Episode #521: Dr. Marty Jablow, David Pleva, & Tim Caruso at ADA SmileCon, with Dr. Marty Jablow, David Pleva, & Tim Caruso

Do you have pain in your wrists, neck, or back? Then you need to listen to today’s episode! To talk about this important but overlooked subject, Kirk Behrendt brings in three experts, Dr. Marty Jablow, David Pleva, and Tim Caruso, to help dentists and their team prevent and treat the physical suffering that comes with dentistry. From prophylactics to choosing a great mattress, they offer the best advice for recovering from long, stressful hours at the office. To start feeling recharged and pain-free today, listen to Episode 521 of The Best Practices Show!

Episode Resources:

• Dr. Jablow’s email: [email protected] 
• Dr. Jablow’s Facebook: https://www.facebook.com/jablow
• Dr. Jablow’s blog: https://dentechblog.blogspot.com
• Dr. Jablow’s social media: @martyjablow
• Tim’s email: [email protected] 
• David’s email: [email protected] 
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Links Mentioned in This Episode:

Raving Patients: https://www.facebook.com/groups/ravingpatient

Westin: https://www.westinstore.com

Main Takeaways:

Start taking care of your body ASAP.

Be mindful of your posture throughout the day.

Learn how to breathe properly and practice it daily.

Accommodate your body for aging and other changes.

Sometimes, it’s okay to ask patients to accommodate you.

Don't forget about your team members. They are suffering too.

Quotes:

“Bury [bad reviews] with good ones. That's really the thing. I'm lucky. We get really good reviews. We’ve got a lot of them. You can use companies to get them. There's a Facebook Group Dr. Len Tau runs, which is Raving Patients. You might want to get in that and some of the stuff there. With that, you have to remember that we’re all going to get bad reviews. My office gets an occasional one-star review. But most of them are not about treatment. A lot of it is strictly about money. And you know what? People will dismiss some of that stuff. But some of them have legitimate complaints. And you know what? You need to address them. But unfortunately, you cannot address them in public. Be very careful what you say. There are HIPAA violations and things like that. So, if you do have one, reach out to people who may be able to help you craft a very nice response that will keep you within lines of HIPAA. And with that, do the best you can.” (1:06—2:12) -Dr. Jablow

“My office, we’ve got 400, 500 reviews. We’re a 4.9. So, we’re not perfect. We’ve got one-star reviews, two-star reviews. If you get a one-star review that says nothing, that's fine. I mean, it’s dismissed. So, with that, bury them with good ones. Everybody is going to have a bad one. We’ve all been to a restaurant and had a bad meal, or bad service. It doesn't mean I don't always go back. It’s the consistency in that. So, do the best you can. Address real issues in real ways but be careful doing so.” (2:15—2:54) -Dr. Jablow

“If you ever get a negative review, the best thing you can ever do is call the patient right away — like, immediately — and not be equipped with an agenda. Just say, ‘Listen. I care, and I noticed. Tell me.’ And then, at the end, say thank you. A lot of times, that's a good start.” (3:29—3:47) -Kirk

“Sometimes, you can negotiate them taking [negative reviews] down. Again, if it’s real, then you've got to fix something. That's really the important part. If it’s a real problem, fix it. Admit to the error. That's always the case. If it’s the crazy person, well, thank God, you're not treating them anymore.” (3:48—4:09) -Dr. Jablow

“Crazy people don't know they're crazy. So, don't try to reason with crazy people. If they have this long history of being unhappy, you're not going to change that.” (4:11—4:21) -Kirk

“Don't necessarily take [negative reviews] personal. It may be directed at you, but don't take it that personal way. It makes it more difficult for you to deal with it on a non-emotional level.” (4:25—4:36) -Dr. Jablow

“Everybody has their own, what I call, issues. None of us sit the way we’re supposed to. I always say, even for my patients, the thing I really want to invent has already been invented but no one will pay me for it, which is to sit up straight. And so, I always said to the patients, ‘You sit in front of your computer monitor, and all you're doing is slouching.’ So, I want a broom handle with two suction cups. You get the idea. And you can't come in. That would solve a whole bunch of neck pain, TMJ pain, all of that stuff. But you have to first get the patient to understand that posture matters.” (8:24—9:06) -Dr. Jablow

“Whether it’s a patient or the dentist, if you don't understand that your posture can be a problem, is contributing to your problem, you're never going to accept the solution, just like everything else in dentistry.” (9:08—9:19) -Dr. Jablow

“Dental professionals will do anything on the planet to make sure that the patient is comfortable, to their own detriment. They're doing gymnastics and cartwheels, and they keep asking, ‘Are you okay? Are you okay? Are you okay?’ And the patient is only in the chair for one hour. And so, if you would say, ‘Can you turn your head? Can you scooch over? Can you open your mouth bigger for a little bit longer? We’ll be done sooner, and you'll feel fine.’ But the dental professionals are there for 12 hours, sometimes longer. And they're suffering.” (9:40—10:14) -Tim

“I make the mistakes that [Tim] is talking about. There are times that it is easier for me to move than it is to move the patient. And if I can do that for a short period of time — and I'm lucky. I've been doing this a long time, and I've got the gray hair to prove it . . . But with that, you have to sit there and go, ‘Okay, what are my physical limitations?’ I remember when I had hurt my back — and it had nothing to do with dentistry — I couldn't do an extraction for a week. I compensated for it in different ways. And you have to understand that. But there are always what I call the cheat. You know what? It is easier for me to turn than the patient. Or I'll stand up and do something because it’s easier. And as long as I can keep that small, that's great. But when it starts getting to be too much time and my back starts to hurt from it, then I have to be able to say to the patient, ‘You're going to have to help me.’” (10:30—11:35) -Dr. Jablow

“One of the big things that we see is that patients will do all the exercises we give them. But posture, if you don't watch posture — it’s the key to everything. I'll have patients back in my clinic all the time saying, ‘I do the exercises, but they don't help.’ But then, you look at them, and they sit slouched, and they're not watching their posture enough.” (11:41—11:58) -David

“Exercise is like flossing.” (12:05—12:06) -Tim

“I always say, ‘What's the hardest exercise that you've been doing?’ And they go, ‘Um . . . Um . . . Um . . .’ They can't show you what the exercise is, which leads us to believe that they're not actually doing the exercise. So, same when I go and I'm bleeding to death on my bib in the dental office and they say, ‘Have you been flossing?’ and I say, ‘Um . . . Um . . . Um . . .’” (12:13—12:35) -Tim

“There's something that says 90-something percent of households in the United States have floss in them. So, everybody pretty much has it. Using it is a completely different thing. And what you're saying is true. I can do all the exercises, but I can't compensate for the fact that I may have an issue that I'm not addressing.” (12:44—13:06) -Dr. Jablow

“It’s kind of like breathing. You can control it. But when you stop thinking about it, you then lose control over it. So, you need something to remind yourself all the time that you're slipping into something that's not healthy.” (13:13—13:26) -Dr. Jablow

“I have a quote in one of the talks that I give. Dr. [Balanky], and I can't remember where he worked out of, but the quote said, ‘When the exception presents itself,’ so, those are the people that you have to accommodate, ‘treat them exceptionally. But that's not what your daily routine should be.’ So, be mindful.” (14:02—14:20) -Tim

“Everyone has their musculoskeletal complaints. We do a little survey. I think the male dentists have more lower back pain. The female dentists have more upper back and neck pain. And the hygienists and the assistants are their wrists and their hands, generically, what we see. The other thing that we see is when the new equipment is purchased — and no offense to the dentist to my right — they get the new chair, and the staff gets the old, broken chairs. They don't get a new one too. So, sometimes, that’s an issue, where ergonomics comes into play. The staff is accommodating to the broken equipment that they have to make use with during the course of the working day, to their detriment as well. Like, the seat pan is loose, so I have to sit askew in order to balance the seat pan in order to treat the patient. Or assistants can't see because the dentist’s back of the head is in the way.” (14:43—15:41) -Tim

“Or the chair is placed at a different level. I watch, sometimes, where I have to say to the patients, ‘Can you turn to your left so that my assistant isn't reaching so far, or having to stand, or do something different?’ Again, asking the patient to accommodate. Sometimes, as a dentist, you're going to have to accommodate too for your own assistant. It’s a give-and-take.” (15:42—16:06) -Dr. Jablow

“One of the assistants asked me yesterday, ‘Well, I really can't ask my boss that.’ And I'm like, ‘Well, shouldn't you have a working relationship? There's no “I” in team. Hey, doc. Can I get a peek?’ They can take a look and see what they need to do. And equipment for assistants, just thinking about it, the archaic belly bars, the new assistant programs are using saddle seats because then they could physically get closer, get higher, turn and move a whole lot easier and maintain a better posture. Because if that belly bar is there, typically, they're hanging on to it for dear life so that they don't fall on top of somebody.” (16:09—16:47) -Tim

“People accessory-breathe. Accessory breathe means they're shrugging their shoulders and using their neck musculature in order to breathe when you should be using your diaphragm. Like, all the stuff from your belly button up, your diaphragm should be working when you breathe, but your shoulders shouldn't go anywhere near your neck, and your chest shouldn't move. If you're a singer, you sing from your diaphragm. If you talk to singers, they got it. So, if you put one hand on your chest and one hand on your belly, if you're breathing properly, the hand on your chest shouldn't go anywhere. But your belly should move when you breathe in and breathe out.” (17:44—18:20) -Tim

“A little more oxygen in you is good, and it relaxes you. You're not going to be as stiff. So, you can do [breathing and exercises] in between patients. You can do it when you can. They talk about getting to a traffic light and tucking your stomach in for 10 or 20 seconds as a way to try and work on your gut. Some of this stuff is easy. You just have to know from these guys what to do, and then be serious about instituting it and incorporating it into your day.” (19:01—19:33) -Dr. Jablow

“More of it is trying to teach you what you need to do. Because you can come to us three times a week, and we do our stuff in the clinic, and you feel better. But if you keep falling apart at home, you're never going to get better. So, our goal is to teach you the correct exercise to treat yourself. And you'll start monitoring, ‘I'm getting stiff. I need to do my exercises. I'm starting to have pain. I need to do my exercises.’ So, our focus is on getting you to take control of your own symptoms. That's where it’s all at, at this point, is you become a self-treater. Because if you want me to do it, we’re never going to get anywhere. You have to take responsibility and treat yourself.” (21:35—22:07) -David

“I can think of this lady who had back pain with sciatica, and she wanted to go back to play tennis. And this is a long time ago when [David and I] worked in the clinic in Oak Park together. So, we got rid of her sciatica. I got rid of her back pain. She was playing tennis. And she came in one day with this piece of paper in her hand. And I said, ‘Hey, how are you doing?’ And she goes, ‘Oh, I'm great. I'm doing my exercises. I'm playing tennis.’ She goes, ‘But I want to talk to you about this.’ And I'm like, ‘What is it?’ It was our bill. And I said, ‘Is there something wrong?’ And she said, ‘Well, it’s the bill.’ And I said, ‘This is what we charge everybody. We didn't charge you more or less than anybody else. Did we not accomplish the goal of you getting back to doing what you wanted to do?’ ‘Yeah, you did. You did. But you never touched me.’ I didn't have to lay hands on her to get her back to doing all those things. And so, I said, ‘Well, I'm really sorry but this is what it costs, whether I touched you or not.’ I learned something after that. So, now, when someone comes to my clinic, I put my hand on their shoulder when they come in, and I go, ‘How are you doing?’ And then, we have no problem with that ever again.” (22:14—23:27) -Tim

“We get that too in dentistry. If you don't actually touch them, you just do the exam, sometimes they go, ‘But the doctor didn't do anything,’ because the treatment is what you're paying for, not the knowledge to get you there.” (23:30—23:45) -Dr. Jablow

“Typically, when we look at massages, they don't provide long-term relief. People come to us and say they feel better, temporarily. And all you're doing is relaxing these muscles. But if you still have a problem there, as soon as the brain recognizes, ‘Wait a minute. There's still an issue there,’ they're going to tell that muscle to spasm again to not move that joint. So, it’s kind of like relaxing a little bit. But until you address the problem, it’s never going to be fixed. That's our goal, is to fix that problem so you don't have to rely on other things to get you back to where you need to be. And sometimes, it’s just a matter of doing simple exercises every couple of hours.” (24:24—24:57) -David

“One of the basic things we do is talk about retraction for necks. So, between patients, you're doing this, walking down the hallway. You're sitting with the patient, and you're getting stiff and sore. You do a couple of those, and go back in. Sometimes, they're really basic things that can get you through your day. But people tend to not do that. Now, they're in pain again. And now, we start the whole cycle again.” (24:57—25:15) -David

“We all love a nice massage. But if my two fingers are numb in my hand, or I have raging sciatica down my leg, that's probably not going to get rid of that. Now, once we get it where it’s under control and manageable, and you want to go for a massage, or you want to go for something else, that's perfectly fine. And it’s great if you can do it. Or get the [massage] gun out and relax my shoulders a little bit. That's fine. The issue that we see as clinicians is people will start with their trainer, or someone who doesn't know how to care for medical conditions trying to manage that, to their detriment, where they make it worse.” (25:18—26:00) -Tim

“The human body can only be subjected to so much.” (27:09—27:11) -Dr. Jablow

“Everyone’s body reacts differently to the stresses put on it. And we all have about the same parts, give or take. But everyone responds to the stresses put on that at different rates . . . As a dentist, sometimes the procedures that are pretty benign, the patients are flying out of the chair and their response to that is way overblown compared to how you think it should be. And it’s the same with people with back pain and neck pain where it shouldn't be a 10 out of 10, but it is, for some people.” (27:29—28:05) -Tim

“For dentistry, if you guys beat yourself up all day for 10 hours, whatever it happens to be, and you don't go home, and you don't rest enough at night to recharge the batteries and let your body recover from the stresses you put on it, and you go back and do it again, do it again, do it again, do it again, four days in a row, five days in a row, and you're out of balance, physically, bad things happen.” (28:08—28:32) -Tim

“There are things I'm going to be able to do when I'm younger. But now, when I get older, there are things I'm going to have to make accommodations for. And we need to know that.” (30:12—30:20) -Dr. Jablow

“The last two days, we’ve seen a good number of students [with pain in] their shoulders, their necks. And some of it is the equipment they're using and their programs. It is what it is. That's what they have to use. But making them more mindful. Or the loupes that they're using. They're all set in an office — they're not in their office, they're set in the exhibit hall or wherever they buy their loupes, and the focal length isn't enough, and they're dropping their heads to focus, even though it’s supposed to make things easier for them to see and visualize.” (31:16—31:50) -Tim

“We’re getting measured for a new set of loupes. And they have all my measurements, so they know what they are. But the reality is, I'm leaning in more. And I know I am. Why? Because my eyesight has changed too. And we don't always change our loupes because the magnification works. But the rest of it isn't, so I'm leaning in more. So, again, you have to always think about all these little pieces of the puzzle that may change exactly what we’re doing, even if you don't think anything changed. That's the reality.” (31:54—32:26) -Dr. Jablow

“Get your iPod, put on your comfy clothes, take your comfy pillow, and go to the Back to Bed store and tell them you're going to be there for a little while, and lay on their beds. It annoys the heck out of the sales guys. And you need to find one that's comfortable there where you lay on it and you go, ‘Oh, I think this is the one.’ But make sure it has a return policy.” (33:40—34:03) -Tim

“I think it’s hugely important, and it’s hugely overlooked. That's really a big part of this, is that it’s overlooked. Unless you're having an acute problem, nobody pays attention to it. And stopping the problem, just like everything else in dentistry, prevention is much better than the cure.” (40:06—40:22) -Dr. Jablow

“People listen better the more they hurt.” (40:28—40:30) -Tim

Snippets:

0:00 Introduction.

0:30 Q&A: How do we get rid of horrible reviews on Google?

4:37 Tim’s background.

8:19 The solution to your body’s pain.

11:36 Exercise is like flossing.

14:29 Think about ergonomics for your team members.

16:48 Take a moment to breathe.

19:33 Is it okay to pop your neck?

20:49 Monitor and take control of your symptoms.

23:46 The role of massages and other prophylactics.

26:19 Start taking care of your body early on.

28:33 Accommodate your body as you age.

32:35 Tips on buying a great mattress.

35:59 Break bad sleeping habits.

38:01 How to get in touch with Tim and David.

40:01 Last thoughts.

Dr. Martin Jablow Bio: 

Dr. Martin Jablow, DMD, is a clinician, speaker, and author. He presents and publishes worldwide on many topics, including state-of-the-art dental technology and dental materials. His recurring columns can be found on DrBicuspid.com and Dental-LearningHub.com's Apex Magazine. Dr. Jablow is president of Dental Technology Solutions, a lecture and consulting company. He is an active member of the ADA, NJDA, Middlesex County Dental Association, and has achieved Fellowships in the AGD and International Academy of Dental Facial Esthetics. He serves on the Dentalcompare CE Advisory Board, along with the Eco-Dentistry Association Advisory Board. 

For over 20 years, he has been a member of his local peer review. He also attended the JFK Medical Center in Edison, New Jersey, where he worked with patients and trained residents. As the internet has grown, so has Dr. Jablow's online presence, with his dental blog, webinars, and as host of TakeFiveWithMarty.com.

David J. Pleva, PT, MA, Dip. MDT Bio:

Dave is a physical therapist who graduated in 1989 from Concordia University with a Bachelor of Arts degree in Exercise Science. In 1990, he earned his Master of Arts degree in Human Services from Concordia University. He then earned a Bachelor of Science in Physical Therapy from the University of Health Sciences/The Chicago Medical School in 1992.

Dave first was introduced to the McKenzie approach shortly after graduating from physical therapy school, while working in a private practice in Oak Park. He began his formal training in McKenzie in 1992 and completed all coursework in 1995. In October of that same year, he passed the McKenzie Credentialing Examination. He then completed the McKenzie diploma program in Minnesota in 1998. He is one of only 250 clinicians worldwide to hold a diploma from the McKenzie Institute International.

Timothy J. Caruso, PT, MBA, MS, Cert. MDT Bio:

Tim is a Physical Therapist whose two decades of experience in healthcare have included home health, rehabilitation, burns, orthopedics, education, research, and pediatrics. He has focused his professional expertise in the area of manual therapy and orthopedics, specifically neuromusculoskeletal disorders. To that end, he has taken numerous post-professional orthopedic manual technique courses and has been credentialed in mechanical diagnostic therapy from the McKenzie Institute. In addition, he has received a Master of Science degree in Business Administration with a concentration in Organizational Development, and a Master of Science degree in Management with a concentration in Organizational Behavior from Benedictine University.