Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard:

It is a huge honor for me today to be podcast interview Jim Metz. How are you doing Jim?

James:

I'm doing great Howard. How are you?

Howard:

I'm going to read your bio. Dr. James Metz is a 1973 graduate of the Ohio State University College of Dentistry. That's a Buckeye, right?

James:

That's a Buckeye.

Howard:

What is the Buckeye? It's a seed that has eyes on it?

James:

Yeah, it does. I was actually the team dentist for Woody Hayes, the great coach that was here.

Howard:

Right on. Dr. Metz maintains a general dental practice in Columbus, Ohio with an emphasis on dental sleep medicine and restorative dentistry, is the Affiliate Director of the Ohio State University Medical Center Sleep Medicine Fellowship Program. He has previously served on the AADMS Board of Directors Course Development Committee, Public Relations Committee and was the Chair for the Introductory course of Dental Sleep Medicine in addition to being the Co-Chair for the annual meeting 2014. He is the current Chair of the American Thoracic Society Interest Group on dental sleep medicine and a member of the Executive Committee, the Sleep Respiratory and Neural Biology Assembly of the ATS.

I just got Arianna Huffington's book. It's everywhere. She's on every talk show. She's on all the news stations. She's all over. Basically five years ago no one really talked about that. Would you say it was five years ago? How long ago did this explode?

James:

I would say about five or six. I've been in it for about twenty. I've been doing this for a long time, but it's really interesting that Huffington book because I haven't read it all. I just bought it, I haven't read it, but I've spent a lot of time in China, and there's three basic groups of human beings in the world. We all derive from Africa, and one group stayed there, one went toward Europe and one went toward Asia. The Asians came up with the worst airway and the Europeans with the best. I feel a lot of the eastern philosophy and meditation and all the things that she's talking about is what the Chinese learned to do five thousand years ago to control this airway issue, and we've gotten away from it.

She's talking about being responsible, and I think it's really appropriate. It's a way to control things to a degree.

Howard:

I also thought the book was interesting about how she wants to change the culture where don't let people brag about, "Oh I only got three hours sleep, I've been up all night," blah, blah, because you're not being productive, and that's not something you brag about.

James:

That's true.

Howard:

It'd be like saying, "Yeah, I was up all night and drank a gallon of whiskey and smoked a carton of cigarettes to get this project done," when everybody should be saying, "Dude, you were drunk and sleep deprived."

James:

You know what's really interesting Howard about that? Is I've done almost ten thousand overnight testings with pulse oximetry, and if you find a CEO type, somebody that's really very productive, they normally have an incredibly active heart rate. What they're doing is they're running on pure adrenaline. They use high test fuel. That's what Huffington does and that's what most of the people do that have high power jobs. I always say that adrenaline will either turn you into a CEO or a couch potato, one or the other. It depends on the culture that you grew up in as to how well you do and I would love to write that up. I have about a hundred and fifty CEOs that I've tracked and almost every one of them has this active heart rate which is uncommon.

Howard:

Explain more. What do you mean they have this active heart rate that is uncommon?

James:

What it is is overnight every time your body senses that it's not getting breath it releases adrenaline, every time. The heart rate goes up and down, up and down, up and down, all night long and those people really stay in light sleep. They don't get into deep sleep, stage three sleep, but they stay in this light sleep and it's like they work twenty four hours a day seven days a week and they get up early, they get up at four in the morning and they're right on it. During the day they'll start using tricks like anger management or getting really worked up about something or really excited about something or laugh at something very strong, and they use athletics a lot for this too.

What they do that for is to pump themselves back up so they don't fall asleep. People learn how to control sleep problems with adrenaline. Anger management is one of the major ways people do that, lack of anger management.

Howard:

You think when people are moody and throw a fit, it's really to re-energize them.

James:

It's sleep, it is. It's funny, these high level people keep getting divorces. They come at it all the time. I think they need airway management instead of marriage management. I honestly feel, it was interesting, Beyonce and, what's his name?

Howard:

Jay Z?

James:

Jay Z. They were going at it. Well they're two high level people. What's interesting is if they had their airways controlled, it's long before sleep apnea, way before sleep apnea. This starts off when kids are four and five, six years old. If they had that controlled, they would be more rested because it tends to create a lot of anxiety during the day, a lot of tension. Your memory becomes, that's the ADHD part of a memory and it tends to frustrate other people. If they were more calm, they might get along better. I think that's one of the reasons why so many high level marriages are difficult.

Howard:

We should do a sleep study on that couple. I'll send Jay Z to your house, you send Beyonce to mine, and then we'll monitor their sleep pattern.

James:

I don't know if I could keep up with that guy or not.

Howard:

I also read something that one of the biggest taboos that people are not talking about is the fact that forty percent of marriage couples sleep in separate rooms and they've learned that over the years that they just feel so much better, but you don't want to come to work and say, "Yeah, me and my husband, we sleep in different rooms," because then people might be thinking, "Oh yeah marriage problems" or you don't have a sex life or whatever, but the bottom line is once you're asleep who cares if there's someone next to you. It seems like I have so many friends where just listening to their talk, they're like, "My dog, he woke me up three times. Every time a car drives by he starts barking," and you're just like, "Yeah, you probably shouldn't be sleeping in your bed with a dog or another big monkey or the TV on. You should really try to put more thought and time into your sleep hygiene of where your sleep cave is, dark, cold, quite, no other animals moving."

James:

What's really interesting Howard, we sleep in a mechanistic fashion. Men and women and humans have never slept like this before in the history of human beings. We would sleep usually in groups for protection. We didn't have these soft beds, they're like these sleep machines. We didn't have any of those things, but what's happened is over the last three or four hundred years as we have gotten more and more away from the hunter gatherer, we don't develop into what we were, it gets into the genetics and the epigenetics of what the human being is capable of. The idea of eating tough meat, making the job grow, always breast feeding, it's really a very interesting thing the way we sleep and the way we are. The jaws have gotten smaller so our airway gets smaller, so a lot of women, see women get sleep apnea later in life than men do, men about forty and women about sixty.

Before that, they had this active heart rate if their airway is small. That's the reason so many TMJ patients are women, and I can explain that if you like. The idea that they're working to keep their airway open all night so they never go to into deep sleep, so anything wakes them up. That's part of the problem. It's the man snoring and the woman in light sleep is what creates the problem. It's not just the man snoring, it's the woman in light sleep that's the issue too because by the time we get to be about sixty or sixty-five we pretty well normalize in about the same number of men and women with sleep apnea. The idea of just saying sleep apnea is really wrong, because from the very beginning of our being, when we're four or five, six years old, that's when you get into the ADHD, and that has to do with breathing disorders.

If you take the tonsils out on normal weight children, about sixty to seventy percent of the ADHD will go away. If the child is overweight, when you take the tonsils out it only is about twenty percent. The idea that people live with this their entire life is a real problem. I believe that we've always said, and I can't back this up entirely, but I believe that when we talk about type II diabetes and high blood pressure and all those things and we say that's genetically linked, I think it's genetically linked to a small airway is what I believe. That's the reason why people say, "Well headaches run in my family." Small airway runs in your family. The apple doesn't fall far from the tree. The idea that people, you get blue eyes or brown hair or you're five foot seven or four foot two, one of those things, all that runs in your family. So does the size of the airway. We do inherit it from our family.

Howard:

I thought diabetes runs in families that never run. I want to go back a little bit because you said something that just made a lot of people say, "What?" Everyone's always wondered and talked about why so much of TMJ is women. Some people say eighty percent of their TMJ patients are women. Talk about that.

James:

Well I'm mostly restorative dentistry, but I was going to put a sign out in front of my office I specialize in small women because I have about a hundred and fifty offices that refer to me for TMD every year, physicians and dentists, and we do really well with it. What's really been the key to it is when we have learned how to manipulate the airway. Those refractory TMD patients, I sent these people everywhere. I couldn't make them better, so I sent them to everybody in town, they couldn't make them better. I sent them to everybody in town, they couldn't make them better. They went to notable places and they didn't make them better. They came back to me and they said, "Can we just get our teeth cleaned here" and was like don't ask don't tell policy. I won't talk to you about the TMD and you don't bring it up either and we'll just get along fine, do that.

I started to get into sleep, and Ron [Prane 00:12:08] down in Houston talked about TMD and sleep being interrelated. What I did, I had about twenty-five of these patients, and what I did is I made an appliance for them, and nearly every one of them resolved their chronic TMD, which had been there for twenty years or more that I knew of. It was the best part of my career. I swear, to have these people that you really cared for and you really wanted to help and you couldn't, and all of a sudden this little magic airway thing comes up and bam they're gone.

Howard:

What percent of the TMD in America do you think are women and exactly why is that?

James:

I think they're smaller people. The airway is smaller in women than it is in anywhere else. I can go through this in detail with you if you like and show you the lateral assess and we take those to a very strict protocol so we can actually see the size by the airway. Men's are somewhat larger. For some reason women have to work harder to maintain airway, and that was what I think that it is. Men wear their teeth out and women get headaches. We've always said that about TMD, and I think it's partly because the mechanics and the size of the jaw. It's just what the muscles have to go through to cause a spasm. I've always said it's like they're running in high heels all the time, if you ran in high heels with your calf muscle spasm. What we do with bite planes is we just give them a splint, which his like giving them a pair of tennis shoes and that's how we resolve it. That's pretty much it.

It's not too complicated.

Howard:

Repeat again what you were thinking about the age on sets of women versus men and how it tapers, all goes away, you said seventy-five, is that what you said?

James:

Well what it is, women about sixty, men about forty. You've been around this world a long time with TMDs too, and you've heard everything, and you know what's funny about it is demographically you look at the old TMD studies and they'll say TMD demographically goes away by age fifty. When I was young and stupid, twenty-five years old, they said, "Well by the time you get to be fifty years old, your life's calmed down, everything's good, you don't have any financial worries anymore, the kids are out of school and all that, and the stress goes away so the TMD goes away. That's just baloney. My life kicked into high gear at about fifty. To take that as an example is crazy.

What happens is I believe is, and there's some research to show this too, that you actually burn up the reflex and the ability to brux. You get a older man and they may not have the ability to brux and that's when sleep apnea goes through the roof, because TMD is a protective mechanism.

Howard:

Because it starts to grind when you get hypoxic to wake you up?

James:

Yeah. There's been some really good studies on that. The body cannot stay in its intermittent hypoxia, the oxygen going up and down, up and down, up and down. At the American Thoracic Society last year, that's was the core message of their entire meeting was intermittent hypoxia. We've been able to introduce increased cancer rates in mice by doing intermittent hypoxia. We've been able to create impotence problems in mice with intermittent hypoxia. We've been able to do a lot with mice. We've never proven this over. David Gozal just published a paper with an N of 3.5 million and he H matched off the Wisconsin Cohort Study one million seven hundred thousand people in each group, and it showed several things like depression is six times higher in women with sleep apnea than without, and high blood pressure.

There's so many comorbidities here that go together. If we control the sleep apnea, the possibility of having so much trouble with type II diabetes and high blood pressure, you could do better. You don't have to have as much trouble as we have.

Howard:

Let me hold you to some specific stuff, because you've been doing this probably longer than anyone I know. This is a big train that left the station five years ago and you've been doing this for two decades. You've got these kids coming out of school and they've got limited resources for continuing education, and they see they can learn how to surgically place implants or maybe they can go learn Invisalign or whatever. Talk to that person. What is the scope and size of this epidemic? Is this something young dentists should be investing dollars to learn about or should they be referring this stuff out?

James:

That's a great question Howard. I've been listening to your podcast. I really like, you did the one with Carl Misch that I thought was amazing too, the long one, the two hours. Anybody should watch that that wants to learn about a young practice and the philosophy behind it was great. What's really interesting about this is I always said the old guys should do sleep because you learn how to work with people and you do this and you do that, and you get along. Plus you want to taper off. The thing is you start a sleep practice as you get older, you can sell your restorative practice for the amount that you could have sold it for to begin with and take the sleep practice and go, so you can double your income from selling your practice by creating two practices.

Just for example, what I did is I incorporated them separately. I work for the corporation and I can go and network in that corporation, but I'm not in network for dentistry but I'm in network for sleep. That's been really, really good. I thought that you know what the trouble with that is? In the last ten years, we haven't gotten a darn good better with the numbers of people we're treating than we were hardly ten years ago. The epidemic, it's at least forty percent of the people in the United States have some semblance of problems from this. We're treating about this much. At this point, we're not even ticking the scale. We haven't even gotten the speedometer rolling yet.

One of the problems is nobody's taught a system on how to do this to get great outcomes. What I've been working on for the last two years is a paper that we just submitted to Northwestern. It's a hundred and forty nine consecutive patients, and the statistician, we had one hundred and two patients out of that group totally clear and our results are very similar to CPAP for even severe sleep apnea patients. I got to see what the statistician says about that, but that's going to be a major paper I feel.

The thing about that is though we spent a lot of time to do that, and we had to charge enough for our time to be able to do it. To go back to your idea that if the dentist made a hamburger, did I quote you right, it would cost $35? I have always loved that quote. Certain quotes have hung with me my entire career, and that's been one of them that has. What it is is we have to get it forty percent. What does that mean? Two hundred million people. That's eighty million people that need this care, and what are we doing every year? Maybe twenty thousand. Maybe at the max. A lot of people are getting snore guards, but those don't count because they cover up the symptoms and I just don't think that's appropriate and I don't think young dentists should learn how to do that.

I was sitting in China and I did twenty appliances on the heads of the hospital, and the head of the hospital came back and said, "Jim, these appliances are wonderful. Everybody's happy. This is all good." I spent three weeks making these twenty appliances. He says, "What we want to do now is a thousand appliances a month," and I about fell off my chair. How do you do a thousand appliances a month? There's nobody in the country doing more than forty or fifty. Sixty's the highest I've ever heard of really good quality appliances. You got to charge a lot for them, but there's not enough dentists, there's not enough money, there's not enough anything to go at it that way.

What I've been focusing on is to be able to do that thousand appliances a month. I think that's going to take a young dentist or two or three young dentists to treat that number of patients, but I think you can move a lot of people through, save a lot of lives. Instead of treating the guys that have already gotten run over by a truck from sleep apnea, the idea of predicting and preempting it before it's a problem, from this active heart rate, from these DSATs when the oxygen drops when they're young and they shouldn't have them. We should be treating those people. If we do, I think we can put them on a different course of their life.

I used to think that just one day you get up and you fall over and die. That's kind of what happens. Now I don't believe that. I feel you can control that time fairly dramatically if you want to and if you're responsible. That's the reason that Huffington book is good, but our appliances are better. I got to tell you. I can do a lot more than you can ...

Howard:

Back to this young kid. They're under thirty, they're anywhere from senior dental school to five years out. That's the major podcast audience out there. Where do they learn? I'll tell you what they're saying. This is dentistry uncensored, so I'm going to ask you a stressful question. A lot of these kids, the rumor's out there that when you go learn sleep medicine, most of the training is by somebody trying to sell you a specific machine.

James:

That's true.

Howard:

Is that true?

James:

That's absolutely true. I agree with them, and I think it's like the wild west out there right now. Most of its bogus, and you got really have your radar up and your detectors running at full speed because it's there in spades. That's the reason why I like something like the American Thoracic Society, because what that's going to do, the only way we're going to get this is when physicians start believing that we can actually take care of patients, and once we get the podium there and we start getting people well trained, so it isn't a BS meter, then we're going to start making inroads. I don't think that's happened yet. I feel this protocol hasn't settled down at all.

Now it's kind of like, "Well I'll do three or four a month and that's kind of fun, and maybe they'll work, maybe they won't," but I don't like that. I want them to do well with it. I have my own appliance. I have the Metz appliance, but I've never advertised it. It's really not sold. We make about fifty of them a month.

Howard:

I don't mean to interrupt, but explain thoracic. People are listening to this a hundred and forty countries, a lot of people are probably wondering, did you say Thoracic Society? What is the American Thoracic Society?

James:

It's part of the chest positions. It's mostly Pulmonologist and sleep related people in the sleep, respiratory, neurobiology section that I'm in. There's also the COPD section. There's also the cystic fibrosis. There's all the other things that have to do with diseases of the chest are represented there too. The meeting has about sixteen thousand physicians in attendance every year. Worldwide there's about between thirty and thirty-five thousand chest physicians that are part of the American Thoracic Society or its sister organizations.

It's a heavy duty organization mostly around research. I like that because we're not in competition with research people. I think that's a problem with some sleep physicians. They see us as competition. We're really not. There's more than plenty to go around, but they don't see it that way. The American Thoracic Society doesn't. They've been incredibly open to me. They even gave me a mentor to work with for this paper. I got a high level Pulmonologist to help me review my numbers, get my statistics worked out, because that's not part of our culture. I didn't learn that in dental school. The idea that this is moving into medicine is really pretty cool.

It's really a medical problem that we treat with dental means. They can't get by without us and we can't get by without them. This isn't a lone ranger type of treatment. If someone has an interest in working within medicine and working to really control quality of life in people, I think it'd be a great thing for a young guy to get involved in. I wouldn't go off and spend $150,000 to put in a sleep practice and that they're selling. I'd go to a good meeting, I'd start being around people that are actually doing this on a regular basis day in and day out, and learn.

Howard:

You're specifically recommending they join the American Thoracic Society? That would be a good entry level to start learning this?

James:

Actually I like the American Academy of Dental Sleep Medicine too. I was on the board of that for quite some time. They offer intro courses in their lower, what I like to say is they're not as intense of courses as the American Thoracic Society, but the trouble with that is you're always around dentists. There's very little true interaction with physicians. With the American Thoracic Society, once you start knowing the glossary of terms, so to speak, then you can move in and go into the Thoracic Society and be able to sit there, listen, study. It's a lot of work Howard. I'll tell you, I've spent more time and energy on this than anything I've ever done in my life.

Howard:

That website is www.AADSM.org. AADSM.org. American Academy of Dental Sleep Medicine.

James:

They do great for the intro courses.

Howard:

Do they have any of that online?

James:

When I started with the ATS, I dropped away from the ADSM a little bit, and so I don't know what they're doing online. I don't think there's anything online. Now we have things online. We run two courses twice a year, step up to advanced and intros to sleep medicine.

Howard:

You do those courses yourself?

James:

I do along with, I bring in keynote speakers. One of the nice things about running courses is it does two things for me. One is I get to hear exactly who I want to hear. If I have a speaker and I keep it all going on the same track and I've had some of the world's best speakers come here to Columbus, Ohio for a hundred and fifty guys. You have direct contact with them. You go to the cocktail party with them, all that thing. I really like that. The other thing that we do with the money we make from, I have a dentist that works for me, Micky Harrison, and the reason why we've been able to do what we do is he doesn't see patients.

Eight hours a day, three days a week, he reads and he scans the literature for the last three years. We've categorized over four thousand papers related to sleep apnea. Micky helps me pick out the speakers, helps me be able to organize the literature. You can't run a restorative practice and do this too. I got to sleep sometime. I'm getting into the thing that Huffington's talking about, sleeping four hours a night and I'm talking about sleep.

Howard:

I wish you would make one of these courses on Dentaltown. We put up three hundred and fifty courses on Dentaltown and they're on the app too, and those three hundred and fifty courses have been viewed over five hundred and fifty thousand times.

James:

You tell me what you want to hear on Dentaltown and I'll do whatever length you want, and what you think your listeners would like to hear, I'll do it.

Howard:

It's two hundred and sixteen thousand dentists from every single country on earth. I think they're from two hundred and twenty countries. I think it's the largest online group of dentists anywhere. I think a curriculum. The more the better. In fact, I want to ask you what would be the first part you should talk about is what exactly do you think the comorbidities are with this?

James:

You have a flip chart in front of you Howard. I sent it to Ryan.

Howard:

Oh yes.

James:

This is how I talk to patients all the time.

Howard:

You can hold it up and go through it.

James:

Here's the comorbidities. You don't even have to remember them. When I do an interview on TV or on the radio, I take this with me. I have this with me all the time. It's in every room. It's just like the top one, drug resistant hypertension. You're on two blood pressure medications at least and your blood pressure's still not controlled. Eighty percent of those people have obstructed sleep apnea. Eighty percent. Severe obesity, seventy-seven percent. Congestive heart failure, this is the one that I've really spent a lot of time with. Seventy-three percent of those people have sleep apnea. What it is is we all talk about the snoring, but what else is happening when the tongue falls against the back of the throat, the diaphragm keeps pulling and it makes the inside of your chest very negative.

The blood inside your heart is positive, so it causes your heart to expand. That's the congestive heart failure. One of the cool things we can do with an oral appliance is actually break the seal at the back of the throat and actually help with congestive heart failure I believe. The use of this appliance, we haven't even begun to touch. You know those young guys you talk about on yours? They're going to be able to do wonders with this. I wish I was twenty years old again. I would be all over this like a cheap suit.

Howard:

Oh my god, I'm not going to go back to twenty again. When I just think of those years, I get exhausted. I think the greatest thing about being fifty-three is I look back at those, I had four kids in sixty months. How insane was that? I don't think I slept for ten years.

James:

I know. Well see I'm sixty-nine, and so it's getting to the point where I want somebody else to pick up, and what my goal has been is to train people so this will keep running. The ATS, like I said, that meeting, it's May 15th, and they offered quite a deal for us to go. It's only $150 for the whole day to go on a Sunday.

Howard:

Where's it at?

James:

It's in San Francisco. In the evening, they're doing a reception for us, drinks and hor d'oeuvres and all that. You're going to hear two of the greatest speakers, David Gozal and Atul Malhotra that are going to speak directly to us, and people can go to that for free. They don't even have to pay [crosstalk 00:33:12].

Howard:

Spell those names. David Gozal?

James:

Yes, G-O-Z-A-L.

Howard:

G-O-Z-A-L, and it's in San Fran when?

James:

May 15th. It's next Sunday.

Howard:

Next Sunday, okay. David Gozal, is that a DDS or an MD?

James:

No, he's MD. David, he's one of the five largest medical researchers in the world. He's always in the top five. He's done all of the work with ADHD. He was able to control and bring kids up levels in classrooms early on in his career by removing tonsils and working with ADHD in kids. He's an amazing man. He's a powerhouse. He's going to be the president of the ATS this coming year. Atul Malhotra is the current president.

Howard:

That's the second one? David Gozal and who's the second?

James:

Atul, A-T-U-L.

Howard:

That's his first name?

James:

Yes. Atul Malhotra. I always spell this wrong. M-O-L-H-A-U-T-R-A I think.

Howard:

Egyptian?

James:

I'm not sure. He's been in the United States a long time. If he is I don't know. You'd never know. He's in San Diego. He publishes all the time and he works with dentists. I've got a good friend there and he works with Todd Morgan all the time. He's very open to dentistry.

Howard:

It's very open because I had my four boys, when they were all in elementary and middle school and high school, just seemed like one third of their friends were on ADHD medication. It was almost like some popularity contest. When you were talking about drug resistant hypertension when you're on two medications, I was reading this article on Polypharmacy, and they were basically showing that by the time you're taking five things, and it could even be prescription or over the counter, it could be maybe you take liver oil, but by the time you're taking five pills a day you're starting to get yourself in trouble. By the time you're taking ten medications a day, you're really hurting your life expectancy.

James:

You know what's really interesting, I remarried about three years ago.

Howard:

You didn't learn your lesson the first time?

James:

No, I didn't. I found a wonderful person, I really did.

Howard:

You just decided you had way too much money this time to just lose it all again?

James:

She's way better off than me. What was interesting is she's been really very helpful. Her husband passed away and I looked over his medication lists, and what's really interesting is the one med, see as soon as you give a heart med, you're hitting the fright/flight system. The body's trying to protect itself and you're trying to kill it. It's not a good thing. It got to the point where the problem with all this is the release of cortisol. You get the heart kicks up, you dump glucose. That's the reason why type II diabetes is a fright/flight. You clench your teeth, and down the line just a little bit you get cortisol.

That cortisol, how can we heal in the presence of a steroid. That's the reason why things like osteoporosis, fibromyalgia and all those things are going to get wrapped into this. They had to start supplementing his cortisol. They had killed the system so much. You get that you're actually a product of your pills. The idea is if you do some simple things, like nobody, when they get to be sixty or more, should sleep on a flat bed. You should raise the head of your bed about sixteen, eighteen inches, and what hat does, I don't have time to go into this on this but I will if you want me to for the courses, acid comes up your esophagus, the GERD. If you raise the head of your bed, a plumber top, meaning that it runs back downhill, and it goes back into your stomach so you don't have as much trouble with GERD.

You try to stay off your back and sleep on your side. We put backpacks on people all the time, and they just wear a backpack to bed full of towels. They're not going to sleep on their back with a backpack on. A lot of sleep apnea is positional. You can do a lot with this. Instead of buying one of the $6,000 from whatever that cranks up, on Amazon they sell this thing called a Mattress Genie, that is air bladder that inflates with this little air pump that's all electric. You put it between the mattress and the box springs and it just pumps the head of your bed up. It's simple stuff.

Putting a couple bricks underneath the front, you just slide off.

Howard:

I got an interesting phenomena. On Dentaltown, if anybody publishes anything holistic or a real doctor when you say, "I have indigestion, I'm coughing up acid," a real doctor wants to just write you a prescription and a pill to stop your stomach from secreting acid. Then when a holistic natural guy comes and says, "Why don't you put the two front pillars of your bed on a couple of red blocks," which I first heard about twenty-five years ago. I can't tell you the name of the patient because it would be a HIPAA violation. His name was Bernard Wells from Wichita, Kansas, and he was an engineer. He figured this out himself twenty-five years.

he told me about and I thought did it work? He goes, "Hell yeah it works. It's just simple mechanics. It's simple plumbing." When dentists hear things like this, they get all mad, but then when you talk to the dentists themselves, I say, "Do you believe in the American healthcare system, the fact that we're five percent of the world's population and take over twenty-five percent of all of the prescription pills?" They're like, "No." The dentist, if you question them, they are very skeptical about the U.S. healthcare system, but they're anti-naturalists, holistic, whatever, but the consumer market, they've lost respect for the congress. You see the approval rating has been around eleven percent for almost twenty years.

You don't normally find any Americans that say, "Man, our government's really good and really efficient." You know what scared the hell out of me is my friends that are physicians here in town, they say, "Well I don't really know who to send a person for that I just want checked out with heart disease because I'm just afraid they're just going to filet him open for $100,000 and do a bypass on any lead or new patient that walks in the door." I think just like the Americans have lost a lot of respect for the government, they've lost a lot of respect for this Polypharmacy U.S. healthcare system where they're just now sitting there writing scripts. Then when you talk about lifting up a bed or if you can't quit sleeping on your back, go to sleep with a backpack on, dentists will think, "Well that's holistic, weirdo, wacko stuff," but that's where the market is.

I think the dentists are there, they just don't like the term holistic or natural. What term do you like for trying to fix something without a pill? What do you like to call that?

James:

Good sense. I don't know.

Howard:

Common sense is not very common.

James:

It really isn't. There was a quote that I wrote down that I wanted to make sure I said to you. The eyes only see what the mind is prepared to comprehend. [Harold Shevell 00:41:13], a friend of mine, told me the eye only sees what the mind tells it to recognize. Once you've changed a dentist, they really become very almost spiritual about this. That's what I really love about it because dentistry, more people come to dental offices every year than they go to medical offices. Here's a little pulse oximeter, this thing. This is what I was saying I wanted to send to you to wear. You wear this thing for three nights. It is one of the best screening tools in the world. It is a different type of oximeter.

I don't any part of this or anything. I records a tenth of a percent and you can't diagnose from it, but boy you can get darn close. The couple of things that I've had trouble with too, you talk about it, the other thing are the pill pushers, the Oxycontins and all that stuff. Do you know in the United States we consume eighty-five percent of the world's pain killers? We only have five percent of the population. I'll tell you what, that knocks the hell out of sleep. It just kills sleep.

The other thing that kills sleep is alcohol. Women should not drink after about 6:00 in the evening. Takes about four hours to metabolize the alcohol if they have a couple glasses of wine, and I guarantee you, I can show you, and if you wanted to try it, take two or three drinks before you go to bed, run this thing. You'll see. That's part of the reason why oral appliances get a bad rap, because we're totally natural and CPAPs are mechanical.

Howard:

Don't tell them you're natural. They're going to think you're a hippie out in Sedona, Arizona with crystals.

James:

That's true. They usually smoke pot, and that really screws this thing up.

Howard:

Does medical marijuana, does that help you sleep at night?

James:

It's funny, I don't have enough experience to tell you one way or another. I can tell you about one patient. I was getting this guy and he's a close friend, getting under control and he came in and he had an AHI of, oh god, he was probably thirty-five or so.

Howard:

Explain what an AHI is.

James:

The Apnea-Hypopnea Index. It's how many times you stop breathing per hour. I show this one all the time, this one on the flip chart. This is Wisconsin Cohort Study. Basically what it shows that if you have no apnea, less than five, which is by definition, your probability of living eighteen more years is ninety-seven percent. These are men and women thirty to sixty. If you have mild apnea, which is less than fifteen, your probability of living eighteen more years is around ninety percent. You go fifteen to thirty, which is called moderate, your changes are about eighty percent that you'll live to be eighteen years older. If your Apnea-Hypopnea Index is greater than thirty, your probability of living eighteen more years is fifty-seven percent.

Half of those people die. Part of the reason why, and this is sleep apnea stuff, the population as we get older gets thinner. You know why it gets thinner demographically? Heavy people die. That's why. It's not because we get thinner with age, it kills people off. If you have somebody who had a stroke and you're a Caucasian, around seventy percent of those people you can bet had sleep apnea. If you're Asian, the numbers have been as high as ninety-two percent. In China, they lose seventeen million people a year to the workforce. I know more about the statistics in China than I know anywhere. The seventeen million people per year to the workforce and about four million a year die from stroke.

Things are big numbers. If I've seen anything that motivates somebody to wear their appliance at night is tell them, "Your Apnea-Hypopnea Index is thirty or above, and you don't wear your appliance, your probability of dying of a stroke is fairly high."

Howard:

I want to ask specifics because money is the answer, what's the question. These young kids, I know what they're thinking. Do I have to buy $100,000 CBCT machine?

James:

No.

Howard:

Do I have to buy one of these $5,000 machines that the patient takes home and puts these lead wires on? What type of machinery, because I got $350,000 of student loans and I can't buy everything on day one.

James:

This is $750. I feel that is all a dentist needs.

Howard:

What is it?

James:

It's the Minolta 300i, and there's only one supplier. It's Maxtec in Utah.

Howard:

Maxtec in Utah?

James:

Yeah. The trick to that thing is not the oximeter. The oximeter is different from every other oximeter on the market because it records the tenth of a percent rather than the whole number. What hat does, it creates grafts. You can apply algorithms to those graphs. What that does, it gives a diagnosis is what it gives. The physicians will say it doesn't diagnose, and I say it diagnoses. The FDA says it does. It's a great device. What I think that I've been working with and was developed here in Columbus is patient safety software. If I've ever seen a Nobel Prize idea it is patient safety software, because it takes the data out of that and tells you more about a patient than you could ever imagine. I can tell what they were drinking. I can tell when they were hyperventilating. I can tell when they were sleeping on their stomach. I can tell if they're on their back. I can tell what their [inaudible 00:47:30].

Howard:

Are you talking about the Max Venturi?

James:

M-A-X-T-E-C.

Howard:

The website is Max, M-A-X, tec, T-E-C, Maxtec.com. They sell a lot of things, so what is the actual product you're talking about?

James:

Minolta 300i.

Howard:

For $700 they can get into sleep medicine?

James:

They got to buy a cord to connect this thing, and I think that's $200, but then you know how many of these I have Howard? I have thirty of them. If you want to create a big sleep practice, what you do is you put these on everybody. I guarantee you, that's what I did in China. I was in a small hospital and I can't speak Chinese worth a darn. I'm just not very good at that. What I did is I took ten I think or fifteen of these oximeters, and I gave them to all the heads of the hospital in China. Within a couple weeks the clinic was flooded with people. That's how you get the patients. You identify them, you talk to them, and then what you do is you set down and you go over the report with them before they go to the sleep physician and tell them, "You have an option. You can have a mandibular advancement device or you can have CPAP. You can have whichever you please."

That's not the physician's choice, that's the patient's choice. As soon as that patient though accepts the mandibular advancement device from a dentist, the dentist needs to take care of that patient and get a great outcome. With this oximeter, it tells you everything. It's how I developed the appliance. I have tried every appliance on the market. You put this thing on, and it'll tell you whether it's working or not.

Howard:

You said at the beginning of this program you were working on these cases with cephs. Does the pano/ceph work? Do you need a CBCT?

James:

You absolutely do not need a CBCT. Contrary to the i-Cat thing, I think it's absolutely, I can't say too much about it, they'd probably sue me, but I don't think that you can see much with it. The airway is dynamic. It takes fifteen seconds to take a CBCT, and during that time people swallow, people breathe, people do all kinds of things, so you're recording an image of a moving airway. The only thing that you can record that's predictable is the smallest airway. We take a lateral ceph, and what I did, I have never been one to spend money Howard unless I have to, but what I did is I went out and I wanted a digital pan/ceph unit. What I did is bought them on eBay. I didn't buy a new one. Kodak installed it for me, and I paid $29,000 for it instead of $60,000 or $70,000 that they're charging for now.

Now the world is flooded with cephs. You can probably buy a good ceph for $10,000. Everybody wants CBCT and everybody's throwing them out. If I was a young guy, eBay has been my friend, I got to tell you. Most of this more advanced equipment, you can't buy the 300i on there, but all this other advanced equipment if you want, most dentists buy it and then they don't know what do with it and they sell it. What I do is you buy it for twenty cents on the dollar. My best one was an air abrasion unit. It's one of the fancy ones, creative or whatever, $20,000. I paid $160 for it on eBay. $160. Now it came out of a repossessed office. The guy had bought two or three of them and went bankrupt. I bought it, I sent it to the company, they refurbished it for $1,000, so for $1,160 I had a brand new machine.

Howard:

You are a Midwestern values conservative guy. That's another thing, Dentaltown has the free classified ads. There's fifty-six hundred free classified ads posted there now, and you're right, getting stuff used, whether it's a car or an air abrasion or whatever. This is really amazing. In the beginning you really said though that if you're a young kid maybe this isn't something you'd jump into right away. You said you'd do it when you're older and slowing down?

James:

No. I used to think that.

Howard:

Oh you used to think that.

James:

Now what I would do is I wouldn't get into it quickly. I would train myself. I would read. I would go to the meetings. I would study. I would become good at it and start running this pulse oximeters on people. If somebody wants to send me a pulse oximeter report, I'll help them read it. I do that for a lot of people. If I get bogged down, my partner does it.

Howard:

In my standard advice, I remember when I was in dental school. I used to think the coolest thing about dental school was realizing that now because of all this knowledge that I wouldn't lose all my teeth and wear dentures, that I wouldn't have gum disease and my kids wouldn't, and I think the most interesting thing is when you get into anything in dentistry, like this, sleep medicine, first you're reading about it and then testing your aunts and uncles and grandmas and kids and families.

James:

That's what you do Howard.

Howard:

Start this at Thanksgiving dinner.

James:

I've seen people pay $150,000 for a franchise or some stupid thing. It's ridiculous. They don't have the education. Even you and I, when I got into it, you know nothing about sleep. I always say we've created fairly highly polished careers. We've gotten good at doing crowns. We know how to make a good gold crown. We know how to make a good veneer. We need to know how to do all this, but we don't know beans about sleep. You need to learn it. If someone really goes at this in an educated way, they don't need to spend a whole lot of money. You could get a subscription and start reading about it.

Howard:

When I saw all those people spending $150,000 on those sleep programs, it just reminds me of ...

James:

It's just stupid.

Howard:

... I grew up in Wichita, Kansas and I went to Creighton in Omaha, Nebraska, and in 1980 as a freshman and Warren Buffett came and spoke to our class because we were in Omaha. I love Warren, and he says, "The difference between successful people and really successful people is that really successful people say no to almost everything." Is that Omaha with a capital O?

James:

Oh my goodness, it's perfect though.

Howard:

Then there was some big lawsuit thing on Dentaltown where everybody's all whining because this company was coming by and they were leasing a television that you had put in your office and everything, and the bottom line was this thing was like $30,000. I couldn't help but reading that whole thread thing, well why the hell did you pay $30,000 for some guy to put a TV in your waiting room? People were complaining about spending all this money. The first thing I was thinking was Warren Buffett, well why did you spend that much in the first place?

James:

Yeah, and talk to your patients anyway, don't put them on TV for Christ's sake. Just talk. I enjoy talking. That's what's grown my practice. I have a fee for service practice. I don't accept insurance.

Howard:

You're sixty-nine years old right?

James:

Right.

Howard:

You know why sixty-nine is my favorite number?

James:

I don't want to ask.

Howard:

That's how old Mother Teresa was when she got her Nobel Prize.

James:

Oh really? Oh good.

Howard:

Yes. I lectured in her country and went to see where she was born. She's a big idol of mine when I was a kid. I want to ask you a question, since I only got you for three more minutes. You're sixty-nine years old. You've been in this field a long time. What do you say to these young kids that say, "Jim, you and Howard are lucky. You guys got in in the golden days."

James:

Bullshit.

Howard:

"You didn't have any student loans and there was not corporate dentist chains and the economy was rocking hot, and now I'm a martyr because I got $350,000 student loans. Corporate dentistry is going to roll up all the dental offices and we're all going to be working at Walgreen's." What do you say to that?

James:

One, there's always room at the top. You know that Howard. You and I both know that. I always said sometimes fire makes people better. When you have to withstand the fire of somebody coming after you, you got to get better. If you were to rely on the television in your waiting room to sell crowns, you're up the creek. It ain't going to work. You better find something like this flip chart or something where you can sit there and talk to people so they like you. Can I do one thing before we leave?

Howard:

You can do anything you want buddy.

James:

Okay. You got four straws sitting in front of you. These?

Howard:

Yep.

James:

I had to go through a lot of drinks to get these also. What I want you to do is demonstrate the airway, and several things will come from this. You take all four and you breathe through them. Hold your nose. Now what's amazing to me about it is it very hard for you to breathe through your nose?

Howard:

No.

James:

Look at the loom and size. It's really not very big. You're breathing very well through that, so it doesn't take much of an airway to get somebody breathing. Now take one away. Gets harder right? Take another one away. Now where are you starting to feel tension? Are you starting to feel tension in temporalis?

Howard:

Man, four straws no change, you're just breathing. At two straws it starts taking effort.

James:

Well what it does, you'll start to also notice that the TMJ muscles that we always say cause pain start to light up because you're working to breathe. TMJ is about breathing. Then you go down to one. Are you starting to get a euphoria? That's the epinephrine. Then what I always do with my courses, when I say, "Okay, start breathing through it," now hold your breath for ten seconds, that's an apnea.

Howard:

I know my homies well. I've been hanging out with dentists my whole life, so my job is dentistry uncensored. I know what they're thinking, so I have to ask you some of the tough questions. Back to TMJ, they say things, when you say why are all TMJ patients women, they say, "Man, they're just crazy women. They have this look."

James:

They're crazy because they don't sleep. That's the reaction to not sleeping. I can prove that off of that three and a half million demographic study if someone will listen to me for five minutes. You can prove that stuff. All TMJ patients are crazy because most of them don't sleep.

Howard:

I always remember I was so much better raising the fourth kid than the first one because you have no training. I went to eight years of college to do a filing and I didn't go to a one day course before I had Eric. What does it mean when a kid's crying? He's tried. He's hungry. It's just so basic with a human.

James:

You know what's really interesting in a TMD patient?

Howard:

You mess up their sleep and you get them behind on their meals, and they just lose it right there on aisle three in Safeway.

James:

That's exactly it. The people that say, "I don't want TMJ patients in my practice. They just throw up all over you. They're nasty," you got to learn compassion. You got to learn how to walk the mile in the other person's shoes. When that person comes at you heavy like that, just back off like you would. What do you do with a kid that's cry? You start bawling too? You go, "Now, now, now, now, now, now quiet down. There's no problem here. It's all good." That's how you take care of TMD patients. It's the same thing.

Howard:

Jim, I really hope you put an online one or two or three, back to online CE. The research is really clear. They're saying that when humans go to learn, they can't really learn longer than hour.

James:

I'm about twenty seconds sometimes.

Howard:

This model, I keep reading about it because I have a huge online library of dental education, and they're saying that these kids going to school from eight to three is crazy. A lot of them are saying they're too tired to even learn until 10:00. They're not even waking up until 10:00. I don't know if you can teach this to all the dentists on Dentaltown in an hour. This might be a two hour course of a three hour, a three part series or something because I really feel this, let me tell you my Litmus test. I've had several dentists on Dentaltown saying, "Oh come one, this is just another fad. This is just a fad. Ten years from now ...

James:

This ain't no fad Howard.

Howard:

... no one's going to be talking about this, but here's how I know it's a fad," because come on, porcelain veneers during the 80s, the bull market run from '93 to 2000 right here in my own backyard, probably a hundred dentists quit pulling teeth, doing dentures, partials, they all became cosmetic dentists and all they were going to do is veneers and bleaching and bonding. Then when that NASDAQ popped on March of 2000, they literally went bankrupt. The only ones that could reverse engineer are the ones that didn't lose their skill on how to do a root canal, extract a tooth, partials. They lost their ability to be a well rounded dentist.

I was telling them during the cosmetic boom, I said in the United States a third of a billion people, two hundred and eleven thousand Americans are alive today that have a dental degree. I can only find one practice with a practice limited to veneers and it was in downtown Manhattan with Larry Rosenthal and [inaudible 01:02:35] and those guys. What really caught my attention with sleep medicine is it barely got out of the gate, and I was finding dentists in places like Kentucky and Mississippi and Texas, just grounded salt of the earth people who already had a practice limited to sleep medicine. There was so much of this they quit doing all general dentistry within a year.

James:

Howard, if you notice I'm restorative. I did two reconstructions a month for years. That's what I like to do. What you're going to find with this sleep is this is going to change restorative dentistry. It's going to change how we make dentures. It's going to change everything because you know what, you can affect the heart, and I can prove it, by how you make a denture. How do you determine the vertical dimension of occlusion? I determine it with this. When the heart calms down, that's my vertical dimension of occlusion. You can tell so much about the body. I like this quote by Charles Mayo. In 1915, he said, "The next great step in preventative medicine must come from dentistry."

Howard:

Really?

James:

Yeah. I love that quote.

Howard:

Charles Mayo of the May Clinic?

James:

Of the Mayo Clinic.

Howard:

Wow. I was not aware that he said that.

James:

I found it in old book, I found it in a 1928 book. The books behind me are not now. I have mostly old literature. I read that more than I read the new stuff sometimes.

Howard:

My last question is back to the American Thoracic Society, what percent of that's MD versus DDS?

James:

DDS, last year there were three DDS out of fifteen thousand.

Howard:

The rest were MDs?

James:

Yes.

Howard:

What do the MDs think of hanging with dentists?

James:

They actually like it because they know that they don't have the answer with CPAP. Do you know that CPAP does not terribly impact what's called bio-markers? Every disease process in the body gives off a waste product. The CPAP does not decrease bio-markers markedly at all. It just really doesn't impact. The funny thing about it is I think oral appliances do, and that's what I want to improve. We have an EndoPAT, which is an expensive machine, but it measures the endothelial health of the blood vessel. What we're doing is we're tracking people, we're tracking them when we bring them in and then we're tracking them every three months to see the change.

It takes almost a year for a dental appliance to really hit full tilt.

Howard:

Jim, I believe right now ten percent of the dental offices are what you call big box corporate, meaning there are multiple locations. It's about ten percent. Where do you think that's going to be in twenty years? Where is that percent going to be do you think?

James:

It depends on the dentist. Dentistry is a wonderful profession. The thing about it is it's like we're given a Ferrari. You can treat that Ferrari like a beat up old Ford or you can treat it like a race car. You can do anything you want with dentistry. You know that. If it can come in your head, you can do it. You got to work for it though. Guess what, I didn't believe to a country club. I wish my car wasn't eight years old. It's a nice car but it's eight years old. There's a lot of things that you do in life you make choices as to what you want and what's important. Dentistry's been important. I really truly love it.

It's a great profession, and if you give to it it'll give back to you.

Howard:

You know why I never joined a country club?

James:

Why?

Howard:

I would never join any country club that would take me as a member. Jim, that course is May 15th in San Francisco?

James:

Yes it is Howard.

Howard:

You're going to be there?

James:

I'll be there.

Howard:

It's a one day or two day?

James:

It's actually four days, and I'll be there the entire time. You can give out my email or whatever you want, and they can email me. I even gave out my cell phone number.

Howard:

Well give it out. Let's hear it.

James:

614-260-3841.

Howard:

Say it again.

James:

614-260-3841.

Howard:

If you're listening to this in a bathroom stall, write on the wall, "For a good time, call Jim at 614-260-3841." What's your email?

James:

DrJamesMetz@yahoo.

Howard:

What is Metz? It's an off spelling of a baseball team?

James:

That came from the Metropolitan.

Howard:

The name of the Metz came from the Metropolitan?

James:

Yes.

Howard:

You have a Z in your name and anything with a Z is German.

James:

Yeah. We actually came from what used to be east Germany is where the name came from. I spent three years in the army in Germany and we actually found our roots. It was really funny. We went into the rat house where they kept the records, and they pulled this old book off the wall, and it went clear back to the 1600s. They traced my family all the way up to 1835, and the whole family it said noch America, went to America.

Howard:

Wow. That is so cool. I love Germany. It's got to be one of the greatest civilizations in the world. Their dentists are so evidenced based. They really think about things like removing all wisdom teeth just because they exist. That's now how German does it. A German would want data, they want numbers. I love the way they're always challenging.

James:

My saying is if you love it prove it. One of the troubles with dentistry is we're what eminence based dentistry instead of evidence based dentistry.

Howard:

They're saying what?

James:

Eminence based.

Howard:

Eminence based?

James:

Instead of evidence based.

Howard:

What does that mean.

James:

Eminence that means your stature.

Howard:

A false front.

James:

I wear a nice $3,000 suit and you think I know what I'm talking about.

Howard:

That was one of my favorite songs by The Who, Eminence Front. You remember that, Eminent Front, it's a put on by The Who?

James:

I don't remember that one.

Howard:

That's one of my favorite deals that you have this false front out there.

James:

That's true.

Howard:

It's a put on. I think it's my number one Who song. Hey, we're out of time. Seriously Jim, I really hope you develop some online CE course for them because these dentists love it because they can watch it on their iPhone, their smart phone, their iPad, their home computer.

James:

I'll do it Howard.

Howard:

A lot of them with their iPhone, if you have Apple TV, you just pull that course up on your iPhone and you throw it on your big screen. Now you're at home and you got big screen, surround sound. The other thing that it's helping so much is so many of the dentists with young families who when they go home at night they got kids, and they need to get dinner and pack lunches, so they really can't go to the study club up the street. It's really inconvenient to go. Then what really gets my heart going the most is we make these courses available in the poorest countries. I've gone to so many of those dental offices where I'm in these poor places like in Soweto or Tanzania or Ethiopia and I walk in there and I tell them I'm the guy from Dentaltown.

Sometimes they just burst out bawling. This little muslim girl was telling me in Tanzania that she can't even afford to go all the way to Darussalam. That's like a month's wages for her just to go from where I met her in Tanzania to Darussalam to take any continuing education course. She's sitting there in her dental office watching these courses on her iPhone.

James:

I think that's awesome. Howard, I'm not saying this to blow smoke and make you feel good, but you know what, I really enjoyed you asking me to do this because I started looking at all your podcasts and whatever, and like I said, the one that I just dearly loved was Misch's. He's had such travels. That's a wonderful, wonderful program.

Howard:

I'm going to ask you this as the very last question, so if you don't like the question I can edit it and cut it off here. It's all over the news, Prince couldn't sleep and so he was going to his doctor. When I'm saying this, the autopsy is not out, but a lot of people are saying that he was taking medication because he couldn't sleep and that he ended up going to sleep for life in an elevator.

James:

You know why that is Howard? He was incredibly, incredibly, incredibly gifted. Those are the people that get nailed by this because they're running on high octane fuel at night and they can't sleep.

Howard:

Do you think Prince had a sleep disorder?

James:

I would bet $10,000 on it, and for me to say that, that's a lot.

Howard:

I'd prefer you say that you'd bet $1,999. Remember the song 1999, party like it's 1999. It's pure speculation now, but some people are saying and they're reporting that at one time he went a hundred and fifty hours without sleeping, so he was going to one doctor and getting sleep medication.

James:

Michael Jackson is the same way. It's the same thing Howard. You know what's funny, this will be all and I'll shut up. I've been reading the New York Times. It's like their atlas or everything you need to know. It's an encyclopedia about this thick. I've been reading the bibliographies in there for almost four years. They have a little paragraph about this long about each one of them. Most of the very influential people in this world died young.

Howard:

Wow.

James:

That's totally non-scientific but it seems to be the case.

Howard:

What I'd like to remind all women is that not a single woman who was well behaved ever became famous, so start misbehaving with me. No. If you want to get the most podcast views of all time, we should say why Dr. James Metz thinks Prince and Michael Jackson had sleep apnea.

James:

I'll do it.

Howard:

I think that'd be a great title. Seriously, there's even a thread on Dentaltown about Prince. It was tragic.

James:

It is.

Howard:

I share a birthday with Michael Jackson. We were both born on August 29th, but I can still remember the day that we heard Michael Jackson died and it was somber the whole day. It was like a relative died.

James:

You know what's really interesting Howard, is if you treat the sleep apnea and get them straightened around and get their heart rate calmed, I'm not sure you have a Prince when you get done.

Howard:

Because you think if you start getting them sleep well that they'll slow down?

James:

Yep.

Howard:

Wow. How many of the greatest artists and scientists of the world were also not right in the head, kind of mad scientist?

James:

That's it.

Howard:

You listen to these stories about, who's the guy that painted the Sistine Chapel upside down?

James:

Michelangelo.

Howard:

The more you read about that guy, you wonder, that guy wasn't all quite normal, was he?

James:

Van Gogh, he was totally mad and his paintings sell for gazillions of dollars now. There's something here Howard. I'll tell you, it's why these big athletes, I've worked with a good many athletes and I think it's why they don't heal after an injury, because that heart rate stays up and they produce so much cortisol they can't heal.

Howard:

Interesting stuff. Jim, I really hope you make us some online CE course. My email is Howard@Dentaltown.com, but I'm Howard Farran. We have a Howard Goldstein that does all the online CE, so he's Howard Goldstein. He goes by Hogo, H-O-G-O, at Dentaltown.com. I wish you would email Hogo@Dentaltown.com and build us some courses. By the way, to the listeners out there, if there's specific courses you want on Dentaltown, you send an email to Hogo@Dentaltown.com and as always you can email me, Howard@Dentaltown.com.

Jim, thank you so much for doing this and I'm going to try to get to San Francisco myself. I do think that is one of the coolest cities in North America. I think San Fran and Vancouver, British Columbia, Canada are the two ...

James:

Oh they're beautiful.

Howard:

... coolest towns on the west side. My favorite Mark Twain quote is "The coldest winter I ever spent was a summer's day in San Francisco." I swear to God, it's always cold in San Francisco.

James:

That's right. Thank you Howard.

Howard:

Thank you Jim.