of town to miss the noise. I was not home last Sunday but my daughter told the workers it was illegal to work on Sunday’s but the workers continued working anyway. I spoke with the contractor later in the week, and he said that he did not “even know what day it was since he was hospitalized over the weekend due to an infection.” I asked him if he knew it was illegal for contractors to have their workers work on Sunday in the City of Los Angeles, and he said I was wrong. I know the rules since I was President of our homeowners association for 10 years, and would get occasional calls from neighbors complaining of work being done on Sunday’s, which is why my daughter knew the rules. I got my laptop and showed him the LAPD website, which lists the allowable construction hours. After viewing the web page, he apologized but he said he would work again on a Sunday since he had texts and emails from the owner saying the construction needed to be finished ASAP, and that he does not care when he works as long as he gets paid. My point is that the apology I received was followed by a “but,” it was not sincere, and the contractor did not consider his actions a mistake since he would do it again for money.

When you make an apology, make it sincere by not adding the word “but” followed by a whole bunch of other words that the person who was wronged might not even hear since you qualified your apology. “I’m sorry” by itself is much more powerful and much more sincere. I know I’m going to make more mistakes in my life, and if I wrong you, I hope you will only hear “I’m sorry” without anything else! That’s my opinion and I welcome any comments.

A Father’s College Advice for His Daughter

Posted on: July 24th, 2014 by Dr. Rich Hirschinger No Comments

I wrote this for Drew, my daughter, right before we dropped her off to start her freshman year at UCSB. It was shared many times on Facebook so I decided to post it to my blog. Please let me know what you would add to the list. Enjoy!

1. Trust yourself
2. Make decisions based on what you think is the right choice to make.
3. Listen to live music.
4. Take advantage of the rec center, and the beach.
5. Accept that four years is a short amount of time.
6. You are going to have hurdles in college, and in life. Find a way to get over them but don’t be afraid to ask others for help.
7. I guarantee you will find friends for life in the next few years, and even in the next few days.
8. College is much harder than high school. It’s supposed to be. Don’t let that scare you.
9. Go to class.
10. People rarely change so don’t expect them to.
11. Meet your professors, go to their office hours, and ask them questions. They love to teach and get to know their students.
12. Get involved with something you are passionate about. You will make friends with others that share the same passion.
13. Floss
14. Worry about the things you can control, and don’t try to control the things you can’t.
15. Something I never had to think about was the immediate impact and reach of social media. Have fun but always remember that one photo or video of what you are doing and/or saying can have a long lasting impact on your life, and remember that viral can be as bad as a virus.
16. We live in s small world but the planet is huge. Take advantage of the fact that you will be meeting people from all over the world.
17. Don’t forget to laugh at yourself when you make a mistake but be sure to learn from it.
18. Even though you are an adult most of the boys at college are still boys. Pay attention to how they treat others since they will eventually treat you the same way.
19. Learn to say no and make sure the person hearing you knows that is your answer.
20. Keep watching for shooting stars like you saw on the beach your first night on campus with me.
21. Advice is what others give to you. Seek it out but accept it as advice and know that the decision on what to do is up to you.
22. Everyone around you is feeling the same type of emotions you are feeling so don’t be afraid to talk to your friends about what or how they are feeling.
23. Listen to live music. I know that is a repeat but it is worth the reminder.
24. Don’t be afraid to try something new as long as you are making the choice and it is something you want to do.
25. Don’t pay for an extended warranty…except for Applecare.
26. Don’t let school get in the way of your education.
27. You can’t force someone to repay money you loaned them unless you plan to go to court or to jail so giving people money is rarely a good idea unless you don’t need it back.
28. Bend with your knees not with your back.
29. Measure twice, cut once.
30. Be amazed by our world. You will have a nightly reminder looking at the stars from the beach.
31. Realize that the people you think are “normal” are the ones you don’t know very well.
32. “When it comes to men who are romantically interested in you, it’s really simple. Just ignore everything they say and only pay attention to what they do.” Randy Pausch
33. College is your first time living away from home but home is always here.
34. If you love someone, tell them.
35. I love you. I’m proud of you. You are my inspiration and I can’t wait to live vicariously through you for the next four years.

An Anniversary, A Single Day on a Bike, And Two Valuable Life Lessons

Posted on: July 22nd, 2014 by Dr. Rich Hirschinger 1 Comment

This is a story about an anniversary, which occurred today, and a single day on a bike, which occurred three days ago. I hope you get something out of it because I did and I think the thoughts and experiences are worth sharing.

Today, July 22, 2014, is the five year anniversary of my double spinal fusion surgery at L4-L5 and L5-S1, which is why I wear a CamelBak even on a road bike. L4-L5 and L5-S1 are the two lowest vertebrae in your back. I like to say that I was screwed five times in one day, and I can prove it. Prior the day of the surgery, I could not get my own socks on or off or tie my own shoes.

The left side shows the herniation of L4-L5, and the collapse of L5-S1. The middle and right images are the spinal fusion screws.

The left side shows the herniation of L4-L5, and the collapse of L5-S1. The middle and right images are the spinal fusion screws.

I was an avid cyclist before my back was injured, which originally occurred when I was rear ended by a van while riding my bike. I was thrown of the bike onto the sidewalk and slid over 20 feet before coming to a stop right before a concrete light pole. That accident eventually led to a microdiscectomy at L5-S1 in 1999, and I was fine after that procedure. Then, in 2007, I was driving my car with my daughter in the back seat when a driver ran a red light and hit us as I was turning. That led to the double spinal fusion and I stopped riding my bike for several years until I caught the “bike bug” again at the end of October 2013. It felt great to be back on the bike but I was hit again by a driver who made an illegal U-turn when I was traveling straight in December 2013. I have never needed my bike helmet like I needed it that day, which was also on the 22nd of the month. My head bounced off the street after I ran straight into the car’s driver side rear door. I have always said, “there is only one reason to wear a helmet, which is if you have a brain,” and I basically walked away from that accident with sore ribs, some back pain for a few months, and a scar on my right knee.

After I recovered from that accident, I started riding even more. I rode my longest ride ever, a 117 mile journey from Los Angeles to the campus at UCSB to visit my daughter who was finishing her first year in college. That ride was six days before the murder rampage in Isla Vista that took the lives of six UCSB students.  This past Saturday, one of my friends in Velo Club La Grange, which is my local cycling club, wanted to go on a long ride with a lot of vertical climbing. The ride ended up being over 107 miles long with over 9,000 feet of climbing but it is what happened on the ride that is important. I use Strava, which lets you track your activities along with your friends activities, and I was very surprised that I had the longest ride of the week last week for my cycling club, which is something I would not have envisioned five months ago let alone five years ago.
About 12 miles into the ride, we had to take a detour on Pacific Coast Highway (PCH) since the road was closed due to a very tragic decision a young lady made. Those of you that ride PCH in Santa Monica will notice the squiggly line indicated by the yellow arrow on the map below, which is the detour we had to take through the Bel Air Bay Club up to Sunset and then back down to PCH.

The young woman, who was in her 20’s, tried to cross PCH at 3:30 a.m. That was likely the second to last thought she had since she was hit by a car, which is why the road was closed. She died from her injuries the same day. It was not lost on me the split second decisions we make during our lifetime, which in this case, was a fatal decision. Take the time to really think your decisions through. Some thoughts are not work the risk.

From PCH we climbed up Topanga Canyon to Mulholland Drive then back to PCH via Malibu Canyon, then back up to Mulholland via Encinal Canyon. At Mulholland and Malibu Canyon, which was at mile 72 give or take a few tenths of a mile, my friend saw one of his friends on the side of the road with a flat tire. We stopped to help, and coincidentally there was a NBC News reporter interviewing a cyclist about a video rant that had been posted online by a reserve police officer for the Santa Paula Police Department. The video was about how much she hated cyclists, and how much the driver of the car she was in would charge to run them over. Some people think this is merely freedom of speech. Others think it is very disturbing that anyone, let alone an officer of the law, would suggest running over cyclists with a car.

Jane Yamamoto was the NBC News reporter who interviewed me as well as a few other cyclists to get our opinion on the video, which  you can watch below.

The decision made by the reserve police officer to post her video took several hours since the video had to be conceived, filmed, edited, and then posted. It was not a split second decision. But the decision cost her her job since the Court of Public Opinion convicted her of horrendously poor judgment, and she ended up resigning from her position. What astounded me is that she is a personal trainer yet she hates cyclists even though they are outside exercising, which is what she has her clients do for a living.

I’m very happy with the decision I made five years ago to have my back surgery done. Some people question my decision to continue to ride my bike since I have been hit by a vehicle twice. I feel good about my decision since riding my bike makes me feel alive, and we have to live when we are above ground. Take the time to make good decisions in your life. Quick decisions can cost you your life, and other decisions that you think are the right decision at the time can turn out to cost you as well.

Lastly, don’t make excuses for why you can’t do something. The mind is a very powerful tool. You can talk yourself into not doing something or you can talk yourself into doing something. Anything worthwhile is going to be hard work. Which is why work is a four letter word. Be safe, have fun, and take advantage of the time you have. It is a very precious gift.