1 00:00:00,000 --> 00:00:21,280 Hi everyone, and welcome to Airway First, a podcast from the Children's Airway First 2 00:00:21,280 --> 00:00:22,280 Foundation. 3 00:00:22,280 --> 00:00:25,160 I'm your host, Rebecca St. James. 4 00:00:25,160 --> 00:00:30,600 On the show today, we have two guests, Dr. Kevin Boyd, a board-certified pediatric dentist 5 00:00:30,600 --> 00:00:37,720 practicing from Chicago, Illinois, and Dr. Darius Legmani, the director of the Advocate Children's 6 00:00:37,720 --> 00:00:42,160 Sleep Network at Advocate Children's Hospital in Chicago. 7 00:00:42,160 --> 00:00:47,240 I'll include the bios of both of our guests in the show notes so that you can check out 8 00:00:47,240 --> 00:00:52,280 all the great information about them, their background, and the work they do at your leisure. 9 00:00:52,280 --> 00:00:55,600 I'm super excited about today's conversation. 10 00:00:55,600 --> 00:00:56,600 Just want to get it out there. 11 00:00:56,600 --> 00:00:58,600 I want to share it with everybody. 12 00:00:58,600 --> 00:01:06,840 Without further ado, let's jump into my conversation with Dr. Darius Legmani and Dr. Kevin Boyd. 13 00:01:06,840 --> 00:01:07,840 All right. 14 00:01:07,840 --> 00:01:09,360 Thank you both for joining us today. 15 00:01:09,360 --> 00:01:11,520 It's great to see you on a Friday afternoon. 16 00:01:11,520 --> 00:01:14,920 Nice to see you too. 17 00:01:14,920 --> 00:01:19,640 Really, I am so really looking forward to this. 18 00:01:19,640 --> 00:01:20,640 Good. 19 00:01:20,640 --> 00:01:21,640 Me too. 20 00:01:21,640 --> 00:01:29,040 Just so everybody knows, we'll cover a few questions just for parents on sleep that I've 21 00:01:29,040 --> 00:01:30,040 received. 22 00:01:30,040 --> 00:01:35,920 But after that, the main focus today is to talk about collaboration on the two sides, 23 00:01:35,920 --> 00:01:42,120 medical and dental, and the benefits, which is why you're both here. 24 00:01:42,120 --> 00:01:47,600 One of the things that I got a question on, if you don't mind, I just made the Darius, 25 00:01:47,600 --> 00:01:53,760 if you would just kind of elaborate on this, and I've heard you talk about this though. 26 00:01:53,760 --> 00:01:56,600 Good sleepers, bad sleepers when it comes to children. 27 00:01:56,600 --> 00:01:59,600 Can you just dispel that myth for us right out of the gate? 28 00:01:59,600 --> 00:02:00,600 Yeah. 29 00:02:00,600 --> 00:02:05,160 I mean, I think that there is a sense, and it goes beyond just sleep. 30 00:02:05,160 --> 00:02:10,280 I think in all elements of life, we think that there are nice people and mean people. 31 00:02:10,280 --> 00:02:17,360 We think that there are, you know, we just like to have dichotomies. 32 00:02:17,360 --> 00:02:20,480 And we like to put people in a box and say, this is where they are. 33 00:02:20,480 --> 00:02:21,480 I've met them. 34 00:02:21,480 --> 00:02:25,040 You know, this is why there's so much emphasis on like first impressions and that sort of 35 00:02:25,040 --> 00:02:27,240 thing, because you may never see them. 36 00:02:27,240 --> 00:02:29,600 With children, it's different, right? 37 00:02:29,600 --> 00:02:31,240 Because you're with them every day. 38 00:02:31,240 --> 00:02:34,480 Every night is different. 39 00:02:34,480 --> 00:02:38,640 And especially for young children, as they're growing and developing, they're different 40 00:02:38,640 --> 00:02:42,040 every couple of weeks. 41 00:02:42,040 --> 00:02:47,080 So I think to be able to step back from the idea of are they good sleepers or bad sleepers 42 00:02:47,080 --> 00:02:52,160 and start to think about how are we nurturing this capacity to transition from the day to 43 00:02:52,160 --> 00:02:57,920 nighttime, from wake to sleep. 44 00:02:57,920 --> 00:02:59,920 Then we can think about it more like walking, right? 45 00:02:59,920 --> 00:03:02,880 Like you wouldn't say that a baby is a good or a bad walker. 46 00:03:02,880 --> 00:03:03,880 Right. 47 00:03:03,880 --> 00:03:07,520 If they took a couple of steps and fell down, we wouldn't say, well, I guess that's it. 48 00:03:07,520 --> 00:03:08,520 Right. 49 00:03:08,520 --> 00:03:09,520 He's a bad walker. 50 00:03:09,520 --> 00:03:10,520 Yeah. 51 00:03:10,520 --> 00:03:14,320 You're going to be bad walkers and you never dance and never sing. 52 00:03:14,320 --> 00:03:21,280 So if we think about it as a process, how are we fostering this process of transitioning 53 00:03:21,280 --> 00:03:24,960 from the daytime to nighttime, it becomes easier. 54 00:03:24,960 --> 00:03:27,000 And there's a likeness to it. 55 00:03:27,000 --> 00:03:28,000 Right. 56 00:03:28,000 --> 00:03:31,760 Now the parent can actually learn about how am I helping them wrap up the day? 57 00:03:31,760 --> 00:03:35,800 What are the things that I can do to help them know that their day is done? 58 00:03:35,800 --> 00:03:40,040 What are the physical signals and what are the mental things that we need to be able 59 00:03:40,040 --> 00:03:42,280 to help them do? 60 00:03:42,280 --> 00:03:48,400 So let's kind of build on that because one of the things that we talk to parents about 61 00:03:48,400 --> 00:03:53,920 a great deal is when your kids are sleeping, go in there, listen to them, listen to the 62 00:03:53,920 --> 00:04:00,080 sounds, are they snoring, are they restless, all these kinds of things. 63 00:04:00,080 --> 00:04:06,160 As a parent, if I have a child that's a chronic habitual snore and I come into my airway-centric 64 00:04:06,160 --> 00:04:09,200 dentist, how does this work? 65 00:04:09,200 --> 00:04:13,800 Because a lot of what we're hearing, which is why we're here today, is a parent will 66 00:04:13,800 --> 00:04:18,080 come in to a dentist and this refers to the pediatrician and we hear, no, don't worry 67 00:04:18,080 --> 00:04:21,320 about it, they'll grow out of it, whatever the reasons are. 68 00:04:21,320 --> 00:04:24,920 So let's talk a little bit about that. 69 00:04:24,920 --> 00:04:31,040 A parent comes in to an airway-centric dentist, first, what can we expect? 70 00:04:31,040 --> 00:04:37,280 One thing is airway-centric dentist, what does that mean? 71 00:04:37,280 --> 00:04:38,280 Right. 72 00:04:38,280 --> 00:04:43,160 So obviously, we know, you know, we know, you know. 73 00:04:43,160 --> 00:04:50,440 So when I first started hanging out with Darius at then Children's Memorial Hospital, it's 74 00:04:50,440 --> 00:04:56,920 called Lurie Children's now, but it was sort of like I learned all these things from him 75 00:04:56,920 --> 00:05:04,360 and Stephen Sheldon and then I was like a new convert to a religion almost. 76 00:05:04,360 --> 00:05:12,800 But I just sort of had to tell everybody about it and started doing a deep dive and then 77 00:05:12,800 --> 00:05:19,440 I started getting invited to dental, you know, study clubs and meetings and I remember one 78 00:05:19,440 --> 00:05:23,000 of the first ones that I talked at. 79 00:05:23,000 --> 00:05:31,160 I brought up bedwetting and this older gentleman, kind of cantankerous, actually stood up, didn't 80 00:05:31,160 --> 00:05:32,160 he raise his hand? 81 00:05:32,160 --> 00:05:33,880 He goes, I thought this was a dental meeting. 82 00:05:33,880 --> 00:05:37,720 What are you talking about bedwetting for? 83 00:05:37,720 --> 00:05:43,120 He was getting ready to walk out and the person who invited me said, you know, Dr. Gillespie 84 00:05:43,120 --> 00:05:48,440 or whoever you are, you know, just please listen to what Dr. Boyd has to say. 85 00:05:48,440 --> 00:05:57,720 And then, you know, so and now it's so in the public domain that parents and, you know, 86 00:05:57,720 --> 00:06:04,440 blogs and people come to my office, not anymore surprised as to why would you be asking me 87 00:06:04,440 --> 00:06:05,440 all these questions? 88 00:06:05,440 --> 00:06:11,640 I thought you were a dentist, you know, it's sort of like they come and they said, you 89 00:06:11,640 --> 00:06:15,840 know, they not only get that they come preloaded. 90 00:06:15,840 --> 00:06:21,960 I mean, it's just sort of like they know what's going on and they want to get to the bottom 91 00:06:21,960 --> 00:06:22,960 of it. 92 00:06:22,960 --> 00:06:26,640 So that's helped a lot for me. 93 00:06:26,640 --> 00:06:30,600 And I don't really like the term airway centric dentist. 94 00:06:30,600 --> 00:06:38,720 It's sort of I like it amongst us, but getting it out there, it's almost like an advertising 95 00:06:38,720 --> 00:06:43,400 gimmick or something that, oh, you know, I'm different. 96 00:06:43,400 --> 00:06:44,600 But I understand it. 97 00:06:44,600 --> 00:06:46,760 I'm not passing judgment on people that use it. 98 00:06:46,760 --> 00:06:50,080 I just, I don't like to call myself that. 99 00:06:50,080 --> 00:06:57,760 I'm just a pediatric dentist to understand that sleep and breathing health is a component 100 00:06:57,760 --> 00:06:59,320 of oral health. 101 00:06:59,320 --> 00:07:03,000 And that's, you know, the American Dental Association now has a policy statement on 102 00:07:03,000 --> 00:07:04,000 it. 103 00:07:04,000 --> 00:07:10,880 So, you know, cavities, gum disease and airway, you know, they're all in the same plane. 104 00:07:10,880 --> 00:07:12,160 Right. 105 00:07:12,160 --> 00:07:13,440 So. 106 00:07:13,440 --> 00:07:21,640 So hopefully it was, this does actually take a hold and it's hot in medical school or dental 107 00:07:21,640 --> 00:07:22,640 school. 108 00:07:22,640 --> 00:07:28,520 It could just be dentists because we know it's just part of what you look for. 109 00:07:28,520 --> 00:07:29,520 Right. 110 00:07:29,520 --> 00:07:34,200 Well, I never called myself a cavity centric dentist. 111 00:07:34,200 --> 00:07:35,200 Right. 112 00:07:35,200 --> 00:07:40,880 Or diet, a diet centric, because I am. 113 00:07:40,880 --> 00:07:47,960 I mean, I studied nutrition before I became a dentist and I understand the dietary component 114 00:07:47,960 --> 00:07:50,640 of, you know, sugar overconsumption. 115 00:07:50,640 --> 00:07:54,960 That's what causes so much need for dentistry anymore. 116 00:07:54,960 --> 00:07:58,600 Our whole dental industry is built upon sugar. 117 00:07:58,600 --> 00:08:01,160 It just is whether people want to talk about it or not. 118 00:08:01,160 --> 00:08:03,480 But so I don't know. 119 00:08:03,480 --> 00:08:10,840 I like this change that attitude that we're not just putting out sugar fires all 120 00:08:10,840 --> 00:08:16,160 day long, you know, but there's other things we can do for children. 121 00:08:16,160 --> 00:08:19,880 And you know, that's one of the things we hear a lot though in our various podcasts 122 00:08:19,880 --> 00:08:22,320 with guests. 123 00:08:22,320 --> 00:08:24,880 Dentists at this point are kind of becoming the gatekeepers. 124 00:08:24,880 --> 00:08:32,160 You know, you're seeing things in your, you're going past just like you said, just past cavities 125 00:08:32,160 --> 00:08:38,440 or you're looking at, okay, is there airway blocked or are there other issues that we 126 00:08:38,440 --> 00:08:39,960 need to see? 127 00:08:39,960 --> 00:08:44,320 And then you've started this collaboration with Darius. 128 00:08:44,320 --> 00:08:49,040 And let's talk about that a little bit because this is one of the things that calf really 129 00:08:49,040 --> 00:08:53,280 is rallying for is we want this inclusive medical team. 130 00:08:53,280 --> 00:08:57,840 You know, it's not just pediatricians over here, my own functional therapists here and 131 00:08:57,840 --> 00:08:58,840 dentists here. 132 00:08:58,840 --> 00:09:02,760 And we're looking at kids, particularly holistically. 133 00:09:02,760 --> 00:09:12,480 Darius, why don't you talk a little bit about the evolution of our, you know, that one day 134 00:09:12,480 --> 00:09:20,520 that you talk to me in, you know, in the telephone room back at the old children's. 135 00:09:20,520 --> 00:09:21,520 That's where it all started. 136 00:09:21,520 --> 00:09:25,960 You're the one who started it, not me. 137 00:09:25,960 --> 00:09:31,640 We've been thinking a lot about this because the truth is that we don't see, there aren't 138 00:09:31,640 --> 00:09:33,440 medical dental collaborations. 139 00:09:33,440 --> 00:09:40,440 I can't name another dyad like this with Kevin and I. 140 00:09:40,440 --> 00:09:44,640 I've been thinking a lot about it and is it the data is not strong enough? 141 00:09:44,640 --> 00:09:47,160 Is it that people haven't been introduced to the concepts? 142 00:09:47,160 --> 00:09:48,160 That's not it. 143 00:09:48,160 --> 00:09:50,920 I mean, people really understand all that stuff. 144 00:09:50,920 --> 00:09:58,360 I think the reality is that I think we have been underestimating the local nature of this, 145 00:09:58,360 --> 00:10:05,480 how specific this kind of a collaboration has to be, that it's a person with a person. 146 00:10:05,480 --> 00:10:08,240 Kevin and I are friends first. 147 00:10:08,240 --> 00:10:14,400 And all of these collaborations, the way that we've been treating, I mean, if you look at 148 00:10:14,400 --> 00:10:17,440 the way that Kevin's been practicing, it's changed over time. 149 00:10:17,440 --> 00:10:20,080 If you look at the way that I've practiced it, it's changed over time. 150 00:10:20,080 --> 00:10:23,400 It's not because Kevin said you should do XYZ. 151 00:10:23,400 --> 00:10:28,840 We've been evolving towards each other because we have a common center. 152 00:10:28,840 --> 00:10:30,840 He and I both care about the child. 153 00:10:30,840 --> 00:10:37,160 When you keep the child at the center, if you move towards improving care or trying to understand 154 00:10:37,160 --> 00:10:40,520 the reality of the child from these different perspectives, you see how we start to move 155 00:10:40,520 --> 00:10:41,760 closer to each other. 156 00:10:41,760 --> 00:10:47,200 If we were to try and move closer to each other without that common center, we're always 157 00:10:47,200 --> 00:10:52,680 going to be necessarily somewhere we'll be further from the other. 158 00:10:52,680 --> 00:10:53,680 I think that's... 159 00:10:53,680 --> 00:10:55,480 Yeah, go ahead. 160 00:10:55,480 --> 00:11:01,120 Well, do you remember when we first were introduced to each other? 161 00:11:01,120 --> 00:11:04,920 And I found out that you did some of your training at Rush. 162 00:11:04,920 --> 00:11:06,880 And I said, do you know so-and-so? 163 00:11:06,880 --> 00:11:08,800 And you said, yes, he's a legend. 164 00:11:08,800 --> 00:11:11,920 Do you remember who that person was? 165 00:11:11,920 --> 00:11:13,440 I'll give you a hint. 166 00:11:13,440 --> 00:11:16,440 He has no hair. 167 00:11:16,440 --> 00:11:19,880 Did you know what I saw? 168 00:11:19,880 --> 00:11:22,880 He just walked out of the room. 169 00:11:22,880 --> 00:11:26,360 I'm in his office at Rush. 170 00:11:26,360 --> 00:11:28,280 These are... 171 00:11:28,280 --> 00:11:30,280 It's this level of... 172 00:11:30,280 --> 00:11:36,560 The number of connect points that we had grew. 173 00:11:36,560 --> 00:11:38,360 So I don't know how much of this is personality. 174 00:11:38,360 --> 00:11:41,000 How much of this was just... 175 00:11:41,000 --> 00:11:45,680 As soon as we met, Kevin and John Kelly and I, we just started having conversations because 176 00:11:45,680 --> 00:11:46,680 we were interested. 177 00:11:46,680 --> 00:11:48,240 We were trying to learn. 178 00:11:48,240 --> 00:11:49,240 Right. 179 00:11:49,240 --> 00:11:51,040 But the question isn't about learning anymore. 180 00:11:51,040 --> 00:11:53,800 Like healthcare in general, it's not about learning. 181 00:11:53,800 --> 00:11:56,720 It's distributing what you know. 182 00:11:56,720 --> 00:12:03,040 So the fact that there aren't that many of people with this training makes this a scarce 183 00:12:03,040 --> 00:12:06,960 resource so that people are fighting over access to this scarce resource. 184 00:12:06,960 --> 00:12:08,680 And so then that drives up cost. 185 00:12:08,680 --> 00:12:13,320 I think one of the things that we've recognized is one of the main barriers to this collaboration 186 00:12:13,320 --> 00:12:20,720 is actually just culture in both these fields around money. 187 00:12:20,720 --> 00:12:22,600 About how things are paid for. 188 00:12:22,600 --> 00:12:23,600 Right. 189 00:12:23,600 --> 00:12:27,560 Like in medicine, everything's paid through the insurance. 190 00:12:27,560 --> 00:12:32,200 And doctors never have that conversation or their offices never have that conversation 191 00:12:32,200 --> 00:12:33,200 with the patient. 192 00:12:33,200 --> 00:12:35,280 Like it's always talk to your insurer. 193 00:12:35,280 --> 00:12:36,280 Right. 194 00:12:36,280 --> 00:12:38,800 But in dentistry, it's a different story. 195 00:12:38,800 --> 00:12:39,800 Right. 196 00:12:39,800 --> 00:12:44,800 And there's a service, this is something that's beyond what's covered with insurance. 197 00:12:44,800 --> 00:12:47,760 And it's, oftentimes it's cash. 198 00:12:47,760 --> 00:12:50,200 It's right out of pocket. 199 00:12:50,200 --> 00:12:54,760 And what I've found is when I'm describing this to people, to physicians, they're like, 200 00:12:54,760 --> 00:12:55,760 that's great. 201 00:12:55,760 --> 00:12:56,760 This sounds really good. 202 00:12:56,760 --> 00:12:59,920 And then they'll send a patient to be seen. 203 00:12:59,920 --> 00:13:05,080 And when the price of the treatment comes back, that's the last referral that they'll 204 00:13:05,080 --> 00:13:07,600 make to dentistry. 205 00:13:07,600 --> 00:13:13,560 So this idea of like, how is it that we're also taking responsibility for the cost of 206 00:13:13,560 --> 00:13:19,640 these procedures so that we can respect the expertise that goes into it. 207 00:13:19,640 --> 00:13:23,240 We can respect the amount of money that a chair time is no joke. 208 00:13:23,240 --> 00:13:24,240 Right. 209 00:13:24,240 --> 00:13:30,760 Like if you can go in for cavities, like you have to be able to, we have to respect that. 210 00:13:30,760 --> 00:13:36,640 But then how is it that in this collaboration, we're making it possible to take care of children 211 00:13:36,640 --> 00:13:37,480 for less? 212 00:13:37,480 --> 00:13:39,520 Kevin and I talk about this all the time. 213 00:13:39,520 --> 00:13:42,240 It's like, this is part of why we started a course. 214 00:13:42,240 --> 00:13:47,520 We started like training more dentists to be able to think systematically and act systematically 215 00:13:47,520 --> 00:13:50,680 in reviewing x-rays, reviewing records. 216 00:13:50,680 --> 00:13:56,840 And to be able to identify patients that for any, any dispassionate observer would be able 217 00:13:56,840 --> 00:14:02,880 to look at the data and say, this is a kid that needs, that needs to be expanded. 218 00:14:02,880 --> 00:14:05,920 So how does this work then with the, the, the two of you? 219 00:14:05,920 --> 00:14:10,280 I mean, it is something that is reproducible. 220 00:14:10,280 --> 00:14:15,560 I think the, I think what we've found, at least in this, in, in like the, these initial 221 00:14:15,560 --> 00:14:19,080 efforts that we've made in terms of bringing people together to think, to think together 222 00:14:19,080 --> 00:14:20,080 about this. 223 00:14:20,080 --> 00:14:24,880 I think when we know that there are common questions and people learn how to, how to, 224 00:14:24,880 --> 00:14:30,560 how to step back from this idea of, I need to convince you. 225 00:14:30,560 --> 00:14:36,200 Because this is usually the tone of the, of the, of the conversation between like, like 226 00:14:36,200 --> 00:14:39,080 two practitioners, it doesn't matter what, what kind of person. 227 00:14:39,080 --> 00:14:40,080 Right. 228 00:14:40,080 --> 00:14:43,480 Like, I remember when I started at advocate, we were just starting this sleep program and 229 00:14:43,480 --> 00:14:45,920 went and met pediatricians and I'd say, this is what we're doing. 230 00:14:45,920 --> 00:14:47,920 This is what we're like, we're running sleep studies. 231 00:14:47,920 --> 00:14:51,240 And they're like, oh, so you're here to sell sleep studies. 232 00:14:51,240 --> 00:14:52,240 I see. 233 00:14:52,240 --> 00:14:54,440 I was like, well, I don't want you to do a sleep study. 234 00:14:54,440 --> 00:14:56,320 I don't want any of your kids to have sleep studies. 235 00:14:56,320 --> 00:15:00,480 But if they're snoring and they have sleep apnea, I do think that this, like, I don't 236 00:15:00,480 --> 00:15:01,480 want to do a sleep study. 237 00:15:01,480 --> 00:15:05,160 I think, so the question becomes less about like, I want you to do this and becomes more 238 00:15:05,160 --> 00:15:10,680 about, well, what kid would you actually send for a sleep study? 239 00:15:10,680 --> 00:15:15,440 Now we have a question and now we have a partnership around that question that we know serves that 240 00:15:15,440 --> 00:15:16,440 child. 241 00:15:16,440 --> 00:15:24,000 So to develop more collaborations that Kevin and I are having, we're trying to, to help 242 00:15:24,000 --> 00:15:27,440 people actually develop those attitudes and those qualities, right? 243 00:15:27,440 --> 00:15:28,840 The quality of like humility. 244 00:15:28,840 --> 00:15:30,640 I don't know what the kid needs. 245 00:15:30,640 --> 00:15:33,640 I'm not going to say every kid needs to be expanded. 246 00:15:33,640 --> 00:15:39,400 Like some of them, and some of them will need to be expanded for a malocclusion, right? 247 00:15:39,400 --> 00:15:42,160 So that's well in the, that's in the wheelhouse of a dentist. 248 00:15:42,160 --> 00:15:44,000 Don't call me about that kid. 249 00:15:44,000 --> 00:15:49,840 But if there's a kid that has that snoring, gasping has it as signs of an airway issue 250 00:15:49,840 --> 00:15:54,800 and needs expansion, let's think about which kids, which kids to be expand. 251 00:15:54,800 --> 00:15:59,960 And then one of the targets, like how like, like Kevin now is measuring like now has, 252 00:15:59,960 --> 00:16:02,560 as you know, he's got the Bogue index. 253 00:16:02,560 --> 00:16:07,720 He's got, he just sent me today slides of about 81 and 82 that just showed like the 254 00:16:07,720 --> 00:16:13,840 different, the different changes in the, in the airway, the nasal pharynx, the oral pharynx 255 00:16:13,840 --> 00:16:16,720 after palate expansion, right? 256 00:16:16,720 --> 00:16:21,040 Developing that common language to be able to, so that we're, so we're comparing apples 257 00:16:21,040 --> 00:16:22,040 to apples, right? 258 00:16:22,040 --> 00:16:26,880 Otherwise you end up with like, I'm looking at tonsils and he's looking at the interval 259 00:16:26,880 --> 00:16:30,200 or width and neither of us really know what we're talking about. 260 00:16:30,200 --> 00:16:33,040 Like, like the other one's talking. 261 00:16:33,040 --> 00:16:34,040 Right. 262 00:16:34,040 --> 00:16:44,880 So then when it comes to implementing this in schools, is it more that we have to get 263 00:16:44,880 --> 00:16:51,800 everyone trained on airway or this new collaborative approach or is it both? 264 00:16:51,800 --> 00:16:56,880 I think we need to be able to think systematically and think and act systematically. 265 00:16:56,880 --> 00:16:59,920 So the questions are common and very simple actually. 266 00:16:59,920 --> 00:17:04,000 We don't need, I don't know that we need like an elaborate screen. 267 00:17:04,000 --> 00:17:06,320 Because your child's small more than three nights a week. 268 00:17:06,320 --> 00:17:09,400 Do they have trouble following asleep and staying asleep? 269 00:17:09,400 --> 00:17:13,760 If the answer is no to both of those, you probably don't need to see a specialist. 270 00:17:13,760 --> 00:17:19,120 Because even in asking the question, you've put it on the radar of the air. 271 00:17:19,120 --> 00:17:25,520 And more and more pediatricians are seeing like ADHD, like in a type of activity or sign 272 00:17:25,520 --> 00:17:29,800 of sleepiness as well as it could be ADHD. 273 00:17:29,800 --> 00:17:35,600 So if as those three kind of, as we kind of socialize those questions, just help more 274 00:17:35,600 --> 00:17:41,040 and more people know that these are important considerations when you're looking at a child. 275 00:17:41,040 --> 00:17:47,120 Then I think we'll see, like more people will recognize the need for collaboration in this 276 00:17:47,120 --> 00:17:48,120 regard. 277 00:17:48,120 --> 00:17:57,560 I think what Darius and I have sort of, we've got a really good handle on it, is that, you 278 00:17:57,560 --> 00:18:04,400 know, what does the face have to do, the face and jaws, what does that have to do with sleep 279 00:18:04,400 --> 00:18:05,400 and breathing? 280 00:18:05,400 --> 00:18:11,760 And it's like Darius knows as now that the, you know, the face is the front of the airway. 281 00:18:11,760 --> 00:18:19,000 And you know, me, well, I'm a dentist, you deal with teeth and gums and, you know, the 282 00:18:19,000 --> 00:18:23,440 palate, you know, what does that have to do with sleep and breathing? 283 00:18:23,440 --> 00:18:32,040 And that is so obvious to both of us of how much I have learned about his world and how 284 00:18:32,040 --> 00:18:34,840 he has taken the time to learn. 285 00:18:34,840 --> 00:18:39,480 Like when I remember, well, he's, you know, John Kelly and I would go into a room with 286 00:18:39,480 --> 00:18:45,920 one of his sleep patients that was referred there because the kid already has apnea and 287 00:18:45,920 --> 00:18:49,600 maybe already had a sleep study or is going to get one. 288 00:18:49,600 --> 00:18:52,160 And John, he would have us come and look. 289 00:18:52,160 --> 00:18:53,160 So what about the mouth? 290 00:18:53,160 --> 00:18:54,160 What's going on? 291 00:18:54,160 --> 00:18:55,160 Well, he's crowded. 292 00:18:55,160 --> 00:18:56,160 Crowdy. 293 00:18:56,160 --> 00:18:57,160 What do you mean? 294 00:18:57,160 --> 00:18:58,160 Crowdy. 295 00:18:58,160 --> 00:18:59,160 What does that mean? 296 00:18:59,160 --> 00:19:08,200 And the kind of, I don't know, glib comment that I always say is physicians, if they had 297 00:19:08,200 --> 00:19:15,560 one lecture in medical school on dentistry, they either missed it or they forgot everything 298 00:19:15,560 --> 00:19:16,560 they learned. 299 00:19:16,560 --> 00:19:20,680 And, you know, so they're, they're new, but that's a good thing because they're a blank 300 00:19:20,680 --> 00:19:22,880 slate, a tabla ratha. 301 00:19:22,880 --> 00:19:29,040 You can, and somebody like Darius who's curious and hungry to inform his own science with 302 00:19:29,040 --> 00:19:37,880 my science, it's magic what can happen when we're both collaborating on a single child 303 00:19:37,880 --> 00:19:42,680 and parents, parents can feel it, they appreciate it. 304 00:19:42,680 --> 00:19:46,280 And we want to teach other people how to do it. 305 00:19:46,280 --> 00:19:52,640 And yes, you can package this and you can, you can show it to other people who want to 306 00:19:52,640 --> 00:19:53,640 learn. 307 00:19:53,640 --> 00:19:59,880 But if they don't want to learn, like Darius said, if they don't want to learn, you know, 308 00:19:59,880 --> 00:20:05,960 that that's they, if they're not curious about this and it's a waste of time. 309 00:20:05,960 --> 00:20:11,880 So we're very, we'll talk to anybody, but if it's a big group, we're lucky to have three 310 00:20:11,880 --> 00:20:15,560 or four people out of 100 that will come up and they want more. 311 00:20:15,560 --> 00:20:19,720 It's just, you know, but it's changing. 312 00:20:19,720 --> 00:20:22,120 It's more and more people are really wanting to know about this. 313 00:20:22,120 --> 00:20:24,720 And it's what you're going to dentistry. 314 00:20:24,720 --> 00:20:30,480 I don't know what Darius is finding more physicians that want to know more about dentistry, but 315 00:20:30,480 --> 00:20:36,960 I know a lot of dentists that want to know, you know, about sleep medicine. 316 00:20:36,960 --> 00:20:45,640 Then it's groups like Airway Health Solutions or the Sleep Education Consortium. 317 00:20:45,640 --> 00:20:48,920 They're both trying to reach, I say both sides. 318 00:20:48,920 --> 00:20:53,680 I don't want it to sound like, you know, it's a worrying fraction here, but, you know, the 319 00:20:53,680 --> 00:20:57,840 medical and dental, they're, they're focused on trying to bring in this collaboration. 320 00:20:57,840 --> 00:21:03,440 I think theoretically it's very clear and it's easy, right? 321 00:21:03,440 --> 00:21:06,840 You just say we just need, we just need medicine and dentistry to collaborate. 322 00:21:06,840 --> 00:21:11,280 But I think we've underestimated just the difference, like the distance between the 323 00:21:11,280 --> 00:21:18,080 two and it really traces back to like the early 1900s, like where like that, where educational 324 00:21:18,080 --> 00:21:20,080 standards were put in place. 325 00:21:20,080 --> 00:21:24,680 And that was where you really saw this divide where like the ACGME like, like, like the 326 00:21:24,680 --> 00:21:32,960 standards for medical education and the standards for dental education became separate. 327 00:21:32,960 --> 00:21:37,040 And the collaborations between the two also then became separate. 328 00:21:37,040 --> 00:21:44,440 And then, you know, a date, a date that's a point of departure and it might be coincidental. 329 00:21:44,440 --> 00:21:48,560 I don't know if it's cause and effect, but it's World War II, 1940. 330 00:21:48,560 --> 00:21:53,920 I mean, I have so much literature and Darius and I, I've shared it with him. 331 00:21:53,920 --> 00:21:59,200 I'm, I'm publishing on it and I'm putting in, I'm putting in references in my bibliographies 332 00:21:59,200 --> 00:22:04,280 that, that in the, you know, not too long ago, they would have been rejected, but the, 333 00:22:04,280 --> 00:22:11,880 the information like an invited commentaries or, or book chapters that I write, the information 334 00:22:11,880 --> 00:22:19,440 is so compelling that the publishers will include references from 1912 that highlight 335 00:22:19,440 --> 00:22:26,360 the collaboration between what they called right now, just they, we call them ENTs now. 336 00:22:26,360 --> 00:22:30,520 And you know, dentists and orthodontists, it wasn't just orthodontists that did this. 337 00:22:30,520 --> 00:22:36,000 It was, it was family dentists or what we call primary care dentists now. 338 00:22:36,000 --> 00:22:42,600 This was on, there was so much communication between medicine and dentistry relative to 339 00:22:42,600 --> 00:22:52,600 the comorbidity of malocclusion underdeveloped jaws and faces and airways and, you know, 340 00:22:52,600 --> 00:22:54,560 the symptoms that they had. 341 00:22:54,560 --> 00:23:03,600 And then what the, the old fashioned language that Dr. Bo gave DDS and the early 1900s used 342 00:23:03,600 --> 00:23:11,200 was expanding the deciduous arch to gain nasal respiratory advantage. 343 00:23:11,200 --> 00:23:13,520 That's how he described it. 344 00:23:13,520 --> 00:23:19,840 And he was a physician who almost limited his practice to kids under six years old. 345 00:23:19,840 --> 00:23:28,240 And, and you know, that to me was so enlightening when I discovered his body of work and it's 346 00:23:28,240 --> 00:23:31,440 all evidence, you know, it's evidence-based. 347 00:23:31,440 --> 00:23:38,400 It's, it's backed up by, by controlled observational trials that are published that, that all over 348 00:23:38,400 --> 00:23:39,400 the place. 349 00:23:39,400 --> 00:23:45,080 And Dr. Bo expanded his first kids seven years after the end of the civil war. 350 00:23:45,080 --> 00:23:48,800 That's when he started expanding kids because he just, he had a hunch. 351 00:23:48,800 --> 00:23:51,600 They're using vulcanized rubber. 352 00:23:51,600 --> 00:23:55,600 Vulcanized rubber instead of acrylic, you bet. 353 00:23:55,600 --> 00:24:01,880 So these are, I think these are the things that like to return to that would not be like, 354 00:24:01,880 --> 00:24:06,240 it's not going to be a natural, like it took, it took a hundred years to get rid of that 355 00:24:06,240 --> 00:24:07,240 collaboration. 356 00:24:07,240 --> 00:24:09,560 It would take time to bring it back. 357 00:24:09,560 --> 00:24:15,360 I think the key point is, because like, when we come back to like the question of cost, 358 00:24:15,360 --> 00:24:21,600 like Kevin and I, when we're initially collaborated, like Kevin just ate the cost of those kids, 359 00:24:21,600 --> 00:24:23,080 like, like, of care. 360 00:24:23,080 --> 00:24:26,640 Like these are, most of the kids that we take care of in academic centers are public aid 361 00:24:26,640 --> 00:24:27,640 kids. 362 00:24:27,640 --> 00:24:29,600 They don't like, they don't have, they're not going to be able to come up with the amount 363 00:24:29,600 --> 00:24:33,000 of money that often costs to do this. 364 00:24:33,000 --> 00:24:37,040 So Kevin, it's not that he would do it absolutely for free because there has to be buy-in and 365 00:24:37,040 --> 00:24:40,480 others, but this, but he was willing to work with them. 366 00:24:40,480 --> 00:24:45,120 I think that willingness to sacrifice, I think is really important, right? 367 00:24:45,120 --> 00:24:47,880 Because this is time and energy that nobody has extra, right? 368 00:24:47,880 --> 00:24:48,880 Nobody has extra time. 369 00:24:48,880 --> 00:24:49,880 Right. 370 00:24:49,880 --> 00:24:54,840 The amount of like, I mean, if you like, Kevin will tell you, like our big breakthroughs, 371 00:24:54,840 --> 00:25:01,880 like our, like on beaches after talks or in the pool before them, you know, like, it 372 00:25:01,880 --> 00:25:05,880 takes a lot of time and just being like, I wonder why this is like this. 373 00:25:05,880 --> 00:25:10,920 What if we looked at it from this perspective and then just a dedication to time, like, 374 00:25:10,920 --> 00:25:14,720 okay, let's try this for a little while and see where we go. 375 00:25:14,720 --> 00:25:18,840 But those are, I mean, really, this is like, it's mutual support. 376 00:25:18,840 --> 00:25:20,360 It's encouragement, right? 377 00:25:20,360 --> 00:25:26,600 Like we're, when we're getting in touch, we're, we're asking real questions. 378 00:25:26,600 --> 00:25:28,600 We're challenging each other. 379 00:25:28,600 --> 00:25:31,600 We're saying, tell me, why would you do that? 380 00:25:31,600 --> 00:25:34,840 And then what else, what can we do to make this more accessible? 381 00:25:34,840 --> 00:25:36,840 Often to our detriment. 382 00:25:36,840 --> 00:25:37,840 This kind of collaboration. 383 00:25:37,840 --> 00:25:38,840 Yeah. 384 00:25:38,840 --> 00:25:39,840 I'm sorry. 385 00:25:39,840 --> 00:25:45,000 I was going to say this kind of collaboration can go just beyond sleep medicine and dentistry. 386 00:25:45,000 --> 00:25:48,360 I mean, you guys could truly expand this, right? 387 00:25:48,360 --> 00:25:49,360 Yeah. 388 00:25:49,360 --> 00:25:54,120 That's the, like the question is like, I mean, when you talk about like, we're lucky enough 389 00:25:54,120 --> 00:25:58,080 to have Jody Walker, like as a my functional therapist in our area, right? 390 00:25:58,080 --> 00:26:01,080 Who just as a person is remarkable. 391 00:26:01,080 --> 00:26:05,600 And it's sort of to be able to spend time with like, when we get, when we get together and 392 00:26:05,600 --> 00:26:10,360 we're talking about patients, we're not limiting it to like, are you going to send them to 393 00:26:10,360 --> 00:26:11,360 me or not? 394 00:26:11,360 --> 00:26:12,360 Right? 395 00:26:12,360 --> 00:26:13,360 It's like, right? 396 00:26:13,360 --> 00:26:15,680 Like how many more kids like this make their be? 397 00:26:15,680 --> 00:26:19,000 How are we going to make this available to kids that maybe don't have these needs? 398 00:26:19,000 --> 00:26:22,960 If we were to work in a school, how are we going to fund this? 399 00:26:22,960 --> 00:26:27,680 This is where like lessons that we've learned from cystic fibrosis or we learn from the 400 00:26:27,680 --> 00:26:29,960 from the polio vaccine become really important. 401 00:26:29,960 --> 00:26:30,960 Right? 402 00:26:30,960 --> 00:26:36,040 Like if there are foundations that are interested in supporting, supporting the growth of this 403 00:26:36,040 --> 00:26:42,520 work with the expansion of access to, to providers that currently is scarce, what cystic fibrosis 404 00:26:42,520 --> 00:26:46,960 did is they said, is there an area that has access to these patients? 405 00:26:46,960 --> 00:26:50,800 And what do they need to continue their work or to advance their work? 406 00:26:50,800 --> 00:26:53,440 Do they need a nurse, a nurse coordinator? 407 00:26:53,440 --> 00:26:57,160 Do they need a fellow to help cover the rest of their work so that they can, so that they 408 00:26:57,160 --> 00:26:59,200 can get, that it came more attention to this? 409 00:26:59,200 --> 00:27:04,840 But I think what they did is they supported the grassroots collaborations in service to 410 00:27:04,840 --> 00:27:05,840 the patients. 411 00:27:05,840 --> 00:27:06,840 Right? 412 00:27:06,840 --> 00:27:07,840 I don't know. 413 00:27:07,840 --> 00:27:12,920 I know there's been a lot of efforts are changing curriculum, medical and dental curriculum. 414 00:27:12,920 --> 00:27:15,200 I don't know that that's going to lead the way. 415 00:27:15,200 --> 00:27:16,200 Right? 416 00:27:16,200 --> 00:27:21,200 Medical like when we take our boards, we know that you don't write the answer of what you 417 00:27:21,200 --> 00:27:22,200 would do. 418 00:27:22,200 --> 00:27:23,200 Right? 419 00:27:23,200 --> 00:27:28,680 You write the answer for what they're looking for, which is usually maybe five years, right? 420 00:27:28,680 --> 00:27:36,960 But we're actually. 421 00:27:36,960 --> 00:27:44,560 You're listening to Airway First with today's guests, Dr. Darius Legmani and Dr. Kevin Boyd. 422 00:27:44,560 --> 00:27:48,360 You can find out more about the Children's Airway First Foundation and our mission to 423 00:27:48,360 --> 00:27:54,480 fix before six on our website at children'sairwayfirst.org. 424 00:27:54,480 --> 00:27:59,400 The CAF website offers tons of great resources for both parents and medical professionals, 425 00:27:59,400 --> 00:28:04,960 including videos, blogs, recommended reading, comprehensive medical research, podcasts, and 426 00:28:04,960 --> 00:28:06,880 so much more. 427 00:28:06,880 --> 00:28:11,080 We also encourage parents to join the Airway Huddle, our Facebook support group, which 428 00:28:11,080 --> 00:28:15,440 was created for parents of children with Airway and sleep related issues. 429 00:28:15,440 --> 00:28:22,720 You can access the Airway Huddle support group at facebook.com backslashgroups backslashairwayhuddle. 430 00:28:22,720 --> 00:28:27,760 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 431 00:28:27,760 --> 00:28:32,400 If you suspect your child might have an airway issue, contact your pediatric airway dentist 432 00:28:32,400 --> 00:28:34,480 or pediatrician. 433 00:28:34,480 --> 00:28:40,200 And now let's jump back into our conversation with today's guests, Dr. Darius Legmani and 434 00:28:40,200 --> 00:28:45,200 Dr. Kevin Boyd. 435 00:28:45,200 --> 00:28:56,920 Yeah, it's interesting to kind of piggyback on that because in a meeting that Kevin and 436 00:28:56,920 --> 00:29:03,160 I were in last weekend, I guess it was, it was talked about that the moms, the moms are 437 00:29:03,160 --> 00:29:05,960 going to be the catalyst for this. 438 00:29:05,960 --> 00:29:09,880 Yeah, I mean, is that, yeah? 439 00:29:09,880 --> 00:29:10,880 100%. 440 00:29:10,880 --> 00:29:11,880 100%. 441 00:29:11,880 --> 00:29:20,560 But where do they, like what venue do moms have to be able to demonstrate that, that 442 00:29:20,560 --> 00:29:25,240 like what they've learned to support each other, to be able to, right? 443 00:29:25,240 --> 00:29:30,560 Like the Cystic Vibrosis Foundation started was started by parents of kids with Cystic 444 00:29:30,560 --> 00:29:31,560 Vibrosis. 445 00:29:31,560 --> 00:29:32,560 Right? 446 00:29:32,560 --> 00:29:37,240 And they just started collecting data on what they were doing and what their child had 447 00:29:37,240 --> 00:29:38,760 and what tests were being done. 448 00:29:38,760 --> 00:29:45,880 And they started to registry, but that registry was focused on the number of patients, right? 449 00:29:45,880 --> 00:29:51,280 The last thing we want is for every dentist to say, I took a class in dental school and 450 00:29:51,280 --> 00:29:54,480 now I'm an airway centered dentist. 451 00:29:54,480 --> 00:29:55,480 Right? 452 00:29:55,480 --> 00:29:59,240 Like this is, this is like we are very early in our process. 453 00:29:59,240 --> 00:30:03,800 And when you're an early in a process that's this complex, you have to move systematically. 454 00:30:03,800 --> 00:30:08,240 You have to be able to document what you're doing in a systematic way. 455 00:30:08,240 --> 00:30:12,320 And you have to be, you're interested more in the questions than the answers, right? 456 00:30:12,320 --> 00:30:16,080 You don't take an answer that you got from an initial effort and say, now everyone should 457 00:30:16,080 --> 00:30:17,080 do X. 458 00:30:17,080 --> 00:30:18,080 Right? 459 00:30:18,080 --> 00:30:19,080 We say, oh, that's how you saw it. 460 00:30:19,080 --> 00:30:20,080 How did you see it? 461 00:30:20,080 --> 00:30:21,080 What did you do? 462 00:30:21,080 --> 00:30:28,240 So I think this is why, like really what we're, what we're moving from is, is a, the two fields 463 00:30:28,240 --> 00:30:35,040 that like in healthcare in general, but dentistry and medicine certainly where you have certification 464 00:30:35,040 --> 00:30:36,040 to do something. 465 00:30:36,040 --> 00:30:41,880 And then you go out and you do it, but certification isn't, it's not sufficient. 466 00:30:41,880 --> 00:30:45,560 I'm certified as a surgeon, but if I operated, someone's in trouble. 467 00:30:45,560 --> 00:30:50,600 You know, I'm not, I'm not, I shouldn't be operating. 468 00:30:50,600 --> 00:30:55,760 But if I was to say like, so rather than being focused on certification, we should be thinking 469 00:30:55,760 --> 00:31:00,080 about who has access to what we want to learn about. 470 00:31:00,080 --> 00:31:03,480 And truthfully, parents have the access to what we want to learn about. 471 00:31:03,480 --> 00:31:05,320 How did you expand them every day? 472 00:31:05,320 --> 00:31:07,560 What's it like to try and expand a four year old? 473 00:31:07,560 --> 00:31:12,720 How did you explain to your, to your, to your spouse why your kid who was speaking fine 474 00:31:12,720 --> 00:31:14,720 yesterday is having a little trouble today? 475 00:31:14,720 --> 00:31:18,200 How long is that going to last with this pallet expander in place? 476 00:31:18,200 --> 00:31:26,600 Now, how does Darius know how to be so eloquent because he's got his own children and he's 477 00:31:26,600 --> 00:31:28,280 watched all these things. 478 00:31:28,280 --> 00:31:33,160 It's not that I told him this happens or he, he's, he's experienced it with his own 479 00:31:33,160 --> 00:31:41,800 kid and you know, it really adds depth to your opinion, Darius, about this. 480 00:31:41,800 --> 00:31:45,400 I, I've never, I've never even thought about it. 481 00:31:45,400 --> 00:31:48,000 You like, let's say boy, listen to him. 482 00:31:48,000 --> 00:31:49,760 Oh, that's right. 483 00:31:49,760 --> 00:31:51,160 His kids, he's got three kids. 484 00:31:51,160 --> 00:31:52,160 Right. 485 00:31:52,160 --> 00:31:58,440 I mean, but there's, I think what we've seen is healthcare has always been about the knower 486 00:31:58,440 --> 00:32:00,760 telling somebody what to do. 487 00:32:00,760 --> 00:32:03,320 In medicine, we are the knowers, right? 488 00:32:03,320 --> 00:32:05,840 We have the, the robes and everything, right? 489 00:32:05,840 --> 00:32:07,640 It's almost like a priesthood, right? 490 00:32:07,640 --> 00:32:10,280 You come in, you tell me, you confess your sins. 491 00:32:10,280 --> 00:32:11,280 I'll tell you what to do. 492 00:32:11,280 --> 00:32:15,600 And then you, and then you go and you either do it or you don't come back to me. 493 00:32:15,600 --> 00:32:16,600 Right. 494 00:32:16,600 --> 00:32:19,000 So, but we have to flip that, right? 495 00:32:19,000 --> 00:32:20,480 Physicians and dentists. 496 00:32:20,480 --> 00:32:23,560 We are, we're at the service of our patients. 497 00:32:23,560 --> 00:32:24,560 Right. 498 00:32:24,560 --> 00:32:30,400 We, we are in a position to actually give voice to what we're hearing from our, from 499 00:32:30,400 --> 00:32:31,400 these parents. 500 00:32:31,400 --> 00:32:36,760 So I think, like to be able to do that most effectively, again, like it's a, it's a super 501 00:32:36,760 --> 00:32:38,560 local process, right? 502 00:32:38,560 --> 00:32:43,960 In Chicago, we have a unique opportunity because we, because we're here, but if we started 503 00:32:43,960 --> 00:32:49,480 to bring together the parents of the kids that, that they've had this treatment, we 504 00:32:49,480 --> 00:32:50,960 would learn a ton. 505 00:32:50,960 --> 00:32:51,960 Right. 506 00:32:51,960 --> 00:32:56,000 But where's like, there's no mechanism for that because Kevin's busy expanding them 507 00:32:56,000 --> 00:32:57,000 and I'm busy. 508 00:32:57,000 --> 00:32:58,000 I'm busy. 509 00:32:58,000 --> 00:32:59,080 I don't like, right. 510 00:32:59,080 --> 00:33:04,280 But that's, I think the organization and the structure that would be most effective 511 00:33:04,280 --> 00:33:06,440 is getting those stories from the parents. 512 00:33:06,440 --> 00:33:07,440 What did you see? 513 00:33:07,440 --> 00:33:08,720 How did it affect them? 514 00:33:08,720 --> 00:33:10,440 How far did you expand them? 515 00:33:10,440 --> 00:33:13,640 What are some tricks that you did to be able to help them? 516 00:33:13,640 --> 00:33:15,520 Yeah, absolutely. 517 00:33:15,520 --> 00:33:22,200 And I think also this is why it's so important we always tell parents advocate for your child. 518 00:33:22,200 --> 00:33:23,200 Right. 519 00:33:23,200 --> 00:33:25,440 Because you know your child best. 520 00:33:25,440 --> 00:33:26,440 Exactly. 521 00:33:26,440 --> 00:33:27,440 Yeah. 522 00:33:27,440 --> 00:33:30,920 I know the medical term, but you know your child can't sleep or you know your child's 523 00:33:30,920 --> 00:33:34,520 having trouble swallowing or whatever it is. 524 00:33:34,520 --> 00:33:35,520 Yeah. 525 00:33:35,520 --> 00:33:37,920 And if they don't know, we don't argue with them. 526 00:33:37,920 --> 00:33:38,920 Right. 527 00:33:38,920 --> 00:33:44,120 Like if, if Kevin sees a kid and they say, are they snoring? 528 00:33:44,120 --> 00:33:45,880 Like, yeah, snoring where it's not too bad. 529 00:33:45,880 --> 00:33:49,000 Then he just says, well, look at these questions, take them home. 530 00:33:49,000 --> 00:33:54,760 And then this is what is very, very, very, as the, as the, what does he call it? 531 00:33:54,760 --> 00:33:55,760 The private eye? 532 00:33:55,760 --> 00:33:58,640 Like the, where he says, just observe your kid. 533 00:33:58,640 --> 00:33:59,720 Here's a list of things. 534 00:33:59,720 --> 00:34:01,720 Just observe your kid. 535 00:34:01,720 --> 00:34:03,440 And we'll talk again in a couple of months. 536 00:34:03,440 --> 00:34:05,960 We'll talk in six months. 537 00:34:05,960 --> 00:34:07,800 And then when they come back, they're like, yeah, you're right. 538 00:34:07,800 --> 00:34:09,520 Every time I watch him, he's wide open. 539 00:34:09,520 --> 00:34:11,280 And I'm like, yeah, he is snoring. 540 00:34:11,280 --> 00:34:12,280 He's restless. 541 00:34:12,280 --> 00:34:16,240 And you know, our job is not to convince people that there's a problem with the child. 542 00:34:16,240 --> 00:34:20,680 I think that's another, another element of the, of the approach that's historically 543 00:34:20,680 --> 00:34:25,680 been taken that I think is really making it hard is there's an alarmist kind of like, 544 00:34:25,680 --> 00:34:30,200 if you don't do something tonight, your child's going to lose brain cells. 545 00:34:30,200 --> 00:34:37,080 We have to step back from that because it's, it's frankly too frightening for parents to 546 00:34:37,080 --> 00:34:43,520 think that they've been ignoring their child as their brain is, is, you know, after being, 547 00:34:43,520 --> 00:34:51,200 you know, I had a consultation today on a seven, I think a seven year old that, you 548 00:34:51,200 --> 00:34:58,520 know, the radiology report said that the airway is 80% occluded in the area of the ad noids 549 00:34:58,520 --> 00:34:59,840 and nasopharynx. 550 00:34:59,840 --> 00:35:03,440 And you know, the parents are very astute. 551 00:35:03,440 --> 00:35:08,080 They just moved here, but they've been all over the country. 552 00:35:08,080 --> 00:35:16,280 And you know, I brought up the term habitual chronic mouth breathing is dangerous. 553 00:35:16,280 --> 00:35:19,920 And you know, they was like, is that a little extreme? 554 00:35:19,920 --> 00:35:24,680 And I go, well, you know what, I, that's one thing I don't soft sell. 555 00:35:24,680 --> 00:35:29,520 And then I explained to them and then I showed the x-rays and how important it is for nasally 556 00:35:29,520 --> 00:35:34,920 inspired air to be cleaned and humidified and release nitric oxide, you know, all the 557 00:35:34,920 --> 00:35:35,920 basics. 558 00:35:35,920 --> 00:35:43,400 And at the end of the consultation, you know, the, the, the father was just sort of like, 559 00:35:43,400 --> 00:35:49,880 wow, we've been to UCSF and we've been to, I don't know, various insiders. 560 00:35:49,880 --> 00:35:55,440 And I've been to different institutions and nobody has really said he won't grow out of 561 00:35:55,440 --> 00:35:56,440 it. 562 00:35:56,440 --> 00:35:57,680 He'll just grow out of it. 563 00:35:57,680 --> 00:36:02,560 And it's like, I said, well, you know what, nobody knows your child and nobody has an 564 00:36:02,560 --> 00:36:05,000 instinct for your child like his parents. 565 00:36:05,000 --> 00:36:10,840 And if you guys don't think this is right and like I'm maybe, but I, I don't soft sell 566 00:36:10,840 --> 00:36:15,040 that part of it, but I might not be the right practice for you. 567 00:36:15,040 --> 00:36:16,600 And this isn't for everybody. 568 00:36:16,600 --> 00:36:23,840 Your instinct has to tell you this is something I need to know more about or the, the, I need 569 00:36:23,840 --> 00:36:26,560 more information and that's fine. 570 00:36:26,560 --> 00:36:30,240 And I'll just say, look, he's seven. 571 00:36:30,240 --> 00:36:37,120 I, you know, if you want to wait a year, I'd rather see him at eight than 10. 572 00:36:37,120 --> 00:36:38,520 And I really do. 573 00:36:38,520 --> 00:36:45,320 I want parents to rely on their own instincts for their own child because the kid will pick 574 00:36:45,320 --> 00:36:46,320 up on. 575 00:36:46,320 --> 00:36:52,320 And even if one parent is in doubt, it's not going to work, you know, because the child 576 00:36:52,320 --> 00:36:58,440 gets confused and it, and it can affect their ability to want to do, you know, to be compliant 577 00:36:58,440 --> 00:36:59,440 and do the treatment. 578 00:36:59,440 --> 00:37:01,560 I feel really strongly about that. 579 00:37:01,560 --> 00:37:06,200 There's a, there's a, there's a shift then I don't know if it's happening in a public 580 00:37:06,200 --> 00:37:07,200 position. 581 00:37:07,200 --> 00:37:08,200 I know I'm definitely having this shift. 582 00:37:08,200 --> 00:37:11,960 And maybe it's just that time, like the time of my career or what, but like, whatever, 583 00:37:11,960 --> 00:37:15,440 what I realized is like initially I thought of myself like a detective. 584 00:37:15,440 --> 00:37:16,440 Okay. 585 00:37:16,440 --> 00:37:20,720 You know, like when I'm visiting with someone I'm listening and I'm like, tell me more about 586 00:37:20,720 --> 00:37:21,720 this and what about this? 587 00:37:21,720 --> 00:37:25,080 And I'm doing a physical exam and looking at it and I piece it together and I'm like, 588 00:37:25,080 --> 00:37:26,160 I think I know what you have. 589 00:37:26,160 --> 00:37:27,760 This is the diagnosis. 590 00:37:27,760 --> 00:37:28,760 This is the treatment. 591 00:37:28,760 --> 00:37:30,160 Let's see how it goes. 592 00:37:30,160 --> 00:37:32,800 You come back and then we'll say, Oh, thank you, doctor. 593 00:37:32,800 --> 00:37:37,720 I think increasingly what I'm realizing is I'm actually the sketch artists. 594 00:37:37,720 --> 00:37:41,520 They're describing what's happening. 595 00:37:41,520 --> 00:37:42,920 And I'm trying to piece it together. 596 00:37:42,920 --> 00:37:44,360 I'm saying, okay, okay. 597 00:37:44,360 --> 00:37:46,840 Tell me more about this part. 598 00:37:46,840 --> 00:37:48,560 And then they're telling me and I'm writing it down. 599 00:37:48,560 --> 00:37:50,160 I said, tell me more about this. 600 00:37:50,160 --> 00:37:51,320 What about this piece here? 601 00:37:51,320 --> 00:37:56,600 And they tell me because I know kind of like, I need to ask more questions about the eyes. 602 00:37:56,600 --> 00:37:59,440 I need them to describe the ears and the hairstyle. 603 00:37:59,440 --> 00:38:02,840 And that's, this is what's going to help them recognize what's going on. 604 00:38:02,840 --> 00:38:07,600 Then when I reflect at the end of the, of the visit, I can say this is why I was asking 605 00:38:07,600 --> 00:38:09,600 these questions. 606 00:38:09,600 --> 00:38:16,320 And then after, after when they know, if they know why I'm asking those questions, then they'll 607 00:38:16,320 --> 00:38:19,080 know the importance of their answers. 608 00:38:19,080 --> 00:38:23,040 And then they'll say, Oh, okay, that's why. 609 00:38:23,040 --> 00:38:28,960 So then they're not surprised at the end of the diagnosis or of the treatment recommendations. 610 00:38:28,960 --> 00:38:33,920 All of that clicks for them because I've been able to explain like the scientific principles 611 00:38:33,920 --> 00:38:39,160 involved as well as allowing them to fully explain what's happening with their child. 612 00:38:39,160 --> 00:38:44,040 And they recognize their child in the principles and they can figure out what the next steps 613 00:38:44,040 --> 00:38:45,040 are. 614 00:38:45,040 --> 00:38:46,040 Yeah. 615 00:38:46,040 --> 00:38:51,320 And that says a parent, that's helpful because we don't get it. 616 00:38:51,320 --> 00:38:54,400 We don't understand where we're told your child has this go do this. 617 00:38:54,400 --> 00:38:59,160 Well, unless you're one of those people that goes and digs and digs, you just take it at 618 00:38:59,160 --> 00:39:01,160 face value and move on. 619 00:39:01,160 --> 00:39:02,160 All right. 620 00:39:02,160 --> 00:39:05,840 And so I think one of the, one of the things that Kevin and I really bad to do, especially 621 00:39:05,840 --> 00:39:11,960 with the people that were in these initial cohorts was to say, look, these are the questions 622 00:39:11,960 --> 00:39:15,320 that when you ask them, they help people understand. 623 00:39:15,320 --> 00:39:19,120 These are the concepts that when you explain them, people start to understand. 624 00:39:19,120 --> 00:39:21,800 I mean, and it's not 100. 625 00:39:21,800 --> 00:39:23,680 It's like 10 things. 626 00:39:23,680 --> 00:39:29,640 If you tell them, like, like when you say like, you know, prehistoric skulls, they all 627 00:39:29,640 --> 00:39:33,520 had straight teeth and they didn't end their wisdom teeth fit. 628 00:39:33,520 --> 00:39:38,240 And they didn't have cavities and there were no dentists. 629 00:39:38,240 --> 00:39:39,240 People always like, really? 630 00:39:39,240 --> 00:39:44,160 Like, yeah, straight teeth, no cavities, everything was great. 631 00:39:44,160 --> 00:39:47,240 And the wisdom teeth fit. 632 00:39:47,240 --> 00:39:48,760 So the skulls are changing shape. 633 00:39:48,760 --> 00:39:50,720 It's like, it looks like the skulls are changing shape. 634 00:39:50,720 --> 00:39:52,160 And this is what we're seeing. 635 00:39:52,160 --> 00:39:53,160 It's a why. 636 00:39:53,160 --> 00:39:55,160 And then what's the impact, right? 637 00:39:55,160 --> 00:39:59,240 All that stuff, like when you provide someone with that background, then they're joining 638 00:39:59,240 --> 00:40:01,040 you and looking at the child, right? 639 00:40:01,040 --> 00:40:02,040 They're the most important. 640 00:40:02,040 --> 00:40:03,040 Right. 641 00:40:03,040 --> 00:40:06,560 They're the most important kind of element of this system. 642 00:40:06,560 --> 00:40:08,080 They're the frontline workers. 643 00:40:08,080 --> 00:40:13,320 We are working, we're supporting them to think clearly about their child. 644 00:40:13,320 --> 00:40:16,200 Yeah, and that makes sense. 645 00:40:16,200 --> 00:40:20,920 So usually at the end of a podcast, I turn it over to the guest. 646 00:40:20,920 --> 00:40:23,120 And in this case, it's the guests. 647 00:40:23,120 --> 00:40:28,960 For you guys, just to have the final thought or, you know, message for parents or medical 648 00:40:28,960 --> 00:40:29,960 providers. 649 00:40:29,960 --> 00:40:33,360 And then, please go first. 650 00:40:33,360 --> 00:40:34,360 I like that. 651 00:40:34,360 --> 00:40:40,000 Well, I just, I learned something new every time what he reflects on what we've been doing 652 00:40:40,000 --> 00:40:43,840 over the last 10, 12 years. 653 00:40:43,840 --> 00:40:47,800 And I just like to build on whatever he says. 654 00:40:47,800 --> 00:40:54,880 I think the most important thing at this stage in the development of the field, at this stage 655 00:40:54,880 --> 00:40:57,240 in terms of medical and dental collaboration. 656 00:40:57,240 --> 00:41:03,080 And the most important thing is to be able to clearly state what are the questions that 657 00:41:03,080 --> 00:41:05,560 we're asking together? 658 00:41:05,560 --> 00:41:10,360 And what is the systematic way that we're pursuing answers to them? 659 00:41:10,360 --> 00:41:15,560 Are we thinking and acting systematically in determining which kid needs what kind of 660 00:41:15,560 --> 00:41:16,560 treatment? 661 00:41:16,560 --> 00:41:22,920 The better we are at actually saying those things, the easier it'll be for people that 662 00:41:22,920 --> 00:41:27,720 are interested in those same questions to join us. 663 00:41:27,720 --> 00:41:31,880 And I think that really it's going to have to be at the level of people. 664 00:41:31,880 --> 00:41:37,840 We're going to have to be able to say, we're going to start with these two people and then 665 00:41:37,840 --> 00:41:39,240 maybe some of their friends. 666 00:41:39,240 --> 00:41:44,240 And how do we support spaces where some of their friends can come together and to think 667 00:41:44,240 --> 00:41:45,240 together, right? 668 00:41:45,240 --> 00:41:47,600 I don't mean in terms of talks. 669 00:41:47,600 --> 00:41:55,480 But when you have a speaker, you've limited the knowledge of the room to that one person. 670 00:41:55,480 --> 00:41:57,240 Right, because it's one direction. 671 00:41:57,240 --> 00:41:59,600 Yeah, it's one person's experience. 672 00:41:59,600 --> 00:42:03,760 If you have a room full of providers that take care of sleep patients, why wouldn't you 673 00:42:03,760 --> 00:42:05,880 want to hear from all of them? 674 00:42:05,880 --> 00:42:12,680 That's what you have, you would multiply the number of insights you'd have access to. 675 00:42:12,680 --> 00:42:19,600 So I think that having a systematic approach in that way of saying, I think Chicago's right 676 00:42:19,600 --> 00:42:20,600 for it. 677 00:42:20,600 --> 00:42:25,360 Kevin and I are going to be speaking at a symposium that we're organizing in this way, 678 00:42:25,360 --> 00:42:30,640 where there would be sort of talks from an ENT, Kevin will share, the other sleep provider 679 00:42:30,640 --> 00:42:34,320 that will share, and that'll follow a case. 680 00:42:34,320 --> 00:42:38,240 And then afterwards there'll be a lunch where we'll get to hear from everybody. 681 00:42:38,240 --> 00:42:43,760 I think this idea of actually allowing for reciprocity from other providers, from the 682 00:42:43,760 --> 00:42:47,160 people that are participating, and from the parents. 683 00:42:47,160 --> 00:42:51,120 There needs to be a space, like an interest in the parent voice. 684 00:42:51,120 --> 00:42:55,440 What's been your experience, not as a patient, what's your experience as the parent taking 685 00:42:55,440 --> 00:42:59,320 care of this child that is undergoing this process? 686 00:42:59,320 --> 00:43:02,440 Dr. Boyd? 687 00:43:02,440 --> 00:43:09,440 So I think what I'd like to leave people with is, if you think something's wrong, and what 688 00:43:09,440 --> 00:43:17,080 you're hearing from trusted, respected, deservedly, wonderful healthcare providers that you've 689 00:43:17,080 --> 00:43:25,200 had confidence in for yourself and for your child, when they say, well, relax, things will 690 00:43:25,200 --> 00:43:28,200 get better, they'll grow out of it. 691 00:43:28,200 --> 00:43:32,400 And that doesn't make sense to you, or there's just a little bell ring in there, a little 692 00:43:32,400 --> 00:43:37,280 voice in your head that says, maybe not, listen to that voice. 693 00:43:37,280 --> 00:43:43,960 And like today I was telling you, I had a consultation with these parents about this 694 00:43:43,960 --> 00:43:47,840 child who's got some significant issues. 695 00:43:47,840 --> 00:43:52,520 And the father was at the end of, I took him through everything. 696 00:43:52,520 --> 00:43:57,480 He just said, well, everyone told us that he'd grow out of it, and they were right. 697 00:43:57,480 --> 00:44:00,280 His snoring did after a few years. 698 00:44:00,280 --> 00:44:01,280 It went away. 699 00:44:01,280 --> 00:44:07,920 And so I didn't want to say, well, what happened in those few years? 700 00:44:07,920 --> 00:44:08,920 We don't know. 701 00:44:08,920 --> 00:44:14,800 And there's something called the chat study from Children's Hospital of Philadelphia, 702 00:44:14,800 --> 00:44:19,440 where they did this watchful waiting with kids who had large adenoids, and let's not 703 00:44:19,440 --> 00:44:20,440 do surgery. 704 00:44:20,440 --> 00:44:24,840 Let's just see if the snoring and the mouth breathing gets better. 705 00:44:24,840 --> 00:44:26,480 And sometimes it does. 706 00:44:26,480 --> 00:44:27,480 And often it will. 707 00:44:27,480 --> 00:44:34,160 But what's going on while the body is trying to come up with compensations for that? 708 00:44:34,160 --> 00:44:36,800 I don't need to get into that with people. 709 00:44:36,800 --> 00:44:37,960 It's their child. 710 00:44:37,960 --> 00:44:40,920 And I just look, I'm here if you need me. 711 00:44:40,920 --> 00:44:44,480 But that's the advice I would give. 712 00:44:44,480 --> 00:44:51,920 And also, especially in the realm of orthodontics, is that the orthodontic association by age 713 00:44:51,920 --> 00:44:56,040 seven, that's when a child should be seen for the first exam. 714 00:44:56,040 --> 00:44:58,040 Or it's a diagnostic exam. 715 00:44:58,040 --> 00:45:01,640 And that's like a kid with a nearsightedness. 716 00:45:01,640 --> 00:45:07,640 And four, well, you know, ophthalmologists want to see kids at two before age two. 717 00:45:07,640 --> 00:45:11,520 And they correct vision if there's a problem, because it will worsen and it could lead to 718 00:45:11,520 --> 00:45:12,960 neurological problems. 719 00:45:12,960 --> 00:45:14,560 What does that sound like? 720 00:45:14,560 --> 00:45:20,720 Malocclusion, if a jaw is too narrow, and if it's too far back, and it's too long or 721 00:45:20,720 --> 00:45:30,680 too short, say at the age of three, four, five years old, it 100% will persist. 722 00:45:30,680 --> 00:45:33,400 That's been known for 100 years. 723 00:45:33,400 --> 00:45:40,400 Skeletal deficiency, maldevelopment of the craniofacial respiratory complex does not 724 00:45:40,400 --> 00:45:41,400 self-correct. 725 00:45:41,400 --> 00:45:42,800 It cannot self-correct. 726 00:45:42,800 --> 00:45:46,120 It will only become more complex. 727 00:45:46,120 --> 00:45:48,960 So that's what people need to understand. 728 00:45:48,960 --> 00:45:52,320 That is a medically defensible statement that I just made. 729 00:45:52,320 --> 00:45:55,560 It's a scientifically supportable statement. 730 00:45:55,560 --> 00:45:57,840 And that's what I'd like to leave people with. 731 00:45:57,840 --> 00:46:05,520 I think that those, I think as more of us are able to kind of speak to those kind of, 732 00:46:05,520 --> 00:46:10,600 those kind of, the data around those things, I think it'll be easier to have those one-to-one 733 00:46:10,600 --> 00:46:11,600 conversations. 734 00:46:11,600 --> 00:46:13,600 I really don't envy institutions. 735 00:46:13,600 --> 00:46:16,840 I don't envy the Academy of Sleep Medicine. 736 00:46:16,840 --> 00:46:27,240 I don't envy the Academy of Pediatric Dentistry or the ADA or even foundations like CAP or 737 00:46:27,240 --> 00:46:32,800 because the role of the institutions, it can't be to raise awareness because there's nowhere 738 00:46:32,800 --> 00:46:34,760 for them to go. 739 00:46:34,760 --> 00:46:39,520 We don't have, and I think this is a part of why pediatricians, when someone comes and 740 00:46:39,520 --> 00:46:43,840 says my kid is snoring, pediatricians are like, you'll probably be okay because there 741 00:46:43,840 --> 00:46:47,320 are only 300 pediatric sleep doctors in the country. 742 00:46:47,320 --> 00:46:48,800 There aren't that many labs. 743 00:46:48,800 --> 00:46:55,120 Like every time we open a bed, like there's a three-month wait time for it. 744 00:46:55,120 --> 00:46:56,840 It just builds up to that. 745 00:46:56,840 --> 00:47:00,720 The need far outstrips the capacity to respond. 746 00:47:00,720 --> 00:47:03,000 So what is it that an institution does? 747 00:47:03,000 --> 00:47:07,840 I think increasingly, I think the lessons from cystic fibrosis and polio come in. 748 00:47:07,840 --> 00:47:14,280 I think we have to be able to figure out how do we support the groups that are doing this 749 00:47:14,280 --> 00:47:18,760 work so that they have time to systematize their approach. 750 00:47:18,760 --> 00:47:24,440 Then you raise up a number of locations around the country where people are doing this. 751 00:47:24,440 --> 00:47:27,040 You just collect the data. 752 00:47:27,040 --> 00:47:31,280 And then systematically, like cystic fibrosis, they used to just put out, they used to say, 753 00:47:31,280 --> 00:47:32,760 these are all the centers. 754 00:47:32,760 --> 00:47:34,720 This is the FBV-1 for each center. 755 00:47:34,720 --> 00:47:37,920 I said, this one's better than this one. 756 00:47:37,920 --> 00:47:38,920 Why is that? 757 00:47:38,920 --> 00:47:44,040 So then they're thinking about, okay, how do we support more people? 758 00:47:44,040 --> 00:47:48,880 The efforts of cystic fibrosis, like overtime, the commitment to long-term effort and supporting 759 00:47:48,880 --> 00:47:55,400 work at the grassroots, now we have cure for CF. 760 00:47:55,400 --> 00:47:57,920 This was a huge accomplishment. 761 00:47:57,920 --> 00:48:01,120 But I think we're not going to have, it's not going to be one thing that changes and 762 00:48:01,120 --> 00:48:02,120 then everything gets better. 763 00:48:02,120 --> 00:48:03,880 It's going to take time. 764 00:48:03,880 --> 00:48:14,040 So I think what Darius brings up about supply and demand is that the demand for sleep-related 765 00:48:14,040 --> 00:48:17,080 services is starting to be in the public domain. 766 00:48:17,080 --> 00:48:27,680 The demand is rising, but the supply of competent, qualified providers is minimal. 767 00:48:27,680 --> 00:48:36,520 And it's the same thing that, I mean, recently I got a letter of referral of a six-year-old 768 00:48:36,520 --> 00:48:42,840 who had malocclusion and sleep disorder, breathing comorbidity, and this orthodontist said, Kevin, 769 00:48:42,840 --> 00:48:44,280 I'm downstate. 770 00:48:44,280 --> 00:48:46,480 This family is three hours from you. 771 00:48:46,480 --> 00:48:48,720 However, I'm aware of your work. 772 00:48:48,720 --> 00:48:51,680 I'm aware of your successes. 773 00:48:51,680 --> 00:48:54,640 I know this kid needs what you can do. 774 00:48:54,640 --> 00:49:00,480 I unfortunately am not comfortable treating this child, but I, they said they'd be willing 775 00:49:00,480 --> 00:49:01,480 to try. 776 00:49:01,480 --> 00:49:02,480 This is an orthodontist. 777 00:49:02,480 --> 00:49:06,560 I framed him who said, look, this is out of my purview. 778 00:49:06,560 --> 00:49:10,480 I've not had much luck treating this, but I know it needs treatment. 779 00:49:10,480 --> 00:49:11,480 And he sent this kid. 780 00:49:11,480 --> 00:49:15,600 So let's see more that is still very rare. 781 00:49:15,600 --> 00:49:22,360 But Darius and I are so determined to get more people competent and qualified so that 782 00:49:22,360 --> 00:49:26,280 we can solve problems before they, you know, he has to see him. 783 00:49:26,280 --> 00:49:30,320 He's responsible for 200,000 children in greater Chicago. 784 00:49:30,320 --> 00:49:32,040 He can't do all that. 785 00:49:32,040 --> 00:49:34,520 So he's ultimately selfish. 786 00:49:34,520 --> 00:49:40,760 He's trying to create an army that can help parents solve these problems. 787 00:49:40,760 --> 00:49:42,760 He's a valiant warrior. 788 00:49:42,760 --> 00:49:47,240 Yeah, the rate-living step at this point isn't necessarily the skills. 789 00:49:47,240 --> 00:49:49,240 It's the qualities and the attitudes. 790 00:49:49,240 --> 00:49:53,200 Treating somebody that when they're doing it would be able to say, like, I actually don't 791 00:49:53,200 --> 00:49:54,200 know. 792 00:49:54,200 --> 00:49:55,200 I don't know how to do this. 793 00:49:55,200 --> 00:49:58,520 Like for that orthodontist, if they had a relationship with Kevin where they could say, 794 00:49:58,520 --> 00:50:00,720 like, okay, well, let's look at the films together. 795 00:50:00,720 --> 00:50:05,640 Like, all right, now let's look and see what are our goals here. 796 00:50:05,640 --> 00:50:09,120 And then maybe send them and I can get them started and you can follow them. 797 00:50:09,120 --> 00:50:10,960 But we don't practice like that. 798 00:50:10,960 --> 00:50:11,960 Right? 799 00:50:11,960 --> 00:50:14,360 Interinstitutional collaboration doesn't happen. 800 00:50:14,360 --> 00:50:15,360 Right? 801 00:50:15,360 --> 00:50:18,800 Like, because like in medical world, it's because your insurance requires you to go to this 802 00:50:18,800 --> 00:50:21,200 hospital or this hospital. 803 00:50:21,200 --> 00:50:24,560 And in dentistry, every clinic is its own business. 804 00:50:24,560 --> 00:50:25,560 Right? 805 00:50:25,560 --> 00:50:26,560 So why would I help? 806 00:50:26,560 --> 00:50:27,560 Like Kevin is an outlier. 807 00:50:27,560 --> 00:50:29,800 He's like, I'll help you take great care of your kids. 808 00:50:29,800 --> 00:50:34,680 I don't want you to, I don't like, you don't have to, I'm not going to build them for that. 809 00:50:34,680 --> 00:50:36,960 I want to like send me the name of this. 810 00:50:36,960 --> 00:50:37,960 I'll help. 811 00:50:37,960 --> 00:50:40,080 But that's a quality. 812 00:50:40,080 --> 00:50:41,080 That's a quality. 813 00:50:41,080 --> 00:50:43,400 That's a like, that's humility. 814 00:50:43,400 --> 00:50:45,560 That's that's courage. 815 00:50:45,560 --> 00:50:50,840 That's dedication to the good of the child, which we need more of. 816 00:50:50,840 --> 00:50:56,080 Well, I can't thank you both enough for being on the podcast today. 817 00:50:56,080 --> 00:50:58,200 I really appreciate it. 818 00:50:58,200 --> 00:50:59,720 Thanks, Rebecca. 819 00:50:59,720 --> 00:51:01,680 You do yourself professional. 820 00:51:01,680 --> 00:51:06,120 You just great questions and you really understand the depth of the problem. 821 00:51:06,120 --> 00:51:12,080 And well, that's rewarding for me and Darius because, you know, the information that, that 822 00:51:12,080 --> 00:51:17,120 you sort of extract out of us, it's going to help a lot of people. 823 00:51:17,120 --> 00:51:20,760 But your skill is very much appreciated. 824 00:51:20,760 --> 00:51:21,760 Thank you. 825 00:51:21,760 --> 00:51:23,760 I appreciate it. 826 00:51:23,760 --> 00:51:28,920 Thanks again to today's guests, Dr. Darius Likmani and Dr. Kevin Boyd for sharing their 827 00:51:28,920 --> 00:51:33,680 medical insight and each of you for listening to today's episode. 828 00:51:33,680 --> 00:51:37,000 If you're a NATO our podcast, please don't forget to subscribe. 829 00:51:37,000 --> 00:51:40,880 And if you enjoyed today's episode, leave us a review or comment telling us about what 830 00:51:40,880 --> 00:51:43,080 you enjoyed most. 831 00:51:43,080 --> 00:51:47,080 You can stay connected with the Children's Airway First Foundation by following us on 832 00:51:47,080 --> 00:51:50,960 Instagram, Facebook, Twitter and LinkedIn. 833 00:51:50,960 --> 00:51:51,960 Parents can also join us. 834 00:51:51,960 --> 00:51:58,120 They are our Facebook support group, the airway huddle at facebook.com backslash groups backslash 835 00:51:58,120 --> 00:51:59,120 airway huddle. 836 00:51:59,120 --> 00:52:03,040 If you haven't already, check out our new YouTube channel. 837 00:52:03,040 --> 00:52:08,040 You can find a variety of informative original video content as well as the video recordings 838 00:52:08,040 --> 00:52:12,240 and excerpts from selected Airway First podcast episodes. 839 00:52:12,240 --> 00:52:16,560 You can find a link to our YouTube channel on the CAF website. 840 00:52:16,560 --> 00:52:20,800 If you'd like to be a guest or have an idea for an upcoming episode, shoot us a note via 841 00:52:20,800 --> 00:52:28,520 the contacts page on our website or send us an email directly at info at childrensairwayfirst.org. 842 00:52:28,520 --> 00:52:32,520 And finally, thanks to all the parents and medical professionals out there that are working 843 00:52:32,520 --> 00:52:36,840 hard to make the lives of kids around the globe just a little bit better. 844 00:52:36,840 --> 00:52:39,680 Take care, stay safe and happy breathing everyone.