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Let's Go! Part 2. The One With Trauma Dumping · The Resting Stitch Face Podcast

• Brendan: All right, here we go, here we go. On the podcast today, Dr. Erin Sheffield and Dr. Sarah Harding of the Stitch Resting Stitch Face Podcast. Let's go. Erin: Let's go. Brendan: Where the buttons? Where are the buttons that you had before? Erin: ⁓ yeah, Sarah has all the Sarah: Over to the right on yours where you're the host and it says like people, media, something, something, something over there on the side. Click on media. You see it? And then you can scroll down, you've got all the different types of like sound effects. Erin: No, we need something good. Sarah: Yeah. Woo Woo. Yeah. That's so funny. I don't know. Brendan: So can you can you give like a quick quick intro into Resting Stitch face podcast? And then also, if like into like individually too. ⁓ yeah, so the little face. Erin: ⁓ well I'm Erin Sheffield. I'm a board certified oral maxillofacial surgeon. I practice out of rural Illinois. ⁓ you might see me online at Dr. Erin Sheffield. I am now the founder of the Doctors All In retreat and community, which is helping women who are getting lost in achievement kind of find themselves again after years of training and caregiving. Sarah: And I'm Dr. Sarah Harding, also a board certified oral surgeon. I'm in San Diego and I spend most of my time raising little boys, picking avocados and coffee and trying to figure out a good way to sell those. So hey. Erin: Hey And together we are the Resting Stitch Face Podcast. Sarah: Yep. Brendan: Who came up with that name by the way? Sarah: Erin did. All credit. All credit goes to Erin. My sister said it was a stupid name because it wouldn't people that weren't surgeons wouldn't like it. And so I was like ⁓ Erin: I don't know. People would think we were like knitting people or embroiderers. And I was like, but I really like it. And then later I was like, can't we just do it? That's my favorite one. Sarah: I do like doing that stuff. Brendan: Yep. I think it's hilarious. It's great. It's on its own point, you know? Erin: I know, right? I mean I feel like script yeah, Maxillarious. Yeah, we had so many, we had like two hundred ideas. So if anyone needs a podcast "Biting back with Sarah and Erin", I mean we had so many ideas, but ⁓ Brendan: That was over was that one or two years ago when you guys got that gone. When you f finally got it gone? 'Cause you were talking about that. I know Dr. Ern, we were talking about it for a while at ESC. Two years ago? Yeah. Sarah: Well, Erin: We have been recording together for about a year but we've published for probably a year in July maybe is when we w went live. So we're getting there to our anniversary. Sarah: Yeah, we released episode forty six tomorrow and it's weekly, so pretty good. Brendan: Forty Six episodes. I didn't know that that there was that many. Yeah. Yeah. ⁓ my goodness. And also, we were talking about it on our on our other podcast just moments ago, but I really think it's well, one again, thank you guys for coming on today, right? We're nice. But number two, I think it's excellent. Because what we were talking about is like with mentorship, you really kind of need to see yourself in kind of see them what the mentor's doing to kind of envision yourself like. Sarah: Seven us. Brendan: your career, how you wanna work, where you wanna work, what you're gonna be doing day to day. Are you gonna go all in and really get like you're gonna work seven days a week, or are you considering other things outside of work that's a part of your life that are important to you? And so I just I I'm so glad that you guys are, you know, you formed a podcast, you're having you're doing everything as far as mentorship, the conferences, which I I would like you to give a shout out to quickly in a second, but I was talking with another oral surgery resident, young woman, and that was a big thing for her. It was like in her dental school to kind of see the old surgery residents to envision them. And I think we were just talking about this too from your perspective. So a lot of people have the same issue, the same thing where they need to see a mentor doing it because it's similar to them, that looks like them, that has similar interests as them. And so I think it's so important. And I I love that you guys are doing it. Plus you guys are so much fun to talk to. Sarah: Thanks. Yeah. And I agree. It's like you can't start from ground the you can. You can all start from ground zero, right? But why not have somebody there that has done it before you that you can look at and say, Okay, I can build from there, right? Because it makes the transition from dental school to residency to private practice or wherever you're going, like so much easier, you know, to have somebody that's done it before that you can ask questions of. So I think it's awesome. Erin: And I think sometimes we get hung up on thinking you have to find someone that like looks like me and I think that's helpful. Like I think that's one reason I'm a big advocate for like DEI programs because people, patients, they need to see themselves in you. Like I think there's a lot of trust that's built with that and having a good spectrum of the community and the the world that you're working in. to be able to see themselves. I think that's really important. But sometimes it's less about how you look and more about seeing yourself like in the values that they're promoting, the lifestyle that they are living, things like that. So it might be hard when you're a woman oral surgeon to find a female mentor And again, that's part of why we're doing the Doctors All In retreat and the communities, because we're trying to build that access for women like us. But but I think the more important thing is finding someone who's in alignment with your values. Brendan: Can you give a quick quick information for all listeners, viewers, when the next conference is, where it is, timing, right? Erin: Yeah, it's going to be happening in Austin, Texas, February 26th-28th, 2027 at the Miraval Resort, which is ⁓ a fabulous, all luxury wellness ⁓ location. ⁓ it's ⁓ definitely a different than AAOMS or the typical stuffy conferences you are going to. You know, you can go and get Right. We're doing like ropes courses, like climbing and flying above the air, if that's your thing. ⁓ we're talking more about things like burnout and personal wellness, health, ⁓ building your practice, things like that. So hopefully it's something that's really going to fill your cup and help you be rested and rejuvenate and excited to go back home to your life and your practice. Brendan: I think that's so important. We're talking about burnout on the other thing, but ⁓ did you guys ever experience burnout like any day to day in the beginning, right now, in this this moment, maybe today? Sarah: Yeah. You know, when I was in the Navy, so I finished residency and I did the HPSP scholarship. So I did they paid for dental school and then while I was in dental school I applied for residency and they said, ⁓ great, we want you to go out service and so then I had to apply to out like ⁓ civilian programs. So I applied, got into Baylor and so I was an active duty Navy ⁓ person I was in residency and then after residency I went straight to an aircraft carrier and deployed and then ⁓ came and then was in clinics ⁓ on East Coast and then on the West Coast. And I remember thinking I I don't know if I just don't like oral surgery or if it's just that I'm tired of the Navy. You know, and so like that was my key to the ⁓ I think I have this is what burnout might feel like. I don't I don't know. Because I was just so annoyed with the crap, the day to day crap, right? And as it turns out it was really probably just a lot of the bureaucracy of the Navy. Erin: Yeah. Sarah: Because I love surgery and I love patients and I love operating on you know, all of that. And so yes, I experienced it in that way. ⁓ how about you, Erin? Erin: Yeah, I think for me burnout's more of like a moment to moment thing. It can hit me at any time. And I notice I know I'm facing burnout. We said this the other day on our podcast. My compassion goes out the window when I'm feeling burnout. That's how I can tell. Because like if I have a unruly sedation, you know, or they're like I'm like, sit down and shut up. That's what my brain says I never say that to the patient. Where normally it'd like, ⁓ it's okay, you know, but I can tell I just don't have that emotional capacity anymore. And usually it's when boundaries have been crossed, you know, when the time like my schedule has been eked on, that I wasn't planning, something got jumped on me, my nurse has a million questions on top of everything. You know, it's usually a tr I find it's because I've been asked to do a little too much. And not able to like establish those boundaries and control. Brendan: That's a great point. That's a great I I definitely know what you mean, where it's like maybe a certain patient who maybe j just isn't understanding, but it's like they have to ask the same question of like seven questions, but the after you they ask the third time, then they finally move on and it's like I I guess I said that differently on on try number three than try number one. Yeah. But then you go into the next patient room and then they ask that question twice and Erin: Well I had an example of this the other day. ⁓ I try to limit my OR cases to once a month 'cause it used to just be, ⁓ I go this Wednesday and I go that Thursda Tuesday and you know, next thing you know it's just like, ⁓ and so it's like, Okay, we need to do it once a month. It just needs to go and do a block and be done with it. My schedule needs to be set and it can't be so crazy. And so we were trying to get something arranged and then this mom calls and is like I can't do that day, I can only do Mondays. And I was so annoyed. I have Mondays and Wednesdays off, so that's usually when I go to the OR. So do I really care if I go on a Monday or a Wednesday? Not really, but the fact that I felt like she was demanding that day without like, would a Monday be okay? It made me like, we're going on a Wednesday thing. You know, and I'm like, that's not the kind of doctor I am. Like if I can accommodate, of course I want to. But my boundaries have been crossed. So then I'm wanting to act in this passive aggressive manner that I normally wouldn't. Where again, my big boundary is not feeling appreciated. I don't like to be put upon. I don't like people demanding things from me. So if you would have just said, Hey, Mondays are a lot better, if that could work, that would be great. Then that's a much different than like I only do w Mondays, make it happen. Yeah. Sarah: You're like, Well, I only operate on Wednesdays, sorry. Erin: Yeah, yeah, exactly. That's how I wanted to respond. Brendan: Is it true that patients are getting less polite? Maybe people are just getting less polite in general, but like the rudeness So I was just talking with a general dentist who's been at it for like thirty two years and he was saying like he doesn't know what it is, but within the last five to ten years ish, he's like, I don't know what it is, but patients are completely different. This is not what the profession was. Sarah: I'll tell what I think it is. I think that it's because there's competition and so everybody's offering something, free consultations. ⁓ we have late hours on this day. Hey, ⁓ our office is open on Saturdays. And then so patients are seeing these things and then they're starting to expect it. And so whereas if you go to Mexico, for example, you know, they're like, ⁓ well, these are our hours and people are like, ⁓ I'm so th so thankful that I was able to get in today. Thank you so much. You know, just like normal whatever. I feel like the entitlement has is exponential now simply because we've been like giving little breadcrumbs throughout the profession and so patients are like, Well he gives that, so why don't you? I want to come to this office and I like you better and say compliment you and then but I need you to accommodate me and my schedule and all of my things because surgery you're doing surgery on my child, but I need to tell you when you can do surgery on my child. You're like Erin: Yeah. Sarah: Okay. Well that doesn't make sense. So I think it's an entitlement thing. Erin: I think it's entitlement. I don't have any competition really. That's the benefit of being in a rural community. So for me that's not necessarily it, but I think some of it I think some of it's financial. Like it's so much harder to make a buck. Your buck doesn't go as far. Inflation, all of those things. And I I think that's part of it. There's a lot more suspicion and distrust. And some of that comes down to the money. Like is my dentist trying to scam me? Is my dentist the equivalent Of a used car mechanic where they're just trying to make a buck, you know, and then I'm the first to get on social media and defend dentists like, no, we went into this because we want to help you. We're here to help. And if you hear you have ten cavities and the next guy says you has none, that's just a different treatment philosophy. And then you start hearing about people talking about ozone therapy and cavitations and Bone grafting third molar sites every time and then I'm like I can't defend you guys anymore. 'Cause you are maybe a scammer. I hope you don't really think in your heart that that's what you're doing and you believe what you're doing, but still that distrust makes it hard to come and then you're already kinda fired up and trauma informed care is one of my big topics that I like to talk about. The understanding people have trauma and this underlying basis that they're meeting you on and that affects your whole interaction. And that changes it. So they're coming in already kinda hyped up, already full of anxiety, they're not really trusting you. And so then you're kinda digging yourself out of a really deep hole just to like get back to baseline. I think like my husband's a physician and he's ENT and ⁓ I it's so interesting because the way ⁓ he about his experiences, like ⁓ someone's You make kids cry ⁓ And then I'm like, he's a pediatric ENT and he probably makes way more kids cry than I do. But like looking in their ears, the parents just like hold him still and look in his ears, it's fine, he's gonna cry. But I feel like when we do it's like you evil dentist. Sarah: Yeah. ⁓ probably 'cause they already have their own trauma around dentistry. Maybe they were put into a Pedo burrito or whatever it was, right? ⁓ Brendan: Yeah. Erin: Sure. ⁓ there's a lot to unpack there, but that's kind of what I Sarah: that old pediatric philosophy that they used to teach it was the hand over ⁓ hand over is that what it's called? Yeah. Erin: Yeah. ⁓ Did you learn that Steve and talking about that still, Brendan? Brendan: I did not learn hand over mouth, I learned voice control Erin: Sit out and shut up. See, I learned it somewhere. Yeah. Brendan: Yelling at him like yelling. Mm-hmm. The Papoose, that was another one, and then Tell Show Do. That's a good that was that one Erin: Works. Sarah: that what I the Pedo burrito? That's what I was the papoose is the same thing. Yeah. Yeah. ⁓ Brendan: That's a good one. ⁓ Erin: She lives in San Diego where that Mexican, you know, influence is strong. Brendan: Espanol? ⁓ Erin: We were just in Mexico City and we were both very sad that our español is Sarah: So bad. Yes. I got a lot of it. I did my anesthesia at Parkland and so we had a lot of big Hispanic population there. And so I have some decent anesthesia Spanish. And that's it. Yeah. Brendan: Something. That's something. I mean I don't know. Erin: ⁓ Is that right? Where you're having pain or something that's Sarah: ¿Dónde? Abre su boca. Abre su boca. grande, grande. Yeah. Brendan: But I guess not too much anesthesia Spanish in Mexico City. Or maybe there was. Sarah: It was at an oral surgery conference, so we got a little bit. That's pretty good. Yeah. Brendan: A little bit, okay. Okay. That sounds fun. Did either of you guys get sick from the water or Sarah: and I even brushed my teeth with it. Erin was like, Are we supposed to brush our teeth with it? and was like, Well I have been. I seem to be doing okay. Yes. ⁓ Erin: Did great. That was great. It was fun. I was speaking at the Mexican Oral Surgery Association meeting. So I brought Sarah as my companion, content creator, emotional support, pal. Sarah: Yeah. Yeah. Eater of tacos extraordinaire. Brendan: How were the tacos down there? Better than San Diego? Erin: my gosh, you have no you you have not tasted a taco before. You think you have, but I cannot believe I was like why do we not have these back home? Sarah: And we have good tacos in San Diego, but no Erin: People making the tacos. Why are they not making these tacos? That's a every meal we were like asking that. Why? Yeah. Sarah: Like at a fancy restaurant and a at a not fancy restaurant, at some little corner place on the street. Erin: They were just like the the street tacos were just as good or better than the Michelin Star. They were all just like mind blowingly fabulous. And at one point I was asking our host, like, what is this one? She's like Beef. And I was like, But what is it? I'm like, how do I order this, you know? She's like, It's a tortilla with cheese and beef. And I was like, No, it's not. What is it? Yeah. Like Brendan: There's something else in there. Sarah: What kind of crap are they putting? Erin: This, you know? How do I say this? Yeah, incredible. Yeah, hundred percent recommended. Brendan: Man. Well I'm gonna have to try that. Erin: And there's so much Sarah: Yeah. ⁓ Brendan: What was that w ⁓ welcoming? Erin: ⁓ it was the best. It was the best trip. It was just amazing. Sarah: hosts. That's amazing. Yeah. And they've got I think that they've got their next Congress meeting. I think that one of my friends that I made said that their next Congress is in Oaxaca in November. I guess we should go. Yeah, I think that was the first time in a long time. It's usually by the beach. ⁓ they said. Yeah, but I think they said their their next one is in November. And interestingly, they said that it's like a requirement for them to go to these meetings. Right. So that would be like them requiring everybody to go to Anus. Erin: Yeah. Sarah: as part of their well and the way that they do it I think it's awesome because theirs is really fun and it's really collegial and welcoming and they were assist Erin: there ⁓ the hotel. Having ⁓ behind me as I'm speaking, they have they kept like showing the ads, you know, for like what's happening for the meeting, and it was like Churritos, World Champ boxer. ⁓ they're like, Are you coming to see Churritos? And I thought 100% it was gonna be like pay per view. And then we walk in and there's this giant boxing ring with people ⁓ in person, like sandwiches and beer. ⁓ Sarah: A no telling They're handing out beers and sandwiches. Yeah. Erin: And we're all like What? And they're like, You thought it was gonna be on TV, you silly willy and we're just like I mean ⁓ Sarah: Yeah. if if Amos was more like that and less like hi, ⁓ are you doing these days? And how many how many how many staff do you have and and what's your practice model and you know, like that? ⁓ many offices do you own? Yeah. Erin: like, "Baile" , "Baile" and next thing you know you're dancing. You're like, I don't even know the cumbia, but I'm doing it. Yeah. It was great. And I think it's a small enough community. It'd probably be fun to come and see like the people every time. And I don't know. I enjoyed it. I listened to many a lecture in Spanish and I don't even really speak much Spanish and I thought it was ⁓ very despite being in f Spanish. I learned a lot. So we should go next year. Sarah: ⁓ Brendan, they are so collaborative. Like they have their own a lot of times they have their own practice and then but they have a like a group that they've like a couple of other practices that they a couple of other doctors that they work with ⁓ they will go and do bigger cases with them. So they'll just like pop over to so and so's office and do cases with them or if they are going to the OR they'll pop over with them, but they're totally different practices. It's not like a group practice. And so it was so cool and so collaborative to see how these how different they practice. You know, and and the guy that I was talking about earlier, he's like, ⁓ I didn't get home until about eight o'clock tonight. I was doing the big implant case with my friend at his office and I'm like, That's so cool. Like we don't have that. ⁓ well now I have to get a group practice because that's the only way that I can get somebody to come and do things with me and then you're in your group practice and then everybody's busy doing their own thing and so it's hard to coordinate Brendan: You know Sarah: people to do things together. But there it's just I think because it's regulated financial and s yeah, rest less regulated and less financial incentive, I think, that they are so collaborative. It's so cool. Erin: Yeah. Brendan: The malpractice insurance too is a big problem for like us to work in other office. So it's like there's so many like you said, regulations. The rules and regulations and laws really prevent us from kind of collaborating in that aspect. And yeah, I always Sarah: You can't talk about your fees and you can't talk about anything else and what the heck? Brendan: You know? And one of my ⁓ one of well yeah, one of my assistants is from Mexico. She's actually a trained dentist in in her sister's an orthodontist and her sister's husband, so her brother in law is an oral surgeon of Mexico. So I was I mean it she was saying like 'cause we were, you know, through the day I worked basically the last year with her and she was saying like it it would be much easier, it would be much better, much more financial incentive wise in Mexico. She was I told her some of the fees that we were getting from the insurance companies and Erin: ⁓ wow. Brendan: She's like, doc, you make a lot more money in Mexico. And it's you know, if you you get more freedom to do that. If there's less regul you need regulations to keep things from getting like out of hand or like complications from happening. Which is also weird because we have a lot of like we have general dentists allowing basically kind of like do whatever they want except for orthodnatic surgery, which is another topic for another day, I guess. But Sarah: Yeah. Yeah. And they can even label themselves as an oral surgeon on their Facebook business page, which I just found the other day. So there you go. Brendan: Yeah, that too. That too. So I don't know. It's it's so confusing. Sarah: Well and I found that they are doing more full scope stuff too. They're still maintaining that like ⁓ scope practice ⁓ of residency if even if they're not based in a hospital, because ⁓ can. You know, it's not so ⁓ and ⁓ here it seems like, ⁓ those those are the people that go to the OR, those are the people that do the orthognathics in town, those are the people that do this. But they're ⁓ know, they all are still maintaining it. I just think it's great. ⁓ Brendan: It is great. I'd be curious to see an orthognathic surgery case in Mexico, just broad scope, like is it reimbursed by insurance? Does the patient have to pay out of pocket? If it is reimbursed by insurance, how much is it? 'Cause like I know one of the attendings told me last year they're getting like six hundred dollars a jaw from some for some ⁓ insurances here in New York, in the hospital, and it's like you just can't I can't take it all from work. You know, you you Erin: One third molar with sedate like less than one third molar with sedation. Like it's crazy. Brendan: Like what what are we doing here? What do we do like do we want people to get care? Then what is that even an insurance? Erin: I'm spending hours cutting your face off and putting it back together and caring for you for weeks leading up and six hundred dollars and the liability. It's crazy. Sarah: All the person. Brendan: Months to plan, months to follow up. Yeah, like what's crazy. Anyway, anyway, so we really jumped in with a lot of things right off the deck, though. Can we just we gotta get to that post by the way about ⁓ then the comment that I got literally this morning. But first, can we I know it it Doctor Sheffield, we kinda went into this a little bit on our last podcast, part one. This was like a year ago or so, maybe a little longer. But can you guys just give a little like I wanna like just for for listeners, viewers, refresh them and also Doctor Harding, who don't know. Like obviously San Diego, right? And but like where you're practicing right now, you said urban versus rural or subs, and then ⁓ how many days a week you're working, what your office looks like, how many days you're going to the OR. ⁓ Dr. Harding you were talking how billing in the pediatric office. I I wanna know all about this and I know the viewers wanna know too. They wanna you when we're talking about the mentorship. Let them really embrace kind of your situation right now, like what you're doing, what the vision is, what the goal is, what you're doing day to day. If you can and how you're managing that on top of being, you know Yeah, a family. You guys have a family and I wanna make sure we show that aspect too. Erin: True. Sarah: I'll start because mine is pretty ⁓ easy. I am not really working right now. So I finished the Navy in 2023 and I went out into private practice and I was doing one to two days a week. ⁓ sometimes more, but around that area. ⁓ And then was that practice is about an hour and fifteen minutes each way and I was not interested in the commute ⁓ after a while. And ⁓ so then I left that practice. I've been covering at a practice a little bit closer to me since I was still in the Navy and then continued, but it's not busy enough to keep me busy. And so lately I've just been working with the podcast and then I'm building this little pediatric this little mini practice inside of a pediatric practice. My goal is to not work full time. My goal is to work a couple of days a week, if that, because I really enjoy spending time with my kids. I really enjoy farming and taking care of chickens, doing sourdough, all of the things that a you'd expect a forty one year old woman to be doing. So that's what I'm trying to do. There you go. Brendan: Wait, when did you have your kids? Did you have it while you were in residency or dental? Sarah: ⁓ thank you. Yeah, so I ⁓ no, I for sure did not have kids in dental school or residency and was told that that could not happen and that that wasn't allowed to happen. And then I went to the Navy and then I was deployed. And then after I got back to from deployment, then I you know, met my husband, we got married and then we had a kid. So I was out of residency four years, I guess before I had my first kid, and then I had my second one three years later. So I was thirty four and thirty seven when I had my kids. So now they're seven and four, two boys. Brendan: And that's excellent. And I I'm so glad that you said that 'cause that shows the timeline of that you can do it. You can do it. I I love that. Thank you. Sarah: You can but it makes it really hard, right? Because those are not your fertile times, right? And so but you know, I think it's just I think more and more days more and more these days women are able to have children earlier, which as we're seeing with a lot of times if you're not, then you're having to go into fertility treatments and things like that. And so thankfully I didn't have to do that. but yeah, I think I was frustrated because it was not on my own timeline. It was basically so I was told when I could or could not have children. So Brendan: And now, and that's a and that's a great point. On that topic, if you could it like they told you no. Could you have do you think you could have squeezed that in somewhere like during residency or dental school? Would you have have had it maybe before, had kids maybe before dental school? Like I'm just I wanna get the inside of like your mindset and like if you were to go in hindsight, yes, no, when how you know what I mean? Sarah: Yeah, I think that if you can do it and you have family support close by, you it's just so difficult to afford childcare, right, when you're on a super limited salary. If you have family support close by then it's possible. There's literally no way that I could have done it in my residency. I would have been fired. And I know that you're not allowed to do that, but they would have find a w they have they would have made a way made it happen. Because it wasn't the first female resident that they told something like that. There was one, you know, she finished probably twenty years before me, but they told she like had a pregnancy scare and the chairman called her in. This is a different chairman, but he was one of my attendees. But he called her into the office, and the whole building could hear him screaming at her. Erin: Well tell him what they said to you. Sarah: So when I I just posted about this 'cause we talked about this in our last episode, but my third year of residency I was off service. I was I think I was on oculoplastics and I my one of my attendings called me and said, Hey, I need you to come over to the dental school 'cause I need you to have a meeting or whatever and I'm like, ⁓ dear. And so I went to the dental school and the oculoplastic practice was up at a different town. Brendan: Wait, wait, one second. It's it's like cutting off. Are you getting that, Doctor Sheffield? Erin: Yeah, she's freezing. Sarah: ⁓ sorry, am I can you hear me? Can you see me? Erin: I can hear you now. Sarah: Okay. Better. Okay. And so it was my third year. He called me in from off service and I s came and I sat down and it was like this airing of grievances. Brendan: There we go. Sarah: And there was a bunch of things, you know, I've heard that you said that you were just a dentist and he got all upset about that because it was part of that movie. I don't remember what is it called. Hangover. ⁓ and then he said, And I've heard that you want to be a wife and a mother and if that's the case you should cut your losses and cut the navy's losses and leave now. Brendan: Wait, it's ⁓ it wait, Doctor Harding, it's it's coming in and out again. Erin: Yeah. Brendan: Wait one second, Delger Harden it's coming out. Sarah: Okay. I'm back, but you're not breaking it. Brendan: ⁓ man Erin: I can tell Sarah: There we go. ⁓ Erin: Should I tell a a dramatic retelling? There you are. Sarah: I live in the sticks, so I just switched over to Erin: shit. Brendan: Wait, now you're now it's a pitch black. What happened? Erin: Sarah, come back. I feel like I should do the dramatic retelling. Because Yeah, she lives on a avocado farm. ⁓ I hear her laughing now like the Cheshire cat before I could see you. Brendan: Aren't you really out there in the sticks? I guess so. Sarah: All right, I'm back. There's for dramatic effect. Brendan: All right, all right. Erin: Yeah. Sarah: Yeah. So then he says and it's him and then a couple of other attendings. And so you think somebody here's got my back, right? No. So it was I ⁓ and I also heard that you want to be a wife and a mother, and if that's the case, then you should cut your losses and cut the navy's losses and leave now. Yep. As a third year, of four. And of course what do I do? I cry, right? Because that's just how I react. So that was great. Yeah. Erin: I think. Sarah: And so I didn't even have a boyfriend at the time, as it turns out, so Brendan: What you didn't even have a boyfriend at the time and they're talking to you as if you're married with a k Sarah: Yeah. So yeah. Erin: Yeah. Which is so crazy because everyone knows if you're a resident and you go a man down, like that is killer for everyone in the program. So why don't you want to like eek out as far as you could go, you know? Like it's just ridiculous. Sarah: was just mad at me, you know, I mean whatever. ⁓ but yeah, that was that's kind of the defining ⁓ thing of my res my residency was a lot of that. I had a great experience like my residency training was incredible. But that there was lots of that thread ⁓ ⁓ throughout my residency. And I even filed a ⁓ Erin: Complaint. Sarah: complaint after I finished residency with the big school and had to do like a deposition and all kinds of stuff and then yeah, they came back and said, ⁓ we didn't find anything and then but one of the guys got fired and the other guy died so Brendan: Come on. Erin: Karma comes back around. Sarah: Yeah. So goodness. That got deep, sorry. But it's been over ten years and I feel like my my statute of limitations or whatever you want to call it is expired. Brendan: I'm sorry I had to go through that. That's just insane. And it doesn't make the ki the dots don't connect as far as everything we told. Sarah: Yeah. ⁓ Yeah. So there you go. Now you know. Yeah. Brendan: No. Erin: I can drop dump my trauma next or we can talk about something more friendly. Brendan: Let's get into the trauma. Wait, let's let's draw it. Let's let's keep it going. Let's keep the stories going. I wanna hear this. I wanna hear it. Erin: I was a new resident out of residency in my first job. It was hard to find a job 'cause I was in Iowa City which is oversaturated with people 'cause of the university. And so I finally found a job like May as I'm graduating, end of April. And I was gonna travel seventy five miles commute each way to reopen a practice that had been closed 'cause the doctor was out after hurting their back. So I took this on and it was going great, but I was also going through IVF treatment trying to get pregnant and I finally after many, many, many rounds of treatment, got pregnant. I even Change the timing to if I did get pregnant then hopefully that'd be better timing for the practice, you know, like and that was hard, like waiting when you're just like going through this like I'm already getting pregnant much later if I get pregnant all than I'd anticipated. And so I finally got pregnant, find out I'm pregnant with triplets. I didn't give three I didn't put three embryos in by the way. I did two in one split, so I had triplets. Ended up losing one of the babies very early on. and so continued with my twin pregnancy, went into preterm labor at like 32 weeks, was able to carry the twins till 36 weeks. I worked up until the day before I had the babies. I even had to go in my ACLS was up to be renewed and at that one all I had to do was like do like some online training and then do C PR on the dummy with the connected to the computer to find out if you're doing it good enough. ⁓ And I went I was huge. I was like a whale. I was so big. And I go down to the the hospital education center and I'm doing CPR, thirty six weeks pregnant, going to deliver twins the next day, and I I failed the second round and they were like, ⁓ that's okay. I can tell you know what you're doing, you're just getting tired and I was like, Yep. And all these people kept like ducking out around the doors just because you know they're going, You gotta see this lady is doing CPR, it's crazy. So anyway, that's like the context. So I like worked up until basically the day I delivered. I delivered like the next day. I had preeclampsia or not they had to deliver me early. And so when I was gonna come back or they were gonna get a locums person, they couldn't, and so they were mad at me for taking maternity leave. And so when I came back it was a very hostile environment and they were trying to bully me to come back early, even though like I had preemie twins that having some health issues and I was still recovering from this traumatic delivery where like I almost died too and so they were really mad at me and so when I came back it was pretty unpleasant environment being there and I ended up recruiting a graduating resident to come join our practice. thinking that okay I could go part time so I can be home with these babies instead of commuting seventy five miles each way every single day. And so they signed him on. It's supposed to be like a two and a half man practice. And as soon as he signed on they let me know that they're letting me go. And they told me like, Now that you're a parent, we know what we would want to do and we'd want to be home with our kids type of thing. So here I was without a job. Sarah: So frustrating. Erin: I I'm without a job. Again, it's a oversaturated market. My husband's ⁓ MD PhD ENT ⁓ into fellowships were like ⁓ in Iowa City for a million years. So I filed for unemployment. ⁓ you never think after doing like thirteen years of training that you're gonna be dropping off job applications at Burger King, collecting your six hundred dollar unemployment check because you're the breadwinner for your family of four. ⁓ Brendan: On top of your two newborns, yeah. Erin: So it's crazy. It's how things go sometimes. So I ended up fighting. Sarah: You would have been the best damn burger flipper that ever existed with those skills. Erin: Honestly thought about that and I'm like, I could be so good at that now. I would flip it with so much joy. People just be getting love and light and service from me with every bite. Yeah, exactly. Brendan: Yeah. Erin: char broiled or I don't know, whatever. So yeah. But yeah, that was really hard to go through. ⁓ definitely kinda shook up my identity and Sarah: Just Erin: Tough, yeah. And and so unfair. So I filed with the EEOC, which if you ever have a discrimination case, I think some key points to know is like there is a timeline, so you have to file in a short period of time. And then the state of Iowa did find after a very extensive like one year or longer thing and he also died by the way. Going back to Sarah's theme. Sarah: Dying in the process. Erin: This would made it kind of tricky to like continue with our filing, but that's sad and that's too bad for him. But they did find probable cause that discrimination had occurred. So a lot of people were like, You're just a terrible employee. Well, the state of Iowa said that's probably not really what happened. So And it's hard to get those, they hardly ever come down with that. You have to have a lot of evidence. So I had like hundreds and hundreds of pages of things, but yeah, so that's where we're coming back from. Discrimination. Yeah. So we ended up ⁓ coming to an agreement through mediation after very long drawn out legal Sarah: Yeah. Erin: I mean the wife was the practice manager and really the one that most of the harassment and the s you know, egregious things came from, so it continued against the the estate. Brendan: Was the wife? ⁓ I thought it was the practice horror whole Erin: He was sick and hardly around, you know, like Brendan: It was the wife. Sarah: ⁓ the same reason why I my orthognathic rotation ⁓ a really prominent ⁓ surgeon ⁓ cut short ⁓ two months, which is what everybody else got, to one month because ⁓ wife office manager felt that it was ⁓ a safe environment for a female resident to be alone in the office with ⁓ husband. Erin: Which is really just a pretty a blonde. Sarah: So I didn't get the full experience. Brendan: Easy. Erin: So terrible. Brendan: We're getting into the the nitty gritty with good stories today. Erin: Wha I mean we we yeah, why are we giving him all our best stuff, Sarah? Or maybe just come to the Resting Stitch Face podcast for even nitty gritty details. Sarah: Yeah. ⁓ Sorry. Brendan: That too. That too. Yeah. Yeah. Yeah. ⁓ man. And also so now you're practicing in in Illinois. and then where also how many days a week? I know you were you were talking before it was Tuesday, Thursday, Friday, and then Monday and Wednesdays off, but but just to kind of give the layout, you know, or or also the trend, like were you working a certain number of days in the beginning versus now? ⁓ you also mentioned did you mention sometimes you work with your husband because he is ENT or or no? Erin: yeah. So ⁓ husband and ⁓ both took jobs at Quincy Medical Group, which is ⁓ big multi specialty physicians group. So ⁓ feel like it's a really unusual it's not a hospital. It's just it used to be a doctor owned ⁓ Now we're kinda or owned by V C but so we're both in this big doctor group over a hundred doctors, so ⁓ I work at a separate facility. My partner who's an oral surgeon we have our own on site clinic but they have like a bigger campus where my husband works. So I don't see him directly very often, but we definitely will do OR cases together if there's something that, you know, is of interest or would be helpful. So like I was recently doing a big placing a recon bar on osteomyelitis patient and so it was just like People don't know how to help me with this. I need an extra set of hands. So it was really nice that like I got done with my cases early, I'll pop over. So that kind of stuff. Or he'll be like, Ooh, I don't feel super comfortable with this mouth thing. Will you come help me? So that part's fun. And people act like, E and T, I can't believe you could marry an ET. What a rivalry. But it's matched up really well for us. So that's been fun. ⁓ Yeah. So we both work at this group. it's nice because Brendan: Yeah. Erin: Basically less so because, you know, venture capital, but corporate medicine. It takes away some of the autonomy that's kind of leaking down over time. But for the most part it's kind of like having the benefits of being an associate. Like I don't have to do all of the marketing or the hiring or all of those kind of things. I can kind of show up but I can also have a little bit of a say. So it feels more like being a partner as far as ownership. ⁓ of the decision making, etcetera. But you know, you have the support. So it at least at least initially it was kind of the best of the both worlds. So again, we're kind of trickling some of that autonomy away. Happens. Sarah: can you tell ⁓ a little bit about the the difference because you don't have an MD and so because it's a physician multispecialty group, there is like a nuanced part of that but you're not getting the full benefit of it. Erin: I'm technically not a partner, like my husband is, because I'm not an MD. So my partner is a dual degree MD. ⁓ But state of Illinois says you cannot ⁓ own medical group if you're a non ⁓ medical and so they don't allow me to. So most of the time it's fine, but there are little things like ⁓ profits our surgery center I don't get to participate in. I only get my ⁓ Share of the profits. Or if we sell to venture capital again, you know how it works every five years, I don't get part of that sale unless they decide to throw me a bone. Like last time they gave me like a third of the sale price just like to be nice. So I don't get to vote or be on any board or anything like that. So that's a little bit frustrating. So it's not it's not a model necessarily mil built for dentistry and for the most part it's fine. But every once in a while there's just little nuances where it's kinda frustrating. But Overall we've been very happy and again I we live in a smaller town than I ever anticipated living in, but it's been really great for our family. You know, our income is high, our expenses are low, there's no traffic, even though people complain in town that there is, you know. Things like that. It's really a a nice option. I don't really have to do any marketing. Like I get people I'm sure you do too, every day in my DMs like, Hey doctor, I love your content. I would love to help you get more patients and I'm like, I have too many patients. My partner's out on sick leave right now, so I'm booking out till probably October. So I have too many patients if anything. But Sarah: Isn't this funny? It's like in direct contrast to what you and I experienced, Brendan right? Low income, high cost of living, so much traffic, for patients. Brendan: Yeah. Erin: That's something I recommend. I mean you feel like I wanna live in New York, I wanna be in the big city, I wanna live in San Diego, I wanna live the sunshiny life. And that's amazing, but you pay for it in other ways. And me, like, I can take as much vacation as I want. My house costs three hundred and forty thousand dollars. Sarah: I can't even get an ADU for that. Erin: No, like ⁓ I don't have to market for patients, you know, like there's a demand and there's something really wonderful about like hanging your shingle and having people just so glad you're there, you know. So yeah. paperwork for the twelve thousand patients I saw. So I mean, if people are looking I think a lot of those opportunities people snub their nose at them, but there is some really Golden opportunities out there to consider. So if anyone has questions, DM me. I'm happy to talk about my experience. But I thought I grew up in a town of like two hundred thousand. I'm from Utah. And if you're from Utah, you know, th there's not like huge cities, but it's a big urban, like everyone's just like in a strip of people and so it feels a lot bigger. There's traffic and all that. But so I thought like, ⁓ moving to Iowa City seemed like a Whoa, that's not very many people. And then moving to Quincy seemed like even more of a downgrade. But we've been really happy. So it definitely works for our family. It's a easy pace of life. There's a lot of benefits to the lifestyle we're living. ⁓ yeah, low lower stress for sure. Brendan: Where's your husband from? Was he also from Utah or Erin: He's from Iowa City. Yeah. His father's a physician, scientist at the University of Iowa for the past like thirty years, so that's where he's from mostly. Yeah. Brendan: ⁓ It it's it's funny you mentioned that. I was like the the whole time I'm thinking about like you in the OR and all of a sudden you know your patient needs a FESS or something, you're like, Hey Papi, come here, get this FESS done for me. Erin: Sometimes maybe. Yeah, if only, huh? I mean we could definitely arrange that for sure. Yeah, definitely. That part's nice. ⁓ I work three days a week most of the time. ⁓ it's nice 'cause if I'm going on vacation and I don't wanna take the time off, I'll just work a couple extra w days before and after or whatever. So that makes it really flexible. ⁓ and then I spend a lot of my extra time on my side gig, which is the doctors all in, content creation, and all that. Brendan: How ⁓ my ⁓ my question was gonna ask, how big is your office? 'Cause you said you have a partner. Can you both work in the same office? How many chairs do you have? How many s you know what I mean? Yeah. Erin: We have five chairs. We have two assigned to each other and then a s third one that we kinda share for consults and things like that. I would love to have more but I'm greedy. Now that he's gone I guess I have Brendan: Absolutely. Sarah: Brendan, do you find in New York that itinerant surgery ⁓ or ⁓ surgeons going because you're in a highly saturated sort of area here in California we have a lot of general offices that are wanting to bring a surgeon in. Is that a big thing there as well? Brendan: Yes, it is. ⁓ I think it has to do with the taxes, the overhead, the real estate and everything. I'm noticing ⁓ that was one of the things ⁓ the bosses at the practice want us to go out and you know, network and game of fronts and stuff. And so so I did, right? And and I did very, you know, hey, come on the podcast, like, hey, can you meet here for dinner? Just what bring them donuts, bring I brought orchids to a couple practices. So I met a lot of people, regardless of how he looked at that. But I met a lot of people and there's like the older dentists. Who are in their practices, whether private or DSO, they've all referred to the same oral surgeon or parrot for 25 plus years, right? They're not gonna refer to me. It's the younger-ish dentist that I need to go out and meet, right? So then I go out and meet them. And there's two groups. There's some who are Erin: Yeah, you're not Brendan: doing like everything. They own their own practice or they're working towards it or but they do everything themselves. They're doing third molars. They're doing all the implants. They're doing clear aligners They're doing molar root canals. And so it's like, unless I'm gonna come in and do sedation and bring on the for the All-on-Four surgeries for their practice, it's like they don't really they're not gonna refer they refer out anything. If they do, it's I I don't know. I don't know where it goes. But that's that. So they're doing most of their stuff in-house. And then there's the non-younger general dentists who are doing a lot of They're not doing all those procedures, but they're at a DSO. So the DSO either has the surgeon or periodontist coming house or they own the surgeon or periodontist group to send to. So now if you're in a private practice group that's kind of in the middle, it's not a DSO, it is private, but for a younger associate, where do you go? It's it really just comes down to who are they sending? Us, the people, because we take the insurance that these other groups are not taking. Those are the literally the only cases that I would get. Or super high anxiety needs to be sedated. Right? Like and then that's that's the cases we get. So yes, to answer your question, absolutely. ⁓ some of them were like, Why don't you come work in my office on a Saturday, one Saturday a month, and we do an all an X or something? And it's like it it would be great, but that was not conducive to what my boss wanted at that group. So it's ⁓ it's it's difficult. He's very high competitive competitive, saturated, high tax, high Sarah: It's not at all what we thought it was gonna look like. Erin: And I am so lucky 'cause I still get the please T E number eight. Like all the time, you know? Like I feel like that's your easiest one to take out and I still get those all the time, which is really nice. My dentist is busy enough. What? I don't know if he wants to open up that bomb shell of a Sarah: Do you graft it? Brendan: Top, level. Sarah: No, it's not even gotten to third molars yet. Erin: We're breaking all the we're bringing all the hot tea for you today, Dr. Gallagher Brendan: ⁓ man, that's Wait, let's let's talk about that because there was a post that you had just put up a little like whatever a little while ago or so on and so forth. ⁓ no, this was like a week and a half ago, I believe. And so we were talking about how ⁓ you had gotten you put up a post of how here's a reason why we take out third molars. And it was Maxillary third molars and it was it was basically destroying the distal distal but whatever, distal the back end of the second molar. So now you're taking out Two teeth rather than just the wisdom tooth before causes all these potential problems. And then I said to you, because we kind of like intro this for listeners, ⁓ I said to you just literally just this morning, I got a comment on a YouTube post, and someone was saying, like, why would you take out the it was I was talking about how you know we take out third molars to prevent sometimes. Not every third molar is meant to be taken out. No, we don't take out everyone, but many of them have the potential to cause problems, destructive problems. And so they were the comment was like. Why would you take that out? That's like taking out the spare tire of your car. And I'm like, what like and I know a lot of international another a lot of other countries, they just wait until third molars become problems to take them out. That is one way of doing things. But now it's like you could have fixed a problem for like that was nothing. You heal better, you recover better, you less swelling, less potential for long term complications, less potential of that leading into another tooth that needs to be removed now. So why not? And this isn't for every patient, right? But it's like a good more than fifty percent. Let's just let's do this on that. Let's make this a lead topic. I know we gotta but what are you guys your thoughts on that? What sparked your thoughts to make that post, Dr. Sheffield? Erin: Well, it's just disappointing when you have someone come in and they're thinking they're getting their wisdom teeth out and then you have to tell them you have to have your second molars out also. And it happened to me I just took one out again on Friday. on a friend's child, like, sorry, number fifteen's being resorbed, so we gotta take it out. And yes, this time we left the spare tire number sixteen, but like I don't know. I'm not a orthodontist. I'm not seeing these cases long term. I don't usually see these teeth magically appearing in the right position, especially when you're like twenty years old, you know, like it's not usually gonna happen. It's usually gonna come in sideways and in kind of a sp funny spot or I had maybe a Sarah: You get period issues on the mesial. Erin: Different thing but similar vibe. this patient came in and they're like, I think he needs a biopsy, he's got this really thickened leukoplakia, and you're like, ⁓ the adjacent tooth is super erupted and pounding on that tissue. So let's take it out and see if that resolves the trauma to the tissue, you know. So there's so many reasons that we remove them preventively. ⁓ and people like to argue, but I was lecturing on third molars in Mexico City and one of the points I was making was they've done studies that actually have shown it might actually be more expensive to maintain the wisdom teeth or to maintain and then have to remove them later with all of the problems. So it's actually cheaper to like bite the bullet, get out on your young teenager before you even have the complications, instead of like limping along. So I think All oral surgeons would love to have like a consult with that fourteen, fifteen, sixteen year old before we're having to have those awkward conversations of like, Ugh, the nerve and what do we do? Sarah: If you're wondering why I'm going into pediatric practice, there you go. Erin: Yeah. Sarah: See? Brendan: Yeah, and just just ⁓ to harp on that really quickly, like with the third molars, say you take out the second molar and then the orthod you think the orthodontists might have a chance. One of my best friends in orthodontists, and he said most of the time, they can't move a third molar that distance. They're like it's cortical bone on the bottom or the maxilla, it might be different, but the fact of the matter it's gonna wanna tilt measily It's a very long distance. It's not like moving an incisor or a premolar with one root. This thing's got two roots on it. On the max it's got three. Moving at that distance, it's futile. And it's like most of the time you can't do that unless maybe. And they're at like they're like fifteen years old. So it's it's the the ninety percent or more of the time. Erin: I mean I guess at times I wouldn't tell I wouldn't tell. But like think of how many x rays you have where you're going like did you have a tooth removed when you were a kid? 'Cause I can see it's like in the right spot. It just doesn't look right on the x ray. And then how many thirds you take out they're just like weird man. They're like small or like really long and triangular shaped or you know, like they're just they're not they're not teeth to keep. They're not worth Sarah: It is true that is true like the spare tire, like the little skinny one, you know, that people will put on. Erin: That's good analogy. Yeah, exactly. Sarah: Yeah. And you don't want to drive around forever on that thing, that's for sure. Erin: It has stuff going around social media and I know we've had these conversations like on, you know, texting before too, like who is spreading all this misinformation? Things like it's a scam, the billion dollar wisdom tooth in industry is just trying to scam you and And you're talking about like other countries aren't necessarily removing them preventively. But one, they've shown that's a higher cost, but two, it's a higher cost as far as patients go because yes, less people are having third molar complications because less people are having them removed. But when you have them removed, there's already some complication that's making you take them out and then they're older and we all know after age twenty five pretty much every bad thing that could happen is more likely to happen. So a lot higher chance of having nerve damage and nerve damage without recovery, having periodontal defect, having damage to the adjacent teeth, having some kind of pathology that's destructive to the anatomy in the area, et cetera. ⁓ the preventive model, I mean, we get paid to say that right. Like if we take out thirds we get paid, but It's so much easier and recovery is so much better. Sarah: Yeah. And the other thought that I've had a lot is that ⁓ the American diet really contributes a lot to the reason why we need to be more preventive in our treatment of third molars. Because if you think about the diet in foreign countries, there's a lot less processed food. They're actually using their they're chewing more, they're you know, they're just it's just different, right? And so the way that we eat here just isn't conducive to sitting around and waiting for it to blow up. 'Cause that's what's gonna happen. Brendan: Right. Another thing was ⁓ Yeah, and and younger you more likely to recover if there was that nerve injury paresthesia, but another thing was that cavitation surgery. Let's hit on that topic real quick. I just again another post, it was a LinkedIn comment, two comments actually. Most people supported like, yeah, that's ridiculous. You know what I mean? A couple of dentists hopped in and they're like, Why why are we seeing this? Like, 'cause we talked about the cavitation surgery, ⁓ ozone or bone grafting third molar sites. And yes, for listeners, sometimes you It is beneficial to bone graph third molar sites if there's significant periodontal bone loss on the distal of the second molar. Sarah: Especially if you're over twenty five. Yeah. Brendan: Yeah, but but otherwise the bone's gonna grow back to where it needs to be over a couple of months. Give it some time. This cavitation surgery I just had two comments saying that, Are you even a doctor? How do you not know this exists? I'm like, whoa, wait a minute. Two, another one said, Yeah, but this is well documented in the literature that bacteria grow in these cavitations and I'm like, Great, the blink here. Post the link here and they're like, I don't need to tell you where the link in, you're a doctor, go find it. I'm like, In your recent search history, which is what you just said you were looking at it this week, put the link here. You know what I mean? It's never it's always a deflection. Sarah: Yeah. Also tell me what part of the body is sterile and without any bacteria? Erin: Your urine, but they don't like to hear that either. ⁓ Well and it's frustrating. Yeah, they come back at us as if we are uneducated or we are somehow part of this cog of this industry machine that has reason to like teach us wrong and Sarah: Yeah. Erin: And we're not the ones making money off of that. That's the thing. Like I if I wanted to treat cavitations, I could do it every single person, like, okay, a year after your third molar's come back and we're doing another surgery. And they never charge like two hundred dollars. It's like I I'm hearing things like I had eleven thousand dollars worth of ozone cavitation thing with pure oxygen bar like whatever it is. You know, it feels like a lot of these biologic dentists And not to say some of their stuff may be valid, but I feel like so much it's like this money making scheme. They're preying on people's fear. They're charging a fortune for these things. It's frustrating. And I even saw a physicians community group on Facebook talking about it this week, ⁓ saying, you know, my brother got recommended this and what do you think? And then you're even getting physicians on there like, Yeah, it's a thing. I work with this Oral surgeon group where we do fibulas to repair people's cavitations and Austin Ivey, who if you don't know Austin Ivey is like the Facebook oral surgery guru. They're like, Austin Ivy, weigh in. And he like has this amazing discourse on it as he always does. And then they're like, Yeah, but ameloblastomas have to be treated. And we're like, calling an ameloblastoma a cavitation. Is that accurate? I guess it is a cavitation, but is that a descriptive term that gives us diagnostic information and criteria? No. Like that doesn't make any sense. It's just like saying it's kinda like saying leukoplakia. Like yeah, we can name it but that doesn't tell us what it is or what needs to be done. Brendan: It's a description. It's not a diagnosis. Yeah. Erin: It's frustrating. And and then people again going back to the trust, like, well you're not a good doctor if you don't know about that. You're not up to date on all this stuff and it's hard to explain some of this quack science away. Brendan: Yeah, how do you explain that, right? Because now you're being pa painted as the bad guy and it's like, wait, I'm literally telling you, you don't have to pay me anything because you don't need this. Yeah. I there's nothing to gain here. Like we're like we're not being distorted. We're being honest. ⁓ I wish people would just take a step back and be like, huh. If I do this cavitation or ozone therapy, does that mean I have to need that that I need to pay more? Or not, right? Yeah. Sarah: Meanwhile we're like Is it okay if we just a if we if we I know that it's gonna cost a lot for me to take out this tooth and I'm really sorry and I'm sorry that it cost this much and you know it's like we're having to justify that, but then you know, we've got plenty of other people that are making eleven thousand dollar treatment plans for unnecessary treatment, so Erin: Yeah. Brendan: Cause gotta dance around. But hey, just one last thing, one last thing before you guys head out. A lot of a lot of ⁓ viewers have been asking me, give me some feedback and asking if if you guys have the time. I know it's it's getting later, but if we could go over your third molar sequence, like how you remove third molars, which one you start with, which one you and then also the local sequence. If you guys beside you starting, you saw the top, you saw the bottom, how many corpus do you use, what corpus do you use? If you guys could go through it each and then ⁓ and then we'll we'll we'll call it a day. I know it's it's getting later. Sarah: Can you really? Erin: Sarah, you wanna go first? Sarah: me start. ⁓ my ⁓ ⁓ ⁓ I'll do ⁓ ⁓ seventeen, sixteen. So in taking them out. And so then I anesthetize in that same pattern. ⁓ I give a carpule of local so I start on I start anesthetizing on the right side. ⁓ right, I'll give a carpule of ⁓ lidocaine as a block. ⁓ then I'll give ⁓ Erin: Yeah. Sarah: Two thirds and three quarters of carpule of marcaine as a block, and then I'll give the last little bit of that as ⁓ a long buccal. And then I'll move up to number one. I'll give a carpule of lidocaine at number one. And then I go and I do the same thing on the other side. And then I'll come back with another carpule of I like to use septicane, but if I don't have it, I'll do ⁓ oftentimes I'll take another carpule of marcaine and I'll go one and sixteen again, just as like before I start, I'll give a little bit of of marking at one and sixteen most. Brendan: Hmm. I like using septo too for a little local infiltrations too. Sarah: Mm-hmm. Erin: I usually go one, thirty-two, sixteen, seventeen. Sarah: Why do you do upper first? I feel like it gets all the blood into my surface. Erin: I know people say that. It doesn't really bother me most of the time. I l feel like they have more time to get numb. You know? Like the lower takes longer to numb, so I just I also think funny enough I think patients are a little more bothered by the upper ones 'cause I'm relying on force more to get ⁓ out. You know, the lowers I'm cutting up so much, so I like to get that done while they're like Sarah: Yeah. Erin: early in the anesthesia process. The amnesia portion. Maybe that's part of it. ⁓ and then I do four carpules of Lido, one in each quadrant, and then I do a carpule of Marcaine on each lower. And that's usually what I do. If I'm doing a coronectomy, which I do probably every day, I will do one, sixteen, seventeen and then thirty two. And that's purposeful because I have had too many times where I sit down in the chair, I sit also, is that weird or what? I sit down in the chair and I get going and next thing you know I'm like, good thing I realized I'm doing a cornectomy here or I've maybe even taken out a tooth that I was gonna do cor 'cause like my brain after ten, fifteen years of doing this, we just go. We're on like autopilot. And so to me that tells me and my team, Okay, we are doing something different here. Pay attention and remember. ⁓ because I've been caught a few times, so that's my strategy there. Sarah: How about you? What do you do? Brendan: That's a w would you do one sixteen seventeen thirty-two for the cornectomies? Mm-hmm. ⁓ interesting. So you do the two tops, get them out of the way, and then you get Erin: Part of it is like emotional thing like, okay, we like got the easy ones done, now we're like gonna focus and do this, you know. Brendan: Yeah, yeah, yeah. I like that too, especially when patients are awake to get the easy ones done 'cause they're super nervous and like Yeah. That was it? This bottom one might take a little longer, so don't get your hopes up, ⁓ Yeah. ⁓ you you're you're asking what do I do? I do for lido ⁓ for the ⁓ an anesthes the local anesthesia I ⁓ four carpuls of lidocaine, so I'll ⁓ I'll give ⁓ no, actually I do six. Six carpuls of lidocaine and then one of septo. So I'll do Erin: It kind of builds rapport. Right. Yeah, definitely. Brendan: One and a half of a block on thirty two first and then ⁓ to get the long buccal and then I do number one outside inside and then I'll do the other side ⁓ seventeen and I'll give one and a half carpuls for the IM block, half a carpole for the long buccal and then I'll do one carbule palatal ⁓ buccal palatal for number sixteen, and then I'll split the septo. I'll do half a septo, just local infiltrations on the buccal of thirty-two, and then the other half on seventeen. ⁓ What's your guide? Do you do you guys have time what's your when you give when you do have these sedations, what's your ⁓ what's your like what medications do you like to use? What's your sequence on that? Do you use fentanyl, like kind of things like that? Sarah: So in the Navy we didn't really use propofol. We had it, but we had to they had this regulation where you had to have two provide like two general anesthesia enabled docs or whatever, you know, in the room in order to do it. And so we just never did it. And so I got away from using propofol, which now I kinda don't really like it. ⁓ but I usually will just use what I prefer is ⁓ versed, fentanyl, and ⁓ a little bit of ketamine. And like just twenty five and I don't redose it. And then depending on the patient I'll give auxiliaries, right? So like Versed, Decadron, Toradol things like that. Brendan: That's pretty good. That's pretty good. What about you, Dr. Sheffield? Erin: man. I'm like a versed and fentanyl if I can get away with it ⁓ only. I feel like it's getting a little hairy, then I'll try to keep that a little lower dose and add in some ketamine. I use propofol sometimes, but ⁓ I like how fast it comes on and off and I feel like you get in that weird stage two where you're fighting people or they're apneic. I just don't like fighting with that. And most of my patients do great with ⁓ versed and fentanyl. ⁓ so that's what I do most of the time. Sarah: How about you? Brendan: Yeah. I you guys both use fentanyl. I like six months ago or so, I just stopped using fentanyl entirely and I'll give like five of versed and then I'll give fifteen to twenty of ketamine. And then ⁓ the patient, you know what I mean? Like some patients, ⁓ alcohol, heavy other stuff, right? Then maybe I'll give little more ketamine, maybe a little more versed like another two of versed later on. But I usually ride that wave and I'll give little pushes of prop I used I used to fill the stick with like ten of prop. Now I'm just doing six C C's of prop and they ride that versed ketamine and just a little push of prop here and there. And I gotta say, the it's not as much of like a rodeo surgery. I'm I'm still learning as I go. So that that's been a profound change and and like it I feel like I'm getting somewhere now with with learning the sedations, much less of the apneic. If the Dr. Sheffield mentioned that. Erin: Yeah. Brendan: month and a half I've had two brief laryngospasms. One of them, like the sat drop to like the sixties and everything was fine. Everything's fine. Thankfully like I didn't But like yeah, that and and if it's a kid too, ⁓ my God, your heart practically stops. It jumps out of your chest. But yeah. That's the one thing with the ketamine and the increased secretions, that laryngospasm, you need to be suctioning, suctioning, suctioning. So anyway. Erin: Mm. Yeah. I don't do kids ⁓ I don't do general in my office anymore with kids under probably twelve usually. I used to, but I just didn't see we have our own surgery center now and so it's so easy to go over there and they've got a rate arranged that's much more affordable. It's not that much different than doing it in the clinic and I just feel like it's not worth it anymore. It would it's not you spend an hour wrangling them, getting I V and Sometimes if you can't the parents are angry at you. Like I've had an issue where like a mom was so mad she left in a huff and I'd already numbed the child and the child was like kicking her legs up under the table and I was trying so hard to get it done. It was just a front tooth and we were already numb but she lost it and I said, Like, I'm really disappointed in how this is going. And then mom said, I am too and I thought she meant like about the kid, 'cause like obviously I was doing everything I possibly could. And mom's holding her in the lap and got the nitrous going and and then ⁓ she goes and calls the dentist and tells her how horrible I was and somehow got in with another dentist who of course got the tooth out and it was great because they're already frickin' numb. Like I already did the hard part, you know. ⁓ But it's like, ⁓ it's just not worth it to me and if something happened I'd you know, it just happens so fast on kids that just don't have nearly the time. So I really like to utilize that option now. But I used to feel kind of strong armed into doing it 'cause again, I'm the only person in town doing any of this stuff in like a hundred mile radius or more type of thing and the hospital when I try to go over there for tooth extraction can easily cost at least thirty thousand dollars for like one tooth. So You feel kinda like, Well, I'm trying to help here and so then you're doing things that you're not really super comfortable doing. Not that I haven't done it hundreds of times, but it's just I just don't think it's worth it. I think as a parent I would want to have like a full team there taking care of Brendan: Wow, yeah. Sarah: Yeah. But I've also had the other s flip side of that when you ⁓ bring in ⁓ like a anesthesiologist into the practice for the kids 'cause in California we have a little bit of different regulations. We can't there's certain things you have to add if you're gonna see patients under thirteen and then you have to whole have a whole separate pediatric rider on your license for under seven. And so ⁓ if you have s a kid like I've had kids before and I bring in the anesthesiologist and I've had some that will tube them and I've had some that will do Mac. ⁓ and it's so interesting how like they all do things differently too. You know what I mean? ⁓ Erin: Yeah, we had coming in to help us 'cause the our surgery center wasn't open yet and they'd already hired him and so we're like, this is perfect. We already have one on staff, have him come over and I hated it so bad. Mm-hmm. He would I was like, ⁓ this will be so efficient and I'm gonna feel so safe. He would snow them so deep and I'd be like, We don't have to go this deep. We're gonna be done in like two minutes and I would be like all worried and Then it would take him like forty-five minutes to wake up, and you're like, this just isn't worth it. Like I don't feel and then he's billing for the anesthesia side, but using all of my instrumentation and drugs and stuff. So I'm like, boy, he's really loving this. Like, this just doesn't seem fair, you know. So you have to have some kind of arrangement to make Sarah: Never mind. Erin: That side makes sense too, but ooh, I hated it. It didn't make my life easier or better. So I'll go on your turf and then you do it there, but I d I didn't like it. Brendan: Yeah, use their materials, their their meds and stuff. That that makes more sense, you know. Well guys, thanks so much. This was what a day. This is a great day. Thank you guys for coming out and doing this and and back to back. Like this is this was great. Thank you. Erin: Yeah. Sarah: Thank you. This is awesome. I really appreciate it. Erin: Yeah, if you want part two, come to the resting stitch face podcast where we also had Doctor Gallagher Brendan: Wait, let's call it actually let's do this. Let's call that part one and then this won't be part two since literally it was Yep. Let's do that. Let's open this up as part two. Erin: Should we love it? Brendan: Thank you guys. Well, I hope you have the a great rest the week and I hope ⁓ you know we can have a part three in like months or or at least at least within a year. But it'll be fun. I really had a good time with you guys. Yeah. Sarah: I think we've got a lot of changes upcoming, right? Yes we do. There we go. Sure. Erin: need the updates for sure. Brendan: ⁓ wait guys. Erin: You'll be brave enough to talk about bone grafting. Sarah: Yeah. One day. All right. Well good luck with your hospital privileges. Brendan: Thank you, thank you. I still haven't received an email. I'm actually getting pissed. So I'll let you guys know. Thank you. Sarah: Thank you, appreciate it.