SPEAKER_02 0:00

This episode of A Why Did I Become a Doctor is brought to you in partnership with Medical Brief, South Africa's leading daily healthcare news service. Stay informed with trusted reporting, expert insights, and analysis that matters to healthcare professionals. Subscribe free at medicalbrief.co.za forward slash subscribe. Enjoy the show. Alrighty, welcome back. First time we're doing a part two with somebody so soon. I mean Abby. Yes. I'm going to read something. Yeah. I have no microplastics in my balls.

unknown 0:36

Okay.

SPEAKER_02 0:37

Yeah. That's a tweet. That's like the first tweet I I read this morning. Okay. And I said it's it fits in perfectly because I I was thinking, how are we going to do the part two? How am I going to introduce it, right? Right. And I wanted to ask you a philosophical question, but let me read this tweet. Brian Johnson, you ever heard of him?

SPEAKER_01 0:56

Hmm.

SPEAKER_02 0:57

Have you ever heard of him? So he says, I have no microplastics in my balls. This should not be possible. Studies show that 100% of men have m microplastics in their semen. I'm the first human ever to show a complete reduction to zero. And then it's a long thing. Just go read. Followed Brian Johnson, right?

SPEAKER_00 1:13

Is he the guy that's trying to like reverse age that guy?

SPEAKER_02 1:16

Brian Johnson is the guy that's trying to live forever. Oh, okay. I was thinking like Michael Johnson and his basketball. His Twitter bio says conquering death will be humanity's greatest achievement. Right. Now this guy tries everything under the sun to re almost, you know, pause aging and live forever. That's his goal. And it ties in perfectly with the first question I'd planned to ask you, which is like, Do you think we'll live forever? No. Why not?

SPEAKER_00 1:40

It's um I think as as a a carbon-based life form, scientifically it is um and it is an inevitability that life will lead to death. Um with current science. I think so. Um look there's I I think that's there's maybe maybe the ability to uh download one's um persona or adapt an AI to yourself, but I don't think that's have you been thinking about that? No. I don't think uh I don't think the existential crisis has hit me yet. Um beyond my twenty-four hours in a day.

SPEAKER_02 2:22

So you mean you just figured that out on the fly? Because that's a very deep thing to to think about. Okay. The persona thing.

SPEAKER_00 2:28

Um I I I don't know. I've thought about it. Yeah. And what are your what are your thoughts on it?

SPEAKER_02 2:33

Okay, well look, before before we get there, would you like to live forever?

SPEAKER_00 2:37

No.

SPEAKER_02 2:37

Why not?

SPEAKER_00 2:39

Are we gonna go around the table and ask? Yeah, why not? Okay.

SPEAKER_02 2:42

Yeah. I I wanna I would want to live forever.

SPEAKER_00 2:44

Yeah? Yeah. I think the beauty of life is that it's limited. I think if you Okay, have you watched Interview with the Vampire?

SPEAKER_01 2:52

Mm-hmm.

SPEAKER_00 2:53

Okay, you can bring that bitter in here next. And Tom Cruise. Um but like at a certain point they get tired of the immortality. And I think that's the that that's what makes life so beautiful. It's being able to know that um whatever we're going through is finite in its existence, in its nature is finite. Um this could be the last time you see a loved one. This could be um the last time they see you, uh, it could be the last time you see a friend at a table. Um and that's what makes these moments so special. Um so no, I would I don't think I'd like to live forever. As much as it seems enticing to want to spend an infinite amount of time with uh doing the things we love and with the people we love, I think that, well, personally, my opinion is uh that's what makes this life so beautiful, knowing that it's gonna end sometime and knowing that we only have a finite amount of days left to experience this life.

SPEAKER_02 3:53

Aaron Powell It's interesting that you answered it with the perspective that everybody else is gonna live forever too. Because I had this conversation with a colleague recently, and they said no, they don't want to live forever. And then I said, but why not? And they had assumed that everybody else is gonna die and they just live on forever and they'll be alone and lonely. I said, no, I want to live forever because I want everybody that I love to live forever and to keep on doing the same stuff that I do forever. Why why should why would it end? Yak, you know, yeah, I I tend to agree with you because you living forever also means that you're gonna be aging at the same rate of what your lifespan is gonna be. Which means like you're gonna be like this uh geriatric 200-year-old. What are you gonna be doing? How how are you what's your quality of life going to be? No, but what if you pause aging? You stop like right now, yeah? How you are right now? Yeah, that's a different question. But then then again, like also you the the life is finite. At pausing life at this age means at this particular moment you get to experience everything that life has to offer and it's not gonna change. And then life will become bored. But then at the same time, like as I think I know where you're going with this by saying that. I don't know where I'm going with this.

SPEAKER_01 5:07

I really don't.

SPEAKER_02 5:08

I genuinely don't. Because if if if longevity improves, so is mortality. Life and the universe will find a way to kill you.

SPEAKER_01 5:18

Yeah.

SPEAKER_02 5:19

So I don't think life can go on forever, because no matter our advancements in science, I think the universe and the environment is gonna provide for alternatives to make sure we don't live forever. Yes. I just find it interesting that you guys want to die. Like it that's what you're telling me. No, you don't want to die.

SPEAKER_00 5:36

That's not what we're saying.

SPEAKER_02 5:38

Um So what are you saying? I mean, you you you want you want it to end one day. Why? Why why not enjoy this forever?

SPEAKER_00 5:46

Look, I uh it I don't think that's the message that we we're putting across. I I know for from my side, that's definitely not the message I'm putting across. It's just that um there's you you'd want to spend as much time with the people around you as humanly possible. And that funny enough, that's a that's an odd way to say it. As humanly possible. Um but you know, you you married to the same person for 200 years. Um you know, you gotta clean diapers for 200 years. Are you telling me that is a life that you cannot get bored of? Or at least I mean, what are you gonna do? And and I think again, it's it's um it's it's just in its existence being or knowing that just the time that you have is special. And that's that's the crux of it all. Is that it's so limited that it's what makes every day with your spouse, with your partner, with your kids, knowing that they're gonna grow up, become something else, you're gonna be proud of them, watching them grow, uh, seeing your friends uh excel through their lives. Um it's all of these things that I think is what makes life special. What's your favorite food?

SPEAKER_02 7:01

My favorite food toasted cheese and tomato. Imagine if that is the only thing you could have like forever. Would you would you still if you if you if you were to ask me what's one thing you could you had to eat forever, I'd say that probably. Or pizza. You don't think you get bored of it? Of course you get bored of it. But that's a diff that is a different question, yeah. I'm saying life at the moment, it carries on forever. But but maybe it's because I don't look at it from the perspective of maybe it's because I don't approach life currently thinking that I need to cherish these moments. Because I feel like I'm gonna live forever right now. I I don't I can't imagine myself dying or getting old. You know, I'm still too young. But this is also not a new philosophy up his head. For from the time he was in Stanerton, yeah. He used to tell people that science is showing that if you are alive now and you're under the age of 40 or something. Under the age of 50, by the year 2011. I can't remember the exact. This is what he used to tell people in real life. No, I genuinely think we might live forever. Okay.

unknown 8:00

Cool.

SPEAKER_02 8:03

Right. What do you do with your life if you're going to live forever? A lot of things change, right?

SPEAKER_00 8:09

Yeah.

SPEAKER_02 8:10

You know?

SPEAKER_00 8:11

Okay, let's let's let's go down that rabbit hole with you. Okay, so assuming one could.

SPEAKER_02 8:15

So then I just keep on doing. I mean, then I'm I'm happy. I I would not mind doing what I do now for the rest of my life, forever, and if it never ended. I'm content.

SPEAKER_01 8:25

Yeah.

SPEAKER_02 8:26

Yeah. Um It's it's weird, huh?

SPEAKER_01 8:29

Weird to think about it.

SPEAKER_00 8:31

I think even the things I I love doing can become a bit monotonous. Um I love I love wildlife photography. I could spend about a third of my year in in the in just the bush doing some photography, driving around, seeing some animals. But I think I can get tired of that. Um I love what I do for a living, but I also think I could get tired of it.

SPEAKER_02 8:54

So um But isn't that why you you you alternate these things, right? You'll go to the bush and then you'll work for a bit and then rinse and repeat every year. Yeah. Yeah, but those things are finite as well. Yeah. There's not like an unlimiting amount of things to do. You spend a hundred years doing prostodontics, another hundred years doing wildlife photography. Yeah. And you get bored of every single possible How do you know you get bored? The toasted cheese. But that's toasted cheese every day. I'm not sure you asked me like, you know, if there's one meal that I had to eat. Yeah. Actually, I changed your question almost. Yeah. But I'm saying So you're saying repeat that cycle.

SPEAKER_00 9:32

Life enjoy.

SPEAKER_02 9:34

Because there's the other thing that that that some of these people I'm I'm into weird men like this. Not me, men weird people. Like Brian Johnson is a weird guy. He even says it. He says like his life is his his pursuit of trying to figure out how to live forever is so consuming, all consuming that he sometimes gets tired of it. Like this guy measures every bodily fluid in his every bodily fluid that he produces, right? Yeah. But there's also weird guys like Elon Musk, right, who think that in 10 years' time none of us are going to be working anymore. Right. You know, and and imagine if that's true. Like we're we're not going to be working. There's going to be a universal high income that just gets paid to us. We can do whatever the hell we want to because AI and robots are going to do everything. No, what would you do then?

SPEAKER_00 10:25

I I think that's in it in itself is um is a fallacy. I don't think that's even humanly possible, because the human condition and the whole thing about money is money is a means of transacting. It's a means of exchanging. And I mean, remember, before money it was you trade services, you you barter, you I give you shells, you give me grass, something like that. Um and money just became a commonality in which to transact. So what's the point in m having money if no one's gonna accept it for something? I mean, uh yes.

SPEAKER_02 11:01

But that's that's that's what they're saying. The robots will do everything that we don't want to do. Like if you need food, some robot will harvest and do whatever.

SPEAKER_00 11:10

Yeah, but you still need to go to the shops and buy your your, you know, and and be toasted cheese. Yeah, your toasted cheese. And someone's gonna have to bring that to you. Or uh yeah.

SPEAKER_02 11:21

So let me I'm gonna I'm gonna give you a question, but I'll give you my answer first, right? So let's just say Musk is right that in 10 years' time we don't have to work. We can do whatever we want. And if Brian Johnson tests enough of his bodily fluids to make sure that we live forever, right? Those two conditions are met.

SPEAKER_01 11:38

Yeah.

SPEAKER_02 11:40

And I had to ask myself, what would I do? For you know, what would I just do forever? It would be like just being around people and talking. Right. Because and that's what we're doing here, right? Why we why are we even doing this? Like, why do we even have these conversations? Why do we sit together in a room and talk?

SPEAKER_01 12:00

Yeah. Like, what's the point?

SPEAKER_00 12:02

There's a there's an old song by um Savage Garden. It was called Affirmation. Do you remember it from the I wrote this out, but if you give me the There's a line there that uh that this the singer says he says, he believes that junk food tastes so good because it's bad for you.

SPEAKER_01 12:16

Oh yeah.

SPEAKER_00 12:17

All right? And I mean, yes, Brian Johnson is probably he's living this life where he's controlling every substance that goes in, every substance that comes out, and they are taking these measurements. Do you think the average human could survive on that? I mean, we love a hamburger, we love our alcohol, we love all of these vices that really speaking, we shouldn't be putting into our bodies. We should be eating fruit off a tree. And even if we consider the fruit that we buy from a shop, even that is genetically modified. Bananas aren't supposed to look like a banana that we buy today. They're not supposed to be that sweet. The grapes we have are genetically modified or genetically streamlined to give us something that is more palatable, but it's not as healthy as the actual form that we should be consuming. So everything in life is sort of consumer-driven. And I don't think that the average human could get away with uh Brian Johnson Johnston Johnson Johnson kind of um lifestyle or he's the pioneer, he's doing it so he can figure it out for us.

SPEAKER_02 13:27

But you didn't answer the question though. What if those conditions are met, what would you do? If the conditions give you, you were forced to live. No, you that's just how life is. Yeah. You're gonna live forever at this age now, that you are this health, forever with and doing you have you don't have to go to work to earn a living. Right. You could get whatever you want just by asking an AI.

SPEAKER_00 13:51

What like what would you do to keep yourself occupied? That's the big question. What would you do? And why why then would it be so I would sit around talking crap all day. That's what I would. Suicide rate would go through the roof. Why do you think this? Why? Because I would people would be would feel useless. I mean, yeah, we you could sit and talk, but then you'd run out of things to say. You'd run out of I mean, yeah, we could ha three of us could hang out for a month or two talking, but then Oh, he's giving me only one month. That's actually a call. Before we run out of commonalities between us. I'd get tired of myself much, much sooner. And then like we we meet with other groups of friends, but that's what I mean, is that you you see you getting there. So you just go, you you speak to different people. Okay.

SPEAKER_02 14:35

Just talk crap. Ask them about what was life like before the that we crossed the threshold, you know? What did you do when in your past life, when we had to like make money? I'm not sure what's money is a weird thing, eh, isn't it? Yeah. Like it as you said, it's just for transactional purposes. I need something else. I need you to do something for me, and you pay me. But do doesn't it bring you joy to just talk with people? Yes, of course.

SPEAKER_00 15:03

Yeah. I mean, I I I don't think I uh as much as I like to be alone and with my own thoughts, I think I prefer to be around people more. And the photography thing? Um, I usually do it with people. I do it with my family, my friends. Um, my Max Fac friend Shaylin, uh, my wife, my kids. I told you my son has his own DSLR. Yeah, yeah. So we go together and we do photography. So um yeah, it's it's um it's also a social thing as much as it is a personal thing.

SPEAKER_02 15:30

And prostodontics?

SPEAKER_00 15:32

What about? You never mention that.

SPEAKER_02 15:34

Yeah, never featured once. So you're in retirement.

SPEAKER_00 15:38

We start big well, I assume if we don't have to work, then but there will always be um a need for I say don't have to.

SPEAKER_02 15:47

Like you can if you want to.

SPEAKER_00 15:48

Oh, then I definitely would.

SPEAKER_02 15:50

Yeah.

SPEAKER_00 15:50

Um yeah, I mean, people will always have rotting teeth and malacclusions, and um they would always look in a mirror and see something they want to fix. So I think that there'll always be a need for what we do. And I mean, especially with prosodonics, there's also the maxillofacial prosodonic side. I mean, living longer would mean you have probably have a high incidence of cancers and stuff like that. So we'd probably have to get involved more, do more um ablative surgery, more reconstructions. So I think there's a there's a lot you'd probably need to put onto those as conditions. You could live forever or live 200 years, but you're probably gonna get a lot more cancers as your cells turn over and turn over and turn over and turn over.

SPEAKER_02 16:34

They get you. Yeah, cute. You didn't answer any the question, I don't think. Or what would I do? Yeah, if those two conditions are met. Probably something to do with with wellness or mindfulness, actually. I'd concentrate more on that. What is that? Because knowing that you I mean you guys were saying it now, like you you'd get bored of yourself very easily. And you also said that yeah, people would get bored of each other and the suicide rates would go up. So I think to master the longevity would be to master oneself in mind.

SPEAKER_01 17:03

True.

SPEAKER_02 17:03

Because then if you can be okay with doing all of these mundane things and and having to deal with like Yash talking to you all the time, then bringing up Bob topics from who knows where. No, but maybe you guys are just are just restless people because I could do the same thing every day. Yeah. And I'm sure there are people that do the same thing every day for 40 years and they die quietly and peacefully.

SPEAKER_00 17:31

I think you maybe there's a a big yeah, that's probably got a lot to do with it. Because I I don't think I could be still I can't sit at home and do nothing for a day. That's that's the worst torture for me. I've gotta be moving, I've gotta be doing things.

SPEAKER_02 17:45

What's uh what did you do most recently? What did you do yesterday? Worked, obviously, probably.

SPEAKER_00 17:50

Uh I worked and had a date night with my wife.

SPEAKER_02 17:53

Okay. Friday night. I must say we we're recording this on on on the 9th of May, right?

SPEAKER_01 17:59

Yeah.

SPEAKER_02 17:59

Just because that's when Bru I just wanna Yeah, I I don't even know why I'm saying the date. But that's just because that's when I read the Brian Johnson tweet. He tweeted it one day ago. He talks about microplas Do you w worry about health and things like?

SPEAKER_00 18:14

Yeah. Yeah, I try to say quite fit.

SPEAKER_02 18:16

Yeah. But like, are you like now I don't even touch you know when you go and pay for something and they said you want a receipt and that machine prints out the thing. I saw on one of these podcasts that that thing is dangerous. Not most dangerous, but it's high in BPA. Yeah. Yeah. So she's she's recommended that you never take those, don't touch, don't even touch it. Because we need them for tax purposes, man. Gotta take them. Gotta take them. You see, this is why we need uh to be in a world where we No, this is why we need to be in a world where we don't need to work, because then tax is irrelevant, right? Yeah. Okay, so yeah, you guys are restless people, I think.

SPEAKER_01 18:54

Yeah.

SPEAKER_02 18:55

Is that what you think makes that kind of mindset create somebody that becomes a specialist one day, or not really. Whoa. No.

SPEAKER_00 19:04

What's it like being a specialist? Ah, it's the best thing in the world. Why? Um there's there's a guy that I'm mentoring now. Um, he's from Nell Sprit. Uh his name is Henko Janssen. And he wants to do prosthetonics as well. So um we work in cases together. I teach him a bit, give him a bit of tips. And, you know, he back when I was um he wanted to decide what to do with his career and his path in life. Um, he asked me the same question. What's it like to be a prostheticist? And I said, the the thing about it is you get to be at the tip of the spear, that as things are changing, as things are evolving, and as things are being disseminated to everyone else, you get to be the one at the front of the crowd saying, this is it, this is what we're doing. Um and but look, don't get me wrong, as well, it's not it's not true of all specialists and of all specialties. Um I mean, there's there's great, well, and if I use prosthetics as an example, there's great prosteronists, there's good prosthetics, and there's bad prosthetics or just prosteronists who are just comfortable and average and just sit in their little surgery. And it's true of all businesses and all jobs. There's people who are great at what they do and people who are just coasting by. Um, but it allows you to at least have that in your life, where if you are driven enough to be hungry for it, to want the information, you know, forever at your fingertips and be able to disseminate that, you can be there. It's it's not where you've got to wait for someone to give it to you. You go out and you find it. Or if you can't find it, you make it happen and you research it and you do it. And that's what being a specialist gives you. It gives you the flexibility to to either effect change or or um or accept change and do something.

SPEAKER_02 20:56

Like if if you're at the the apex of you know change and innovation and things like that, don't you question your the treatment that you've done like last week? Absolutely.

SPEAKER_00 21:04

All the time. Yeah. All the time. And I mean, just by the if you go with just the literature, there's so many things that we we subscribe to today that five years ago it it wouldn't even exist. And they may have been recommending something completely different five years ago. And the worst thing is when it comes to uh industry, a lot of the stuff that gets put onto us is not clinically trialed. They'll give us a new material from in the market and say, yeah, go have fun. Or they'll give us a new implant design and say, there we go, let's go for this. And then it's only five or ten years later that we start seeing the problems. Take take zirconia, for example, uh, a material that we all use in dental practice today. Um it entered the market in late 90s, early 2000s. And back then it was uh it was the best thing since slice spread. We use it like a metal uh substructure. So for anyone that's watching that is not dental, I I learnt my my lesson from your last yes from our last interaction. So when when people are having crowns made, they um so if you lose tooth structure and you need a dental crown done, there are different materials that can be used to make you a dental crown. And back in the early 2000s, there was a material that came out that was called zirconia. It's a ceramic material. Uh it's an oxide of zirconium, the metal.

SPEAKER_02 22:27

Sorry, if I can ask, what was its predecessor? What were they using before that?

SPEAKER_00 22:30

They used metal. Yes. So they used metal and they used porcelain, normal porcelain, but it was very weak and its indications were very limited to the front of the mouth. But they used porcelain on top of metal. So the metal gave it a very dull, non-lively look to it. Unnatural. Yeah. So then as soon as zirconia came out, which was a white ceramic, it was the best thing since sliced bread because now we've got something white that we don't need to cover up, so we can start to make it look very natural. So we layer it with porcelain and give it this beautiful translucency, and it was phenomenal. Everybody loved it. And this was in the early 2000s. So we did a lot of it. And then towards 2010, 2012, we started to see major failures with the with the materials. And what we then realized was that you can't bond porcelain to zirconia the way you could do it to metal. So there's no bonding of well, no chemical or covalent bonds between the materials. And how did they figure that out?

SPEAKER_02 23:31

Just with trial and error type. No, because things started breaking. The passage of type.

SPEAKER_00 23:34

Yes. Okay. And so now we started to see what we call delamination. So the porcelain started completely breaking off the zirconia structure. And then patients would come in saying this crown that you did for me just shattered in my mouth. And there's this white stump left behind, but all the porcelain I could feel gritty material. And the clinicians were probably blaming the patients, huh? And no well, that's what started happening until we started to see the trends. And then it became documented as evidence that veneer zirconia is not good to use. And even today, we don't do veneer zirconia in the way that we used to, because we know the bond is weaker. So when we make the veneer, which is the aesthetic part, the the part that we see in the mouth, now we keep it just to the front, where it's non-functional. So the patient doesn't chip that piece that piece off. So even though it's better now, it's a bit more predictable, uh, it's still a weaker bond than porcelain onto metal. So back to your question then, is that a lot of the things that we used to do, we don't do anymore because the evidence has pointed us away from it. So to a large degree, industry is at fault because they give us all these new materials and they say, okay, try it on your patients, and we'll find out in a year or two years or 10 years or 20 years. Um so how do you deal with this kind of uncertainty?

SPEAKER_02 24:51

Because like it feels like then you can't even get into a rhythm. You always have to be researching and questioning yourself.

SPEAKER_01 24:56

Yeah.

SPEAKER_02 24:57

Exactly. Because I mean, with materials especially, and longevity of materials, it's all you've got to have like longitudinal studies. Yes. And the only place to do it is like live trials in the patient's mouth. It can't be is that is that well, you can't. How can you simulate other like a condition that is is in the mouth? But when when when a a a motor vehicle manufacturer develops a new car, they do simulate things and tests. And surely in vitro, yeah. The motor vehicle industry is as bad as the dental industry.

SPEAKER_00 25:27

Yeah. In vitro and in vivo very seldom overlap into tr into direct one-for-one translation. Okay. There's so many things, oh, sorry, uh in lab or depth bench top studies and actual clinical trials in patients' mouths. Um there are so many variables that are not catered for when you do a lab study. So you could take, for instance, you could take this glass and you could run a whole lot of tests on it. And um and you'd say, Yep, this is fine for market use. But when people start using it and then they start uh make putting coffee into this glass and the whole thing shatters, then you start realizing, oh, wait, maybe that glass is not good for coffee use.

SPEAKER_02 26:09

Or if they're having too much Coke zero or whatever, whatever.

SPEAKER_00 26:11

And then you start to see changes in the surface of the cough of the glass. And the same happens in dentistry where they'll do all of these tests in a lab and they'll say, yeah, this is great for use because in our lab where we used extracted teeth and we bonded it to these extracted teeth, that must mean that it's great to use in the mouth. And remember, a lot of the times it's unethical to test it in patients and then put it out because experiment on their own. Exactly. It's it's experimentation. But ultimately that's what it comes down to when it feeds down into clinical practice. Then we just do the experimenting on our patients because the lab studies said it's okay.

SPEAKER_02 26:48

Hmm. And you know why I'm asking this question? Because I was speaking to a specialist recently who said to me, like, you know.

SPEAKER_00 26:53

Can I guess their name?

SPEAKER_02 26:55

Leave their name on. But yeah, you're right. And and I was like, I don't know how you guys do it because specialists, you've got nobody else to refer to. We were talking about this off-camera, right? The buttons stops with you. The buttons with you. So, you know, who's gonna who do you go to?

SPEAKER_00 27:11

The university, the professor.

SPEAKER_02 27:13

No, who do you go to, I mean? Uh uh me.

SPEAKER_00 27:15

Yeah. Um, I have a good network of friends who are prostatonists as well. And if not, I've got the the world leaders in Prostodonics that I have on WhatsApp that I can and that's the nice thing about having a smaller fraternity like Prostodonics, is that you can make good con and and like I said in the last interview as well, like through the ITI, you can make networks and connections across the world with the biggest names, the people who are conducting the biggest studies in the world. And they'll tell you, you know, you can just ask them a question. I've got a problem with this. And they'll say, Yeah, you know what, we're doing a study on exactly that. Try doing X, Y, and Z. And um, yeah, so who I go to is my peers. And um, if there's anyone that is above me that I need to engage, I do. I mean, I've got a good friend, master dental technician, Vincent Firmer in Switzerland. He's amazing. He'll like if he says sees my message, he'll respond within like a second. Uh Murali Srinivasen in uh Zurich University, um, he's on the cutting edge of removable prosthetics. Uh Irina Saylor, who's Vincent Firma's wife. But uh, you know, it's so easy to engage any of these people.

SPEAKER_02 28:24

But what sort of things do you grapple with? Like what confuses you or what do you need to ask people?

SPEAKER_00 28:29

So the first thing I would do is if I'm in a position where I'm uh confused about something or unsure or I've made a decision. Firstly, do you ever get in the many times? I mean, there's sometimes where you you do your standard protocol and something goes wrong. It didn't go the way you planned for it. So the first thing I would do is I'd go to the evidence. I'm fortunate enough to have access to the to the university library. So I go to the evidence and I find out what the evidence says. So if it's changed beyond what I've already known. Uh so if there have been no changes, then I'll ask my peers. I'll ask my colleagues. Um there's a case right now that I'm going through that I've had to ask, I've had to refer the case to a colleague of mine, one of my teachers, uh, as our as our registrar. So I sent it to a colleague of mine for a second opinion. And he says, he sends me a letter back and he says, no, what you did was perfectly correct. Um he says he would have done it exactly the same. Um let's try to do this and this and this to try to get your patient um a little more adapting to the patient's understanding because it's I think that it it's hard because remember that when you get to that point, the patient's already frustrated. Exactly. The patient's already emotional. They they felt that they've spent money on something that they they want, but they're not getting there's a disconnect between the expectation and the outcome. Aaron Powell They've probably already been to a GP and then another GP and then And someone said that this specialist is gonna solve your problems. Yes. And when it's not exactly what we want or what they want, then there's a lot of frustration and anger.

SPEAKER_02 30:08

They expect that you're gonna solve everything.

SPEAKER_00 30:10

Yeah. And so how do you how do you manage that? We try to temper the expectations. Okay. Um we tell them this is the limitation. And you know, there was something that our old friend Alistair McElview once said to me once, uh, once sent to me. He said, um when you when you tell the patient something uh before the fact, uh, it's a reason when it happens. But if you say to the patient after the fact, after something happens, it's an excuse why it happened. And, you know, I try to I try to live and breathe that um that philosophy. So when it comes to our initial consult, I try to give the patient as much information as possible about what my interpretation of their problem is. And especially with those cases, and and there's a case right now that um we're struggling to bring the patient to adapt to her current situation. Um I told her right on the first visit, and I've got it documented in my notes, that despite the fact that I see there's a dental problem, I don't think the dental problem is going to solve your general pain that you have. Patient was seeing a neurologist and all of that. So I documented it early. And fast forward to today, like a full year later, patient is still having pain. Patient's still having a lot of those issues from the start. And they thought that getting teeth is going to solve those issues. Um so I think that's it's probably a lot of lateral thinking in what you have to do.

SPEAKER_02 31:38

It's not like one size fits all. Never. And it's it's it's always like unfortunate that you get GPs that are referring to you that will almost, you know, reassure the patient preemptively that you are going to solve the issue. Yeah.

SPEAKER_00 31:53

Um yeah, a hundred percent.

SPEAKER_02 31:55

So you've got to manage for that also, but that's the expectation management thing that you talk about.

SPEAKER_00 32:00

Yeah. And I think with ex you know, with the gun the with Dunning-Kruger effect, yeah. Um you you the further you go down this road, the more experience you get to pick up red flags early and to understand that, you know, irrespective, the patient needs to have as much information before they start treatment uh so that they can they can make an informed decision. But also, if things go wrong later on, you know, you've covered your bases, you've told the patient, you've informed the patient, this is the reason why we told you this, and not I yeah, it's maybe happened now, but it happened for this reason, and then it's your excuse.

SPEAKER_02 32:36

I mean But wait, can I ask you a question with the specific uh scenario you gave? I'll play devil's advocate. If you had the foresight to know that whatever the treatment she was undergoing from a dental perspective wouldn't remove her pain, why would there why would the actual reasoning of your understanding as to the origins of the pain not be explored more?

SPEAKER_00 33:00

So the patient had already seen a neurologist at that point, the diagnosed with migraines and and neuralgias and all of that. So they were two completely separate entities. Um there was a dental need. There was a collapsed seclusion, um, there was uh deflection in the bites, there was uh multiple missing teeth on that patient. So there was a dental profound dental need. And there was also uh with that there was joint complications. And and you know with with TMD, it's uh with temporomandibular disorders, there's a it's multifaceted and occlusion is part of that. And just because you fix the occlusion doesn't always mean you're going to solve it. Um it could, it could fix that, or it could not, and you could still have a lot of other things you need to consider. Um so and that's why, because with that case specifically, there was a dental need, and we still managed to get a beautiful result with the dental rehabilitation. It's just that it didn't always solve, or in this case, didn't solve the pain, the general facial pain, and all of that.

SPEAKER_02 34:07

Okay. You guys are expensive.

unknown 34:08

Yeah.

SPEAKER_02 34:09

Especially wow.

SPEAKER_00 34:12

No, no sugar coating that one now, is there?

SPEAKER_02 34:15

You guys are expensive, and that's another thing that plays into a patient's expectation, right? Yes. I mean you're paying for the rolls, Royce, you expect the rolls well, whatever. That's that's true. How's it in South Africa?

SPEAKER_00 34:25

How's it? It is more expensive than most dental practices, not all. I think there are some dentists that charge more than specialists in in South African landscape.

SPEAKER_02 34:36

Um you're one of those. I don't know, I'm looking at the ground. No coffee. I don't know.

SPEAKER_00 34:42

I I maybe, maybe. Um yeah, look, I think that um if you factor in, there's um look, I I I don't personally um think that we we charge an exorbitant amount. And there's a lot of pro bono cases that we do. Um many cases that um patients come in, they just pay the cost price. We we just want to help people. But what is exorbitant in dentistry? Isn't dentistry expensive just Yes, yes. And unfortunately so many people are left with their genetics puts them in a position where they have to fork out huge amounts of money uh just to fix something that by some unfair lottery they inherited from their genetic pool. Yeah. Um, some kind of malacclusion, some kind of um, you know, lost tooth or missing tooth or um, you know, god forbid some kind of cancer or benign tumor. Um and then they are forced to come our way. So it's not always neglect where patients don't look after their mouths and end up on our table or on our chair. Um it's also sometimes uh congenital problems, cancers, uh, trauma, gunshots, uh car accidents. So there's a lot of the times it's forced. And especially at my practice, when it comes to the latter where it's forced on patients and where they can't afford, we we treat them for free. And we've got a great team of um surgeons and technicians and myself that is more than willing to help these patients out.

SPEAKER_02 36:23

But why do professionals feel bad to to well, clinicians, professional clinicians, feel bad to charge expensive rates?

SPEAKER_00 36:32

Yeah. I mean, I should ask you as a lawyer, man. I mean, you give us one letter and you charge it.

SPEAKER_02 36:36

That's why I said clinicians, because I said professionals, but lawyers are also professionals, right?

SPEAKER_00 36:39

And I mean the you get a single letter from a lawyer and you I if I have to just give staff a letter and we request it from our lawyer, there's a bill attached to that. Aaron Ross Powell, Jr.

SPEAKER_02 36:48

Exactly. But that's that's why I'm asking the question. Why do you I mean, are you good at asking for money? Because Yak always tells me I can't ask for money.

SPEAKER_00 36:55

I am terrible at managing money. I I always tell my patients I just work here. I just I just do the who does the hard work.

SPEAKER_02 37:03

Why the practice manager.

SPEAKER_00 37:04

So Silicia is the practice manager at my practice and she handles the the hard work. So she is, you know, she is, yes, she's our practice manager, but she's got a history in she her training is in optometry. Uh she's managed a few practices in when she was an optometrist. When we had the kids, she took a step away from optometry and she decided she wants to run our practice. Well, we decided she needs needs to run our practice because I I would run it as a as a charity.

SPEAKER_02 37:33

And at a loss, yeah.

SPEAKER_00 37:34

Yeah.

SPEAKER_02 37:34

I would just And then nobody wins, right? Because if you're not making money, how are you gonna keep on seeing patients?

SPEAKER_00 37:38

If if I go out in reception and uh and my receptionist asks me, what are we billing out today? I'd say, don't worry about it, just forget about it. And then the patient goes away. And then my wife looks at me and she's like, you know, we pay for the electricity when that patient sits on the chair. We pay for the water, we pay for the fancy uh the coffees we give the patients for free. We pay for all of these things. How can you let a patient leave for not paying? Um so she managed she keeps the business alive.

SPEAKER_02 38:09

Yes. I mean clinicians are notorious for not being able to collect, right? Because they want to do the work. That's what their passion is. Exactly.

SPEAKER_00 38:15

And I don't do this for money. Money makes the fires, keeps the wheels turning, keeps fires burning, keeps the lights on. Um but when I work, it's because I have an a personal drive to do what I want to do and to treat my patients the way I want to treat them and to solve problems.

SPEAKER_02 38:33

It's it's but can't you guys go for courses and things? I mean, how do you do it? What? Like you you always tell me I'm bad at you you're outsourcing. I'm I'm so bad that if I have to do it, I would actually tell the patient, sorry, the machine's not working, we'll WhatsApp you later. And then I wouldn't have to do that. But just to avoid what just to avoid having that conversation or that transaction.

SPEAKER_00 38:52

Yeah, no. It's it's an uncomfortable thing that we we and that happens all the time. Patients will just tell me in the chair what when they're sitting with me, they'll be like, um, you know, I can't pay you guys today. It's like, but we're delivering today. I'll I'm thinking of it. Patients like, I can't pay you today, but you know, when I get my tax rebate, I'll be able right? I'll be able to settle. And I was like, Oh, okay. Well, whatever you guys are uh whatever you guys planned and arranged with the front desk, that that and then I go and ask the receptionist, what what was the arrangement? She says, No, there's no arrangement. It's like, are you are you serious now? Yeah. Do we just pay for this patient's treatment? Yeah. Um to answer his question.

SPEAKER_02 39:30

I mean, there there are there's many courses where we can go and it's a it's a it's a business skill. Yes. But that's what it is. But to be honest, I don't want that skill. Why? I prefer outsourcing that because some people are innately good at it. So let them handle that stuff. Like your wife, for example.

SPEAKER_00 39:45

Yeah. Yeah. You think so? Um look, I I think that so Ashen Singh, the prosthetic. So he and I are very good friends, and we always have these um these business chats. So I went to see him a few weeks back. We sat down, had some coffee um in Salter in Umshlotti in Dublin.

SPEAKER_02 40:03

Yeah, North Coast, yeah.

SPEAKER_00 40:04

Yeah, North Coast.

SPEAKER_02 40:05

Nice place.

SPEAKER_00 40:06

Yeah. So we're having uh coffee there, and we just talk business. We talk um, you know, how how our clinical and businesses overlap and how to increase return investment, how to improve our quality of life, how to give our patients a better outcome, how to improve the prostronic experience. So we always have these philosophical chats and business chats. And I think that's important as well, is when you meet with your peers and you realize, oh, that's a great idea. I should try that. And we we've done that. So many times I would tell him about my experiences in my practice, and then he'd say, Okay, can you send me that document and I'd be happy to use it. I'll take the same from him, where he's got an idea that I would be, I would I think would fit beautifully in my practice. And then we we exchange ideas.

SPEAKER_02 40:53

Trevor Burrus, Jr.: It's like collaboration and um sharing ideas.

SPEAKER_00 40:56

Yeah. And I don't think that happens enough. Yeah. Because all too often when you go for conferences, it's always um there's there's the science, there's the lectures, and there you know, it's it's never a discussion. Yeah. It's always clear.

SPEAKER_02 41:09

Or the ethics thing, there'll be consent and all that stuff.

SPEAKER_00 41:11

Yeah. And that's why I think like your your the idea that you spoke to me about with round tables, those are much more powerful because you're talking about your own experiences and and everyone is sharing what they know and what they feel. And that's so much more powerful because you you can latch onto diversity of thought, right?

SPEAKER_02 41:31

100%. 100%.

SPEAKER_00 41:33

And and that's why like I value those those meetings with Ashen and um with with all of the guys in my in my circle, because we we disseminate knowledge. And it, you know, that's the beauty of having a small, close-knit uh fraternity, is that no one's competing. You you're you're doing it as a you're moving forward through time as a collective. Yeah. And like if if a patient of mine had to show up at Karan Beni's practice uh or Alvain Fortin's practice, and they phone me to say, hey, your your patient just showed up, I was like, great, I'm sure I'm so happy they showed up with you. This is the history. If you need anything, just let me know. I'll be happy to provide. And then they'll take on the case and vice versa. And they'll f I'll phone them up and say, Hey, your patients showed up. What do you need me to do? And and that's the beauty. There's no animosity uh between, well, at least I I've noticed with the people I've worked with and the people that I keep in my my friend's circle, is that we don't have any animosity towards each other. And we can sit down and have a great conversation about everything, about business, about life, about prostronics. Um but I still stand by the fact that if I am left to my own devices, I would run my business into the ground and I would be bankrupt many, many times over.

SPEAKER_02 42:50

I think lots of people can relate to that here. Yeah. Um but you also, as a specialist, right, you need people. Well, maybe I'm wrong. You need people to refer patients to you also. True. Or do patients come straight off the street? There's a few.

SPEAKER_00 43:04

Yeah. Um, but we are my practice is about a 95% referral-based practice. So how do you do that? Um good relationships, good work. Um the work hopefully feeds back. So you do good work for another specialist or for a dentist.

SPEAKER_02 43:21

Because I've heard specialists complain that, you know, the GPs are taking on things, uh, a lot of X you know, work that potentially should have been referred.

SPEAKER_00 43:32

How do you that's that's a major yeah, it's a major, let's say, problem in vertical commas these days. Um and again, driven by a lot by industry. Sometimes um you know, I have a personal feeling towards um towards in-house milling with a lot of dentists that are not trained to do it. And um sometimes the Do you want to explain I guess what in-house milling? Oh, yeah. So I mean that's in in in the past, um for you to fabricate a a prosth or a crown for a patient, uh you would prepare the tooth, you would make a temporary crown, you'd take an impression, the impression goes to a laboratory, the laboratory will then design and hand make you a crown, and they would send that back to your practice a few days later, and then you take off your temporary crown and you glue it on for the patient in their mouth. Um today what you can do is you can digitally, there's this digital workflow that allows you to take an impression digitally and make a crown for a patient while they wait. So it'll take about two or three hours sometimes, and you can just manufacture a permanent crown that then gets bonded onto your tooth while you wait, while you're still numb in some instances. So it's a great um technological advancement. And I think that if people do the right amount of training to understand the technology and to utilize it in the right way, it is an amazing tool for dentistry as a whole. Because it's, I mean, right now the technology is rife. I I would say like there's a huge amount of of dental practices that have in-house milling, which means that they do the manufacture of the crown right in the surgery while you wait. Um but I think that there's a very slippery slope that dentists get onto when they get into that. Number one, there's a large capital outlay. And the dentist that will buy it that's out of their budget, they will buy it and now know that I need to do this many units or I need to sell this many units in a in a month to make the payment for this huge uh this huge machine that I bought. And so it starts to get them thinking in a in a perverse way, where previously I could have just done a filling here, but now I can mill an inlay and charge a bit more, but then it's going towards my payment for that. So the the mindset shifts a little. And then it becomes I can mill five crowns, what stops me from milling 28 crowns and doing a full mouth rehabilitation? And that's where we see the danger. So as a specialist, we when we do a full mouth rehabilitation like that, there's several months of planning that goes into it. And a lot of dental dental practices, or from what I've seen, the especially when patients come in with things that are failing massively. What I've seen is that a dentist would do a whole mouth rehab without considering the effects on the neuromusculature, without considering the effects on the joint, without considering um you know the health of the teeth. Uh, they would just prep teeth that need orthodontic treatment. They would just prep it aggressively so that they can get the teeth aligned with the crowns. Um so unethical treatment. So, and you know more than anyone about how I feel about uh about that. When patients are orthodontic patients are are treated as prostodontic patients. Um so it's that do you want to explain that for the for the absolute as well?

SPEAKER_02 47:10

Because that's an important aspect of the phone. 100%.

SPEAKER_00 47:13

So when your teeth are sometimes crowded, so the teeth aren't perfectly straight, um, what we recommend as the correct treatment for that is to get orthodontics. That's the only way to do it. Which is braces, though. Braces.

SPEAKER_02 47:26

It takes a while to straighten your teeth.

SPEAKER_00 47:28

Yeah. So it's not an overnight solution at all. It's gonna take months and months or years to correct. Um but and I I think also society is driving it where quick fix I want it now. Um fast food, I've I've you know, I've paid for this, I need it now.

SPEAKER_02 47:44

Yeah, just scrolling, doom scrolling.

SPEAKER_00 47:46

Yes. Yeah. So it's it's an immediate result, instant gratification. I will go in today and like turkey teeth, man.

SPEAKER_02 47:52

Before and after, yeah. Yeah. Um well, I've heard turkey teeth before. Is it because it's thumb turkey or it looks like a turkey?

SPEAKER_00 48:00

Yeah, okay. Let's let's let's get to that. Get into this, yeah. I'll get into that. So it's in the same vein as this, as this good discussion we're having now. So um so let's just put a pin on that. Yeah. So orthodontics. If a tooth is not perfectly straight, there's only one solution. You must move the tooth. All right. It it's I would say, look, if you have a you know, that's a different audience. Let's let's let's not let's not engage.

SPEAKER_02 48:25

We can get as deep as technology. No, I'd rather not.

SPEAKER_00 48:27

Well, you're gonna defend the authors. No, no, no, no. Offend the prostos. Okay. I think the kid is not. I think that um Don't there's something that Sid Sense Setsa told one of my colleagues once when we were undergrad. He says a little bit of information is a dangerous thing. And um and that's where I'm afraid of going down with that.

SPEAKER_02 48:47

Okay. Yeah, that's fine. As opposed to a lot of information.

SPEAKER_00 48:50

Yeah, because if you're half true. Yeah, so if you have a little bit of information on a on a much bigger topic that you you're not giving all that information, then the decision becomes a uninformed. Yeah, uninformed. So um, so like I said, with crooked teeth, the only solution is orthodontics. However, if we look at instant gratification, in theory, one could make the teeth look straighter by putting some kind of prosthesis on it. So you shave down the tooth or shave down the teeth and make it look like the teeth are actually straighter. Uh, and that's what a lot of dentists with these in-house milling machines do, is that they cut a lot of teeth, so they may be crooked, and then they will make uh crowns that will then make the teeth look straighter. So it's a solution in a day. But the downside is what they're doing is they are grilling, they're drilling away or grinding away more tooth structure than needs to be or than is physiologically acceptable by these teeth.

SPEAKER_02 49:50

And we I mean we must make it clear also, because before they come at us in the comments, right?

SPEAKER_00 49:54

Yeah.

SPEAKER_02 49:55

That you are say you're not saying all dentists do this. No, no, no. And you're not saying you're saying some some of them do. This is what you say. Yes. Yes. Yeah. And that's the reality, right? Yeah. And also from a patient's perspective, then, what are the consequences of having this instantaneous like uh prostodontic intervention instead of auto?

SPEAKER_00 50:14

Um look, the if you prep the teeth too aggressively, you run the risk of damaging the nerve, the neurovascular bundle inside the tooth. So the nerve inside that tooth or the pulp. Uh so if you get too close to that, um you you could damage that that nerve irreparably, and then you would need further treatment, like root canals. Or sometimes they tell you, we're going to do a root canal, and then make this too.

SPEAKER_02 50:38

So you cut away healthy teeth, you make them look straight, and then the patient has pain in a down the line potentially, and then or they could or you prep so much of the tooth away that the tooth could fracture. Okay. Uh make it weaker by cutting away. Hundred percent healthy tooth.

SPEAKER_00 50:53

So the more tooth structure you take away, the more you weaken the tooth. Right.

SPEAKER_02 50:55

And longitudinally?

SPEAKER_00 50:57

Like long-term chronically? Yeah. So look, the the tooth is supposed to withstand function for the rest of your life. And now you've already compromised its strength from just prepping it for a crown. On average, a crown should last about 20 years. Let's assume you do that on a patient that is now 18, 19 years old. They've got a bit of crowding, dentists convince them that, or the patient has convinced the dentist that they're going to get a full straight set of teeth with crowns.

SPEAKER_02 51:24

That's a good I like the way you put that here, because sometimes the patients will say, No, I don't care, Doc. I want it.

SPEAKER_00 51:29

Yes. And and I've had to turn away a few celebrities that have asked me for that.

SPEAKER_02 51:33

Okay.

SPEAKER_00 51:33

And you know, I and I always tell them that despite my my literal profession being crowns and cutting teeth for this, yeah. I don't want to cut a crown if I don't need to. So I always try to convince the patient to walk another direction if it means that they're doing the right thing.

SPEAKER_02 51:52

Otherwise turn them away. Yes. Okay.

SPEAKER_00 51:55

Um Yeah, so so then, and what could happen then is if you do a crown at an earlier point in the patient's life, leading up to their 30s and 40s, that crown's gonna need replacement. You're gonna get marginal leakage, so bacteria's gonna get back in, or the ceramical chip, or something, the tooth may break. Um, and then you go back in, take the crown off, reprep the tooth, refine the margins, or take out the decay, and you make a new crown. So when we're talking about long-term, then the tooth becomes weaker and weaker as you take away more and more tooth structure. And then it becomes a one-way road because you go from what used to be a filling should last you about seven to ten years on average, a bigger filling, another seven to ten years, a crown will last you another 20 years, a crown replacement another 20 years, maybe a root canal down the line, another 15 to 20 years, then extract, replace an implant at about 60 years, 70 years. That was the way. But now you're jumping a few steps and you're taking yourself right up to the middle of that.

SPEAKER_02 52:54

And so imagine poor me, like I'm gonna live forever. What the hell? What's gonna happen to you? It'll be a toothless uh 200 years.

SPEAKER_00 53:00

You're gonna just have dentches. Yeah.

SPEAKER_02 53:02

Correct me if I'm wrong, also, but like if you think about it from a from a physics perspective, you've got the root that's here, right? And then if you prepped, the root is malaligned, you prepped the tooth here, you've got longitudinal forces down on this end. And what's gonna happen to that force being translated into the root?

SPEAKER_00 53:17

100%. The tooth isn't balanced when it's in malacclusion. Yeah. There's there's no evidence to show that malacclusion is increased shows increased morbidity other than maybe just the ability to not clean properly. So if you have crooked teeth, it's your problem, it's an aesthetic problem. It's not a physic physiological problem. Um, yeah, maybe you can crowded teeth, one could say yes, it's harder to clean, so maybe a higher incidence of caries, but you are still physiologically functional. You can still eat, you can still speak, you can still perform all your normal daily life duties with a male occlusion.

SPEAKER_02 53:50

Yeah, but aesthetics is important.

SPEAKER_00 53:52

Well, yes, for sure. But then that's why there's orthodontists.

SPEAKER_02 53:55

Okay.

SPEAKER_00 53:56

So they will correct the the aesthetics. But as you rightfully pointed out, is that when that tooth, despite it being crooked, is in position, it is in balance. But now you put a crown on a tooth that's got a root that's angulated this way and you've made it do this, it's gonna change the loading pattern. So the root of that tooth is gonna start suffering. So you're gonna increase it's it's orthodontic forces. So it's not gonna stay there unless you splint those crowns together. Yeah. Do you have an orthodontist at your practice? No, I don't. We refer to it.

SPEAKER_02 54:25

Isn't it amazing that there's such a huge industry? This is a very random thought that I had when I was driving yesterday. Like the mouth is such a small area, right? And teeth are even smaller. But they are like huge specialties, huge industry built around this thing. Yeah. It's it's it's fascinating. It is. It is, yeah. Like I always tell this to to people. Because I work with I work with medical doctors. They're always like, you know, have a dig at the dentist. Yeah. But when people need something in their mouth, you know, there's specialists that know like so much about a square millimeter of your mouth. Yes. It's crazy. It's so cool. Do you think in future we'll have like super, super specialists that like only work on say central incisors. I think we already have things that we we go to. Yeah, there are guys.

SPEAKER_00 55:18

There are guys that that are like that. There's guys that only do um like I think in Dubai there's a lot of them where there's this teeth in a day thing where you fly in, extract whatever's left, implants go in, you get your teeth. Uh so there are many of those where people have very niche uh super specialties, if you want to call it that.

SPEAKER_02 55:37

No, I mean even further than that, like uh like a central incisor guy. Working on just central incisor guys. Yeah, what about guest tollers? You don't like doing some some aspect of prosto? Audi, you didn't watch the Audi episode. Audi did, Molloy.

SPEAKER_00 55:50

Oh, yeah. I I don't like doing endo's anymore. Why? He's my guy for that though. Um I I started to say take a step back.

SPEAKER_01 55:58

Yeah.

SPEAKER_00 55:58

So But now that falls under prostodontics. It does fall under prostodon, and there are some prostodonists who love their endo. Endo, like root canals. Yes.

SPEAKER_02 56:04

How come it falls under prostodontics though?

SPEAKER_00 56:06

Because there's no endodontists or endodontics in in South Africa. Yeah. So it falls under the prostodonic banner.

SPEAKER_02 56:12

And they train you in that?

SPEAKER_00 56:13

They do. In the specialize. As much as they do with, let's say, maxillofacial prostodonics. Um you just find your niche, you find what works better for you.

SPEAKER_02 56:22

So this is why, because I also had this thought recently.

SPEAKER_00 56:24

How do you say why I don't like doing endo?

SPEAKER_02 56:26

No, he didn't say why. He just said you you don't you don't like doing it. Tell us why.

SPEAKER_00 56:30

I used to love it. Yeah. Um and then I met our good friend Glenn Buchanan. Yeah. The good prof. Yeah. Yeah. And then we we we worked in the Crown and Bridge ward together, where he would manage the endo, and I would manage the Crown Bridge, and we would help each other out. And then at some point I realized there is so much more that this guy knows about endo than I know about endo. And I realized, and and you know, Glenn as well, we used to have these philosophical conversations where Glenn would say that somebody doesn't have any business working in an environment where they're not fully equipped to deal with the treatment and the complications.

SPEAKER_03 57:10

Yeah.

SPEAKER_00 57:11

And that's where I felt I need to start stepping back because I felt here's a guy who's, well, at that point, he's just a general dentist, but he's phenomenally miles ahead of my capabilities in terms of endodontics. And so I decided there's better people than I am for this job.

SPEAKER_02 57:30

So Glenn killed endo for you. Shame on you, Glenn. No, that's okay. I know he's Glynl. One of my closest mates. Glenn listen is on the train to work. I know this. Yeah. He's now in odds, right? Yeah. But but you see, that's that's why I was asking the question earlier, because if you think like that, Abby, then you might not do anything. Because there's always somebody that knows better than you, surely. Well, yes. Or does better. But even in dentistry.

SPEAKER_00 57:53

Yeah. So look, I I decided to step away from endo because I realized that I'd rather send my patients the best person for the job all the time. And and I that's my philosophy when it comes to um like the there's this dentist that that's a one-stop shop. And that's fine. Where you go to a dentist, they will screen you, they will place the implant, they will restore that implant, and you're done. Um, at my practice, what I enforce is that the patient must go to the best person for the job, even if that's not me. So if a patient needs the implant, yeah, I could probably get an implant done. I could probably place that implant for a patient, but I won't do it as well as a maxillofacial surgeon or a periodontist. They're going to put it in a much better way. If there's a complication, I won't deal with it as well or as comfortably as they would.

SPEAKER_02 58:39

Yeah.

SPEAKER_00 58:40

And so the same with endo is that I started to realize that people know a lot more than I do about that subject. And there was the you know, peripheral stuff that started to hit me where endo, I'm sitting for like three appointments or two appointments, my back is killing me, my eyes are straining, I've got this microscope that I'm moving out of the way all the time. Why could you just say you hate endo?

SPEAKER_02 59:04

You know what Yak loves endo.

SPEAKER_00 59:05

Really?

SPEAKER_02 59:05

Yeah. Okay.

SPEAKER_00 59:06

No, no, he's he's on record of saying he hates it. Yeah.

SPEAKER_02 59:09

But then you know, like endo is just mm-mm.

SPEAKER_00 59:12

And so I that's why I like, you know what?

SPEAKER_02 59:14

Audrey, let's talk. But this is cool. So now this is what I want to get at, right? I was thinking about this the other day. Prostodontists are like, if if if you're to ask me, I would say that they are the real specialist dentists in the sense that they do dentistry still. Like a Max Vack will not do an endo, but you could. Yeah. Or a crown. Yes. You could. Yeah. You know? So we can't do an extraction though. Okay, yeah. For where where's this regulation? For better or for words. Is this like uh the legislative thing from HPCSA? It's not stopping an orthodontist. Um so there are there's a there's a regulation if you want to get deep and technical, there's a regulation which says that if you're registered in a specialty, you must confine your practice to the scope of that specialty.

SPEAKER_01 1:00:02

Yeah.

SPEAKER_02 1:00:03

That's as far as it goes. Our regulator can create scope of practice for each different specialty, but I don't think we have that yet for the dental specialties. Yeah. So that's why there's a lot of gray area. Yeah, you know.

SPEAKER_00 1:00:18

Like there's a lot of periodontists that make their own temporary crowns and prostos don't like it. Um there's a lot of um, you know, a lot of this like slight overlap between the specialties. I I like to keep my practice straight down the middle because I don't want to upset anyone. So if surgery is needed, you go to the surgeon. If autho is needed, you go to the ortho. Endo is needed, you go to the endo guy. Um and and it's just purely because I like to keep my hands clean.

SPEAKER_02 1:00:47

And plus clearly you've got enough work that you enjoy doing that can keep you busy.

SPEAKER_00 1:00:51

100%. So the the stuff that I keep at my practice is the stuff I love doing. Yeah. It's it's implant dentistry, it's current bridge, it's uh dental rehabs, it's uh implant rehabs, it's maxillofacial prostho. Um so it's it's the stuff that I just enjoy. Uh has Odi joined you yet? Uh no, no. So uh what was it? Oh, we I had some roof trouble in that surgery. So then I had to sort all of that out. But yeah, he's joining us. Yeah, he's such a great guy. It would be awesome working. He's like his big teddy bear.

SPEAKER_02 1:01:19

You've got to watch the episode.

SPEAKER_00 1:01:20

Yeah.

SPEAKER_02 1:01:20

Please, that that's a really good episode. You must watch it. I'll check it out.

SPEAKER_00 1:01:24

Yeah. He's actually we're doing a case now together. Um uh so he he is working at the practice. But um, we just have to formalize his room.

SPEAKER_02 1:01:32

Turkey teeth? You want to talk about it?

SPEAKER_00 1:01:34

Right, it's turkey teeth. So turkey teeth, there's a so it's called turkey teeth because people fly into Turkey and they get this characteristic straight white uh non-charactered uh rehab. So their whole mouth is like these anyone can Google it. It's not um it's not any secret, but it's it's got a looks fake connotation to Turkey teeth. Um and there's there's disaster stories all over the world where people, especially from the UK, they fly in because it's cheap. They fly into Turkey, do their treatment, head back, and they've got these like it's like a painted white brick wall that they have. Um it looks horrendous. But especially in the UK, I don't know, maybe with the with uh with the industry in the UK. No, but but maybe it's the standards up.

SPEAKER_02 1:02:25

But here's this is what I want to pause there, because you said it's cheap, right? Cheaper. Yeah, and I'm guessing it's cheap for the UK people, relatively speaking. I want to know vis-a-vis South Africa, is it cheap?

SPEAKER_00 1:02:36

Interestingly, so I had patients, a husband and wife, that came to me after they went and did a turkey teeth rehab. So they went into Turkey, spent a week or something, did their whole um turkey teeth thing, they came back, and it was horrendous. It was a disaster. Open margins, overhanging margins, splintered crowns where they didn't need to be splintered. Were they happy? What's a patient happy though? The patient looked like they were happy, they had it. But once they met with uh their dentist for their routine checkups, the dentist pointed out all the flaws and said, This is not conducive to good health. You need to go see a prosthetist. So they came in and then I I stand to be corrected on the amount, but I think they spent like half a m just over half a million for the two of them to get their teeth, which really is a bargain. 250, yeah.

SPEAKER_02 1:03:21

250 This is thousand Rand you're talking about. Right.

SPEAKER_00 1:03:23

And this is full mouth. Yes, full mouth. Two people for 500. So you're looking at about 250 each, that's a bargain. Yeah, that is a bargain. Which is a lot of money. Yeah. And and let that not go unnoticed. 250,000. You can buy a motor vehicle for that much. Yeah. Um but relatively speaking, yes, yeah. It's affordable. Yes.

SPEAKER_02 1:03:42

Affordable in terms of And if they had to do that in the UK, it'd probably set them back over a million rand.

SPEAKER_00 1:03:48

But these were South African patients.

SPEAKER_02 1:03:49

Yeah, but this is we were even in the context of UK.

SPEAKER_00 1:03:52

Correct. And had they done it here, probably would have been about that much per person. So you're looking at about 450,000, 500,000 per person. So it would have spent twice as much here. But now they come in with all these nothing is good. Nothing can be salvaged. So the whole thing needs to be stripped out and redone. So you're gonna end up paying twice. One was half the price of what you would have paid, and then you have to pay again to have it redone and fixed.

SPEAKER_02 1:04:20

How did Turkey end up being this destination? Because like surely South Africa is also cheap for the Brits. Yeah, and obviously India. Like, what is there no Indian tea?

SPEAKER_00 1:04:28

Oh no, you don't want Indian tea.

SPEAKER_02 1:04:30

Oh wow, no, that's racist. I take that that's gonna make a perfect short clip. Uh it can be taken out of context.

SPEAKER_00 1:04:37

Haven't you seen some of the videos on social media with like guys, just street vendors with like a whole lot of dentures and you just watching that? Pick the one you you Yeah, yeah. No, you don't want that, man. You just walk around and just best fit. That'd be awesome. Yeah. Just then that's where you can that's where you can live forever, just in the streets of India, just trying in old people's dentures.

SPEAKER_02 1:04:56

But good question though. How did Turkey become this destiny, not just for teeth, for hair, for like sort of stuff? I think the central location.

SPEAKER_00 1:05:03

Um maybe regulations are low as well.

SPEAKER_02 1:05:06

Yeah. Yeah.

unknown 1:05:07

Yeah.

SPEAKER_00 1:05:10

I've had to deal with a few. And very few actually go on with treatment because now they've spent a fortune on their teeth and now they're out of pocket. And now you've got to quote them twice what they've originally paid to fix what they've done.

SPEAKER_02 1:05:23

Aaron Powell And it's not like they can go to Yash and be like, yeah, sue that's we want to say but if I'm the patient, I might just think, oh, dent dentist was doing checkup. You're being overcritical. I'm I'm happy, it looks nice.

SPEAKER_00 1:05:33

Yeah.

SPEAKER_02 1:05:34

You know?

SPEAKER_00 1:05:35

Yeah, but I don't think that's always the case because a lot of these things, I mean, if you consider those those clinical presentations, open margins is going to be associated with with sensitivity. There's going to be pain. There's eventually going to be secondary carries. So there will be ingress of bacteria at some point, and then it's going to fail. And then you're going to regret, and then you're going to end up with no teeth and dentures and implants. And um yeah, and hopefully. They work because not all um I mean not all implants take and not especially with a lot of comorbidities, people that smoke, gum disease, there's so many things that can go wrong. So you're taking a big chance by you know by doing that turkey tea.

SPEAKER_02 1:06:17

Yeah, do you refer to prostos?

unknown 1:06:19

Yeah.

SPEAKER_00 1:06:20

Just recently this guy came to see me.

SPEAKER_02 1:06:21

Oh, okay. Is it? Okay. That was such an interesting case. Wow. I wish we could talk about it. No, I mean, yeah. I'm just, it's interesting. So how did you know who to how did you know to refer to Abby? Um What made you think of him? The episode, like this podcast. Yeah? Yeah. I mean, I knew you were prostatist, but also, like you you this is bed for view and you're all the way in preparing.

SPEAKER_01 1:06:41

Yeah, yeah, sure, yeah, yeah.

SPEAKER_02 1:06:42

And then um who I usually used to refer to was quite close by.

SPEAKER_01 1:06:46

Okay.

SPEAKER_02 1:06:46

And then I thought to myself, no, this is this case requires like some some expertise, like cream other crop vibes. And then it was actually a Vita that reminded me that, oh, there's Avi. And then I was like, oh yeah, let after that episode. Actually, no, all the ladies at work here. Yeah. Yeah. I'll send Avi the invoice then for the advertising feed. But it's it's it's isn't it interesting? Yeah. And I actually went with the patient too. Because he just broke, I didn't know that you he'd referred a patient to you. It's not like he came to me and said, Hey, do you have a pleased contract? Yeah. Um it was so cool. I went to his practice and there was everyone was so welcome and it's such a cool practice. Oh, you went there? I went with the patient, yeah. I love the story, man, because it it shows that even a dentist watching because you know people sometimes criticize people, other people, for going and putting themselves out there and speaking and all these things. Yeah. You know, earlier when I asked you the question, well, why do we do the what we do? Because we enjoy just sitting and talking around a table, right? Right. It's there will be cynics out there that say will say this is self-promotional and all that stuff. You know, even the LinkedIn posts and all that stuff. But the fascinating thing is he watched your episode and he something in that episode told him that you're the cream of the crop. Right. And that he should take this specific case to you. Yeah, yeah, I just a random observation. It's cool. Do you have any bucket list things that you want to do in life? Um I've got one.

SPEAKER_01 1:08:15

Yeah? Tell me.

SPEAKER_02 1:08:16

It's a it's a weird one. I want to go to an Apple keynote event. Like the Steve Jobs Theater. I just want to say hi, yeah. I was listening to a podcast this morning um where they're talk where the it's journalists, it's tech journalists, and they're talking about, you know, the guy was saying he's gonna probably be at the Steve Jobs Theatre next month or whatever to watch the latest keynote or whatever. Uh I would really love to go and just sit there and watch in Cupertino, California.

SPEAKER_00 1:08:42

Yes. Um You? I don't I don't think I have any bucket list things. So I've got a good friend, Gabriel Pereira. Do you know him? I've heard the name, yeah. He's he's um he's a dentist in Pretoria. Um he runs the family dentist uh practices. Um we go back a long, long time. Uh I think about 20 years or something now. Um we studied undergrad. I think he was six months above me. Um he was in the five and a half year program, we were the five-year program. So we were friends from then, and now we both uh teach at tuckies and we we uh practice not far from each other, we refer to each other as well. Um, but we we we meet occasionally for a beer, we have a chat about life and business and all of these. And he gives me some like pointers about what we're doing, and um yeah, in fact, he was gracious enough that when I was moving between practices, I ran out of time in from my move from my old place to my new place, and I didn't have a place to work. So he was gracious enough to let me use his his practice that they had an extra room. He's like, just come and work and do your thing. And so we ended up working out of his practice, and and I'm forever indebted and forever grateful to Gabriel for that. But he gave me uh this little pearl of wisdom once. Um he told me, take a piece of paper, and this is a common thing, you've probably heard it before. He says, take a piece of paper, and he says, write today's date on it and put down a list of things you want to achieve in five years, and put it somewhere where you'll see it and walk past it every day. And so I put it on my fridge. So I did a list of like 15 things five years ago, and I put it in my fridge. And um he says, just by you acknowledging that this he says, you we all have wish lists and we, you know, we we aspire to many things, but unless you're seeing it physically every day, a lot of it goes by the wayside. I mean, I've I've got so much of work that I've got piled up that I I lose track of what I need to achieve at some points. And I've just yesterday I had to send a patient an email to say, I know this has been on my table for so long, but I promise I'm going to do it this weekend. Um, because I'm just piled on. I mean, I'll work up to about 4 p.m. and then I go home and I work some more up till about 10 p.m. So I'm doing clinical notes, I'm doing treatment plans, I'm doing quotations, I'm doing all this other stuff. And my kids, you know, if it's I feel terrible that I can't play with my kids, I can't spend time with my wife. And that's why yesterday we blocked out date night because I don't have time for anything. Um, so then I I put this physical manifestation of my five years though ending right now.

SPEAKER_02 1:11:24

15 items, right?

SPEAKER_00 1:11:25

Yeah. Yeah. And um truth be told, I achieved all but one. I know what you're gonna ask me. What's the one I didn't achieve? But If you want to share if you want to no, not really. Okay. I I have achieved the equivalent of it, but um not not verbatim as it is on the Be vulnerable with the same be vulnerable.

SPEAKER_02 1:11:44

So it was it was not a thing. Nobody's gonna see it. This is just between the three of us.

SPEAKER_00 1:11:51

So you know, it was things like uh hype hike up volcano. Okay. Um meet Brian Adams, which I got to do like two weeks ago.

SPEAKER_02 1:11:58

Yeah, yeah. Oh, that's cool.

SPEAKER_00 1:11:59

Yeah. So it was it was such uh like odd things that I've I I just wanted to I I took.

SPEAKER_02 1:12:06

But you know there was a possibility to meet Brian Adams.

SPEAKER_00 1:12:09

Not until two weeks ago. But you had it on your list. It was on my list. Yeah. It was on my list. Jeez. Uh I mean he's been my favorite singer through my entire life. Yeah. And I had the opportunity. Cloud number nine, my friend.

SPEAKER_02 1:12:23

Go on, yeah.

SPEAKER_00 1:12:26

That's really a dad joke. So um, yeah. So look, that's that's that was just um the hope you didn't run to him. No, no, no. Okay, yeah. I didn't run to I uh It's when the feeling is is fine, you know? Yeah.

SPEAKER_02 1:12:43

Okay, so you don't want to share the one item. Okay, it's fine. We'll we'll respect the privacy to the to the extent that we can lay out.

SPEAKER_00 1:12:50

But it was things that I like pulled out of the air and manifested it into reality. Every one of them has become well, all but one has become and it was things like hike up a volcano. That's that was really something that I just wanted to do because the first time I did it with my wife, um, it was it where we were, I can't even remember when the first time was, or like what the the circumstances were. But we were in Italy, we were in Naples, and then we said, let's just hike up Vesuvius. And so we did. And uh it was such an amazing experience for us. We bought wine along the along the mountains of along the hills of Vesuvius. It was incredible wine, and it was just this amazing experience for the two of us. And then we had to relive it, so then we put it on that list. So that's sort of my bucket list. It's creating things in short bursts.

SPEAKER_02 1:13:38

Yeah, it's just stuff that you want to do, right?

SPEAKER_00 1:13:40

Yeah.

SPEAKER_02 1:13:41

Do you do that? Yeah, like document things and it's it's a really good idea because you're right. It's just an idea, right? When it's floating around in your mind, and then you don't put your mind to it. Yes. Without seeing it written down. I must try that. Do I have a bucket list? Yeah. Well, short term or long term. Anything, whatever. Do you have something? Yeah. Short term, I I really want to make shuzhu. Yeah. I know I know you told me to. In that bucket.

unknown 1:14:05

Yeah.

SPEAKER_02 1:14:05

I know you told me to uh he asked me before the show if we for shizo. I said yeah. Then I drank. I'm leaving this in in the episode. What are you drinking? Drinking water. Same as you. Is that cup a chip, by the way? Uh it looks like it, eh? Oh, this crazy crack. Yeah. Oh, gosh. Did that happen on on the fly now? No. I don't know. Yeah. But yeah, my I think a long-term bucket list item. It's far-fetched, but I really want to go to Mars.

SPEAKER_00 1:14:30

Well, speak to Elon, man. I think um this guy can hook you up. Yeah.

SPEAKER_02 1:14:35

Well, I'm on the waiting list for Neuralink, yeah. And you know that. Wow. So uh maybe he can hook me up to Neuralink. Yeah. We'll see what happens. You, what's your bucket list? I I don't have one. I that's I don't have one. I I literally thought about this this morning when I was listening to it's called the talk show with uh But what is a bucket list? What that means like you you have to do it or whatever. Isn't a bucket list something that you must do before you die? Yeah, yeah. Exactly. And then if you don't do it, then what? You feel sad about it? Yeah. I wouldn't feel sad about okay if I don't go to the toiley soon. You guys are gonna feel sad. Right. But um but I don't think it's something that I would I would feel bad about if I don't get to to fulfill.

SPEAKER_00 1:15:21

Yeah.

SPEAKER_02 1:15:22

Um I wouldn't feel sad if I don't go to Apple keynote, but it's just something I want to do. Yeah. Yeah. So so so Yak is back from his bathroom break and we were on bucket lists, right?

SPEAKER_01 1:15:36

And what was Yak's thing? Mars. Mars Mars. Where did this come from, Yak? I think Euralink actually unpack.

SPEAKER_02 1:15:52

Just seeing that it's not as far-fetched as I previously thought it would be. And uh I mean Euralink's owned by by Elon Musk and Siffon Zillis, that's his most recent baby mama, yeah, um, is a person that I've emailed before and has that uh actually has replied to me with regards to prosthetics for my hand. Right. And um then like I got on the waiting list and now it was he got involved in the politics and all of that stuff happened. So now it's just a waiting game.

SPEAKER_01 1:16:22

Yeah.

SPEAKER_02 1:16:22

But I'm not that far away from conversing, probably. I'm assuming that's what a bucket list is, isn't it? Yeah. Um from conversing with someone that maybe wants to. My pitch is don't you want to test out your technology? Just tweet him. Yeah. But he's he's he's not very happy with our South Africans at the moment. Uh would you ever retire anytime soon?

SPEAKER_00 1:16:46

Not anytime soon. I enjoy what I do. I I think if I if I do it's just um it's just financial retirement.

SPEAKER_02 1:16:55

Okay.

SPEAKER_00 1:16:55

But um Well, I don't know, I'd have to ask my wife.

SPEAKER_02 1:16:58

Oh yeah.

SPEAKER_00 1:16:59

Um yeah, because I have no idea why we are doing financially. Um, so she she keeps everything uh running. She's um she's the the actual work host in the practice. Um but I think if if I had to retire, I'd just continue doing what I do now. I'd keep doing prostodonics, keep going to the Kruger, keep doing my photography.

SPEAKER_02 1:17:21

And and the speaking events, you do a lot of that stuff also.

SPEAKER_00 1:17:23

Still do a lot of that, yeah. Uh yo, this last few months has been rough. I was like lecturing every week or two weeks. Um, barely had a chance to breathe. I had kidney stones, um, which was uh horrendous. Did you drink more water? Oh, I've been drinking a lot lately. Um let me tell you about that story.

SPEAKER_02 1:17:42

Yeah, it's painful, right? Oh, it was horrible.

SPEAKER_00 1:17:45

Um, why not? You know, I've told the story so many times, might as well tell the rest of the country.

SPEAKER_02 1:17:51

Um this thing goes all over the place, eh?

SPEAKER_00 1:17:53

Yeah, yeah. So um like you read little stories, right? So uh a few well last year, towards the end of the year, I had a a bit of a party at home. Um I got a table tennis board, had a few friends over. Um so we have some drinks going, water, snacks, whatever, and uh we're playing table tennis and drinking and having a bit of a party, just relaxing with some friends. Because now the most of the year's over and we're all like on the downward slide for the holidays now. And so as the day goes by, everybody's drinking the alcohol, everybody's drinking the water, and there's a stack of cool drinks piled up that nobody was touching. So now over the December holidays to January, there's only one guy that's gonna drink all that stuff. So it's this guy destroying my body. So um early Feb. Wake up no, it was a Thursday night, I went to play soccer, and I caught a thump, a ball hit me right in the abdomen and didn't make much of it, carry on playing. Yeah, it hurt at the time, but game goes on. Um that night, I'm lying in bed, and then I get this shocking pain in my back. And first thing I had to do was just check to see that my wife didn't stab me. So I was like just checking, no, there's no no knife there.

SPEAKER_02 1:19:11

Um it's that it's that intense. It was intense. Yeah.

SPEAKER_00 1:19:15

Two patients of mine so far have told me, both female patients, both have had kidney stones, and they both told me the kidney stones were worse than their pregnancies. Um but I I do not take anything away from any pregnant woman that needs to go through, but thank you. Um so, and and my wife, my wife argues me on that. She says, No, uh, kidney stones are nothing in comparison. And I will forever agree with that. Um nonetheless, so once we realized that I hadn't been stabbed, I went to the bathroom. Nothing happening, so it wasn't digestive. So I came back and she says, Are you okay? Like, no, I'm not. Something's not right. She's like, Go to the hospital. So I go to the hospital. And um What's K can can the guy see that as red on the camera?

SPEAKER_02 1:20:03

Should be, but I don't know. Like a like a bright.

SPEAKER_00 1:20:06

Not as bright as we see it. Okay, so that's about the colour of my urine when I got to the hospital.

SPEAKER_02 1:20:11

Well, for the listeners, that's like a red. Yeah, burgundy colour.

SPEAKER_00 1:20:15

Oh, okay. Yeah. So um so they they make me pee in the cup, and then the doctor takes the so I went to the outpatients, the doctor takes the cup away, and she comes back like ten minutes later. I think there's blood in your urine. This thing is like this thing is like brick red. Yeah, you think there's blood in my urine. Confirmatory. Yeah. So then they said, We think you have a kidney stone. I said, okay, cool, let's uh let's do what we need to. Now, my my uh regret is not phoning a friend when I needed to. And had I phoned Ashen or had I phoned Hermann Kluka, um, I would have got very different advice. And I'm I'm wondering whether I should finish.

SPEAKER_02 1:20:58

But these are dental specialists now. Yeah, I'm wondering what have they had kidney stones before?

SPEAKER_00 1:21:02

So Ashen has. Okay. Um sorry if I'm mentioning something you didn't want people to know, Ashen. Um, but Hermann Kluka knows uh some very good urologists. Okay. And he told me in in the wake of my kidney stone, you should have phoned me and I would have told you who to go to. Um so anyway, um I'm I'm wondering if this is the right decision of because of how the story ends.

SPEAKER_02 1:21:26

You can always cut it out.

SPEAKER_00 1:21:28

Okay, let's let's tell the story and you we can decide later.

SPEAKER_02 1:21:31

So um So you call so you you're regretting c not call it having called two of your dental specialists' friends. Yes. We won't name them.

SPEAKER_00 1:21:40

No, no, Hermann Kluka and Ashien Singh.

SPEAKER_02 1:21:43

No, but I'm g I I'm I'm I'm I'm recording an alternative version in case we want to cut off the phone.

SPEAKER_00 1:21:46

No, no, no, they're they're they're fine. Okay, this part is all fine. It's the ending that's the the part that you guys are gonna cringe about.

SPEAKER_01 1:21:52

Yeah.

SPEAKER_00 1:21:53

But uh and that's why we can decide about that later. Um so so the um Just the tip. Yeah. So the um the the doctor admits me. So they said they spoke to the urologist. Uh so they did the scans and everything, the radioisotope scan, found that I have kidney stone. They said, okay, here we go, we're gonna admit you, and we're you're gonna see the urologist later. Urologist comes in and he says that uh we're gonna go in, blast the stone, put it in a basket, take it out, and um unless you pass the stone first. So he says, I'm booking you in for theater for tomorrow afternoon at 3 p.m. Try to pass the stone first. Like, okay, cool. So I'm lying in bed, they cancel all my cases at practice, and um so I'm just there with my phone, my laptop, preparing lectures, knock all. So while I'm in the hospital bed working on my lectures, and then he comes by later in the afternoon, and like, have you passed your stone yet? I was like, no, he said, Have you been to the bathroom? It's like no. Like, why aren't you going to the bathroom? Oh, so like don't even a catheter, they expect you to physically Well, yeah, but that's how they that's the procedure, apparently. Um so it's like no, just haven't felt like it. He's like, okay, where's the water? It's like, what water? So then he goes out, he's like, ladies, bring this man some water. He needs to be drinking water to flush. So, okay. So then they bring me a a jar of water at like 3 p.m. Um So then I start going to the toilet and no kidney stone uh right up to the next day. So by 3 p.m. the next day, it's like any signs of the stone? Nope. Okay, let's roll. So they take me to theater, they do what they need to. They go in with the camera, find the stone, blast the stone, put a basket, take out the stone, and then take me back to the ward. I wake up a few hours later. Then it's the usual story. If you can you if you can pass urine, they'll they can discharge you and all of that. Um so then while I'm lying in the bed, uh he's doing his ward round, he comes to me, he's like, Okay, just pull up your pants and look inside. So I've lift up my pants, I'll look down. He says, See, there's a little cord there. Maybe we shouldn't tell this story.

SPEAKER_02 1:24:04

What? I I'm enjoying this story. Oh, not only there's a cord.

SPEAKER_00 1:24:09

Because now we're talking very, very personal things. Okay, yeah now I'm enjoying the story. Okay, so anyway. Water down. So um so he says, see, there's a little cord, and it looks like like um fishing gut. Oh. Okay, so it's about seven or eight uh centimeters long um that that you can see. And he's like, Okay, so that's attached to the uh stent that you've got in place. So the stent is in place in your ureter, uh in your urethra. No, sorry, in your ureter to keep it patent because of the swelling and the bruising and the bleeding. So it's to keep it patent so that you can still pass urine through that uh stent. Um so he says, uh, okay, so that's attached to the the stent, and um then in a week it needs to come out. So it's like, okay, cool. Uh just uh like fish gut, it's like a few microns thick. So I'm like, okay, that sounds doable. And he shows me the radiograph. So this little fish gut is tied to a little stent, which is about four or five millimeters thick, and then it's coiled up in the bladder, goes up the ureter, coiled up in the kidney pelvis. So then I asked you, okay, so uh we am I gonna come back and take it out? He's like, no, you must just pull on the cable and it'll it'll come out. Like, what? Self-smooth. He said, Yeah, you must just take it out yourself. He says, in a week it'll all be healed up, just pull out the the the cord, the whole thing will come out. Like Jeez. Okay.

SPEAKER_01 1:25:33

Yeah.

SPEAKER_00 1:25:33

And then he's like, no, yeah, that that's all there is to it. It's like, oh, okay. So then I go home that day, and um most painful. It was more painful than the the than when success stopped. That is crazy. I took sign of leave, dorma knocked, and I was out. Um slept to the next day. My brother came to visit me that next day. They put some soccer on. Uh, we were watching the soccer, I fell asleep on the couch again. Um, and Monday I went to work. So I've got this stent in. I went to work because we had like so the week was already booked, and these were the patients that we couldn't move. So the patients flying in from the UK, patients flying from all around the country that were already booked for treatment, patients that had their surgery done need to be immediately loaded. So things you can't defer. So um, so I went into work that whole week. So I just got a stent on Friday. Monday morning, I'm at work. Can't sit down, so I'm standing up and working the whole time. Um for like the first three or four days, still just blood in the urine. There's it's just pure blood. Um, by about day three or four, it starts to clear up, and then it's just looking like urine again. So I'm getting optimistic. So Thursday, getting good. I can see it's clear urine now, drinking a lot of water, just flushing out the system. Friday, I'm getting happy. Friday morning, I wake up, sun is shining bright outside. It's like, okay, one day to go, and this thing is coming out. Because it was, it's extremely uncomfortable as well. Like you can't sit down, you can't, like you have to like sort of slouch everywhere so that you keep the line straight. Because when you slouch or you you bend over, you sit, you're compressing that whole thing, and it's it's very uncomfortable.

SPEAKER_01 1:27:13

And so um I wake up on Friday morning and the little fish gut thing is gone. All right.

SPEAKER_00 1:27:22

So now I'm panicking. Now it's a critical whereas I have no idea. So I there's only one place it's going, it's going in. Okay, it's it's going up. And so then um I start panicking, and I tell my wife, you know what this this thing is gone, this little cord is gone. And then she checks Google and apparently it it can't happen. So when you urinate, it should wash itself through and come out again. So it's like, okay. So I go to work drinking water, water, water. By about two PM I need to go to the bathroom. Go to the bathroom. push as hard as I can and this little thing comes out. Yeah. Okay. So that that little um that little cord comes out and then I grab it at some tissue and say, it's coming out today. This this stent is coming out today. I'm not going through this again. I'm not so um I think this is where we we we should start. This is where we okay long story short the the cord that that small cord was about 10 centimeters long but it was attached to a stent that was about 40 centimeters long and about five millimeters thick that had to be pulled out. And now according to my urologist I I can pull this out yourself yeah so I did. DIY P I Y and it was it was excruciating. Yeah even though he told you it's you said it's fine and when I told this to Hermann Kluke Herman's like no you do not do that. That doesn't sound right and I told this to Ashen Ashen's like no they take you to theater to do that.

SPEAKER_02 1:29:04

Oh my goodness. That's what that's the same thing like okay the implant's placed here's your implant crown patient go home. Go home and you can do it yourself. Yeah. So um but are you sure this is not a patient factor here. Did the I was pretty sure he said that.

SPEAKER_00 1:29:19

Pretty sure he was like 99% sure he said that 100% sure you do so you did it. Man I passed out for like 10 minutes after that and I still had to see two more patients. Needless say I washed my hands and I I saw my two more patients and then I went home and slapped and I got a bit of a UTI after that had to take some levifluxusin man that stuff messes you up. Insomnia but presumably with a specialist no I we we phoned them and um they said no continue with antibiotics and if there's any problems after that let us know.

SPEAKER_02 1:29:55

So they didn't say you did the wrong thing. No. So you actually were supposed to do that? Yeah. Jeez I do not want this dumb I would not want to do that. Because I'm sure there must be some form of damage.

SPEAKER_00 1:30:05

When I did my my research in retrospect when I phoned my friends then I realized that's not how it's done. They take you back to theater and they take it out. Even though it's like a two second thing you don't want to be awake for yeah even sedation.

SPEAKER_02 1:30:18

Yeah right as long as you you don't feel that and the psychosomatic like type of uh you you're watching this thing unfold.

SPEAKER_00 1:30:27

Stopped halfway man and it was it's horrible because you don't even know how much more you got to go. Because by the time you're seeing this much cable, you're thinking okay this should be done by now.

SPEAKER_02 1:30:36

So that's why while we're on camera and recording, let me give you my honest take about this story. Unless you're embarrassed about it, I think we can publish it without cutting the only thing that concerns me is that you've disclosed that Ash has um uh had kidney sores so he must be comfortable with that fine so I'm sorry you will be so you can a we'll we'll ask him yeah that's a cool story I like that story and then if he if he's not yeah cautionary yeah yeah because unless you're embarrassed you can decide and let me let me cut the whole thing off. In in in but it's a crazy story. It's nuts. But it gives you like a human aspect of it. No not even that it's like geez I wonder there'll be doctors watching this and having opinions. Yeah like on what you were told.

SPEAKER_00 1:31:20

Right and then you know when when I found out what should have been done I realized there's much more non-invasive ways to actually treat it. You don't have to go in and and blast it. You can there's a there's a urology hospital in Pretoria that I didn't even know of that I should have gone to um where they put they do this like I can't remember remember the name but one of my colleagues has also recommended that he can you can do this non-invasive thing where they it's like a sonar pulse that they emit through your body and it shatters the stones and then you just pass out the dust which is sounds a lot better than going in and lasering and putting in a stent.

SPEAKER_02 1:31:55

So we'll keep this whole story in provided that Ashien says is cool. Yeah. If not nobody will hear the story. Okay.

SPEAKER_00 1:32:02

Um so then um so when I was on the levifloxus in though like it gave me insomnia so like I'd go to bed at maybe 10 p.m and I'd wake up at 1 a.m and I'd just be tossing and tossing and turning and nothing not even a smallest line of sleep. So then I pull out my laptop and I'd work. So then I'd prep lectures. These are lectures for students or no these are for the I think one of the things we might have done to get no but um yeah so these are normal lectures that I'm prepping for for Sada or from or for uh one of the companies. So yeah so leading up I was giving a lecture the week after that um sitting with my laptop just working on my lectures uh then go to go to work see patients go back home try to sleep not happening um and speaking of pain you know like yak must have been in so much pain this whole time you were telling the story because he's holding back making a pun. Yak loves menu I mean you already said something about it what he's a lane pipe um I and I know I I figured because um I'm I've when I said a few things and I was like yeah there's a double entendre there and I looked at him and he's smiling away. So I figured yeah okay.

SPEAKER_02 1:33:13

Yeah no that's hectic. I'm absolutely crazy yeah I uh I I regret just don't go fishing when you're on that kind of yeah like that's must scow you for life. Yeah no so no never be a pescatorian no but I can I can relate to the story because you know when when I had my amputation I had to go in a week later to get the dressings like redone. Yeah and I'm lying on this table and he's standing there and I'm thinking to myself this is this is easy like I can maybe you know I could have done this at home. And he asked me to look to my left and he starts undressing this thing and and I he still blocked me. Yeah but for some reason I could just feel absolutely everything. Yeah and then he did it and I was like in delirium and then did the dressing and whatever I go to the waiting room I was like am I going to have to come back every single time and do this. And he was like no you're gonna go and learn how to do this now on your own. Yeah. And I promise you for about a month I used to have to psych myself up every single time that I'd change the dressing on my hand. And it was terrible. It was absolutely terrible. Do they ever tell you what causes the kidney stones? What's going to do that prevent did they tell you that stuff? Cool drinks.

SPEAKER_00 1:34:33

Did they tell you? Cool drinks Well he just he just told me what um type of kidney stone it was but then you do your own reading.

SPEAKER_02 1:34:42

So that's my point.

SPEAKER_00 1:34:43

Nobody tells you right they just do the procedure and then In Instagram uh lightens up to your to your algorithm your algorithm starts to and then you just start seeing reels about kidney stones and then kidney how to prevent kidney stones and so how do you prevent kidney stones? I do not lifestyle more more water.

SPEAKER_02 1:34:59

Right.

SPEAKER_00 1:35:00

So it depends on what type of kidney stones you're prone to like red meats and but can I just ask it No you can't I'm too bad.

SPEAKER_02 1:35:09

Too late the y that evening you got hit with a soccer ball. Yeah.

SPEAKER_00 1:35:14

That's coincidental so it was there and then it dislodged you thing yeah it was in the kidney and then the soccer ball probably dislodged the stone. Okay.

unknown 1:35:21

Sure.

SPEAKER_02 1:35:22

And is there I because then that stone must have been there for a while, right? Yeah. I wonder if there's like preventative things you can do like or you know just go for a scan.

SPEAKER_00 1:35:31

Yeah.

SPEAKER_02 1:35:32

Preventatively people just go and like scan for kidney stones. Yeah apparently people go and get um CT scans now.

SPEAKER_00 1:35:41

Yeah yeah full body that's what I want to do actually. Yeah. Um and and you know I s in in in a sort of um retrospective way I I I decided that my my opinion of all sort of specialists and practitioners now is is aligning that personally I would prefer to go to a younger practitioner or specialist. Okay, interesting. Because if I had likened it to myself I feel that I am at the at the peak of my career I'm reading all the time I I know the current current literature and so I would assume that a a specialist in this in another field would be at that level versus someone that's been doing it for the last 30 or 40 years, just biting their time, uh coasting through waiting for retirement. I hear also technology. Right and they'd stick with stuff that they've been doing for the last 30, 40 years because it's worked for them in the past.

SPEAKER_02 1:36:37

I hear you but I disagree with you because there might be very young specialists that also are happy to just have gotten the degree and carry it on.

SPEAKER_01 1:36:49

Yeah.

SPEAKER_02 1:36:50

But more likely a younger person would keep up with the technology especially why why more likely? Because that's what youngsters do.

SPEAKER_00 1:36:57

No, not necessarily or maybe just now in this sphere because right now technology is advancing so fast that if you don't keep up you fall behind.

SPEAKER_02 1:37:07

I think there's I mean there's old timers out there that love keeping up with the times but I think it's all yeah yeah of course I don't know.

SPEAKER_00 1:37:16

I mean there's some guys like Howard Gluckman the guy has every latest technology in his practice.

SPEAKER_02 1:37:21

The next guest we're interviewing Really um not not Howard Gluckman but he his on his Twitter profile he calls himself an aging technophile Andre Hugo autodontics. So I yeah I I wouldn't necessarily say because they're young they keep up with the times you could be young and not interested. Yeah you know yeah fair enough and and I think just because you feel that you are that way therefore unbiased it's a bias yeah cool man where's the next uh overseas trip uh for work next week for this week yeah on Wednesday I'm going to Turkey Alright it's uh ITI Global Congress lovely the sauce is getting rid of the source yeah go do some investigation yeah not going for any work it's to get its work any work done oh no no no no who would you go to if I had to get work done I've got a few good colleagues A Shen um ASHEN uh Sundile um yeah depending on what I need done uh I would I would call in favors with colleagues yeah so Abby anything else we haven't touched on that you you know wanted to talk about today it's part you know first part two so I appreciate it yeah anything else no how about you me no nothing from my side yak I I think I know you retired the question but I'd still like to ask it you do it like your kids how old are your kids six and two oh okay they're very young so do they do they get ever get exposed to what you do at work?

SPEAKER_00 1:38:55

Do you ever take them they are they are fantastic. So my my daughter she's two um so she's at the practice with us every day and that is the best thing I could ask for I mean between patients um so we don't we don't travel to work together because I also have to go to uni some some of the days so and also like I might get in earlier or my wife might get in earlier to start admin. But then it's like the best thing when I'm busy working a patient and I hear my daughter screaming uh something and I just know she's awake or she's in the area or she's playing around. And it's the best thing to to know that you can just at work just go and play with your kids.

SPEAKER_02 1:39:39

That's cool yeah that is cool. No I I had the same experience because I worked from home because COVID right? Yes yeah if it wasn't for that wouldn't have seen my kid as much as I did. Yeah. It was one of the positive things of COVID and working from home.

SPEAKER_00 1:39:53

Yeah. It's really cool. Yeah and in fact they helped us with a patient recently both my kids so so she was very scared very anxious um this is a dental surgery and you know it's not uh something she's used to and she's only three so what we did was we brought my my kids' toys in we put them around in surgery we brought my kids in with her they got to play with her a bit and then my son goes up on the dental chair we make the chair go up and down I take a few photographs of him he climbs down my daughter goes on so we primed them before the patient came in we told him what we want them to do. And then my daughter goes on she does the same thing she sits she smiles we take a few photographs then she comes down and then the patient follows and she was so happy to just do what the other kids are doing. So yeah so they they're a big part of my practice.

SPEAKER_02 1:40:39

Yeah Zayn Dangle was telling us how his kids um remember they assisted him yeah as well so my actual question was like what if your kids wanted to do dentistry like it was immediate no that's no yeah the listeners wouldn't have seen that but Abby shake like shook his head immediate so why um I I think that my reasons for doing dentistry are very personal to me.

SPEAKER_00 1:41:04

And um what I can give them out of dentistry is is based on my life and my experiences. If they want to do dentistry I I I think I'd support them in whatever they want to do. But just I think for the average dentist and um prison company excluded I think for the average dentist you know and and this is like the remember there's there's a there's millions of people out here who will need to use their medical aids who will need to see a medical aid dentist um and you know there's going to be all of these and and I'm I've been there I've been a medical aid practitioner when I was a general dentist and it's not an easy life to you know to to perform treatment and not take money in exchange for that treatment. And there's another company that is sort of promising you that they'll pay you but not really promising you that they're gonna pay you. And then when the statement comes they short pay you so then you start asking around for the money that you are owed for the work that you've done and no one is going to give you that money. The patient's not going to pay the medical aid's not going to pay. And for reasons that you can't fathom you put every bit of your blood sweat and tears into treating that patient and now someone's not paying you what you think you deserve for it. So and if that's a rite of passage that many dentists have to go through sometimes they take on that responsibility for themselves they open up a practice by themselves which I did and I made the choice at that point to go into medical aid practice and it was torture. I had my dad backing me at the time because it was in his medical center. So like with rental and stuff I was let off easy. But I mean people who have overheads who have families to feed it's a very big challenge to take on by yourself. Unless you've got the support it's it's it's hard and and I empathize with um with dentists that have got to face those challenges it's not an easy life out there for the average dentist that is um that is is is uh servicing the the large majority of people um and and not to mention the capital outlay that we've got to put in I mean i the the patients that or people that are not dental that are watching this to buy a dental chair will set us back anything from I mean you can probably get a cheap one for about a hundred thousand Rands um you up to about seven eight hundred thousand rands for a dental chair for someone to just lie back while you do their treatment. So this is if you are starting practice before you've even seen your first patient you've got to outlay about half a million Rand. And if you don't have money somewhere you've got to take a loan you've got to have all these overheads. So on the point of would I want my kids to go through this not willingly I think if they have um ambitions to be like their uncle the the the my my brother Lee that's great. He's he's the aeronautical engineer he's doing great for himself in the UK he's great into finance he knows everything about everything uh that's not dentistry and he's he's if they want to be like that by all means. If they want to be like my other brother medicine by all means. I would try to keep them especially in this landscape South African landscape with medical aid is the way it is and if NHI comes in it's maybe a harder landscape for the future. So I don't know if I I would support that. Or not not support. I'd support whatever they choose. But encourage it I won't encourage it. I won't say do what I do. I do it for myself because it's what I love.

SPEAKER_02 1:44:45

I love that honest answer. It's a great answer. Yak wanted to be an aeronautical engineer that was his thing when people asked him and then he ended up becoming a dentist. Yeah why why do you why'd you forego error failure because I actually went did it ended up in mechanical engineering where at fail at UKZN okay yeah and then dentistry after yeah then exile you know watch my episode it's as long as this one probably would you have I mean but if you had kids would you tell them to do dentistry? Uh my kids I no somebody else's kids. Yeah your kids yeah uh but I f I'd I'd support them in whatever they what they want to do. If they wanted to do dentistry I would support but you remember my answer my answer was the was like the icky guy principles. Yeah it's for them to follow what their passion would be but also like incorporating like environmental factors. Can they make money from it? Yeah are they good at it is something that they love. And if they can answer all of that in favor of dentistry then by all means go for it or whatever it is that they want to do. Yeah. Abid thank you so much man may you live as long as you want infinite and little want as long as you live that's the Irish proverb. And um yeah we'll look forward to part three man I don't know how much you want to hear from me.

SPEAKER_01 1:46:14

Cheers bro thanks man thanks fam