20 Episode results for "American Academy"
Navigating Innovation for Family Medicine with Paul Dow, eHealth Innovation Strategist, American Academy of Family Physicians
"Welcome back to the outcomes. Rocket saw Marquez is here and today have the privilege of hosting Paul Dow? He is the current e-health innovation strategist for the American Academy of Family. Physicians based in Lee would, Kansas with the advent of covid nineteen. The goal is focusing on practice tools that will be robust in the rapid transition that telehealth and virtual patient engagement during the emergency, and beyond policy and innovative thinker and a strategist than the space and I'm excited to be diving into what they're up to at the. American Academy of Family Physicians and for him to share his message around practice viability, and then and his him, and his organizations search for long-term solutions to help with cove in nineteen, and beyond a Paul, such a privilege to have you here if you can give us a little more insight into you and your bio, and and then we could dive into into the the interview. Sure. It's great to be here, Saul, thank you for having me. I. Am a helping petition and have worked for the Academy for about a year prior to that I was at the. Leading Cardiac Society Washington DC for about six years, and then prior to that. Were for medical device vendor for about ten in their clinical education space. Clinical Background is in radiology. Sea Tac X. Ray tech from back in the day but moved were into health it that really kind of seemed like the future and turns out he was so I'll have a variety of other predictions by the end of the podcast, and maybe a few lottery numbers. I love it. I got my plenty handy. Yeah insightful Paul. I definitely was the future, and it is the president now. Health it. The use of technologies like a I digital health. They're here with us and have been accelerated What what is it? That inspires your work in healthcare? I mean you've been in it for for a long time. What keeps you working within the bounds of healthcare? All to me that it's endlessly I guess endless curiosity. He's be interested There's there's so much to learn and file and. It. It feels like there's always a new development into new insights that come out of research or technology. Advancements and trying to apply those into a clinical space you know. How can we make this this thing? This taking care of people more efficient and more effective, not not in the sense of trying to make positions more efficient hamsters. But more, how do you? Leave them off. The monotonous tasks that their their skills are not suited for. Physicians you know floor five stenographers by one then to use their clinical expertise and their deep insight into the diagnostic process as well as also their deep empathy. They got into healthcare because they care about people and if we can have tools. Free up their time then they can focus on hearing for people and You know that that to me is really a huge motivator. A finding solutions that actually work aren't just cool. I'm doing air quotes now But, actually actually are productive and help them on a day to day basis. Love it yeah, it's it's a great great calling, and as as we dive further into into your organ, the organization Europe part of It'd be. It'd be great to to know how you guys see yourselves position to add value to family physicians but also to educate us on on what your community looks like in the breakdown of of physicians that you guys are are helping. Share, so we have about seventy five thousand members of ASAP. if you include residents and medical students that swells to about one hundred, but as far as practicing clinicians in the field, it's about seventy five thousand We have fifty thousand who are employed at a variety of locations, every qualified health centers Medical Centers and the other twenty five thousand are independent practices so basically these are small businesses that are run by clinicians. And we're trying to find solutions to help. Help all of them. You know certainly There is no one perfect technology that's going to fix everyone's issues, but if we are you know patch, some of these technologies together and then provide some insights on workflow your best practices. We share within within the House of Family Medicine. you know then we can start to build some trends and build some some improvements that can be sure to one day. That's great and so give us some examples PA. Love to hear you know some of the some of the resources that you guys are coming up with for for your members, and you know maybe some examples of how something has surfaced that has helped, and how it's helped a great story to share shares always good and miss part. Sure sure so we've been working with a company called. sukey s you KFI and they have a digital digital clinical assistants that works, so it's a little bit like a Alexa, but for you HR's so that they are able to interact with their ehr just with their voice patients reviewing results so that they aren't there and typing in in keyboarding quite as quite as much. You know we're seeing. We've heard stories from clinicians. WHO said that they have? Have about two to three hours per night of data entry basically that they had to do after clinic and then after using Sukey, they were able to leave the clinic on time, and actually leaving on time felt like vacation. Then I think it'd be able to have that. You know ten hours per week back into their back into the bay could choose they wanted to do. They could go to their kid's soccer game or exercise and show some self care. What do you can just? Talk to talk to their family and have dinner at the same time as opposed to bag around for a quick snack at ten o'clock at night, you know and then going to bed Sukey. Sukey data. Yes sukey? Just used them in. Yes, they are a fantastic solution. You know we're we're you don't recommend specific products at the academy were trying to recommend our classes a power, but definitely sukey is one that we've worked with and installed with our innovation lab with a couple of practices in Tulsa Oklahoma in Chicago and some other places. You know that that to encourage tools our goal. Goal is to find tools that are that are effective and our transformational to be able to say you know this I can't live without this tool. This isn't just a you know five or you know. Seven percent increase in efficiency is a of thirty percent forty percent increase it efficiency docs actually feel like they are getting substantial benefit from there and gossip. I think that's great. You know and I love the word transformational over a word like disruption, and you said it. Paul like live without it right, she once you see it, it just totally changes is for good the way that you do things for the better and. You know it like you think of a product category of AI for HR, not necessarily Sukey, but just that category. It's transformative because it's such a pain point for a lot of physicians right this this HR and putting data and their and less less time with patients, and you gave me a visual. That was like so on point is being a better. It's more than just being a better hamster on a wheel like it's about adding fulfillment. It's about adding adding joy and so I think it's great, and in in a great example, yes. Yes. We've heard that from a number of permissions. You know that they are the push again. Pre covid was for productivity. You know that they had to try to cram in that that extra patient per day or two extra patients, which over time had had been leaving to burn out, and that is a huge symptom that I. I don't think it's going away. Get Situation It'll be different but certainly the the you know, the the emphasis is going to be on, you know how do you? How do you efficiently? Treat, patients, you know it's the year twenty twenty. We're still writing. You know keyboarding in you know the patients you know reports, shortness of breath you know. Is there a way that we could pull that data in from a wearable device or team based documentation where you have other other members or even open notes where the patients themselves can say I've been feeling very tired like so that it's not just falling onto the shoulders of the MD or do to document this. Yeah Nine I love that it's a it's a great opportunity to to think about some of these things to to innovate and transform. Everybody's practice and you mentioned that today. A big focus area is is practiced by ability. Tell me a little bit more about that. And how you guys are helping there, certainly with the shift to almost one hundred percent telehealth. Patients are now being screened for cold like symptoms, but we've seen that. A lot of the chronic conditions are of going on the back burner. People coming in for their have a world look at or their yearly skin cancer assessment You know might not be at the top of the list, so practices aren't doing procedures. They aren't doing other other other care mechanisms to be able to provide services to patients. We're seeing if you. If you're doing everything remotely, you might not need as many office assistant. Yeah, so the practice size is going to be impacted, and what makes it extremely difficult is the unknown length of time you know how long would be in this situation you know. Certainly some states are anything there. stay at home requirements. You know. I think people will be nervous sitting in a room of people coughing much less at a movie theater on a cruise, but in a doctor's office, right? You know so I think that that's going to be a challenge going forward. You know what we can do to help with that you know. Maybe it's a simple along the lines of how you know. Apple runs their stores their retail stores. You know you have all this lots of times a little more effectively, so people who do need some interesting attention. you know can arrive effectively and safely you know sequestered assets into a separate area you know, but we try to figure out what those best practices are. You know I don't think I. Don't think anybody knows yet so We'll take a little trial and error and try to figure those out. That's for sure, and it's It's great to have an organization like a F- P to to provide some guidance, and you know articles in and resources to the membership family medicine practitioners A. What would you say has been one of the biggest setback you guys have experienced. That produced the key learning. I I think just the resource availability has has been A. It's been a challenge for us. You know we hear from from tech companies to say Oh. We got the greatest thing since spread, and in only cost you know fifteen hundred dollars per provider per month and you know you gotTa. Practice of seven doctors get real expensive, real quickly, you know so trying to find that sweet spot I mean not that we expect everything to be free or only you know nineteen ninety five per doctor per month, but you know that it. It kind of meets that that point that says hey it. It is a bit of risk financially, but not such a huge risk. It could sink. Sink the practice, so we really have to try to balance. Those those things Moso that that we've had a couple of times. We've seen some presentation and we're thinking. Hey, this is great and then make it to the pricing like you know quietly trying to. That's our breath and say who have an eye watering price where you aiming for with this solution, because it's not family practice Dr. Yeah it's it's a challenge. So how are you finding the best way around that? And have you found vendors that align well with with the budgets? You know factored in for for solutions that you're looking for all we have. We have found some. I think certainly it. It takes a little. Give and take on some of these things you know where we've got some volume we with members. We can offer and say look you know we if you can need slightly lower price point, you're going to have a wider range of potential customers subscribers to service and and some of the WHO to to work with us on that. What's your really exciting as we find? Someone says you know we've got this product. It's still in the developmental stage, and we are trying to figure out how it best fits family practice, and that that that really is exciting to us. US, because then we can bring in talks and say you know. Does this meet your needs? Is this something that's you know? And if not, why not and how can we help? Make it better and companies are willing to listen you know. We really have not heard a lot of well. You know you, you. People just don't understand what this is, and its technology beyond you really have been responsive to okay well. How does how does it get better? How do you get your world? which is which is exciting and gratifying to be to be listening to and to? have. Our members say hey I really felt like you know they want to make some. They're not just trying to be as just A. You know a credit card number and you know something for their their monthly sales goals. They really WANNA. Help me, you know. Doctor You know in you know count smell Montana a better person. Yeah, love it and love it. Yeah, it's it's a there's a great opportunity here and so Paul you know as you as you look for for solutions to help the members. And somebody listening potentially says hey. I have a solution. I could be pretty price competitive. What's the best place for them to to reach out to? You is and and and get more information to you to see if there is a partnership opportunity. Email is is the classic way to go P. B. O. W.. A.! S. P DOT org. is a great way to get a hold of me. We're attending a variety means we used to. Meeting. You know we we I went to their the health conference the. Conference, in Los Angeles last year, and that was fantastic. you know we were planning to go to hymns, but obviously that was You know passed over, so we've already had our registered roll over for next to. and attending some of those events, so we're actively out there. Talking to talking to companies and startups were or interested in in in family practice in family medicine and say hey, this is this is a place who WanNa play love it so there you have it folks. All shared his email. Make sure you reach out if you have something that you believe could be of service during covert, and beyond, because they're interested in both not just Cova Times, they're looking at the long-term practice, transformation and aiding of family medicine. What are you most excited about today? to me seventy the potential for change. I think the vivid to telehealth was incredibly fast. You know the the responsiveness of medicine to say we have a situation. Let's let's adjust you know shows to me that there you know the ability is there so you know if can, we can demonstrate value and and you know show. This is a tool that can help. You know people I think are now going to be open to the idea of asking for help and saying yes. I need this. Let's let's let's try it and see what works and what doesn't and then share. Those lessons learned and then learned for next time. So you know it's it's. It's like like the old saying from Nelson Mandela the either win or learn, and this feels like there's going to be a lot of learning going on in the next. You know eight twenty four months. That's well said Paul anything yet. You really summed it up well, and it's about it's challenging. Times without a doubt and the epidemic is is really hurting a lot of businesses. A lot of. Businesses and practices, and it's that framework of. Learning that will have to embrace to to make it through and be stronger as as a as a as a healthcare group. I on the other side of this I'm appreciative of your of your words of wisdom there Paul, and and and so as you as you've been spending these last few weeks. You know learning what What what books would you recommend to us to sharpen up our our perspective and and Knowledge in in these times? Older is there is a couple? I beat medicine by Eric, Topol about artificial intelligence, making healthcare human again. Basically, he says the idea is that a I can handle a lot of routine tasks to allow. Clinicians to offer deep empathy, to their patients, which I think certainly strikes a chord with all the physicians I'm recommended to, and then also book by Dr Shannon Valor Technology in the virtues, a Philisophical guide to a future work wanting. it's definitely a deeper peace. It's looking at philosophical traditions and asking you know. How should technology be? Benefit mankind and benefit all people. You know so it it. It's a little more philosophical, a little a little deeper read, but but definitely kind of a you know. Where do we want? We want to control the technology I suppose. Controlling US how should we think about it, so it's definitely a fascinating look, a deeper look at. And, and some of those tools some great reads. Thanks for that ball and folks. You know where to go outcomes. Rocket dot health in search BAR TYPE IN afp American Academy of Family. Physicians, you'll find that in the in the show notes. We have a full transcript of our discussion and links to to the books and other resources that Paul has shared with us Paul up before we conclude I'd love if you could just share a closing thought and the best place where the listeners could get in touch with you I know you shared it already, but. This would be a good place to repeat it sure you can get a hold of me through email at. A P dow at AARP dot award. Certainly, the the mailbox is always open they I guess my My my thought is there's so much healthcare is so bad. Get you frequently. Hear the phrase boiling the ocean. when trying to solve some of these things you know dating or operability all of these things so I I ran across a quote from. that said there's only one time that is important now. The most necessary person is the one with whom you are in the most important thing is do that person good? So to me. That feels like. It feels overwhelming to try to solve the world's problems. don't even have to try to solve salt for that. Just help the person that you're with and do that person good and that that will pretty far. Great message all that's a great way to to end our conversation today, and again I appreciate you sharing what a p. is doing for your members, and and obviously the folks listening our make up some of membership and so and also for the ecosystem of companies that feel they have an opportunity to to to collaborate a resource that's priced right for for family practices definitely reach out the Paul and Paul just want to say. Thanks again for for spending time with us today. Very much saw it was honored. Be a part of this Hopefully you can stay safe and be well.
Nature Week Morning I Spy (2-25-2020)
"Chompers is produced by Gimblett and sponsored by milk. Good Morning. It's time for your morning and night toothbrush and show rushing on the top of your mouth on one side and make sure you brush the bowlers always in the back to three its nature week and today we've got some ice buys for you. That means all describe something. I'm seeing to you and you have to guess what I'm talking about. Here's the first one. I'm in a rainforest surrounded by giant trees squawking birds and tiny lizards screwing around. I also see an insect with big beautiful blue wings and tiny little antenna on top of its bitty head. What do I spy shouted out switcher bashing to the other side of the top of your mouth and make little circles with your toothbrush around each tooth? There are more than fifteen thousand different types of butterflies in the world before butterflies grow their stunning wings. They start off. As caterpillars caterpillars of like a worm and once a caterpillar is ready it will form a cocoon around itself kind of like a little shell and cocoon it. Turns into a Fabulous Butterfly switcher rushing to the bottom of your mouth and brush your front teeth to. Here's your next. I spy standing on hot sand and as they look around me I see flat dusty ground and cactuses a hawk screech and Tumbleweed Rolls. By in the dry wing. What do I spy? Where am I shall no Sir switcher brushing to the other side of the bottom of your mouth and don't brush to heart? The desert seemed dusty and empty. But they're actually a lot of creatures that lived there. Many of the animals that live in the desert are nocturnal. That means they're awake at night. That's because the desert gets too hot during the day so animals only come out in the cool of night. That's for jumpers today but comeback tonight from more is by until then make sure to risk to chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or skin. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Grosser Week Morning Song (2-21-2020)
"Chompers is produced by Gimblett and sponsored by milk. It's time for Chompers your morning in nineteenth brushing show. It's grocer week. And today we have a song rushing on the top about thick aside in the tiny circles. With Your Brash. Remember to listen for this sound and when you hear it switch. You're brushing guys. I've got no no nothing. It's a thousand. I'm just minding madness and up. My friend don't want to snap. Don't want Jerem. Just listen to something that you can be after. Sneeze this something you can do. Pass Cow Jumpers. But don't forget to three chompers. A production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or skin. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Grosser Week Night Song (2-21-2020)
"Chompers is produced by Gimblett and sponsored by milk. Welcome back to Chompers your morning and night tooth brushing show. It's Grocer Week. And Tonight we've got a song about something really gross but first time to get brushing and remember to listen for this sound and when you hear it switch you rushing law outside it is so so hot. Wa Life. My face is getting down my armpits. Our even mommy's beal is soup. This pouring out of me can has coupon mountain down in the heat but just when I stopped. Bill gets a million zillion stopped a light breeze a sweat. That's how when the temperature rose this comes. League is scaled. Wet The air of bales. Who is the Max you not? Elo ANIMALS SWEAT. That's a special treat that humans get someone had gets. Hof It licks its for an win up pig guest roles in Muddy Dir Swear that's offered trumpers. Don't forget to why Chompers is a production of Gimblett. Media Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Nature Week Night What's That Sound (2-27-2020)
"Chompers is produced by Gimblett and sponsored by milk. They are you ready for more chompers because here. We are back with more nature week but I start brushing on the top of your mouth on one side and give your tongue quick rush to tonight. We're playing we'll play sound for you and you have to guess what it is. Here's your first one. Did you catch that? Here's that sound one more time. So what's that sound? Shutout thunder switch. You're brushing to the other side of the top of your mouth make sure to reach the molars and the way back. Thunder is the sound made by lightning. But we see lightning before we hear thunder so it doesn't seem like the same thing but they are light. Travels really really fast much faster than south so we see the lightning before we hear the thunder. So what you're rushing to the bottom of your mouth and don't forget to brush your front teeth. Here's your next sound. What was that here? It is one more time. GotTa guess shouted out Hippopotamus. Hippopotamus hippos are the world's second largest land. Animal the only land animal. That's bicker is an elephant Switzer rushing to the other side of the bottom of your mouth and keep brushing both spend most of their time in rivers lakes to keep cool. They can swim extremely well and can stay underwater for five minutes. But don't be fooled by the size of hippos hippos are really fast can actually run faster than humans. That's it for chompers today now. All you have to do is rinse with. Water and Chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Grosser Week Night Whats That Sound (2-23-2020)
"Chompers is produced by Gimblett and sponsored by milk. Welcome back it's time for more chompers your morning and night tooth brushing show start brushing on the top of your mouth and brush all the way to the molars in the back. It's grocer week tonight. We've got more play gross. Sound for you and you have to guess what it is. Here's your first one. Oh excuse me. Here's that sound one more time. So what's that sound? Find out at you switch rushing to the other side of the top of your mouth and brushing tiny circles all the way around each tooth. That's out is a BURP. Burp BURP or a belch is what we call it. When our bodies release gas through our mouths burbs can happen because as we eat sometimes some air which contains gas sneaks into your stomach along with your food to get rid of that extra gas in your belly. Your stomach will push of ball of gas up into your Asaf against the long tube that connects your mouth to your stomach that ball will rumble up through your assault against until you and let it out. Switzer bashing to the bottom of your mouth and keep on brushing. Here's one more sound for you What was that. So what's that sound? What's a fomer folders are birds that Kinda looked like seagulls? But they do one thing that seagulls definitely don't do you'll find out a switcher rushing to the other side of the bottom of your mouth and brush your teeth to folders. Are known for spitting a Super Stinky Keith. Oil At their enemies. If feels threatened by another bird it'll vomit a special oil that it keeps in its stomach. That oil stinks like rotting fish and it can be so sticky that gums up the other birds wings making them unable to fly. That's a pajamas. Today we'll be back tomorrow until then. Chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Sounds Week Morning Jokes (2-15-2020)
"Chompers is produced by Gimblett and sponsored by milk. O'hagan it's Thumper chompers rushing stop rushing on the top of your mouth Russia all the way around each to three yeah. It sounds week today. We want to hear you giggling because we've got some jokes for Ya. Here's your first one. What's the only kind of wave that no surfer can serve? Why is it a sound wave? Bro switcher rushing to the other side of the top of your mouth and brush the molars in the way back when we think of waves we usually think of waves in the ocean like the kinda surfer conserve and subsurface conserve on very high waves like higher than house. But there's no way a surfer conserve on a sound wave Switzer rushing to the bottom of your mouth and brush the inside the outside in the chewing side of each tip. Here's another joke. Why didn't the ears start a band? Why how well? They had eardrums but no ear guitars. What you're brushing to the other side of the bottom of your mouth and keep on brushing you need more than drums to start a band. Let's say you're starting a jazz band. You might want a Trumpet Guitar Bass and Drum and when you put them all together. They sound like chompers tonight. Who REACH OUT BRUSHING? Come back tonight for more sound jokes until then rinse with water before you three to stay. Chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year. Olds they recommend two to two and a half cups of Milk Day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to all the amazing benefits. Dairy milk has to offer.
Sounds Week Morning What's That Sound (2-14-2020)
"Chompers is produced by Gimblett and sponsored by milk. It's never choppers your morning and night tooth brushing show start brushing on the top of your mouth and make little circles with your brush around each tooth three. It sounds weak and today. We're playing that. We'll play a sound and you have to guess what it is. Here's your first one more. Was that here. It is one more time. So what's that sound shouted out alarm clock switch? You're brushing to the other side of the top of your mouth and brush all the way to the back. Your alarm clock might have a different sound like this or like this idea. Is Normal clock that you can set up to make a sound at a certain time you might use one when you WanNa make sure to wake up in time for school and your grownup might use their cell phone. As an alarm clock Switzer rushing to the bottom of your mouth and brush your teeth to we also use alarms to be alerted for reminded about other things like when you cook without an alarm you might forget. Your veggies are in the oven. And then they'll burn to A. Chris turned me off the smoke alarm. Okay here's your next sound. What was that sounds a little like an alarm clock? But you don't have one in your house here. It is one more time rushing to the other side of the bottom of your mouth but don't brush too hard. So what's that sound shouted out school? School bells ring to tell us when activities begin and the first ballot. The day tells you that it's time to get to work for. You might prefer the bell that tells you it's time for lunch. The last ball of the day tells you it's the end of your schooling. And does that sound tells us that you're all done brushing today? Come back tonight for more. What's that sound? And until then we jumpers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Sounds Week Night What's That Sound (2-14-2020)
"Chompers is produced by Gimblett and sponsored by milk there. Are you ready for more? Chompers your morning and night toothbrush. Shell good because here. We are back with more. Sounds the first start brushing on the top of your mouth and make little circles with your brush around each three Brian Tonight. What's that sound? We'll play a sound for you and you have guess what it is. So here's your first one. Whoa what was that here? It is one more time. So what's that sound shouted out? Blow Hard Switzer rushing to the other side of the top of your mouth. All the way to the back. Boats have special warns that they use to communicate with each other different. Honks mean different things. This helps them travel safely and avoid accidents so Let's hear some boat talk. What's ask our boat translator? What these boats are saying to each other boat translator. So why the first boat said I wanNA pass you on my left side and the second vote said I don't understand you switching rushing to the bottom of your mouth and brush your front teeth to. Here's your next sound What was that one more time? So what's that sound shouted out? Siren Switzer rushing to the other side of the bottom of your mouth but don't brush too hard firetrucks have to get going as soon as possible. And they use their sirens to alert people that they're on their way. When you hear a siren getting closer you should stay on the sidewalk. Even if it's your turn to cross the road if you're in a car you're grownup might have to pull over to the side to let the fire truck. Shoot by chompers tonight but make sure you. The e Chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or skin. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Grosser Week Night Jokes (2-22-2020)
"Chompers is produced by Gimblett and sponsored by milk. Welcome back to jumpers your morning and night tooth brushing. Show start brushing on the top of your mouth. Pick aside and brush the inside the outside chewing side of each two three Its Grocer Week and tonight. We've got more gross jokes to make you say while you. Here's your first one. What did the bugger say when the kid picked his nose or Snot it? Here's another gross joke. Why did the nose not want dessert? Why because it was stuffed switching to the other side of the top of your mouth and brushing those molars all the way in the back. Here's your next gross joke. Why are invertebrates such cowards? Why because they're spineless. Invertebrates are animals. That have no backbones like cockroaches. Jellyfish and octopus one of our favorite gross invertebrates is the slimy earthworm. Earthworms don't have feet. So they drag their bodies through the dirt Switzer rushing to the bottom of your mouth and brush your front teeth to earthworms may be a little bit gross and slimy but they do an important job they take care of our soil dirt earthworms eat stuff on our soil as they crawl through it once. They take all the nutrients they need from it and they poop out the stuff. They don't need Switzer rushing to the other side of the bottom of your mouth brushing all that worm poop has lots of Minerals. That are good for the soil and help plants ground so thanks earthworms. Here's one that's gross joke before you go. What do you call a comet with an upset stomach of vomit? That's ever choppers tonight. But we'll be back with even grocer grossness tomorrow until then rinse with water before you chompers is a production of Gimblett. Media Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year. Olds they recommend two to two and a half cups of milk a day. Ideally low fat or skin. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Nature Week Morning Riddles (2-26-2020)
"Chompers is produced by Gimblett and sponsored by milk. Good Morning. It's time for Chompers your morning in nineteen brushing show its nature week and today we've got some riddles to work your brain. I start brushing on the top of your mouth on one side but don't brush too hard. Here's your first riddle ice snow and steam or rain and thunderstorms this is solid and liquid appears in many forms. What is it when rain hits the ground? It doesn't disappear. It goes onto another step in the water cycle. The water cycle is all of the water on earth constantly. Moving around. I'll explain more after you switch your rushing to the other side of the top of your mouth. The water cycle is the way that all of the water on earth moves around. Clouds are full of water when they get really full. That water falls to the Earth as precipitation. You may know precipitation as rain or Snow. What you're rushing to the bottom of your mouth and brush your teeth too. But how did the water get in the clouds? Well that's through evaporation. Won't water down. Here on Earth evaporates when the sun heats it up on hot day. And when water evaporates it heads up to the sky and it becomes water vapor and clouds and then the cycle starts all over again switched rushing to the other side of the bottom of your mouth and depressing. Here's your next riddle sailors sharks and algae can all be found in me. I cover most of planet earth and I am larger than the see. What am I? E L. The ocean covers of the Earth's surface more than seventy percent. That means that if your ten fingers were the entire earth the ocean would be seven of them and only three of your fingers would be land chompers today a comeback tonight for more nature. Riddles until done. Three chompers is a production of Gimblett. Media Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Grosser Week Morning Whats That Sound (2-23-2020)
"Chompers is produced by Gimblett and sponsored by milk. Are you ready for some more clean teeth rate because it's time for more choppers your morning and night tooth-brushing? Shell start brushing on top of your mouth and brush all the way to the molars reading. It's grocer wake and today we've got some totally gross. What's that sound art? We'll play sound and you had to guess what it is. Here's your first one. I have definitely heard that sound before. Here it is one more time. So what's that sound? Find out after you switch your rushing to the other side of the top of your mouth and brush the inside outside and chewing side with each to that sound you. What be cautioned? Did we trick you? Maybe you bought that down with part. But it's actually a whoopie cushion a whoopie cushion around rubber bag. Kind of like a thick balloon people. Use them to jokes on each other. You fill the bag with air and put it on. Someone's chair when they sit down on the whoopie cushion. It makes a sound like fart which rushing to the bottom of your mouth and give your tongue brush to. Here's your next. What's that sound? I think I know this one here. It is again. So what's that sound? A flushing toilet flushing toilet. We use toilets to get rid of our P. And there are lots of different types of toilets. All around the world switcher rushing to the other side of the bottom of your mouth and keep on. Brushing urinals are a type of toilet only for P. and they don't have a seat so you can't sit down on them but days type of toilet used in countries like Italy and Japan with the water shoots out to clean you up after you're done using the bathroom but no matter what kind of toilet e US make. Sure you when you're done. That's chompers today. The comeback tonight for more throws until. Ben Wyatt Chompers is a production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two two and a half cups of milk. Day ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Nature Week Morning What's That Sound (2-27-2020)
"Chompers is produced by Gimblett and sponsored by milk. Good Morning. It's time for Chompers your morning on nine hundred freshmen. Shell stirred brushing on the top of your mouth on one side and brushing little circles around each three royal its nature week and today we're playing. What's that sound What play sound you would hear in nature and you have to guess what it is. Here's your first one. Well okay. Here's one more time. So what's that sound? A parrot switcher rushing to the other side of the top of your mouth and don't forget to brush the molars in the way back. There are more than three hundred kinds of parrots around the world may come in every color. Imaginable and parents are some of the most intelligent birds on her. They can solve puzzles. Create tools and sub can even learn to speak with humans. Plus they can live for a long time. Some parents can live to be eighty years old switzer rushing to the bottom of your mouth pick aside and brushed the inside outside a chewing side of each tooth. Okay here's another sound. Did you get that here. It is one more time. So what's that sound? Crickets make that CHIRP chirp sound by rubbing their wings together. But did you know that it's only male crickets that can make that sound? I'll tell you more after you switzer rushing to the other side of the bottom of your mouth and make little circles with your rush around each tooth. Male crickets have special teeth on the bottom of their wings. Kind like the teeth on a comb the tops of their wings. A little scraper kind of like a bow. He would use for violin when they rubbed the bottom and the top together. You get milk. Crickets can use their songs to attract a lady cricket or to tell other male crickets to back off today. But come back tonight for more natural. Sounds at until then heads with water. Before you chompers is a production of Gimblett media. Choppers is brought to you by milk. Grownups pop quiz. Can you name delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
1183 Jill Meyer-Lippert RDH of Side Effect Support, LLC : Dentistry Uncensored with Howard Farran
"It's just a huge honor for day to be podcast interviewing Jill Meyer, Lippert RDA ch- from Manitoba disconsolate she began her dinner career in nineteen ninety two as a dental assistant receptionist at the same time. Her mother is diagnosed with breast cancer helplessly watching her mother suffer horribly with oral side effects from chemotherapy, she developed a strong interest. And the oral concerns of cancer, survivors, Jordan or degree and became licensed as a registered that'll hygienics in ninety four and continued to pursue knowledge out this very underserved area of cancer care after losing her father to Hodgkin's disease in two thousand five she developed an Hance level of motivation to act and do more Joe created a volunteer program, providing oral care kits with product samples and patient education. At a local college department from two thousand six to two thousand twelve she earned a certificate on college management from the university of southern Indiana Jilin, her husband are the owners of. Site effect support dot com, which is dedicated to helping cancer survivors, manage short-term Orel side effects and prevent long-term damage to oral health associated with chemotherapy radiation to the head neck and some targeted therapies Jill is twenty fourteen recipient of the sun-star America's Ardy toward a distinction, a member of the registered dental hygienists advisory board for the oral Cancer Foundation and has been published in several dental and in college publications. She is a member of the American Academy dental hygiene, the American dental hygiene association and the American Academy of done long college. Joe thanks so much for coming on the show today. And get trained biting me. This is so tell us what what are you doing side effects support dot com? If if people go to that website right now, what are they gonna find? Other going to find information. We have articles blog posts that are directed more towards survivors and their family caregivers. But then we also have more technical information for medical and dental professionals to help get us more on the same page. And then there's also a product section that they can find your Ford -able products that are geared towards helping to minimize some of the symptoms and side effects and also protect long-term oral health in the process. So I see you got to a lot of amazia researches links to the National Cancer Institute on oral complications that chemotherapy and head neck radiation. It's just a what do you think? The average Denison hygienic are not staying on top of that they need to know. More of. There's quite a bit. It's very complex subject matter. And with everything else that were doing dealing with during her Dealey process of same patients. This is something that tends to get lost in the shuffle in our education. And it's hard to stay up on top of all these things because it is such a complex subject. So when my goals was to really make kind of a one stop shopping resource for people because that is something when I developed a passion for the subject a really struggled to find information resources. So I wanted to create something to make it a little easier for people to find what they need. Will you know, the the chemotherapies all came from the fact that when they were learning how to make mustard gases for wars. They realize that the cells are providing quickly and had a high turnover. Those are the ones susceptible to it. But a cell that wasn't multiplying was not. And so that's kind of tough for the mouth because the cells of the mouth have some of the highest turnovers. See if you compare it to Boehner nerve, so. That's so so how do they how do how do they help alleviate some of those symptoms? One of the biggest things we can do. And unfortunately, it's one of our greatest battles is getting patients in very early three soon after diagnosis before treatments begin allows us to be very proactive that we can remove your -tations in the mouth and get them started on preventive strategies that will help to reduce the incidence and the severity of sight of exit may not totally prevent them. But at least it may help to keep more of a quality of life for them and reduce their risk faction before during the process. Anelle saw help to reduce those long term damage issues into survivor ship, enter these mouthwashes, treating dryness. I mean, a lot of the chemo people get fungus infections Kanodia. What are what are you seeing is the most common side effect that you can that you can help them with? Dry mouth is is a big one. And the nice thing is we have so many patients with dry mouth at even aren't necessarily oncology situations that these are also helpful for them. But if you deal with the dry mouth, effectively and not just mask, the issues, you're going to be actually helping to prevent a lot of other problems like the site us because it helps to kick the two she there's even to avoid the fungal infections and things like that dryer people's mouths are the more susceptible they are to the problems. So the only prescription product that there is available on our site is the saliva max. And so I came but everything else is just affordable over the counter products that are have a healthy ph and void of your tasting, detergents. That may cause complications yet your -tations of the mouth extra soft toothbrush. Sometimes really just simple change. That can make a big difference for people and tell us about saliva max, you need a prescription for that. Are you a big fan of that? Yeah. I think the super stature calcium phosphate rinses are a great option for people in that. Also, if you can start that, you know, about two weeks before treatments begin they've proven to reduce the incidents in the severity of developing the dry mouth and the Kasitah. So it's a great preventive option. And also it, you know, it's really replenishing those natural elements of healthy saliva. That's missing a dry mouth with having the calcium on the fast that our our teeth are dependent on for mineralisation. Tissues dependent on for hewing properly. And how long has that been on the market? It's four forward science. Makes that correct. Yes. Say four years or so four years, and and is that your is that your go-to treatment for dry mouth. If if we're able to get people started on that early. I think that's a great option for them. We do have some people that whether it be financial issues or lack of insurance coverage that Bates who's not to go that route. At least we do have some over the counter options, they contri- as well as kind of depending on on that individual persons situation is pretty expensive. No in the nationally have a a copay assistance program. So there is insurance coverage through the prescription insurance plan for resigns can help to reduce or possibly eliminate the copayment of Ford forward science. It says on the they're proud Bruce of oral ide- CYP ide- paths. Ide- H P P, H D And saliva max. I'm you just mentioned saliva max, do you do you ever have an indication for all the other ones? Yes. The other aspects are actually four screening for oral abnormalities. So all of those other devices in products are part of their ID for life program. And that is part of your early detection for oral cancers or abnormalities with the fluorescence, and then more advanced testing kits like the site ID is actually liquid cytology. So if you see a suspicious lesion, and you can take some of the surface cells in them into a laboratory and have a report sent back to know if it's something that needs to be looked at further. And that's. Word that is. Ford scientists that's in Stafford Texas. Yes ford's. So so do you work. Do you work with the THEO Rover Whitman on that? Yes. Nor grab for many years. Yeah. And and Brian picolo Picula yet. Yeah. It's a great company. Great group of people working there. That is a they read a lot of the lot of things going on. So what? You also have. Moisten missed you have law singer. You have all kinds of products on dry mouth. What would what makes us a one product versus the other. Sometimes it is just very individual situation. And like I said, there's really no one-size-fits-all. I wish there was a magic bullet that work perfectly for everybody. But I have many patients bad have issues end just swear by a certain product. And the next person tries it, and maybe doesn't have as good of results with that. So sometimes treating these issues is a little bit of trial and error. So you can try one thing. And if doesn't you go onto the next and eventually you find the right fit for that person. And you're you said on the board of the oral Cancer Foundation dot org. What is that? Like. It's a newly formed a dental hygiene advisory board, and it's really focusing on helping to get the word out there and promote early detection and promote with oral Cancer Foundation is doing because they are really nice organization that does a lot of great things in terms of research and raising awareness and promoting early detection for oral cancers. In how it's toughened dentistry has you have to wear so many hats. I mean, you gotta learn how to root canal fillings, crowns, you got to be a leader HR advertising, Mark everything. And I've always noticed that. If you don't see a case every week if you don't do filling every week or a crown or an implant, you know, it's the if you do fifty two times a year, you can get really fast high-quality profitable, the broom with oral cancers, they don't see it that cancer patients. It's just not that common. Or do you think it is more common lake in dental office right now today as one hundred fifty thousand general dental practices? How often do you think they see cancer patient that is having the side effects? It'd be hard number two guests, but not only thinking of people that are actively going through treatments now. But every week, we're seeing people who are cancer survivors. So being aware of what type of treatments they had what type of site of ExCo along with those treatments and being able to deal with those into surival ship is also part of this. So it in the ideal world, we would see people preventively before they start treatments able to be very proactive to help reduce the problems be there for them during the process of problems arise. But then also be support structure, you know, into Beiber ship and understand what some of the damage on is that can happen what we can do for them. And then we're or your you you say that you have online articles for the dentist or the patient. So we're we're those on your. Tab for under resources for survivors and caregivers. Actually, there's a blog tab on top. Yeah. Yep. You can separate those from the survivor caregivers that are more layman's terms. And then the professionals medical dental professionals that are more technical. I love the anticancer club. It's about life. That is really amazing. So are you getting a lot of positive feedback for survivors that are use this website and articles and products? Yes. It was it was tough to get the word out there at first and tough for me to have people understand what it was about. Because I think that assumption mostly that it was only oral cancers that they may not be presented with these cases often than not of. So as people are understanding more than all types of cancers all types of treatments, and it is very very versatile problem. And when you talk to so many survivors that tell you their stories about the lack of information they received, you know, that that they had problems during the process, they weren't told ahead of time what they may experience. They weren't told what they can do to prevent and being so grateful, and they actually have something that helps them. In your also have articles from the American Academy of dental on college. Yet that that is a. Organization that really isn't connected on so much anymore. But I was I was very very fortunate to go down with Dennis Abbott in Texas key was one of the structures remain instructor in the organizer of the academy. And. We I was one of the only. Hi, Janice in the country that was part of that inaugural meeting. And it was very exciting instructive. A lot of great people that all have similar interests though. It was a really great experience being part about that was with Dr Abbott. Yes. Dennis avid. That's so. So what's he doing down there? He actually specializes with dental college. So he's spoken all over the country. Teaching other dentists about things that they can do in regards to cancer treating our patients going through cancer. What's some of the types of interest that I have? So it was really fine. Like finding a kindred spirit when I found him online. That's awesome. The internet is very very cool. So so what what else should what else are they gonna find on site effect support dot com? Just those resources the information the products and having massive support structure are the support system that I have a lot of. That Email me personally a lot you know, that they have questions about. Now. I'm now, I might be dealing with this. Now, I might be dealing with that you have any suggestions. And and they go back to their support groups, and they bring information for their other friends than there's other people that are dealing with the same types of problems. So it's just it's really awesome to see kind of how it's spreading of from word of mouth from the patience and trying to help each other through it all is it more professional or more consumer on your site. Both original starting a bulk section that is going to be designed for providing products for clinics house battles long term care facilities, as we have one paddock on their efforts time and to grow that obviously to to have more options. So I've also noticed I follow you on Twitter. Your Twitter is. As. Oh my gosh. What are you on Twitter? What's your Twitter? Support as support underscore. Jill isn't it? Yeah. Yeah. That newspapers have picked up on your articles. Yeah. So it's at support underscored Jill I noticed the Green Bay you're only half an hour away from Green Bay. So you've gotten some community press with that congratulations on that. Thank you. Yeah. It's on. I went to some of the score meetings, which was basically like a small business advisory group, and they helped kind of get things started for me. And yeah, they've gotten some good progress or Gooda exposure with some of those things would it would have been the the most help in growing this website in this business side effects support dot com. Why think winning or one of the recipients for the age order distinction Liz much larger than I had imagined it to be at the time. I really didn't understand what that word was when I was a recipient, but the connections and the community that it is brought as been wonderful site met, so many great people, and it just continues to blossom from there a lot of. Just networking and finding people with similar interests. And that entrepeneurship spirit that really everybody wants to to help each other. So it's a great group of people there. So that's the sun star America's award some star America's already award a distinction. Yes. That was you said larger than life for you. How how so is that tells more about that award, and how that got you so much attention. They give the board at RDA chapter one growth and the year that I was a recipient. We had eight of us that were chosen. They have sense. Narrowed it down to four people each year that they choose award recipients by Vegas or a really awesome nudity. Were it has meant to support each other? And in your endeavors and to recognize hygienics that are doing something unusual. They're going above and beyond a typical clinical work. We'll congratulations of that. That's a that's just almost them already H one roof that is the the main event and dental hygiene every year. Would you agree? It is a great event. I recommend anybody going. It's what I definitely would recommend. You. Do you go Koetting? All I wish I could I would love to. Go every year, but it's a little limited right now. But I'm able to get away to do that. But do you do you make any of these products or you just a one stop shop resource for all these products and decently distributor, one stop shop. There is one product that is a fairly exclusive to us. That's the look on. It is made from on economic hasn is a beekeeper here in Wisconsin. And she makes products from her for bees. And that is one of the products that we have so petroleum free entry about their Hearst chemicals that cuss your tation. That's the nursing lip balm yet. Wow. That is. So now, do you do you is it all virtual online or do you actually have to warehouse product, and and put it a box and ship it. Yes, I am. I'm like. Bill Gates on billing computer in his graduate. I have I have a bedroom that is converted into office. Storeroom? I am as we a packaging and mailing out. Orders and and doing sometimes kitchen table is just filled with of packaging supplies, and boxes and products is getting everything together. So you've been doing this since two thousand twelve to two thousand nineteen so you've been doing it seven years is is growing business. It it is in this. It seems like the last year has really been a year that it's it's starting to take off more and what you thought too. I think it's just more awareness. Maybe people understanding better what a need. There is. That seemed to be hard to get through to people at first, you know, really understanding why this was a need. Yeah. I also see that. You're a burst ambassador talk about that. Why why are you burst him Bester? I love that toothbrush. I was a sonacare fan for many many years, the burst for me is something that, you know, people are going through treatments a mechanical brush may not be the best option for everybody. But when they are ready for a mechanical brush, it has extremely soft bristles, they're very feathery. It's got three three modes of setting. So that has a sensitivity setting. So it doesn't have you know, the real intensify. Rations it's has antibacterial of quality to the bristles. And if you put too much pressure on behead like if you get up to tight spat in your mouth, and you put too much pressure on it'll actually shut down the motor of debt. So you're not you're going to minimize your risk for having tissue. Trauma by using it. There's really been a lot of innovations in teeth for I sleep. I mean, they they connected elect rushes to the smartphone. There's Burs IRS quip. There's all kinds of. Made a bamboo shoots for disposable. It's just a huge market because they're seven and a half billion sapiens living on the surface of earth, and they all should be brushing their teeth twice a day. And throwing it away every three months. I mean, if you do the math on that if anybody out one percent of the toothbrush market, it would be a major company. I remember when Bob and the founder dead, Matt he didn't like you need the tooth faces. He thought they were all just a generic anyone to have a high end toothpaste Rembrandt for composites. And I remember him telling me is this market, so huge if I just got one percent of it. It'd be the biggest thing I did. And he did and it went on. But but but as you were saying earlier that everybody's different. Everybody likes different stuff. Are you having success with a burst? Toothbrushes burst care dot com. Yes. Yes. I I found that Mike site -ment for the Christmas gift to the year. My family every every single family member. I have I think gotten a burst toothbrush from us. But is really a quality toothbrush. I think it does a great job with keeping down the bacterial burden inside of the mall, and it's a good salary. It's it's a really great product. In your your lot of interesting. I'm people go there. Just look at all these you have a lot of instinct, really or a chill. What is or Jill? Why is that on your site? That is actually like a cradle fair be type of device for the mouth. So some people they have to shoot your taste in soreness inside of their mouth rather than having a a drug to try to except problem. They can use cooled items to try to reduce on some of the swelling or tenderness inside of their malls. And actually when people have chemotherapy treatments done one of the ways of helping prevent getting mulled source is by sucking on like ice chips or something cold, and the concept is that it's shrinks, the blood vessels in your mouth or constricts them. And then it prevents the same amount of chemotherapy for reaching those tissues to contribute to oral rations. So the Kreil mid orange Phil can help to do that same type of cold cryotherapy for the tissue. That's Joey Santoro out of Sacramento. Yes. And a house up product doing. Good. We're kind of resource that we don't carry directly on our site. But Joyce had a lot of. A lot of cancer. It is family. He's lost a lot of people close to him through cancer. So it is a subject as really near and dear to his heart. And he's extremely generous that of people are going to treatments. He often offices truck for free for them because for him his more important that big at the help that they need as that seems like a your motivation to this really close to home losing your father, your mother had breast cancer. Do you see that a lot in the in the on college? Space. Yes. See that a lot that most people that are involved in some aspect is usually because they've been touched by personally they've seen it firsthand. And they wanna make a difference for others. You'll also you just have a lot of. I mean, there's so many amazing studies all kinds of products and other one is orelon de shine light save lives. Yes. And that's with forward science as well. That's part of their for life program. The oral ID is a fluorescent to vice that helps with early detection for Orlando, allergies or cancers when we're doing our screenings in the office and the other products that go along with at are like the site ID path ID's HP, and those are all agenda of tests that can be used to help to help with diagnosis. I always found it bazaar. How you know you go to the other end of the body on a female, and these these lights and types for Pap smear screenings and had the UV lights and the Pauline blue stains and all that stuff, and it was all paid for by medical insurance. And it was just the go-to. And then we're over here in dentistry, and it's like insurances don't wanna Bill for that stuff. And it's like at fifty. Thousand Americans drop dead for oral cancer every year cronk is the number fifty the in kicking out. And could you imagine the outrage if the metal community told women, a we're not gonna cover the Pap smears, all I'm blue and the purple light. And I mean, the women would go crazy. But then the other end of the mouth the mouth men and women. It's just it's just so it's one of the huge side effects of dentistry breaking off from medicine. And what would what do you think of the typical dental insurance billing for oral cancer screenings or cancer exams? Like you're talking about this this Ford science with with the oral. I d I mean, almost none of that has an insurance code is that correct? For some of them. There can be some some codes used there is a code for using that adjunction of fluorescent Tobias weather's going to be covered or not. Probably not been not awkward. But do you think it's bizarre that fifty thousand people dying from oral cancer? Yes. Just this lame attempt to go after and subsidize any technologies I because money manners. I mean money the answer. What what you can't do all these things with with unicorns in two-thirds? It takes cash and a lot of the I watched it for thirty years. A lot of these oral cancer companies coming out with all kinds of technologies they were assuming the dentist would take it as serious as like. OBGYN and there's no financial support for it. Cracks, you know, it's one of those things that we battle all the time thinking, that's the most is somehow not connected to the rest of the body. And I think that's part of so much with side effects support that that people aren't getting that information the support they need because whatever's happening in their model, you know, the positions are making that connection. What affect that has on the rest of their body and their metal dishes. But yes, it's it's very sad that there's so many people out there that are being affected by cancers. The numbers are rising. They're not they're not going away. They're not getting smaller through the years. Cases, oral cancers are growing, and is something that the dental industry has very much take seriously to make sure that we're screening properly. And if there is something starting to catch up, the earliest stages were seeing some interesting statistics at my age of fifty six I never thought I would see life expectancy pretty much always went up every year and for the face, and then it's gone down the last two or three years, and some of these cancers, you just I always assumed that I was in college at there would just be less. They would just go down every year with more and more knowledge and technology, but smoking one that shocked me like smoking floored bottomed out a couple years ago. And now smoking is coming back up. They attribute a lot of that. Because vaping all kinds of things. So oral oral cancer is going to. It's going to be here. A long time. It is and the the highest growing demographic is not to what we were used to through the years. If it's now, the younger nonsmoking males because of the human capital virus? Some you know, we may see a trend changing with bad as more young boy start getting up tomatoes along with all the young girls. 'cause there was such a push for the young females to be back stated. But now they're also trying to get more young males vaccinated. So hopefully as time goes on the more vaccinations that occur, but fewer cases will start seeing some of these or cancers as well. And you know, the anti vaccine, but doesn't surprising all because I was on the dentist with a Jack Gilbert that got Phoenix date in eighty nine. And I mean, it was like one fourth of all air Zona people. They had the most insane theories about communist plots. And big government one world government. And he and so the people the same. I can't believe it's twenty nineteen. And now, we're having measles outbreaks and antibac- you're talking about HP vaccine. I mean, there's just a good solid. I think it's about right at about one in five Americans are completely shit. Crazy. I I can't believe we'd be seeing the measles. Outbreaks. I mean disease that should have just been gone. And this h I mean, I'm embarrassed my homeys where when this HPV association of oral infringe, you'll cancer came out, hardly any dentist. Dental offices are talking about this appearance. I mean, I mean, it's more important to the hygienist the dentist to get in there and do the pro fee and cleaning and and do do all of that. And it's like my gosh, this kids twelve I mean, wouldn't it have been better to give them a flu shot, but they can't legally. A flu shot, but then walk cross street to Walgreens and have a non pharmacist tech give a flu shot and the flu can kill thirty two eighty thousand Americans each year, the HP vaccine, I mean, why do you think dentistry isn't giving staying on top of flu shots ATV vaccines? I mean, you're you have a four year degree that's a registered nurse in any hospital in America where they're giving shots all day long for this of what what why do you? Why do you think that culture so vastly different? That is a hard one to explain. I think there is such disconnected in our patients minds on. Fortunately, that goes over to the professionals mines while that. You know that? Not even on the on the radar. I think for a lot of dental professionals to be thinking about that. But that is the one thing that I really liked with forward sciences wells that they offer great information that we can provide for patients that talks about HP. So I still practice, and it's something I try to do pretty consistently. When I get kids in tantalum twelve years old. I have a pamphlet that I can hand them and talk about you know, to mom and dad this information for you that of your pediatrician has already talked to you about age. Dhec seen ask them about it. You don't give them some background on it and be proactive on our end. So even if we can't be the one of administering the vaccination, we can at least form them about it in courage conversation with their pediatrician. I mean last year twenty eighteen point the flu winner twenty seven twenty eight hundred eighty thousand Americans died of the flu including a hundred eighty babies children teenagers more than any year since they started tracking pediatric does and like and still. A pharmacy tech would nine months of school across the street from my officer Walgreens can give me these shots and the dental office. I mean, we legally can't even do it. I mean, it's just really bizarre and with fifty thousand oral cancer deaths and having technology ATV vaccine, you would think access to health that a flu shot and HP vaccine would be four more important than determining if they had five cavities and ginger Vitus. And I guess you never know where held tied term through times. Because I think a lot of bit anti vaccination mindset comes from. Not believing. It's real, you know, we've never had to deal with measles, you know, growing up. So it wasn't real to us. So until unfortunately, people start to see these personal experiences of people being affected by I think all of a sudden for probably gonna start seeing a trend going the other way again at the understand the importance of. I mean to put them perspective. The Bonnie plague killed a third of Europe. And it took Europe two hundred years to regain its pre plague poppulation, and what's the answer to that? I against vaccines. I mean, it's just just people are there, so puzzle. You're very close to Canada. What percent of your business of your shipping is America only versus Canada or other countries? We've been staying a'miracle only at this point as we grow more. There might be some other opportunities especially with the goal. Look at the bulk end of options first civilities for hospitals things like that. But I'm right now with a shipping, even though that we are so close it's still is on it makes it hard to to do. So so when you would he ship mostly UPS FedEx. Usually postal surface. And it's significantly more expensive to ship across the border into Canada. The few times that I'd done it yet. Wow. That's that seems like such a ninety percent of the Canadian population lives within one hundred miles of the sport. Or you would think that would not be. An issue. I noticed that one of your products. You sells closest which is in my backyard with Perry. Radcliffe. Started that I remember going to dinner with Perry. Three decades ago. Getting a bottle that it used to be called retarded before is closest you remember that? No. I don't remember that. Yeah. I called retardant. And then they changed the name to closest. So are you what do you think a closest and like it? I think those that product line is very gentle. It's Toyota, so many irritating, tergence and other chemicals that really helped to initiate some of that tenderness of the tissue or me help to result in some of the oil rations and things like that. So. You do like it then. Yeah. His Perry was a period on us. And he was good buddies with Omar read all here in Phoenix. And now his son James Radcliffe runs Roper pharmaceuticals maker closest he was on the show. He was show four hundred eighty four. But yeah, Perry also. I don't know why we don't do anymore in his office. He would always take a swab live and put underneath scope. And you know, and it was just so the teaching was so impactful because you know, back then in the eighties. I mean, you had to explain what gum disease was the people. I mean, they just and there were just so many people that just cannot believe they that was their mouth ice still think it's one of the biggest blast from the past that we have to bring back. I think putting your saliva under a scope and letting them see the zoo of the San Diego zoo what's going on in your mouth. Now, what we've been talking a lot about this oral cancer. But dry mouth is probably a lot more common outside of oil cancers. Paulie fascia when people are taking five or more prescription medications seems like everything gets out of whack and. So are you are you doing a lot of this for pharmaceutical induce zero stone? Yes. I truly found quite a few patients that really aren't even analogy situations, but they've been struggling because of different medications different medical conditions. They have with their dry mouth. And of course, the dryer your mouth becomes more Siddiq throws off and hold bacterial balance inside of your mouth. And fortunately, there are alarmed products that are out in market that are market a two people withdrawal Ambi are damaging oral health. They're citic. Some of them have other you're taking detergents than them. So they're really not good choices up for especially people on couches tuition. So that was one of the goals with choosing products were things that we're not only going to mask the symptoms, but you know, benefit oral health, and and beater, soothing the tissue altogether. You also link on your website, don't oral cancer consulting LLC. Yes. That one of night hygienics, friends Susan cotton. She is on the advisory board with me for the oral Cancer Foundation. And she is a a great advocate for oral cancers for early detection and for training dealt professionals. How to do a proper thorough screening because that is something that really tends to get lost in the shuffle. And a lot of our appointments, and she goes out screening the cotton method. Yes. And until the called method. Are she goes through very systematic approach of what we should be looking for the proper ways of doing it to get the best. Israel's -ation the proper ways of Jackie mentoring and creating office protocols to make sure that your whole staff is on the same page for doing it consistently. And what is her name? It's cotton say is your last name? Yes. Susan cotton choosing cotton. And so how how can you educate more Dennison hygienists how to do all this? I mean have you made like an online, see course or? Tried to summarize this faster easier. I will be working on an online online see course of in the near future. And I do in person presentation cycle to a lot of dental offices, and I'll do full. Staff trainings. I will speak at conferences were meetings for maybe like, the oncology nursing society or a gentle study club for dentists are hijack and it just helps to get the word out to educate, and and put some of that those key informative pieces in the back of their mind ain't so when the. Time comes situations. They they know where to go and and how to approach. Well, if you ever wanna make it online, see course on dental town that would be an option we've put up four hundred one hour courses, and they've been viewed almost one million times because. I think it's just so much more convenient to watch something an hour at a time instead of committing the whole day lying somewhere. I think the Hugh mind is about an hour about enough. I mean, that's a long I do my show because that's our commute. But I think humans learning and our at a time is just a lot better. And a lot of the studies that I see in education are frightening. I mean, I've seen studies show that when kids go to grammar school. They can remember nothing long-term before ten AM. And then when they're listening to the teacher talk, they can only listen and comprehend for seven and a half to fifteen minutes. And then they need a break after need to go eat. I mean, I mean, that's all you got with the Sapien mine. I mean, that's just the nature of it. So online courses or something that you're thinking about doing in the future. Yes. Opportunity has has been approached to be I'd love to it's one of those new aspects that will be going into the definitely I would love to do that. With Dell town can the nice thing is this is such a complex issue that there would be potential outing several courses just focusing on housi-. So there's would you just focus on dental on college? Or would you focus on zero? Steamy too. All that is part of it. Part of the talking about what type of side effects. Why they have the side of acts is so involved that just going into dry mouth in its self is very complex subject talking about why it happens in college or what we can do about it. And that's only one. Aspect of what possible side effects can occur. I'm you also cover toothpaste. What toothpastes do you think are better for dry mouth and versus others? The ones that we chose our website. We do the closest and then I have two types from the squiggle to pay out the things that really attracted me to these toothpastes where were the lack of irritated, detergents. They're very very mild. A lot of problems. Will complain about is that on toothpaste tasted to sharp. It'll burn their tissue if sometimes aggravate nausea things like that. So these two are very very mild. But they're pleasant. They're not watery like some of the drywall toothpastes are out of the market. And they just had a lot of benefits or a hall, and it has a lot of xylitol in it. Yes. Yeah. I'm a fan of silent tall. I think that's a great product to help stimulates saliva gives the pleasant taste, and it helps to keep that healthy petrol balance side of the ball and who's the makers of swivel. Squiggle is a company. Out east and just squiggle name is Dr Cutler, yes, it's his native Dr Pepper, see a dentist. I'm beliefs tea is a armistice. Many. Can't remember exactly what his background was. But he's been very passionate relief. It was a break fit for us. Because when I told him what our permission. Side support. He was very excited because that was really some things that he had been trying to little into an apology settings for quite a long time because he really has seen the benefits that people have with using it with early rotations Hon, Dr Edward Cutler in Pennsylvania. It's amazing. And it's it's amazing. How the long tail is the millennials made the long tail when when the baby boomer's little yet three TVs tastes yet. ABC NBC CBS. Just a couple of radio stations. These said in the radio station be half commercials. Have songs have six three minutes hongs and thirty minutes commercials. So you had all these stars. That would get sell ten million whether it'd be the Beatles, or or Elvis Presley or all that kind of stuff, and then the digital world came out and instead of having three television channels ABC CBS NBC yet cable, which has a thousand channels and digital and you have the internet. So whereas like Americans the baby boomers that have like by one big album by, you know, the Rolling Stones the Beatles or whatever. And everybody's by like American cheese LV. Geez, all those products have plummeted, but the long tell of individual products is going out. I mean, Amazon reports that no matter what book they put on their shelf. They'll sell one unit of it every quarter same thing with tunes on the songs. I mean, you could put a song on eighteenth from a Tibetan monk who filmed it in a cave on her. I phone and it would sell one song a quarter. And I'm looking at some of these toothpastes like the squiggle says, a is vegan free of gluten dairy and soy made it I mean, I mean that just wasn't a market for baby boomers twenty thirty years ago you had crushed or Colgate. Or get out get out of town. And this long tail were were really gonna have a hundred different toothpastes and one hundred different mouthwashes, probably selling to. A huge probably a third or a half the market. So I would only expect crest and Colgate and Proctor and gamble. They're never going to see the glory days that they did when they control all the commercials on ABC, CBS and NBC. I mean, these these big box brands are going to get replaced by the long tail and I just think that's amazing. Who I mean, I just couldn't imagine thinking that being vegan was associated with the toothpaste? But it obviously is right. Yes. And I think for this demographic that they are so susceptible to the tissue rotation that anything that we can do to help keep that quality of life for them and keep them comfortable during the process and just be void of some of those triggers. I never thought about being an shoot either into. But for people who do have the sensitivities if they have a certain chemical in toothpaste that might just even trigger that starts with alterations and tenderness that stirs snowball effect where them they have a hard time brushing in then we get the plaque buildup, the Knicks more susceptible infections complications, their general. Yeah. And and you know, we also live under this Foltz by that we know so much. I don't think humans wants realize that they probably don't even know one percent of all the knowledge in the universe. And so so much. This stuff. You just don't know. And you just gotta listen to people. I mean when someone's telling you when I use this toothpaste. I get canker sores. Well, who are you to sit on your? Pulpit and say that's crazier. There's no research or I mean, I don't even know if they if they know what causes canker sores and who's to say that everybody's cake or sores are caused by the same thing. So trying these different trial and error. I mean, that's the art of dentistry. It's a it's an art and a science, and and then also there's trying to find something that the patient will like some patients. Yes, I notice a lot of the old baby boomers, they love listerine mostly because it burns their eyes and burns your mouth doing something. Yeah. I mean, it's got to be something that almost killed me. I mean my mouth on fire. How could a help could Germer a bug live to that? So this long tail in toothbrushes and toothpaste and mouthwashes, I find very very interesting. What what would you started? This products really surprise, you in popularity would did you start carrying and shipping. A lot of that. You by surprise. I think I'm surprised how popular the spry gum. And the spry gems and minsiter I thought that was going to be something that would just be a nice thing to carry. Because obviously when you're chewing, you're sucking on these audits, it is helping to stimulate saliva, and it's got the silo tall to help. Also stimulates live on give you that healthy 'Bacterial balance. But I was surprised how many people swear by those with helping with dry out symptoms much more than I thought they would. And when you talk about, you know, the newer developments in a certain products and ingredients I think that's really excited about the newest additions that we had with the moist and the Senate on those are made by percents, and they've got a really unique combination of kite. Azan arginine. So the Argentine is an amino acids of. Will feed the good bacteria in your mouth? So it's kinda getting away from that concept of the past of listerine where you want to just get in there. Kill everything of because everything starts to recolonize, what is preventing all of the bad bacteria from overtaking the good when it's recolonize, but if you can concentrate more on feeding that good bacteria and overpowering the bad with that of the arginine comes into play the kite Azan at helps to maintain a stable in the mouth, and it's anti inflammatory. And it's got a really great potential. I think with that a combination of those two, and that's Blaine. It's clear with axe XL Yar Blaine Yates out of American fork, Utah house. Do you work with him very much? Knowing lean. I just know the people that the reps that I deal with. But also are a great company to work with very pleased with some of the updates. They've made some of their products through time and percents actually out of California. That's the with the Senate down in the moist. I can't say enough about their company as I've been very blessed to make a lot of great contacts. That's cinta. You said that's one of the. Sinn ident and moist than bad as comes rinse spray. Mouth. They have rinse sprayer. What they call a missed. Oh, San here. Moisten? They've actually found through studies that it can raise resting salary rates. Han. And that's made by the company prisoner. Percents yet percent. And how long have you been aware of percent of? That's a that's a new one to me. I was saying maybe six months or saying we haven't had on our site that long. But I I really can't say enough about about the product so far in the company of their of their fabulous to work with. Idiot surprises. China. Think of what? Really enjoyed this alley pops as an adult. I probably should enjoy lollipops watch the Deuba veer such a beat product. And that is one that I'm hoping to actually add to a bulk section at some point because college departments do they may provide things for their patients to second during chemotherapy infusions to help stimulate Celaya win. Sometimes it can get bad taste of their mouth. So it's just. A nice thing that they try to do them. But many times they're giving them. You know, jolly ranchers lemon drops things that really causal damage to or health down the line. So I would love to offer some other options of bacon provide for their patients that can that are the taste good. They can stimulate the slime on offer them some oral health protection on the process. That is amazing. Is there any other thing that you wanted to talk about today that I didn't cover I've been all over the board with all these different? As what is there? Anything else? Just hope that I'm grateful to have does that for two to make more people aware of the services that we offered through side effects support. And then also to encourage dental offices to use it as a reference for their patients. So when you have your patients with dry mouth that you have some place that you can direct them to to get these products. Because unfortunately, when you make recommendations for products in the office unless you give them a source to wear where to get them. They're put out into these big box stores wandering aimlessly through these long isles. They get confused. They're not sure what to get a major get what they're what they would. Otherwise, just pick the next thing out rather than really following what you've recommended so it's so convenient for your patients to just direct them to once setting bacon have delivered to their door and also to use it for for education and use it. For. The resources to to reach out. I am always available that if an office has a situation or patient have the situation they have question to to contact me. Because if I don't know the answer, I will try hard to find out and how do they add to you? What's contact you? Other is a link on the site contact us link, but my my Email address is Jill out side effect support dot com. And I love your blogs. I mean, you got some really amazing blogs on there. I mean. Thank you. Very good. I mean, I. Your last one understanding risk of M R O N J in cancer patients. I mean, this is just some some stuff that you just. It's very fascinating. It is fascinating. I really think we're going to be seeing or cases of the medication related osteoperosis of the draw as dental professionals because of some of these newer targeted therapies that are are coming out. So pre important that we're aware of the risks. I also love your chart on the ph of common substances battery out said the stomach acid all the way up to bleach. It's. Dental Rosen is another thing. I remember when I was in school. They thought they still the dental Rosen was from sawing the toothbrush back and forth. And then they thought it was from clues. And then they thought it was her master H. And it's probably from multicultural from all the above, isn't it. Yes. And it's something to be aware of also that sometimes the medications that people are being given in uncowed setting are very acidic or they may contain shooter. So it's it's going to be aware of what some of those medications are what the risks may be what we can do to help curb the the effects from them. Well, I think you should just do it online. See course. I mean just to cover for the team because it's one of those things where if dentist listening this podcast needs the hygienist we on board the everybody everybody has to be on boarded. And what's scary? What's frightening? When you studied dental office, you know, who gets asked the most questions and the entire dental office. Death dusk. Are you giving description or they got a cross your? They got a problem. They call they're asking Valerie who's answering the phone. And then when you go to these dental courts like I just like shirt Saturday in Phoenix. There wasn't any staff. It was a couple hundred doctors, I think three hygienists and that was it. And it's like, why do these people not realize that it's a team approach, and whenever I see a dental office where the dentist it's just standard where the whole office goes to see together. And because he gets it because they're going to be asking the front desk or masking your assistant when he leaves the room. Hell they're in there with a hygienist for an entire hour. I mean, that's most the dialogue that if you if you can't get your staff on board to form informative educating relationships with your patients on all these issues. It's just not gonna get done. Absolutely. And I think that it's one that I loved doing the office education going in and having a complete staff at one time that can all ask questions, and there may be aspects of the the educational part of the technical things that you know, they may feel a little bit. The don't understand what it has to do with them. But it really assault Horton because they are the first line of of making contact with patients. I always use the example that if confirming Mr Smith's appointment, and he says, Well, I I think I'm gonna cancel because I just found out I have cancer to be starting treatments. Two weeks. You know, unless they're aware of some of the issues that can arise it would be human nature to say, oh by all means college back when you're feeling better. But they're missing out on a goals opportunity. Then to instill in that patient, the importance of keeping her appointment and making sure that any work that needs to be done is taken care of before German to cancer treatment.
Sounds Week Night Riddle (2-13-2020)
"Chompers is produced by Gimblett and sponsored by milk. Oh Hey welcome back. It's time for Jumpers your morning and night rushing show stoppers. Shimmy on the top of your mouth. Pick a fight. Brush the inside the outside ensuing side. Yeah it sounds weak and tonight we're back with more riddles for you ready. I'm all ears get it. Here's your first riddle. This is a measure of sound. It helps US figure out. Just how far away you are. If you give a shout what is it speed? The speed of sound Switzer rushing to the other side of the top of your mouth and brush the molars in the way back. The speed of sound is how fast the sound waves are going when you're driving in a car. The car's going a certain speed. Well sound also travels at a speed and it's called. The speed of sound sounds can travel really fast much faster than a car. I mean unless you have a car that can go seven hundred miles. An hour switcher rushing to the bottom of your mouth and brushless rent teeth to. Here's another riddle. You won't hear this happening. It's just a quiet. Click but bats. Whales and dolphins are very good at it. What is this Jason Echo? Location is a way to use sound to know what's around Switzer brushing to the side of the bottom of your mouth but don't brush too hard wheels. Dolphins and bats use echo location to find out what's around them they make a sound and then listen for the echo of the sound to tell them. What's their human skin? Also use echo-location. We created a tool called sonar. It uses sound to censor objects are located when a machine sends out of sonar sound. The sound bounces back or echoes. And it tells the machine that there's something nearby that's tonight brushing now. All you have to do is chompers. Production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or skin. Not only does it tastes great. It's got a natural nutrient package. Growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Nature Week Night Riddles (2-26-2020)
"Chompers is produced by Gimblett and sponsored by milk. Welcome back you're just in time for more choppers your morning night tooth brushing show its nature week tonight. We've got more riddles start brushing on the top of your mouth on one side and make sure to brush the molars all the way the back. Here's your first riddle. I can be both gray and blue. Just look up. You'll see white and fluffy puffs above and airplanes glide through me. What am I so why is the Sky Blue? Because of the Earth's atmosphere the atmosphere is the part of our planet. That's not the ground but also not space. It's sort of like the gase outer layer of our planet Switzer brushing to the other side of the top of your mouth. Brushless front teeth to the light from the sun has to pass through the atmosphere to get to us here on earth. You know when you look through sunglasses. Things can look like they're a different color. The atmosphere is kind of like the earth sunglasses so when the Sun's light goes through the Earth's atmosphere. Those sunglasses make the sky. Look Blue Switzer rushing to the bottom of your mouth and make sure to get the inside the outside and the chewing side of each tooth. Here's your next riddle. I can be light and fluffy or dark and full of rain. You see me floating in the sky and fly past me in a plane. What am I? Have you ever seen a cloud? That looks like a big fluffy marshmallow. Those are called a cumulus clouds. I'll tell you more after you switch to the other side of the bottom of your mouth keep rushing. Clouds come in all shapes and sizes. Big Fluffy Pillowy. Clouds are called. Cumulus clouds thin. Wispy clouds are called Cirrus clouds and Nimbus clouds bring rain. That's today come back tomorrow for more nature and don't forget to do. Chompers is a production of Gimblett. Media Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Nature Week Night I Spy (2-25-2020)
"Chompers is produced by Gimblett and sponsored by milk. Hey it's time for chompers ear morning at night tooth brushing show start brushing on the top of your mouth on one side and make little circles with your brush around each tooth three to one. It's Nature Week. And Tonight we've got more is spies for you to see with your ears. Here's your first one. The ground here is hot. Really hot but the heat isn't coming from the Sun. It's coming from the ground. I see a pool of mud bubbling and I feel rumbling under my feet and suddenly a Cheyenne Fountain of Boiling Hot. Water and steam shoots up from the ground. What do I spot shouted out? Now switcher rushing to the other side of the top of your mouth and brush your tongue to geysers are kind of like nature's teakettles. Have you ever seen a tea? Kettle start boiling water inside the Gets HOT IT CREATES STEAM? And that's team needs to get out. That's basically how geysers work except instead of escaping through a whistle the seam and boiling water geyser spurts out through cracks in the earth. Such you're rushing to the bottom of your mouth and make sure you're brushing the molars all the way in the back of your mouth. Here's another nature. I spy I see blue water as far as the I can see waves crash and gull squawk overhead. Suddenly I see group of animals coming toward me. They're making this sound and they're jumping out of the water playing in the waves. What do I spy switcher brushing to the other side of the bottom of your mouth and don't those front teeth dolphins? I one of nature's smartest animals dolphins can solve. Puzzles worked together to hunt and scientists have even dolphins use tools like using shells to trap yummy fish for lunch. That's jumpers tonight. All you have to do now is three chompers. Production of Gimblett media. Chompers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Sounds Week Night Jokes (2-15-2020)
"Chompers is produced by Gimblett and sponsored by milk. Welcome back to Chompers your morning. And night to -freshing shell start brushing on the top of your mouth. Pick aside and rush the inside the outside in the chewing each to three. It sounds weak and tonight our sound jokes will have you laughing out loud. Here's your first one. What does the worst whisper sound like? I know like this. This is the worst whisper. Here's your next joke. What do cows listen to? While they're on the farm four out move Zach Switzer rushing to the other side of the top of your mouth but don't brush too hard cows actually do listen to music not just their own knowing you know. Sometimes when your favorite song comes on it makes you feel happy. Farmers do the same thing for their cows to make them feel at peace. Some farmers play relaxing tunes for the cows. They say the music makes them feel happy and make more milk Switzer rushing to the bottom of your mouth coupon brushing. Here's one last joke before you go. How does say hello to each other? How like this whole rushing to the other side of the bottom of your mouth ambush way back to. Did you hear how those hollows just kept repeating over and over? That happens when a sound wave hits a hard surface and then bounces back to you. You often hear echoes when you're in a cave or high on a hill where you're surrounded by rocks because rock is a hard surface and the sound is bouncing off so you might say hello and then hear it again. That's chompers tonight. But you did a great job brushing. We'll be back tomorrow with more sounds until then. Rinse with water. And three jumpers is a production of Gimblett media. Choppers is brought to you by milk. Grownups pop quiz. Can you name a delicious source of protein with lots of nutrients easy milk? New guidelines backed by health organizations like the American Academy of Pediatric Dentistry recommend dairy milk along with water as an ideal beverage for young kids for two to five year olds. They recommend to two and a half cups of milk a day. Ideally low fat or Skim. Not only does it tastes great. It's got a natural nutrient package. That growing bodies need head over to pour more milk dot com to see all the amazing benefits. Dairy milk has to offer.
Happy 2019! Let's Talk About SEASONS
"Do you remember when you start at your small business? It was no small feat. It took a lot of late nights. Early mornings in the occasional all nighter bottom line. You've been insanely busy ever since. So why not make things a little easier? Our friends at fresh books have the solution fresh books. Invoicing an accounting software is designed specifically for small business owners. It's simple and to it. If and keeps you way, more organized than a dusty shoebox filled with crumpled receipts create incen- professional looking invoices in thirty seconds. And then get them paid two times faster with automated online payments file expenses, even quicker and keep them perfectly organized for tax time, and the best part fresh books grows alongside your business. So you always have the tools you need when you need them without ever having to learn the ins and outs of accounting. Join the twenty four million people who've used fresh books. Try it free for thirty days. No catch and no credit card required. Go to fresh books dot com slash Mike taught you an enter my taught you in the how did you hear about a section to get started? Hey, guys. This is my league. This is the my you podcast today is Saturday February ninth twenty nineteen twenty nineteen. This is my first recorded podcast of the year. I dropped the first night of my live podcasts that I recorded back in November in Atlanta that's been on. That's been up for a couple of weeks. It's twin a half hours. If you haven't had a chance to listen to it. That is probably my longest podcast that I've ever put up to date, and it is on the topic of marathon mindset, which is really was weighing really heavy on my heart at the end of the year until it was just something that I wanted to tackle. I don't know if it's too late to say happy new year, but I'm going to say to you. Anyway, I wanna say Hello. I want to let you know that I have missed you guys when I am dropping park. More frequently. There's a lot of sort of banter between us I love when you guys tweet me. I love it. When you guys Email me, I probably I never got more emails than when I did the park. The I hate my job podcast one end to like everybody hates their job. I get it. So I I still I still like getting your emails I still like hearing from you. And I like getting the emails sometimes people Email me and say, you know, what I hate my job anymore. And so as I was coming through my inbox today, I saw a couple of those and that makes me happy. I took most of twenty eighteen off to have the baby into be home. And every week. I would get sort of my weekly podcast at and you guys are still listening. And so every week a friend must be telling a friend or inviting a new friend listen to me. And so I just want to say thank you to everybody out there for kind of like keeping me keeping me going because if I was ever thinking about stopping recording these podcasts, the spins always, let me know that you find the information you find it useful. And that is really why I do this. I do this because I wanna share useful information. If you don't know why I started to record these podcasts. I started recording these podcasts because I felt like this was like there's a ton of information out. Now, you know, you you don't really even have to like read a book, and now you can audio book, and you can podcast. It would just so hard to get information that I felt like so many of us needed. And so as long as you keep listening. I'll keep podcasting because you find the information useful. So now fills like no better time than ever to go ahead and get my bag on. I'm going to go ahead and ask you to rate my podcast. I rarely ask you to do this. But rating my podcast is how you all. Keep me relevant. It is how island on the black history month podcast list again on on apple itunes is. So it's like, you know, I have a recorded a ton. But I'm still up there. And I'm still a getting noticed. And so I'm just going to ask that you rate my podcast on itunes when you get a chance those help those help keep me and the mixed during times like this when I've had to sort of shift gears for just a second. But I'm back. I'm back. I'm coming back. I feel like I am okay. Today's podcast is going to serve as a what I've been up to of sorts a how I have been leaning into this current season of my life as well. As answer some of your questions, you can still write me questions. My Email address is my taught you altogether, a lower case at g mail dot com. So you can still write me many people have written to simply ask how I'm doing. And the truth is that I am. Well, I had a lot of growing moments in two thousand eighteen a lot of growing moments, but I feel better. And that's all that matters. I'm drinking my water. I am sitting on the floor in my bedroom. Recording this podcast about twenty five minutes before a date night. So I'm going to if we have to go past my time in I have to be late for my date night. That's just what we gone as how this is how my life is right now is that you know, everything is pushed back about fifteen minutes. So. I'm doing well. I had a lot of growing moments. I've got about nine pages of notes today. I'm not sure where I left off with you guys. Or what I last said when I last recorded podcast because it's all all a blur. But I do have a question you guys. I look back at my twenty eighteen here on the podcast. And I just want to know something. How was I pod casting? How do I have podcast with a brand brand new baby? You guys. What was I even saying? You know, I I still can't even believe I did that. But I did. But anyway, how am I doing what am I up to like anything new adding another human to adding another human being to the family dynamic continues to be an adjustment each week? We're settling into a new life and routine as partners and parents of Noah, and I feel like I have to say this. I have six weeks left. I'm counting. I am still breastfeeding please hold on. For this very quick PSA breastfeeding provides numerous health benefits for infants and mothers alike. The American Academy the American Academy of pediatrics recommends exclusive breastfeeding for approximately the first six months of life and continue breastfeeding with complementary foods through at least the first year that is from the CDC. What is that saying the CDC? The American pediatric the American pediatric the American Academy of pediatrics they recommend that you breastfeed your baby for the first six months of their life exclusively. And then for the next six months to a year, you give them food while also while also breastfeeding sometimes I feel like people are like, you know, they say numerous health benefits. So if you will allow me I would just like to sort of tick through some of the insane amount of benefits that breastfeeding has breastfed babies have stronger immune systems, less diarrhea. And constipation. Fewer colds fewer respiratory illnesses like pneumonia. Fewer ear infections better vision. Law rates of infant mortality, lower rates of SIDS, less illness in overall, less hospitalization. Parents have up to six times less absenteeism from work breastfed babies may become healthier children with fewer instances of allergies. Eggs ima. An asthma fewer childhood cancers, lower risk of type one and type two diabetes. Fewer instances of Crohn's disease lower rates of respiratory illness. Fewer speech in orthodontic problems. Fewer cavities less likelihood of becoming obese letter Chow later in childhood improve brain maturation, greater immunity to infection teens and adults will find benefits for life. They're less likely to develop rheumatoid arthritis and lupus less likely to develop heart disease, in adulthood, Laura risk of multiple multiple sclerosis law rates of pre and post menopausal breast cancers, and mom you are. Breastfeeding produces the naturally soothing hormones oxytocin in proacting that promotes stress reduction and positive feelings increased calmness, breastfed babies cry less overall and have fewer incidences of childhood illness. Breastfeeding Kim support the wellness of body mind and spirit for the whole family benefits for life include low risk of breast cancer, low risk of ovarian cancer. This is for mom law risk of rheumatoid arthritis less in Dmitry, Osas less osteoporosis with age list. Diabetes less, hypertension, less cardiovascular disease. Why did I want to run through all of that? Because despite overall increases in breastfeeding rates for black and white infants over the last decade, racial disparities persist intervention, specifically addressing barriers to breastfeeding for black women are needed. And so I down to my last six weeks of recommended breastfeeding. And I've done. And so with the support of other close girlfriends that breastfeed their big breastfed their babies for the first year. I've also been able to make this possible with the breastfeeding support group for black moms on Facebook with sixty two thousand other black moms supporting each other on the journey as someone with a pretty large platform and this being black history month immediate deciding that this this is the hill. I want to shout from I find it necessary to share this information. It is not easy. But once I got into the swing of it. There was no turning back six weeks ago, and then all bets are off in. So that is my that is my personal PSA to you. If you are considering a breastfeeding, or if you know someone who was breastfeeding go ahead and support them so often because I did not I wasn't breastfed. And I didn't really know a lot of people who were breastfed. So we don't really have all the information in a lot of times, we're uncomfortable. Most of the time we have misinformation and so. Oh, oh, I couldn't breastfeed or a why didn't have milk or. Oh, it was this. You know, a lot of those things are myths. I'm not saying that there are some reasons why you couldn't. But a lot of this that you you've heard are myths in so I'm sharing this with you to support someone who has feeding. Okay. Do not be like, so how long are you planning on breastfeeding or art? That's too long. Do not ever say that to someone that they're doing something too long. There is no such thing. Please don't do that. So support your friend moms or mom, friends who are breastfeeding. Support your your sister's support your wife support your cousins support your girlfriend's do that do that do that. Anyway. That is what I'm up to racing through my six hours a day with a little little one at home. So I'm finally back to work sorta full-time six hours a day. So I guess I I moved on without sharing to you. What the heck I'm doing? So I'm back to work fulltime, which is six hours a day Noah has started educational daycare after staying home with him along with the full time. Nanny I had a full time nanny at four weeks. So I had him by myself for four weeks and then at that point had a full time nanny because I still had to work. So I had help I have to tell you that. I am a huge fan of what he's learning every day at daycare is like, I get these pictures, and it's like they're learning about the weather, and this and that so that stuff is very cool. He so much independence has been gained. And it's almost as if someone has sort of thrown a match on his development years exploded, he's doing everything. Just earlier today. We. Went to go get his foot measure so that we can get our walking shoes because somebody is trying to walk. You guys. But so that's basically what I'm up to. Okay. But I wanna talk about really wanted to spend some time talking about this season that I'm in. I look back. I'm sorry. I don't know why I feel I'm like I think because I'm sitting on the floor in my room. I'm like, I'm a little bit uncomfortable. But let me get I'm gonna I'm gonna. Switch positions. So I look back at my life and my twenties and thirties. And I don't know if you guys know this. But this is your girls last year as at thirty something I'm thirty nine don't cry for me Argentina. Yes. And about three short months. I will be joining the forty club have to tell you that. I am having some light anxiety about it. It just feels old to me. I know I know I recall having a similar feeling as I was turning thirty. You know is just that that switch from decade today. Cade is just like. Wow. You know? But I know once I get into the swing of things it's going to be just fine. The difference in my feelings between turning thirty and forty is that I definitely definitely feel like I use the time wisely. I guess I can say this. Thing about like my twenties from twenty to thirty party, the first half of my twenties. And then I focused like crazy from twenty five on my thirties were about taking things I learned and taking chances taking chances on various entrepreneurial ventures taking much more calculated chances on love and the biggest to date has probably been motherhood. Most of you know, I tried to freeze my eggs, and when that didn't work I decided to conceive naturally, which I did. And I don't necessarily think I should call it trying I just stopped preventing in two thousand seventeen once we made the decision that we wanted to potentially start a family. I wanna be clear that I didn't live my life super calculated with with each day having a sort of checkmark of what I got done and what I didn't. But I will tell you that I moved through life with a sense of urgency. Today's quotable is very little good can happen at a snail's pace. That was the sub header of psychology today article. I read about having a sense of urgency. I'll say it again, very little can happen at a snail's pace. So within this article, I found something that says that I agree with it says fine the right resources to support your success. And that was sort of like, the, bingo, ding, ding, ding, ha moment for me is that you you have to find those that give support you. So you have to build your personal life teen. So a lot of people write me all the time asking how do they how do you build a team as an entrepreneur what is the first higher? And so you can apply that same sort of mindset to your life. Do you need a new doctor? Do you need a nutritionist? Do you need a financial planner an attorney a strength coach, a an accountant, a psychologist psychiatrist a spirit. Leader a college professor a career counselor. Is there particular family member that you need on your side? Do you need a coach? Do you need a yoga instructor? These are just some things to think about an it doesn't always these all of these people don't necessarily have to be your friends or family. I think too many of us are depending on people that don't really have their together to help, you know, they're working on their stuff. So they can't really help us if they haven't got their stuff sorted. And so we just have to give people room to do that many of my greatest resources have been strangers that have now become friends and or family and for that. I am grateful. And so I just I think I'd have done a decent job in the last decade of my life of really finding the areas of opportunity also known as spots that I've been failing stuff that I need to get together. So just doing a really good job of. Of being open and honest with myself about things that I'm maybe not that great editor, maybe on Isam additional assistance because nobody was great. And now here doing everything on their own. But I I really wanna keep talking about this season. So this season for me has been a downshift. I don't care how you cut it. Having a child slows the train down for everyone's safety. Right. Like this. This train had to slow down for everybody on it. I'm still going just not at the pace. I I had been for the past twenty years in the past twenty years. I have built the kind of trust in relationships that allow for me to take a break. I worked very hard on that. And if you aren't quite forty or if you are forty. You still have some time in but one of the questions that I want you to ask yourself is can people trust you? Can people trust you? There will always be someone that feels like they can't. But in general, are you a trustworthy person can people trust you with their time with their heart with their secrets can they trust you to be honest. Do you do what you say you are going to do the other day? I was just this week. I was on a flight from New York to Atlanta. And I was watching in search of greatness, it is a it is like a sports documentary, and it has Wayne Gretzky, Jerry Rice, some other people. I'm not really a huge huge sports person. But the title in search of greatness, intrigued me, and I was. Super fascinated with Jerry Rice who I'm not. I mean, I I had heard of him. But I I didn't really know his Dory. But the one thing they come just like stuck out to me they said in he's in twenty seasons. He was only late to work like once or twice like how many times have you been late to work or have you like just not headed together? And everyone even if you Google because I was trying to find out exactly what he said. And if any Wikipedia any article any anything that you Google about like work ethic, and Jerry Rice like that's all people talk about. And he also talked about dressing the part. He says, you know, I think appearances everything he's a professional. He has he never felt like he had arrived. He accepted criticism. And he said the Mark of a champion makes the players better around the miss someone who makes the players better around them. And so again, I guess I ask can you be trusted? Right. And sometimes I think we think of that. Like can I keep a secret? But it's just like can you be trusted to do? What you say you're going to d- to do or be who you say you're going to be. I also feel like this is the season. I I'm really in finally using all of the books that I read in in many of the life lessons that seemed small back then are starting to make sense you work, and you work in you work, and it's just like four what what am I working for right? You make the money, and you we've talked about this. You can make all the money. But if you're not happy money's not gonna change anything. If you're not satisfied in with your life money is not going to satisfy you in your life. So you get to a point where and hopefully, you get to this point sooner rather than later where you begin to access those intangibles relationships, you know, those learnings those lessons and everything starts to make sense or sometimes you don't because that's the thing is that time. Everything has to you. You have to give things time and that has been like this huge learning lesson for me. I started going to therapy, right? As I started my business and a lot of times, I would go through things professionally and my therapist would remind me that you've never done this before there's only one way to learn that something doesn't work, right? Is that you have to go there. You have to get in and find out it doesn't work. Right. And sometimes you have to do it two or three times because sometimes we are just fools like that. But sometimes you that's the only way you're going to do it. But now, I'm starting to get. I'm like, okay. A lot of these these learnings these lessons the stuff that I've read the stuff that I've seen is all I'm starting to access it. I'm starting to access it at use it and take take advantage of this sort of credit that I have in life. Right. It's like sometimes you are stacking things up that you don't need right now. You are. Building relationships with people that you don't need anything from right now. You know, it might be five years down the line or ten years down the line is all that's where I am in my life. Is that I I'm gonna tell you I promised someone something via Email one week ago. I promise them last week solicited promised in last Friday that they would have it on Monday. And when I went back, you know because things are hectic, and I realized that I did not do what I said I was going to do. And so I sent an Email. I apologized, and I think people who have worked with me long enough. No that that is not how I typically operate. And so I am operating in my grace slash credit area of life. Right. So people are giving me a pass. I'm getting some passes for being a little bit slower. Being a little bit tardy on with some of the things that I'm supposed to be doing. So I am truly living a life by design which took time. I'm sure things will speed back up, and maybe they'll never speed up to how fast they were. I look back at the times. Like when I used to record podcasts. I had so much time. So if you are out here, and you're like, oh my God. I don't wanna be single. Okay. I get it. But please take advantage of the time because I was single and I was recording my butt off. I was single I was home. And I was just I was just grinding. Right. And so now, I've got I looked and I think I don't know how many I've got over one hundred and fifty closer to two hundred thing than zero. So I used my time wisely. So if you're not, you know at the place that you want to be your maybe you want to be in a relationship or you want to have a family. Go ahead and max out this time while you're single. So that you get some credit, and you have a little bit of leeway when these things do happen. Because now, I get it. It was like I used my time. Well, so that now if I don't record as fast, I still for anybody who starts at podcast today. I'm still ahead. Right. But let me get back to my notes. That's what happened. I have these notes, and then I go way off topic. So now we have to just real meat again. I will tell you that. I don't mourn the old life at all. But I am still learning to adjust to the differences thinking about seasons fall. And winter our seasons that don't appear to be productive in the life cycle. But these are the times when trees go through a process similar to hibernation called dormancy dormancy is like hibernation in that everything within the plant slows down the metabolism, the energy consumption, the growth, and so on the first thing we see during the wintertime is the tree turns Brown, the leaves fall off in an on the outside the tree doesn't maybe looked that desirable and sold for some of you that might be in a less desirable season on the surface understand that during the winter. Those roots are still growing deeper. Into the soil and regenerating in time for spring. So you are while everyone may not be able to see exactly what's happening with you. As a tree your roots are going deeper and you are getting ready for another season. And so that's kind of the season that I am. I'm not the brightest tree. I'm not the greenest right now some of my leaves have fallen off. But I am digging my roots in I do really feel that way because I had gotten to a point where I really was just like what next now what enfor me I really didn't want to go through all of this in it, not at least try to create this sort of life that I wanted which included a family like I felt like I owed it to myself to try and if things didn't work out, I I would have known that. I did. And I honestly bought my house in moved into my house thinking that I was going to turn turn forty. I had just broken up with someone and I was like, you know, what I'm going to be single forever. I know it. So let me just get a nice house in the neighborhood. You know about a town house because I was like know I'll be single I'll be alone. I won't want to just have like a. A sing single family home by myself. And and look and look, right. So I try to put the effort out there. So so that's that. So I'm going to different season. You know, I'm not like I said, I'm not China's thing out there. But I I'm putting my roots down for this sort of life that I that I want to have when I'm fifty and sixty seventy God willing. So if you're in a season that may not appear to be that may not appear to be bearing fruit. Don't worry because you're sending your roots deeper into the soil and a Steve Sutherland quote for you. I believe in process, I believe in four seasons. I believe that winters tough, but springs Comey, I believe that there is a growing season. And I think that you realize that in life, you grow and you get better. So I'm turning forty you guys. I made I may need to do a whole podcast on my road to forty. I will tell you that I am incredibly proud of myself now onto some listener questions. Hi, my leak before we before we begin. I would like to start off by thanking you for being the all around awesome older cousin that I've never had. You got it. I m yours you've taught me so much and helped me, cultivate, my views values and practices through your podcast. So deep sigh. I am a new mom to a fourteen month old. He's not really a newborn. But he is my first child after going through postpartum postpartum separation from my child's father and just a life altering experience. I am finally doing what I wanna do. And what's best for me? I have begun speaking up for myself instilling structure in my life and setting boundaries. My latest struggle comes now as in right now while I hear my child tearing up the house while my dad is babysitting him it is now nine thirty pm on a Thursday night. She wrote that in caps. I live alone now. And I love the silence that comes with it. I plan on having my dad come over or sleepover where often to assist with watching baby since I work from home, and technically babies and supposed to be here. How can I be firm, but yet gentle with setting rules of having people out of my house by nine pm? And also by telling my dad to respect my peace and quiet nece that I'm used to if he doesn't spend the night. So I wrote her back, and I just said does baby have a consistent schedule or bedtime. I would guess if we're keeping him on a schedule. I would imagine that a one euro would be sleep by nine thirty right? I guess I'm not sure why he's up on. Why you feel like this is your dad's fault? If he's helping you out more details, please. So she says baby does not have a consistent schedule after speaking with my therapist. I am in the process of developing structure in my life. I've started my four thirty AM routine. Which means I really do my best to have him sleeping by nine. Thirty. The aim is for a bed time of nine thirty. However, it doesn't always work out that way, it's not my dad's fault that he is up. But I do feel like there is miscommunication. When it comes to the rules of my house, and how I run my house if I am implementing structure and staying trying to stay on schedule that I need to find a solution and a great form of communication when it comes to guests that come over or my dad that will be staying over every Thursday night. Am I being ungrateful? I do realize that my dad is helping me out and that I need to just him being in my space because. He really is here to help. So here is my answer. If you have to ask if you're being ungrateful nine times out of ten the answer is yes, this seems like a really easy solve to me. I I am very sorry to hear about the postpartum in the separation from your child's father. But I am also very glad to hear that you found a way of life that works for you. I remember the first week of motherhood being sheer chaos for me. I kept I kept saying to myself. I cannot do this. I literally felt like my life was turned upside down in spinning out of control the first thing I did was find a schedule online. Yes. I just Google newborn schedule and found one that felt I felt what worked for me. And I just stuck to it. I stuck to a regardless of what anyone had to say about it, a friend came by and said babies don't do schedules and another season mom laughed in agreement. Let me tell you something. My baby has been on a schedule since he was one week old. He goes down at the same time. Every day and people are shocked because there's very little fuss. There's naptime good night. And then there's bid time good night more than anything. The schedule helped me gain some control over health things. We're going the routines have some flexibility, and they aren't always boring are routine include a twenty seven minute Sesame Street break. So I can clean up after dinner and just before we go down to bid. I don't wanna hear about your no screens before two. Okay. And don't be afraid to put the kids to bed early. Do your Google's there. Some good schedules and routines out there, you can do one year old schedule, and it really works. It does sometimes people think that if I keep my kid up later, they'll sleep later, but the truth is if you put them to bed earlier, they will still sleep, you know, you can do seven thirty to seven thirty. And I think at around fourteen months, I think they probably need twelve twelve fourteen hours, it might be ten or twelve hours of sleep in. So if you just make sure you're getting that all all will be better. And the other thing too about keeping. His schedule is when you stay on a schedule you pretty much know what's going going on. Right. So if baby's fussy baby, and you and you have a feeding schedule it's like, oh, he's hungry. Oh, if baby's fussy and babies. And baby has had an app. Oh, it's now time, and that's usually a helps. So so much once you're comfortable and confident in your routine, you'll be able to share it. And it doesn't come across like your bossing data around or guests around or anything like that. It's simply what happens in your home. Because if I were grandpa seeing baby every other Thursday night, I wanna play and roughhouse, and if you get into a routine with a baby that is asleep at nine thirty unless you're going out or you have to work. You don't really have the need for the evening sitter anymore and now grandpa can keep baby during times that he's awake. And he's up and he's lively now, everyone's happy. So this isn't necessarily a dad issue. It's a you sort of structuring the home issue, which I think, you know. And once you do it, I'm pretty sure that some of these issues and concerns that you have will probably fall to the wayside next letter. A year and a half ago. I accepted a salary lower than I deserved and way, less than my incumbent. But I was transitioning industries from nonprofit to corporate so justified a step back to propel forward, I'm in a company with a great Nate with great name recognition. And the projects are giving me the credibility for my next move. I am not entitled the job description. I received does not match the responsibility that I have been given always laughing. You guys say I am not indictable because usually you are. But it's okay. It's okay. Prior to my one year anniversary, I met with my boss and share my accomplishments and requested a review of my job, title, and confrontation, my boss. Agreed. I deserved a raise and was going to her manager in September my boss for me. I would beginning raise no numbers were shared at the individual vendor. I followed up in not for the first time with no real news. Her response is she was waiting for her boss. But in that time, my department has had to new hires. And one internal promotion. So clearly, I am not their priority or as critical to the team as my boss states time to get a new job, December, my boss, shares that are has been has cancer and will meet me to be of greater support. Following the news, my boss confirmed my raise the same day. And I know it's because she needs me. But my goal was to be out by the top twenty nineteen but I feel bad for leaving her while her husband is sick over the summer. Her husband had an organ transplant. I held down her job in mine. We were in the process of rolling out new software, I stayed because I had a lot to learn something to leverage this time. I know that issue has nothing to do with MIR my career, but I do feel bad just walking out my quality of work has allowed her to actually take time off in not check in. Then new raise is. Okay. But I know I could do better. My question. Do I continue to leave while her husband is sick? Or do. I stick it out and be of support then leave I feel selfish. Well, you are selfish. But it's business in just about everyone's being selfish in. Business. Your company didn't really rush to give you a raise because they were worried about other things more important than you would could be deemed selfish. So when we're talking about business. It is what it is. So go ahead and be selfish. I will say this. I talked about this in my most recent marathon minds at podcast, and it was this. You took the job at a lower pay. So that you could learn because you didn't have the experience or expertise, and this is now somehow becoming the jobs fault. Remember to keep your eyes on your own paper. We don't know why the new hires and the internal promotions happen. So it's best to not try to compare what the company is doing with what you're doing. Because there are a lot of politics that go on that don't always have anything to do with you. You said you had a lot to learn. And I guess it's fair to say that you feel that you've learned it one bone. I have to pick with you is that when you said, the quality of your work allowed your boss. Take time off and not check in. She was going to take the time off whether you were there or not her husband is sick, potentially dying. So she's going to get this time off. It's great that she has someone that is working. Well, but she she earned her own right to get the time off. And so that is the point that I kinda wanna just like, okay. Says I'm gonna just bring you back. Like, can we just come back here on that one? I can't tell you. How many times I've heard people say that they can do better and to them. I always say go on go on and go do better. But don't torture yourself or others with all of the guessing analytics and speculation just be out. Just be out. You know, good luck. And that is my answer is that if you feel like you can do better go to better, you know. And and I and I've dealt with that on on other sides of the coin of like, you know, I've had people that have maybe were like, oh, I can do better. And it's like, okay, go to better because this is. Business. And I say this as it relates to to business or personal. I don't want anything that don't that doesn't want me as if you don't want to be there when you don't wanna be somewhere. You do everyone a disservice by stay. And so it's not about you. You know, it's not about you staying because it let's not worry about your boss. Her husband, those are her issues. We winner stay focused on you. You don't wanna be here, which makes you know, long ago for the company, which means that you should go. And so to you I say go in good luck. Last question is right here. My leak I need to advice I've dealt with a few failures as far as not getting accepted into certain programs to advance my career in the medical field. I obtained my bachelor's degree in biology after five years, I started out with the passion to be a pharmacist. But after so many rejections decided it was time for a switch. I then decided I wanted to pursue nursing only to have to read. Shake the anatomy and physiology portion of the interest interest entrance exam. My plan is to pass the retake in get accepted into the program. Next fall. I'm late for date night job. I feel like over the years failure has really caused me to become so unmotivated I've given up mentally I write out a study schedule, but can't seem to stick to it have so many excuses as to why I can't stay on a consistent study schedule. I don't really have a strong support system when it comes to my career goals. I want to know if you have any insight on what I can do to get on track to prepare for entry into a nursing program. By the way, I'm thirty one with an eight year old in the three month old. I'm also working to very demanding jobs. One job I work as a lab analysts and the second. I am a paraprofessional counseling special needs children. My answer those last few sentences sound like fair rational reason as to why you can't really stay on a consistent schedule, you're doing a lot. Congratulations on the new baby. By the way. My first question is do you really love this? Do you really want to become a nurse? Or is this something that you're just doing to make more money or to quote, unquote, advance your career because if you aren't going into these programs on scholarship, and you're going to spend a lot of money to make a little more money. We need to think about that. Right. Like, we really need to think about that. So you just you also just had a baby. And maybe you can take this time to figure out what you really want to do that wouldn't require so much studying and qualifying and find something that comes easy to you. I think so often we think that we have to do hard things in that. We can't. It succeed. If what we do if what we're doing is really really hard. And it doesn't have to always be that hard. You can succeed in something. That is like a breeze that you can do while inbetween picking up an eight year old and holding a three zero three month old, right? So I think about this article that I read by Thomas Oppong, and he says time not money is your most valuable asset use it to advance your career in life while you still have it. He also says doing meaningful work, you enjoy takes effort, time and creativity. And there are no guarantees. It's full of risks people who are comfortable hate risks. They choose to -bility over maximizing their potential and that can make you miserable. So when I read this letter, I hear stability over maximizing your potential. And I hear that you are miserable is not that you can come up with every excuse for the studying for the exams. I hear that you are miserable. I hear that you are miserable. Because I feel like you are choosing stability, I could be wrong. And if I'm wrong, right me. But I want you to to take risk. I want you to take a risk in us the time to find something that you love he says, you don't even have to start your own business. What you need is something that you can emotionally in deeply connect with. That's all I got for you guys. This first time. Thank you for listening. As always I will return. You can always tweet me at my league. You can always Email me my taught you at gmaiLcom, I'm on the Instagram Graham at my leak hit me up. I will talk to you guys later.
Episode 77 - January 1, 2019 AFP: American Family Physician
"The AFC podcast is supported by the American Academy of family physicians and by the journal FPM, providing practical peer reviewed advice to help primary care providers. Advanced that our practice patient care and career available in prince and online subscription. Formation is available at af dot org slash f PM. Happy new year. And welcome to the American family physician podcast for the January. First twenty nineteen issue. I'm Steve I'm Joe, I'm Jenna, and I'm Sarah. We are residents and faculty from the university of Arizona. College of medicine. Phoenix family medicine residency today on the podcasts. We're going to talk about de prescribing benzodiazepines, migraine prophylaxis advocacy, urine drug tests, HP vaccine N, P H insulin. And we have a new feature. Our lightning round of AFP clinical answers. The opinions expressed in the podcast our own internet represent the opinions of the American Academy of family physicians. The editor of American family physician or banner health do not use this podcast for medical advice. Instead, see our own family, doctor for medical care. We're gonna start things off with our editorial. From this issue de prescribing is an essential part of good prescribing from doctors feral and mansion from on -tario. So paulie pharmacy is something we all encounter frequently and can be challenging to tackle. It's also something that seems to be more common in our aging patient population. Very true nearly one half of our older adults take five or more medications, an older adults prescribed more medications are more likely to be hospitalized due to an adverse drug reaction. So how do we balanced treating our patients medical conditions with managing the benefits and risks of medication therapy? Unfortunately, easier said than done while they're often exist recommendations to help physicians start medications, there's often a lack of guidelines to help physicians. No win and how to stop so deep describing is an important consideration. When doing just that it means adjusting medications to the minimum effective dosage or stopping medications when the potential harms outweigh the benefits anti prescribing is an important component of ongoing. Medication management, particularly in elderly patients. Medications are metabolized differently in older patients, and they often require lower medication dosages to avoid adverse effects, there's increased risk of medication interactions and potential additive adverse effects of multiple medications. The author suggests five steps to help when engaging and shared decision making with patients and families regarding de prescribing number one identify potentially inappropriate medications number to see if the medication dosage can be reduced or the medication can be stopped altogether. Number three plan how to taper the medication for monitor the patient for symptoms after stopping the medication or the need to restart and five document the outcomes of medication changes making D prescribing a priority is an important part of keeping our older patients safe and is an important reminder to assess risks and benefits of medication management on an ongoing basis. Sarah, I saw that there is also a practice guideline about de prescribing in this edition, which addresses benzodiazepines. What does that article? To say on that subject. I don't know if any of you feel this way, but my heart always sinks just a little bit. When I see a patient on my schedule coming in for benzodiazepine refills for insomnia. I know that this means we're going to have a discussion about de prescribing unlimit, it doesn't always go. Well, that's why I was really happy to see this practice guideline from the D prescribing guidelines in the elderly project to provide some help impractical advice in this effort. We all know the benzodiazepine receptor Agnes, including drugs like soap, it him are often used to treat insomnia while they've been shown to be beneficial in the short term for sleep onset, latency and duration. They have some pretty significant harms, including dependence increase risks of falls, motor vehicle collisions and problems with memory, and these benefits wane after only four short weeks, but the harms persist, especially for older persons as such patients eighteen to sixty four who uses medications for most days of the week for more than four weeks and patients over sixty five taking them for any duration at all should be tapered off. Slowly, what counts is. Slow taper. You might ask a twenty five percent dose reduction every two weeks. And if possible twelve point five percent reductions near the end of the taper or planned drugfree days. Be sure to counsel about expected benefits and possible withdrawal symptoms like insomnia, anxiety, and irritability you can reassure them that withdrawal symptoms are likely to be mild and last only days to a few weeks. They have real management strategies are your friend in this process to cognitive behavioral therapy combined with tapering improve cessation rate when compared to tapering alone. And don't forget to counsel patients on sleep hygiene. What do you guys typically recommend go to bed? Only when tired the bed is only for sleep and sex nothing else. Wake up at the same time every day. No naps. No caffeine in the afternoon. Perfect. So we're all good. We're going to be prescribe Ben's house right aide on it. Good luck. Our first feature article this issue is migraine headache prophylaxis. From doctors haw and Gonzalez out of San Antonio, Texas, migraine headaches are really common in if I do say myself, really crummy if you guys had the rank them on a crummy scale, where would you put them is ten the most crummy, crummy scale can be whatever. Like most of my patients say twelfth I'm gonna go with a nine eight. Yeah. Well, crummy crummy. So we're talking prevention here today, which is super important because many of our patients suffering from migraines would most likely benefit from preventive therapy, but aren't taking prophylactic measures. Currently most of us have a good grasp on diagnosing migrants. So we won't get into that today. Instead, let's start by discussing which patients should be considered for prophylaxis. Sarah. What are we looking for? If you've confirmed that headaches meet diagnostic criteria for migraine. Consider preventive therapy impatience having four or more headaches a month, or at least eight headache days a month. Can you remind us? Difference between headache and headache days. So I think of it like this you can have one headache that lasts for two days. So that's one headache and to headache days. Got it. Okay. Also, consider preventive therapy in patients suffering from debilitating attacks despite appropriate acute management, or if they have difficulty, tolerating or have a contra indication to acute therapy, though. Suffering from medication. Overuse, headaches would also be appropriate candidates. An important point to remember patient preference is a reasonable indication regardless of headache frequency, given the crummy disabling nature of migraines. Definitely if prophylaxis is indicated you should start with their be with medications that have the highest level of evidence based effectiveness. First line agents include beta blockers, propranolol motto per loan, Timmel develop pro x in to pure mate. Or also first line agents. You should also take co morbid conditions into consideration. When you're making a choice, for instance, ama- trip to lean in Venlo vaccine or second line agents for migraine pro flag. X's, but may offer a better fit with Comoran, depression or anxiety and one of the trip dens for ova tripton is actually I line for menstrual associated buying grains along the same line. You should consider side effect profiles and adverse effects when making a decision. Beta shouldn't be used in patients with asthma Braida, cardiac or COPD while dive L pro X until pyramid should be avoided in pregnancy or using caution with women of reproductive age due to potential fetal harm complementary and non pharmacologic therapies are also options pita sites, or I don't know how to say it, but it's an extract of the butterbur plant is affected for prophylactic treatment of migrants in dosages of fifty to seventy five milligrams twice daily the most common adverse effects of butter. Bor our GI upset and belching. But there is a rare association with paddock talk city that has left better off the American Academy of neurology guidelines of note, the Canadian headache society still strongly recommends its use. If it comes from a trusted source other treatments are probably affective. In this category as well such as riboflavin fever few regarding non pharmacologic therapies, a twenty sixteen. Cochran view suggests that adding acupuncture to symptomatic treatment decreases, the frequency of headaches and was at least as effective as prophylactic medication as for treating kids more randomized controls are needed agents commonly prescribed include propranolol into pure mate. But these agents have conflicting results in this population, regardless of choice start with the lowest effective dose when using Mets and titrate every two to four weeks until therapeutic effect or until adverse effects develop remember to set realistic goals successful treatment is defined as a fifty percent reduction in the number of headache attacks days, a significant decrease in duration of attacks or an improvement in response to acute therapy. You also want to allow for an adequate trial for each treatment improvement maybe seen in six to eight weeks, but it may take up to six months for full effect. Great. So let's Ryan help our patients suffering from my greenfield little crummy. Yeah. One of my favorite recurring segments in American family physician is the curbside consultation, and this curbside consultation is entitled effective advocacy for patients and communities. The commentary here is from Dr hack and styles from Madison Wisconsin, we as family doctors understand that advocacy is a core component of medical professionalism. We haven't evidence-based background and our training teaches us about a deep understanding that the health of an individual is tied to the health of families and communities. So this curbside consultation offers a framework based on advocacy at four levels of healthcare interpersonal, organizational, health, system and policy advocacy on an interpersonal level starts with listening carefully to hear patients concerns to work for patients, health and social needs family physicians can recognize. Implicit bias teach others and demonstrate understanding of people from all backgrounds. Organizational advocacy involves serving as a leader to help places of employment education professional membership or worship embrace emission of community service to invest in and strengthen local communities S, family physicians. We know many, social and economic factors influence the health of our patients by advocating beyond individual organizational affiliations, we can help create conditions for collective action. This is the health system level of advocacy. We can promote systems that address social determinants of health, affordable and high-quality childcare, healthy foods public education housing and safe recreation, the fourth level of advocacy is on a policy level, we family physicians can express our support for health promoting policies through communications with political leaders in the public. We are credible champions for policies that support robust healthcare systems financing mechanisms and public health infrastructure. We can train the next generation of advocates an influence public opinion through commute. Outreach writing public speaking an editorial 's if you'd like to build your advocacy skills. Check out the American Academy of family physicians and society of teachers of family medicine resources to gain advocacy, experience on a national level. You might consider attending the AFP's family medicine advocacy, summit may twentieth and twenty first twenty nineteen in Washington DC, Sarah, and I have both gone to this conference, and it is inspiring. It really is also check with your local academy chapter for state advocacy opportunities. So let's close out with some examples from this article to address overweight noted in a child in the office of physician met with local elementary school leaders to organize a community health initiative to promote healthy school lunches and family exercise programs if family physician responding to a patient who had an accidental narcotic overdose. Advocated in her health system for more physicians to be buprenorphine trained. Finally in our third example, a clinic staff member helped a patient apply for health insurance after she lost her job and the physician partnered with colleagues to advocate on a state level to expand affordable health insurance. So we issue a challenge to you. Go out there and advocate for your patients and your communities by dressing issues on an interpersonal organizational health, system or policy level. And let us know how you're advocating for your patients, and we'll share it on a future. Episode Email us at AFP podcast at af dot org or tweet at af podcast next up urine drug tests ordering an interpretation from Dr kale out of UT southwestern in Dallas urine drug testing is often performed for several reasons it's done as part of monitoring drug therapy employment requirements and military or sports participation. They serve an important role in monitoring patients who are receiving long term therapy with controlled substance because you're in drug tests are performed frequently. Is important to know when to order and how to interpret the results urine drug testing when monitoring for drug therapy can be used to help determine adherence to therapy and to evaluate use of non-proscribed substances. But it's important to use the urine drug tests in clinical context, including a focus history physical exam and use of a prescription drug monitoring program. Unfortunately, there are no guidelines to guide us on how frequently to perform these tests knowing when the patient last took a prescription will help determine the likelihood of getting a positive result before ordering a urine drug test. When performed you're on drug testing involves two steps the first isn't initial screening test. The second is a confirmatory test for substances with positive screening results. You may also need to perform confirmatory testing with an unexpected negative results. This can help distinguish false negative from true negative the initial screening tests, which isn't immunoassays screens for the five major drug classes, including opioids cabinets cocaine and. Eta means infants like leading when a positive result or unexpected negative is obtained it is then sent for confirmatory testing and keep in mind that the typical immuno ASI can detect only non synthetic opioids think morphine in coating here. Therefore, you need to consider ordering specific immune essays to valuate for other substances. Confirmatory tests use liquid chromatography and mass spectrometry. These tests have been much lower threshold for detection and are able to distinguish individual drugs and metabolites. Okay. So once we order the tests, how do we interpret them remember that you're in drug testing is dependent on detecting metabolites and does not reflect serum concentrations, false positive results can occur from cross reactivity of commonly used medications. Please see table three in the article for some of the common medications that can cause false positive results. It's a whole lot of drugs, right and interpreting negative results may be even harder to negative test. Results may happen when the patient is not taking the medication as prescribed or if the. Druggist metabolize so rapidly. That metabolites are eliminated before they can be detected false negative results occur when a drug or metabolite is present at levels below detection levels in this case. Confirmatory testing is required other considerations. When interpreting results include tampering and contamination of urine samples additional tests, like urine create levels and test for additive substances can be performed or for patient is sneaky and adds a drug directly to the urine. Then metabolites will be absent. How about some myths with urine drug testing, you know, like poppy seed consumption or I was exposed to passive smoke. It turns out Joe that eating poppy seeds before a test and the passive inhalation marijuana smoke will not result in a false positive test. Now, you're you're in drug test pros Joe you have a Cochran for clinicians for us now from doctors Fogelman and Leman out of Lancaster, Pennsylvania. I do the question here today is prophylactic vaccination against HP safe and effective in preventing HPV infection and result in cervical cancer. The answer HP vaccination and women fifteen to twenty six years of age prevents the development of C I N to and see. I n three in women, regardless of previous HP exposure with the number needed to treat of thirty nine. Yeah. And no serious adverse effects are associated with the vaccine. We know the HP vaccination is. Recommended for preteen girls starting at age eleven or twelve so the debate revolves around the utility of ketchup vaccination, which is currently recommended for girls. Thirteen to twenty six years of age as the risk of HP exposure through sexual contact increases with age. This was a big review involving twenty six RC tease in over seventy thousand international women ages fifteen to forty five looking at prophylactic vaccination versus placebo the surrogate primary outcome of high-grade C. I n and Adna carcinoma inside to was evaluated because assessment for the development of invasive cervical cancer would require prohibitively large in long term. Studies in women fifteen to twenty six HP vaccination provided protection against development of C I, N two and three even when HP status was unknown. Only two studies included women twenty four to forty five years of age and HP vaccination did not appear to provide protection against the I N two in this group. There was no data on CNN three. The bottom line here. Ideally, adolescent girls should be vaccinated before their first sexual contact to allow for the highest vaccine effectiveness, but vaccination will still protect against the I n regardless of previous HP exposure. So you should feel assured in recommending the ketchup h BBC series in young women who missed prior vaccination, a number needed to treat of thirty nine is pretty great time for a poem. Sarah, your member poems are patient oriented evidence. That matters. What do you got this pawn asks delong acting insulin analogs such as gliding or dead? Amir reduce the risk of clinically significant hypoglycemia compared to N P H Enslin. The answer is no this is a big switcheroo from successful marketing campaigns that have convinced many of us that long acting insulin analogs, reduce hypoglycemia. The investigators of the study looked at data from multiple patient and prescription registries with Kaiser permanent day of northern California. The patient cohort had over twenty five thousand. Adults with type two diabetes initiating basil. Insulin therapy, they even controls for a bunch of confounds, including but not limited to demographics history of severe hypoglycemia kidney and liver disease and even medication non it here is and what they found was fascinating the risk of subsequent severe hypoglycemia resulting in an e d visit or hospital admission was about the same between the two with 'em ph. Possibly even having fewer episodes of severe, hypoglycemia, even more. Interestingly in my opinion, glycemic control was significantly improved in patients using NPA ch- this reinforces the M P H insulin is as safe if not safer equally tolerated equally or more effective and way cheaper do at my pharmacy colleagues have been urging me to do for what feels like forever. Consider 'em ph as a good and affordable Goto option for basil. Insulin management. There's a new feature in American family physician called AFP clinical answers and are fearless editor in chief. Dr Sexton explains this before our I if pe- clinical answer segment here, which. Is the goal of this department is to share key clinical questions and their evidence based answers directly from the journals content and Dr sex and did this because she is as American family physician daily, and she really would prefer to use clinical information written by and four family physicians. And Dr Sexton is on a mission to find ways to make this content. Practical and available for all aspects of patient care. So if you have clinical questions favorite articles or tips for finding answers directly from a f at the point of care, please share them with Dr sex net. AFP edit at af dot org. So here on the podcast. We're going to do a f- clinical answers in a lightning round. And you'll know that it's a lightning round because you'll hear this bell your first, Joe what treatments are recommended for nausea and vomiting in pregnancy beginning with lifestyle modification such as eating frequent small meals, vitamin B, six duck, Silliman and. Grip. Shen antibiotics can be added as needed, Sarah. What is the clinical effectiveness of various therapies for Niaz Hjorth rightous for short term pain relief, and our functional improvement beneficial interventions include tents, Taichi and home-based exercise in self management programs glucose me and contract and supplements have medium, but not long-term benefits. She inserts are ineffective long-term benefit long term beneficial interventions include weight loss, agility training and combined exercise program. Jenna is hormone therapy effective for primary prevention of cardiovascular disease in women. Nope. In fact, it's harmful number needed to harm one hundred and sixty five to cause a stroke and number needed to harm of two hundred and forty to cause a blood clot in the loud. Joe what is the effectiveness of recombinant zoster vaccine effective recombinant zoster vaccine brand name shingle Rex will prevent shingles. In over ninety percent of patients number needed to treat thirty-three over three years. Nice has paid. Thanks, guys. Lightning round out. Hello. This is Heather from Phoenix. Arizona a fourth year medical student from Toro university, California and looking forward to being a future family physician. Please send us your thoughts. By emailing us at a p podcasts at a p dot org or tweeting at AFP podcasts. Please subscribe and rate us on I tunes. Our podcast team is Sean Abe ru Jake Anderson Steve Brown. Jennifer cannon, Sarah, Coles, Kim, Kelly K and Joe sealed-off. Are sound technical grew is Tyler Coles are beam song is written and recorded by family physicians. Bill dabs Ryan Evans and Johnston Jenkins. This podcast is brought to you by the residents and faculty of the university of Arizona. College of medicine next family medicine residency. We'll talk to you soon for the next addition of the American family physician podcast.