Empowered Sleep Apnea
Some podcasts give you INFORMATION. Empowered Sleep Apnea gives you knowledge. Join Sleep Medicine master-clinician Dr. David McCarty and Sleep Neuroscientist Dr. Ellen Stothard as they do a deep conversational dive into one of the most complex, common, and misunderstood disorders on the planet: Sleep Apnea. Using a combination of humor, fictional elements, and--yes--even CARTOONS, Empowered Sleep Apnea takes you where no other Podcast has gone before!
Empowered Sleep Apnea
Season 2: STORIES FROM THE FIELD. Episode 8: THE TALE OF THREE FACES
For a PDF of this transcript, click HERE.
To access the Landing Page for the PODCAST EPISODE, click HERE.
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To download "Crows Teaching Crows" [our third POP SONG SPECIAL FEATURE] click HERE.
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Let's start with this:
An Eagle Scout walks into a situation that requires situational awareness and an engineering mindset...
We are super -proud to feature Airway Dentistry pioneer and innovative orthodontist Dr. Bill Hang, as he narrates the story of a LIFETIME...the story about the things he saw...that made everything different...the notorious Thing That Can't Be Unseen...
Join Dave and Ellen as they unpack this incredible story, in light of the ongoing narrative of Emerging Science...paradigm shifts in science are a predictable part of being human…and they have always been a bit…um… rocky!!
As always, you’ll wanna stay tuned til the end for the prizes at the bottom of the crackerjack box…you don’t wanna miss yer Sleep Medicine Dad Joke!
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We’re also thrilled to release a new SPECIAL POP SONG into the wild, like a bird taking flight...a toe-tapping confection called “Crows Teaching Crows”…just a snippet will be played in this episode—the entire song will be released as a SPECIAL POP SONG EPISODE, as Episode 9 in this series…
So…buckle up…climb aboard the Blue Balloon…the adventure awaits!
EXCELSIOR!!
Our Website: https://www.empoweredsleepapnea.com
Official Blog: "Dave's Notes" : https://www.empoweredsleepapnea.com/daves-notes
To go to the BookBaby bookstore and view the BOOK, click HERE!
Empowered Sleep Apnea: THE PODCAST
Season 2: STORIES FROM THE FIELD
Episode 8: THE TALE OF THREE FACES
© 2024 www.EmpoweredSleepApnea.com
00:00 Change the Channel!
00:21 Disclaimer
Announcer: Empowered Sleep Apnea is an educational podcast, which is a bit different from a medical advice show. Clinical decision-making in Sleep Medicine can be complex…and even EMPOWERED patients need a partner! So, play it smart, and make sure you talk it over with your healthcare provider before making any changes to your medical treatment plan.
…and now…on with the show!
00:45 Opening Titles
Announcer: Empowered Sleep Apnea: THE PODCAST…Season 2: STORIES FROM THE FIELD…Episode 8…THE TALE OF THREE FACES…
01:01 Before We Begin
Dave: This is Dr. Dave McCarty, speaking to you from my sturdy wicker basket suspended from our beautiful blue balloon. I am currently…in transit, having departed 19th century Boston, which is where the balloon took us in episode 7, to once again float amongst the clouds.
Interestingly, we don’t seem to be flying far, this time, at least…not in terms of miles “as the crow flies”…below me, I can see the seasons changing, rapidly flickering past like images in a fluttering magazine.
It seems that our Blue Balloon is once again traveling through time, but…we appear to be staying here in New England.
The balloon’s navigational controls are once again useless, and we seem to be guided by the wind and perhaps the will of the balloon itself. Impossibly, we are descending, though the fire for the hot air balloon is burning as brightly as ever. It’s as if we’re being pulled to our destination by a strong but invisible rope.
As we get closer to the ground, the clouds part and we see a beautiful glade of trees, with some manicured grass in between—a park! As we get closer, we see a park bench.
On that park bench, sits our next storyteller.
Life-Fans, it’s my pleasure to introduce you to orthodontist, innovator, and airway-centered dentistry pioneer…Dr. Bill Hang…from his park bench, he’ll be sharing his fascinating journey, navigating the intellectual territory that comes after The Thing That Can’t Be Unseen…
…this piece is called The Tale of Three Faces…I hope you enjoy it.
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03:20 The Tale of Three Faces
The Tale of Three Faces
Written and Narrated by William M. Hang, DDS, MSD
Produced by Dave McCarty
Dr. Hang: I think I can trace this whole story back to my always wanting to do my best and my very strong work ethic—
…which, when you think about it, is a strange way to start a narrative that includes a dark spiral into terrible depression, and a sometimes terrifying and often humbling professional trajectory that made me question everything I’ve ever learned.
But: as the saying goes…spoilers!
I was an Eagle scout, growing up, which, as anyone can tell you who knows anything about it, is serious business. You ask an Eagle scout to do something, you can bet most of what matters to you that it will be done right, on time, and under budget. Dealing with issues inside the human mouth is tricky business, and it rightly should make most human beings nervous. When this Eagle scout went to dental school, I made it my business to master the material.
It’s just what one does.
As I said, my work ethic was really strong. I wasn’t the smartest in my dental school class but worked harder than anyone and graduated #1in my class.
What can I say? I looked at it as my responsibility to master the rule book. When I extended my training into orthodontics, another two years of study, it was the same. I mastered all the techniques I was taught and was so enthusiastic that I was asked to stay and teach at the university right out of orthodontic training.
Talk about see one, do one, teach one!
It became obvious to me that I really wanted to have my own private practice and moved to a small town in New England. Early in my career I remember seeing a pamphlet that was circulated by a dentist--who had not undergone two years of orthodontic training--that was saying something about how retractive orthodontics was “ruining faces”. Saying that retractive orthodontics was causing chronic pain in the temporomandibular joints, and was the cause of headaches.
For the uninitiated: retractive orthodontics was referring to the process of correcting malocclusion—crooked, wonky teeth—by pulling some teeth out or sometimes just pulling the front teeth back to make a nice straight row of teeth, and thus: a pretty smile.
Retractive orthodontics was what I did for a living! It’s what they taught all of us in school. It’s what I graduated knowing how to do.
I looked at that pamphlet and flushed scarlet with rage! How could this NON-ORTHODONTIST have anything useful to teach me?
I was incensed.
I threw the pamphlet into the garbage and told myself to forget about it.
But that night, I slept poorly.
In my ego-armor, a very small crack had appeared.
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I was having lunch with a friend—a dentist, smart guy, and good human—who was also my best referral source, when I realized that the crack had turned into more of a hole.
“Why do you take out teeth so often?” He asked me, between bites of Caesar salad. He looked at me, tone still friendly, but his face was serious. I thought about that pamphlet.
My mouth went dry. I took a sip of iced tea, while I tried to come up with an answer.
I didn’t have one…other than I was doing what I was taught to do.
As an Eagle scout, one learns the importance of discipline, respect for rules and order, and reverence for one’s mentors. These skills help one stay in line, when the going is good.
But one also learns foundational habits of self-reliance and situational awareness. One learns about tailoring one’s response to the complexity of one’s environment. These skills help one navigate in complex or potentially dangerous environments, where there is no map.
I was getting the distinct feeling that we were all in the second situation.
(Where there is no map)…
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I began to seek education about alternatives to retractive orthodontics. I learned that there were practitioners who were achieving pleasing aesthetic results—which is to say “straight teeth and a pretty smile”--without extracting any teeth at all - and they weren’t causing a whole list of problems either!
I began to incorporate this philosophy into my practice, even though it countered what I was taught. Would my cases work out as well as those presented by my mentors? I lived in a small New England town…a new provider practicing in a strange way would surely attract attention…if it countered what the other providers were doing, the attention surely wouldn’t be good. But, on the other hand…if retractive orthodontics does have a narrative for causing harm, how could I continue to go along with it?
What was an Eagle scout to do?
I decided to stop pulling teeth.
Once I seriously considered the question, the answer was obvious. I decided to stop pulling teeth.
Once I’d determined it was possible to achieve a pleasing aesthetic result, without pulling teeth, I couldn’t unsee it. I decided to stop pulling teeth.
I saw myself as an architect of the oral cavity. My job, as I understood it, was to optimize the growth and development of the oral vault, in order to have room for 28 teeth or - even better - all 32 teeth. My job was to allow each mouth to achieve its full genetic potential. I decided to stop pulling teeth.
Along my journey of continuing education amongst the practitioners of non-retractive orthodontics, I knew I could do it.
I decided to stop pulling teeth.
The answer was obvious, going forward.
Looking back, I knew that kids still in braces from my tooth-pulling days would be coming in over the next year, for follow up. Looking back, I quietly wondered what I’d done…
It was during this timeframe in my journey as a provider, when I was simultaneously looking forward and looking back, that the existential excrement hit my existential fan.
It’s here that I’ll tell you about the first of the three faces in today’s tale. And the mom that came with it.
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Face #1: The Irate Mom’s Son
The year was 1985, and the kid in Chair # 1 was excited to have his braces off. One of the last of those trailing follow-ups, a kid I managed “by the book” with 4-bicuspid extraction, to make room for the rest of his teeth to line up like little soldiers. A nice pretty straight smile.
Looking at the straight teeth, healthy gums, excellent articulation, I’d say it was a result worthy of praise from my teachers.
Having removed all the hardware, I walked the boy out to the waiting room, to present the flashy new smile to his parents, as was my custom.
I felt my stomach drop when I saw the boy’s mother get up from her chair and walk towards me with a face caught somewhere between sadness and rage. Her voice was controlled, but loud. “You changed his face!”
Other parents in the waiting room were looking at me.
I looked at the boy, feeling more and more nauseated as I knew she was right. His once full lips had become thin and his midface was caved in, slightly, like an old man.
I’d ruined his face. And his mother knew it.
My mouth parched. My head swam. I thought of that pamphlet. The narrative of ruined faces. I thought of my dentist friend, the smiling-but-serious question: “Why do you take out teeth so often?”
My hands were shaking as I stood there, not knowing what to say.
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The next 12 months were the darkest moments of my life. Every time I’d have a follow up with one of my retractive strategy patients, I’d panic. Every phone call, every knock on the door was a trigger, the Sheriff, delivering a court summons. I lived in terror of being sued. I saw my life going up in smoke.
On the way home from my office, on a winding bit of road, there’s a sturdy old maple tree, right off the road, off a tight curve. Every time I passed by it, I wondered if this would be the day that I’d drive straight into it, and just end it.
There were days, I’m ashamed to say, that I needed relief that bad.
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Face #2: Informed Desperation
I made it, through.
Thanks to a loving spouse and a talented therapist, I waded through those dark days and long nights. I didn’t get sued. I didn’t get run out of town on a rail. I didn’t drive my car into that tree.
I made it. I safely ushered the last of my retractive cases through their last visit.
This all brings us to a new narrative, one that goes beyond the aesthetics of the facial features, one that’s arguably worse than a doting mom’s opinion as to her special boy’s good looks.
The new narrative on my radar screen went like this: retractive orthodontics creates functional problems with the jaw, and can be the source of suffering in the form of TMJ dysfunction and chronic pain.
If one consults the literature, one quickly realizes that there’s no easy answer as to whether this is “true”—there are reputable authors in respected journals that argue the case both ways.
It’s like having two road maps to a destination. At a critical crossroads in the journey, one tells you to turn right, the other one left.
Any Eagle Scout would tell you that, in a situation like that, it’s time to break out your field navigation skills!
In a situation like that, you pay attention to your environment, to see what you might learn.
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I first met Peg when she was 23. The year was 1985, which, you’ll recall was the year of my descent into darkness on account of the story I just told you, about the ruined face and the mom who knew it.
10 years prior to meeting me, when Peg was 13, she had two upper lateral incisor teeth removed for her orthodontics. One of the teeth was very small - what is called a peg lateral incisor. The orthodontist knew it wouldn’t look nice being so small so he had it and the same tooth on the other side removed for symmetry. The two upper front teeth were then retracted - brought back - to close the spaces. The story was familiar.
That’s what she was here to talk to me about! See, her story was that ever since that orthodontic treatment when she was 13, she’d had a constant headache that was taking away every pleasure in life. She’d read about the controversial narrative of retractive orthodontics “causing” TMD and associated headaches.
To her, it explained everything. She had read about how I practiced a more expansive orthodontics approach. She asked me to find a way to give her back the teeth that had been extracted.
She asked me to re-engineer what she felt had been taken away.
At the time, to my knowledge, nobody had ever done this before. Traditional dogma was that it simply couldn’t be done. If it was possible, I certainly didn’t know how to do it.
I felt bad about it, but there was nothing I could do. I told her I couldn’t help her. I sent her away.
She left, disappointed.
That night, I slept poorly.
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Peg’s question left me uneasy and restless. She’d asked me an engineering question. I wasn’t happy with the roadmap I had. I wasn’t happy that I just didn’t know.
Over the next four years, I chose my mentors wisely. I studied with John Mew and a lot of other practitioners to try to find answers. I learned new techniques that would have been considered heresy, back in my dental school days.
Peg came back to my office in 1989. Her story hadn’t changed. The headaches were severe, chronic, continuous. She was convinced her symptoms began as an immediate after-event from retractive orthodontics. She was nothing short of desperate.
She begged me to find a way to re-engineer what had been taken away. She wanted me to open the spaces where her teeth used to be, to allow the teeth to be replaced. She was asking for a mechanical feat of bio-engineering, plain and simple.
But what she was really asking me for was to have her life back again. She knew it, and I knew it.
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There are situations like this all the time, in a boots-on-the-ground practice, where it’s just not clear how it’s going to go, and there’s no easy way forward. Not every case fits into a textbook-ready answer. In such cases, one must disclose known risks vs expected benefits of a given course of action. This is particularly true if that course of action is bringing you into uncharted territory.
Having no idea what to expect, I told her the worst things I could imagine. I did not want her to feel surprised by any outcome, looking to me with a “why didn’t you tell me?” look. I thought about the boy with the ruined face. I thought about that tree on my way home.
I couldn’t guarantee this would make her headaches go away. She didn’t care. I told her she might end up with an open-bite. She didn’t care. She might lose teeth. She didn’t care. She might end up with ugly gum recession.
She didn’t care.
She wanted me to re-engineer what had been taken away.
Thing is, by then, I thought I might know how to do it. I’d just never done it before. She knew the risks and was desperate enough that none of it mattered.
And so, we did it. The decision, in the end, was as obvious as it was difficult.
And you know what? Our plan worked!
We re-opened the spaces where her teeth had been. Her general dentist replaced the extracted teeth. She didn’t lose teeth. Her gums looked beautiful. We got her smile back in line.
The engineering…worked!
But the best part? Her headaches vanished. Gone. Absent. After 10 years of constant pain, she experienced the bliss of just…being. Without pain. Her relief was extraordinary.
As an added bonus, her lips—which had lost their support of the teeth and were pencil-thin—an old woman’s lips—filled out beautifully…so much so that her own mother announced: “Peg! You have lips!”
Such a better refrain than: You’ve changed his face!!
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Face #3: The Logger’s Wife
You might have noticed…I haven’t said anything about sleep yet…or Sleep Apnea. I guess I’ve talked about nights when I’ve lost sleep. But nothing yet, about that fundamental activity we all love and need: nothing about breathing during sleep, or the lack thereof.
For the early part of my career, there was no obvious connection between my job of orthodontics, and BREATHING. It just wasn’t something we were taught. Our job was to engineer straight teeth and pretty smiles.
The size and shape of the mouth matters, when it comes to breathing. But I wouldn’t learn about how my job impacts that narrative, until I met the third Face in my tale.
That Face belonged to Joan, the logger’s wife.
I think of her as “The Logger’s Wife”, because she came from way out in the country. She had no driver’s license. It was a hardship for her to get to my office.
My first memory of Joan is about how much the suffering of her pain had caused her. Joan was 35 years old, though you’d swear she was 55 by looking at her, such was the burden of living with chronic TMJ pain for years, with no answers. Every orthodontist in her region was recommending that she have four bicuspids extracted, with braces to re-establish alignment.
In other words, every orthodontist was proposing retractive orthodontics. Joan had a strong intuition that this was a terrible idea, an intuition that led her to my office, with the hope of a different answer, even though it was a long drive away.
I wouldn’t find out until later that the intuition was based on a symptom that she hadn’t thought it important to share, until later. Symptoms that had to do with sleep. How could that have anything to do with TMJ pain?
On my evaluation, I found that Joan had a retropositioned—or “backward set” mandible. I felt her bite was the likely source of the strain on the TMJ. I recommended that we create an appliance to posture the lower jaw forward, thinking this would best resolve the TMJ stress.
And you know what? It worked! Joan was pain-free and happy for the first time in years. At this point, I simply patted myself on the back for successfully relieving strain on the TMJ.
Like I said before, my learning arrived in something she told me later, after her appliance broke.
And when it broke, a catastrophe exploded.
Now, as I tell you what happens next, keep in mind that this tale comes from many years before anybody had described treating sleep disordered breathing with a dental device…CPAP had only commercially been available for a handful of years.
She came back to the office in an urgent panic, stating that we had to replace the device right away. But it wasn’t TMJ pain she was concerned about.
She told me two things that day that I’ll never forget. The first thing was that when the device broke, she went back into feeling like she would drown or choke to death during sleep.
She went back.
She’d been there before! Feeling like she would drown, or choke to death, during sleep!
Good Heavens! What was going on?
The second thing she told me was that these symptoms were so distressing, and her daytime discomfort was so severe, that she went back to feeling suicidal, and it scared her.
Oh, dear! She…went back! She’d been suicidal before, too!
That’s how bad it was, to not rest. To be unable to breathe.
That’s why she came all this way.
She instinctively knew what would happen if they made her mouth even smaller. If she’d allowed four teeth out, with even less space for her tongue.
She’d choke to death, she figured.
I felt like I’d been shocked by a live wire. The forward positioning of her mandible was affecting her airway! The appliance was allowing her to BREATHE.
I raced to see the lateral head x-ray, and I measured the space between the back of the tongue and the back of the pharynx, where the airway was most narrow. I got my calipers out: 2-3 mm.
What was it supposed to be? I had no idea. We’d never been taught to look at it! I took a minute to phone a friend—an oral surgeon—who gave me an answer that knocked the wind out of me.
A “normal” airway should measure >10mm at that point.
She was working her jaws all night because she couldn’t breathe!!
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I began my journey as a dental professional with the diligence of my Eagle scout upbringing. But my work ethic and academic record just didn’t prepare me for the challenges that confronted me in the real world.
It took the drama of a mother’s rage, the desperation of someone with nowhere else to turn, and the intuition of a country woman to teach me some lessons that they don’t teach in school…
They changed the way I practice.
The roof of the mouth is the floor of the nose. The size of the oral vault matters. Nasal breathing is functionally healthier than mouth breathing. A face that develops with mouth breathing is different than a face that develops with nose breathing.
My career spans what I believe is the begin ning of a turning point in the way orthodontics is practiced. The data are coming in.
My colleagues are beginning to collaborate, to learn from each other, and get their data published.
Non-retractive orthodontics, often including BOTH lateral AND anterior-posterior expansion, has a great future…as I look back, I’m grateful for the lessons I’ve learned from all the faces I’ve cared for. I appreciate the opportunity to share the story of these three faces with you.
As a mentor of mine once wisely said: “Don’t let your education get in the way of your learning!” I think that sums up my experience, rather nicely.
My name is Bill Hang. And this is my story of EMPOWERMENT.
26:28 Cue Majestic Theme Song and Welcome Back!
Dave: Welcome back to Empowered Sleep Apnea…the PODCAST where you learn about the complexity of Sleep Apnea through the power of stories with a patient-centered perspective…I’m Dr. Dave McCarty…and I’m back in the Empowered Sleep Apnea KNOWLEDGE BUNKER with my good friend, Dr. Ellen Stothard…welcome back!
Ellen: Hey Dave!
Dave: I can’t wait to talk about this story!
Ellen: I loved this one…this is honestly my favorite one…it’s another scientist, just like me! I can see myself in this person…a lot more than I’ve seen in maybe other perspectives.
27:15 On Eagles and Crows
Ellen: In the perspective of an intellectual…people don’t talk about what do you do AFTER you’ve learned everything you’re supposed to know when you go through school…
Dave: What happens when you figure out something new? What happens THEN?
Ellen: YES! He said: “Don’t let your education get in the way of your learning.” And I was like Oh My God! It makes so much sense!
Dave: …and here’s a little real world coincidence…the mentor who happened to say that…to whisper that in his ear…is a man by the name of Dr. Jack Hockel…and Dr. Jack Hockel is the father of Dr. Brian Hockel, who is the bass player in the PULMONAUTS!
Ellen: No way!
Dave: I dunno…it’s funny how this language of EMPOWERMENT is bringing us together…
Ellen: Yeah, absolutely! And it’s not all the same type of person, either. Everybody comes from a different background, different training, different personality, different viewpoint…and they’re all coming to the same conclusion…
…you can’t just accept the doctrine as it is.
Dave: I loved his bit about…you know…It’s like I’m on a map, and it says both ways are fine … and it’s like: Well, NO…
…what’s an Eagle Scout to do? And it’s like the tagline for this episode is…you know…”An Eagle Scout walks into an engineering situation…hilarity ensues!” You know?
Ellen: (laughs)
Dave: This is what happened! This is an actual Eagle Scout…and I’m telling you...this is a rare breed of person! This is actually the person we WANT on the pioneering edge of what’s known and not known…because they have skills about navigation and situational awareness…so arguably somebody who has scientific skills on a pioneering edge…an Eagle Scout is our best bet for finding something new!
Ellen: That’s so fascinating. See…I grew up maybe in a weird place where 50% or more of the friends that I grew up with in high school are actual Eagle Scouts!
Dave: That’s probably why this is like… normal conversation to solve problems this way!
Ellen: I’m like: cool! Yeah! He’s an Eagle Scout!
Dave: This is your normal.
Ellen: Yeah, yeah! These are my people! Yeah, that’s really funny! And engineers! All my friends from college are engineers!
Dave: Yeah. It’s a certain mindset.
Ellen: Yeah.
Dave: It reminds me of why I’m so attracted to the crows…you know, as my spirit guide, I guess, on this journey…every time I do my morning walk, I see them…and they’re just…they’re up to something…and it’s clearly—they’re making things…and my mom just sent me an article in the New Yorker today…talking about the intelligence of crows…
Ellen: Ohhh…
Dave: …and about how much they learn, and how smart they are…and how they teach each other for generations about stuff…and I’m thinking…this is a good metaphor for what I want to do with this information…like, this is crows teaching crows.
Ellen: Oh, yeah!
Dave: We wanna know functional aspects of breathing…we wanna know what’s healthy about development of the mouth and the face…and we wanna help other people know it, too.
30:10 The Bloody Birth Canal
Ellen: So you used Robert [character from Season 1] as the first example of these “faces” for you.
Dave: Sure.
Ellen: And it’s…
Dave: …that was my story…it was an amalgam of stories, for sure, yeah, that was my “faces” story…
Ellen: …but I bet if you pulled those stories apart you could come up with multiple faces and tell the story in the same way…there’s probably a lot of doctors that have that similar type of story…something that they can’t “unsee”…
Dave: MmmHmm.
Ellen: …that has changed the way that they practice and interact with their patients…but these are so STARK! The face of the boy that shrunk…
Dave: Oh, God!
Ellen: …and, like…all that sort of stuff…that you—we can all see that…instead of like: “Oh, yeah, this person had…” you know—whatever…
…it’s The Person with The Persistent Headache
…it’s The Person Who Was Suicidal Because of Their Inability to Sleep
…it’s so, so, so…STARK…
Dave: …and again, you know…what’s an Eagle Scout to do?
Ellen: MmmHmmm.
Dave: …and I’m glad the Eagle Scout chose to do what he did…
Ellen: MmmHm.
Dave: …because it was the right choice, obviously…well, the first one was a lesson…that he learned something from…and it was a devastating lesson, and I wanna talk about that in a minute…and the second two were choices that were made as the result of field-engineered solutions…and this is what we’re asking of these people…
Ellen: …and harm that occurred from missed or lack of diagnoses…
Dave: …yeah, or perhaps a different approach…
Ellen: …yeah…
Dave: …that was being questioned…you know it got me thinking about the Semmelweis story…which of course our listeners will be familiar with, but for those who aren’t…Ignac Semmelweis was the “Father of Modern Handwashing” …and he figured out that it was “germs on hands” [N.B.: this was before “germ theory”—so Semmelweis didn’t know what it was that was transmitting disease, only that it seemed to be transmissible from cadavers to humans on providers’ hands] that was causing childbed fever…and he sort of published his real world experience with an announcement basically…and he didn’t really do any sort of research…he didn’t do much to sort of support it..but he really started mandating that people accept his ideas.
On account of that “real world information,” there was another man, a man named Gustav Adolf Michaelis, who was a German obstetrician…and he got wind of that real world data…at a time when his clinic was having problems with puerperal fever…it was at a time when he was caring for his niece…
…now, his niece died under his care before he implemented the handwashing techniques. Out of interest, he was an early adopter…
…and he implemented those handwashing techniques, and found his mortality rate dropped to almost zero.
He never forgave himself for the loss of his beloved niece…and he ended his life months later…
Ellen: Wow.
Dave: So this is the true suffering…and I couldn’t help thinking about Dr. Hang and his maple tree…
…and, good God! This is the weight! And we are in a bloody time of an emerging new paradigm. I think of ourselves as in some sort of a bloody birth canal
Ellen: (laughs) …interesting!
Dave: …the emergence of science is scary…and for the people whose paradigms are different…they have to re-evaluate what they’ve been doing…it can be a very very frightening time…
Ellen: Mmmm. Yeah. That’s interesting…the way that you say that to me, I think of the first hours after a wildfire starts…when you don’t know which direction it’s gonna go…you don’t know when the winds are gonna affect it…
Dave: …you’re not sure if this affects you…yeah, yeah.
Ellen: MmmHmm. And so you kind of like…you almost just have to sit and wait and listen and take all that information in, before you can make a good judgment
Dave: …yeah…
Ellen:…because it’s so…it’s so confusing…it’s such a confusing time…
Dave: MmmHmm.
Ellen: …there’s a lot of talent and strength and learning that can be done from that sort of patience…and the ability to take all that information and to decide from it…and who has the skills to do that? Who has the training or the mindset better than an Eagle Scout?
Dave: I think what he caught wind of is…”We’re in a situation where there’s no map”…because right now the maps do not agree with each other, so I’m gonna have to learn to navigate this on my own…
Ellen: MmmHmm.
Dave: It got me thinking about something you said before we had our conversation…our pre-conversation conversation!...where you said: “Science looks different to someone in the field.”
Ellen: I think a lot about when I was a researcher doing my graduate degree…and we got people who would call us all the time and say: “Oh, you should totally study me! I’m a terrible sleeper!”
And I was like, so focused on the stuff that we were doing where we took healthy people and we disrupted their sleep so that we could kinda “piece apart” the little things that were changing…
Dave: …you were studying what happens to “normal” people when you poke ‘em with a stick…
Ellen: …exactly…
Dave: …ok…
Ellen: …so you can understand the underlying mechanisms…but if you take a system that’s already disrupted, and you disrupt it further…you’re not gonna know where the results are coming from…
Dave: …it’s hard to learn from that situation…
Ellen: …it’s too messy!
Dave: …yeah…
Ellen: and so, I was always—when those people would call I’d just be like: “Ah, Ha Ha…” and you meet someone on the street or on an airplane or something… and you tell them that you do sleep research…and they say: “Oh you should study me!”
Dave: MmmHm.
Ellen: …and…I never really thought about the fact that…I just took that data and just put it to the side because it didn’t apply to me…
…but the fact is…we had such a hard time recruiting these healthy sleepers…and we had a plethora of people who were everywhere…
Dave: …who were desperate…yeah!
Ellen: Yeah! Comin’ out of the woodwork! “Study me! I’ve got all these problems!” And the fact is…as a researcher, you don’t necessarily realize that THAT’s the population that you should be paying more attention to…and we need those researchers to be TALKING to each other, right?
35:56 The Language of Science
Dave: You know…the modern study of sleep sort of began in the 30’s-ish, after the advent of the EEG…and for a long time the vocabulary was just “What is sleep?” and “What is Sleep Stages?” and “What does it look like?” and all of this stuff.
We didn’t even know what “normal” looked like.
Heck, REM sleep didn’t even enter our consciousness until 1953!
Ellen: …and in so many ways, we’re still working on those questions…
Dave: Yeah!
Ellen: …as we need to be!...
Dave: Yeah, what is normal? We’re still—we’re still trying..
…so the idea that science somehow looks different from the field perspective…I guess I’m trying to call attention to a concept that’s been battling out of my mind, which is that “The Scientific Process” is a lens with which to view reality as it’s experienced.
And so if one is a clinician, working in the clinical realm…there is a scientific way to approach that clinical parade of patients coming through your office, you know? Things like real world data and consecutive patient observational trials, for example…we can learn a lot from that.
Right now, these field engineers have been working kind of without that idea that we’re doing this to publish—they’re in the 1930s -1950s for us—you know—studying “sleep”—they’re like: “Well, what really works?” And “How does this face work when you do THIS to it?” and they’re working up this set of principles that seems to hold scientific validity…
…now we have to start publishing…
Ellen: …the researchers…it’s sort of on both sides…it’s not only on the people—because obviously the clinicians out there are treating the sickest people and trying to fix what’s going on…what’s really bleeding in front of them…
Dave: Yes.
Ellen: …and the researchers often have a mindset of like: “Ok…we need to start from a clean slate and recruit the healthy people so that we can perturb the system and see what happens…”
And do it in a scientific manner.
Dave: …or if we’re gonna study “Restless Legs Syndrome” then we have to study someone who ONLY has restless legs syndrome.
Ellen: Exactly.
Dave: …and it makes no mention of the fact that that problem has a bidirectional relationship with Sleep Apnea!
Ellen: Yeah!
Dave: …so those two together are probably gonna be worse than one or the other by themselves.
Ellen: Yeah! And it’s a hard conversation to have when you’re-- … It’s almost like the Boy Scout being like: “This is the Map. This is the Map that I’ve been taught, and this is how I do it.”
And it’s really hard-- you have to be put into that forest before you realize: “Oh, I need to use these other skills that I have to realize how to get myself out of here without a map…
Dave: Yes.
Ellen: …and so having the ability to open the communication between the research world and that mindset…and LEARN from each other, because…you won’t necessarily know that there’s a bidirectional relationship until there’s evidence…
Dave: Mmm Hm.
Ellen: …so the researchers can’t know that that bidirectional relationship exists if the evidence is not documented…
Dave: …until the field engineers who are out there…witnessing this…scientifically observing what they’re doing..and—hopefully—reporting what they’re doing somewhere…
Ellen: …yeah!...
Dave: …right? Because that’s the idea of publishing, somehow. Is that you’re reporting what you’re doing so other people can say “Hey! That’s a different lens!” you know—“That helps me in understanding my lens.” Right? Putting the whole together…
Ellen: …and in another way, it’s speaking the researcher’s language…
Dave: Mmm Hm.
Ellen: So, the researchers need to learn to speak the field-engineer’s language, and the field engineers need to learn to speak the researcher’s language. So that they can—you know—have the same conversation, using the same vocabulary, and GET THROUGH TO EACH OTHER…right?
Dave: Yeah.
Ellen: Because THAT’s the problem is…um…there’s not a level--…there sometimes can be a lack of trust between the two, because they’re speaking different languages…even though they may be saying similar things.
Dave: Mmm Hm.
Ellen: …or things that could help each other…
Dave: yeah.
Ellen: So, yeah…I think about that, and how sometimes we can get in our own way…because we don’t go outside of our silos…and we come back to this conversation every time…there’s a different flavor of it…every single time…which is wild.
Dave: For me, it keeps coming back to this ability to have an empathic connection with someone who has had a different field of view…and recognizing and respecting their journey, how they got there…and not just dismissing it because it doesn’t line up with the dogma you’ve been given…you know…I think that’s why that quote hit us both so hard…you know, Jack Hockel’s quote:
“Don’t let your education get in the way of your learning.”
We’ve talked before about receptivity…
Ellen: …yeah…
Dave: …to something new…and I think that the humane part of me is starting to believe that this beast [Sleep Apnea] is truly so complex…and now I’m beginning to understand just what that complexity does to people.
Ellen: Mmm Hmm.
Dave: It’s a terrifying thing to sort of step back and see the whole thing…and it’s much much safer to say “Oh, that stuff doesn’t exist” you know—“Sleep Apnea is…” fill-in-the-blank for what your silo says…you know…and fill-in-the-blank for your one size fits all solution…
40:58 Airway Board: The Culture of The Future
Ellen: Where do we ever “practice”…together? …in medical…in the medical field? It’s called a PRACTICE, right?
Dave: …yeah…
Ellen: …it’s called a medical PRACTICE.
Dave: …yeah…
Ellen: …but they don’t practice together!
Dave: Right. Often they’re practicing with their head down…trying to click through the computer…you know, I mean…it’s heartbreaking…
…the culture that I foresee…someday…and—my wife—I’ll do a shout out to Dr. Emma Fortney McCarty…and she came up with the concept;…”Well, what you guys need is something like the Tumor Board, for cancer…
…so when I was in the military, whenever anybody got a diagnosis of “cancer,” it was understood that this was something that was gonna cross silos…there was no way for the surgeon to keep up, or the oncologist to keep up with what this patient was gonna need…and so…periodically, we would meet…and it would be the nurse practitioner, and it would be the social worker and the case manager…and whoever had a seat at the table for the management…and we would talk about the progress…and everybody would weigh in on what should happen next…
…so it really allowed for coordinated, truly collaborative effort…as I’ve been talking about all of these issues, you know “Many Moving Parts” of Sleep Apnea…and “Many ways across the river”…and how it’s too complex for one silo…
My wife says…”Well, what you guys need is an Airway Board”
My vision of the culture of the future is that we’ll be able to have a forum where we can talk about these things …where there’s gonna be a dentist, there’s gonna be a chiropractor, and a physiotherapist and a myofunctional therapist…an internist like me…you know?...and we all sit around the table, using the same language…
…so, using the language of the Empowered Sleep Apnea project…Five Reasons To Treat…Five Finger Approach…we can break it down…
…all of a sudden, we’ll realize…how much we have in common. Right? And then we’ll realize that it really is all about the patient in the first place!
And then, suddenly…magic is gonna happen!
Ellen: Yeah!
Dave: Right? Crows teaching crows…and I think…as a good tagline for this episode: I’m proud to welcome this Eagle to our Collaboration of Crows…huh? (laughs)
Ellen: That’s a good one. That’s a Dad Joke and a tagline, all rolled into one!
Dave: There you go! (laughs)
Ellen: That’s perfect!
43:17 Cue Majestic Theme Song and End Credits
This is Dr. Dave McCarty…Empowered Sleep Apnea is a production of Empowered Sleep Apnea, LLC. The show’s opening spoken word essay was written and read by William M. Hang DDS, DMD.
The show was otherwise written and performed by me, David E McCarty MD FAASM and the marvelous Ellen Stothard, PhD.
The cartoon for today’s episode was found crudely stapled to the cover of a 1949 issue of Amazing Stories magazine that was discovered inside an abandoned research station…in Antarctica!
To see it, come to our website at www.EmpoweredSleepApnea.com/episodes...click on the link that takes you to Season 2…Episode 8…The Tale of Three Faces
The music for today’s program contains a special nugget…a little musical poem I made up, about our experience together, playing music with the PULMONAUTS, my musical collaboration of CROWS, I’ll leave you with just a snippet of it. The entire song will be released as a special POP Song Episode, as Episode 9 in this series.
The Blue Balloon seems anxious to go at this point, bouncing a bit at the end of our land-line, stretched taut like justice.
So, go ahead and strap yourselves in, Life Fans…as I take out my coveted Cub Scout knife, and cut the line…
…and with a stomach dropping lurch of acceleration, we go skyward…buffeted onward by winds that smell like springtime rain.
I hope you enjoyed today’s program Life Fans…and I hope you’ll join us on our next big adventure to hear our next story from the field…
Make sure you stay tuned, because after the song snippet…your Sleep Medicine Dad Joke!
For now, I’m gonna leave you with a little snippet of “Crows Teaching Crows”…goodbye for now, Life Fans…
Excelsior!
45:14 Song snippet: “Crows Teaching Crows”
...And just like crows teaching crows
We'll get to know each other better
We'll high-five when we're together
Now that we've got a different lens
And just like everybody knows...
Our best music is together...
We'll play that rock and roll forever
In our family of friends....
45:50 Sleep Medicine Dad Joke
Dad: Well, all right, son, good day out in the fields today….nice work!
Not-Dad: Thanks, Pa!
Dad: Just get the barn door closed here, get our horses tucked away…ok! Let’s get back to the house…
…say, son, that reminds me…you know I finally figured out why nobody sleeps well out here, you know in the barn…
Not Dad: Well, whatcha mean, Pa?
Dad: You know, none of the animals sleep well at night…
Not-Dad: …oh, yeah, why’s that Pa?
Dad: Nobody sleeps well…because there’s too much HORSING AROUND…get it? Too much HORSING AROUND?
Not-Dad: Oh. Ya scared me! I thought there was something wrong with the chickens.
Dad: Nah, nah, It’s only a joke, laddie…watch your step, lad
Not-Dad: Oh, sure, Pa!…don’t wanna step in that!
46:46 Show End
