"Up in Smoke" - The Marijuana Phenomenon....How is Dentistry Affected?

"Rocky Mountain High" has a new meaning...

As of January 1, 2014, the recreational use of marijuana became legal here in Colorado.  The "medicinal" use has been in place since 2002.  When Barack Obama became president, he openly said that he wouldn't make this a judicial priority. Pot shops started to "bud" up all over Colorado. They grew like "weeds".  It got a little out of hand.  Advertisements, crazy names and street sign shakers everywhere.  All vacant commercial real estate became pot shops.  To really put this into perspective, there are more pot shops in Denver than Starbucks.

(A video I took a few years ago of a guy toting a sign advertising $25 1/8th's on Colfax Avenue.  Sign toting has since become illegal for pot shops.)

Imagine, walking into a marijuana store and after perusing the dozens of strains, brands, edibles, etc - pulling out your cash and making a purchase. No need to look over your shoulder. You walk out, you go home and partake.  This is not a hallucination.  It is reality in Colorado.  (Buy stock in Frito-Lay now!)

Before it became legal for recreational use, I had been to many concerts at Red Rocks, an outdoor venue in Morrison, CO. At the start of every show, the rampant outbreak of "glaucoma" commenced and it seemed that the only cure had been to smoke dope.  These poor souls -all those years of suffering - buying tickets to their favorite artist and unable to see the stage due to their glaucoma.  No longer- with the legalization of medical and recreational marijuana, they can see clearly!

I say this with my tongue firmly in cheek.  I thought the medical "guise" was a sham as so few people truly had medical conditions that qualified.  If it was truly for medical use, why weren't pharmacists in charge of its distribution?  They are the only profession qualified to dispense legal drugs.

The recreational marijuana experiment is here to stay.  The State of Colorado is expected to generate over $100 million in tax revenues. If you are not from Colorado, take note, I predict that this phenomena is coming to your state soon.

Before I go any further - for full disclosure, my marijuana days are long over. Mind altering substances didn't agree with my preferred future. I voted against the legalization. Obviously, I was in the minority.  It is here to stay.  It is now as normal to smoke dope in Colorado as having a beer with friends.

I am not going to get into the social ramifications or discussions about the signs of the apocalypse.  I would like to open up the "doors of perception" in my profession and start the conversation.  

How does marijuana affect dentistry?

First of all, our patients use it.  Accept this fact.  A significant percentage always have. We need to ask them about their using habits.  This may seem strange and/or uncomfortable.  We need to know, so we can treat our patients appropriately. There are several risks and maybe even some benefits here. 

Potential Risks:

• Smoking marijuana causes cancer.  I know, this is going to elicit all sorts of responses from the peanut gallery.  Bottom line, it has carcinogens in it that cause cancer.  When we do an oral cancer screening, we need to get over our fear and ask our patients.  We need to council and educate our patients with regards to the risks of use - Just as we do with alcohol.

• Like tobacco, smoking marijuana is also a risk factor in periodontitis which is the leading cause for tooth loss these days.  I am sure that oral hygiene takes a back seat to vegging out on the couch listening to Pink Floyd. I also predict "higher" caries risk due to xerostomia, poor diet and lapses in oral hygiene. 

• Very important point - just because it is legal, we dentists must practice dentistry SOBER!  This goes for the dentist and our staffs - all health care professionals included.  It has never been OK to go to lunch and knock back a few drinks then return for our afternoon patients. This is no different.  I know you say, "it helps with concentration" - Zero tolerance here! 

• Marijuana use can lead to addiction.  We need to be skilled in communicating this fact to our patients as we do with alcohol and other drugs. There is a plethora of resources available to treat the disease of addiction. We need to be well versed in guiding those patients that need help towards recovery.

Potential Benefits:

• Pot may be a viable pain management alternative to opiates.  This is empirical.  But it does relieve pain. Chronic pain is a criteria to get access to a medical marijuana card.  I haven't seen any studies or if even these sort of studies are possible due to marijuana being a Schedule 1 drug. Opiate abuse/addiction is at an epidemic level.  There were three times more opiate deaths than drunk driving deaths in Colorado last year.  Pot is addictive but probably not as addictive or dangerous as opiates. I am not saying that pot is not dangerous.  I don't think it is as dangerous.

• Pot may be a viable anti-anxiety alternative to benzodiazepams.  I will bet that our patients have been smoking pot prior to dental appointments for decades.  Again, I'm not sure if any studies have been done (see above). Another criteria for a medical marijuana card is anxiety.  

I do not proclaim myself to be an expert here.  These are just my observations and predictions as a practitioner and a citizen in the State of Colorado.  There is a wide open frontier of possible opportunities and pitfalls with the legalization of marijuana. Hopefully we can stay ahead of the curve and help our patients as always in the best possible manner.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Is Dentistry a Commodity?

From 1991 - 1995, I went to dental school to learn my craft.  I found out that early on, that the scientific based classes came very easy for me as I was a biomedical engineer prior to dental school.  What didn't come so easy, was the artistic training that was required to be a dentist.  We had to learn how to create teeth out of wax, plastic, amalgam, composite, gold, porcelain, etc.

Looking back to grade school, I was the kid that got sent to the principle's office from art class for being disruptive.  I would do anything to not do art.  I was quickly slapped with reality when I struggled in these early training exercises in dental school.  I had no artistic skills!

I struggled so much that I was required to go to what I call "wax camp" during the summer after the first year of dental school. (Does the movie"The Breakfast Club" comes to mind?)

The other "campers" and I huddled around bunsen burners flames and honed our skills with one-on-one instruction from some very talented instructors.  One day, I don't know when or why, the switch flipped and my right brain connected with my left brain and I was able to wax up teeth at a proficiently high level.  As time went on, I became better and better at it.   In fact, I taught this very same class at University of Colorado School of Dental Medicine for 7 years.

So back to the question, is dentistry a commodity?

Dentistry is an imperfect blend of art and science.  It is not mass produced on a conveyer belt in a factory.  It is provided uniquely and personally to our patients.

A mentor and master of dentistry, L.D. Pankey once said, "I've never had a tooth walk into my office. It was always attached to someone.  Get to know that person, and I may get the opportunity to treat that person's teeth."  Words which I live by in my practice philosophy.  We treat people holistically - mind, body, spirit. You are not a set of teeth, you are a "whole" person.

So is dentistry a commodity?

Can a person go to a dentist and say that he needs a size 12 upper molar and the dentist picks one off the shelf and glues it in?  NO

Can a person go to a shoe store and ask the salesman to fit him in a size 12 shoe? YES

Can that person buy a size 12 shoe for $30, and a size 12 shoe for $300?  YES

Is that shoe store being chastised by community organizations for "gouging" its clients?  NO 

Why then do dentists get chastised by insurance companies for charging a fair price for their services provided uniquely to an individual?  Usually people (insurance agents) placing unfair judgements on things they have no experience with.

If a dentist charges more for a service than a patient values, the patient will not buy that service. Simple economics - supply and demand.

If a person sees a value in either price point for the shoe, he/she will buy that shoe.

The same thing goes in dentistry.  There are different levels of service and challenges in treating patients.  A more difficult procedure may cost more as the dentist to takes more time, care, judgement and skill to perform that procedure to the level of care that the patient expects.

And any patient has the right to put value on things important to them.

Most third party entities (insurance companies, government agencies, etc.) have been masterful at creating a "dentistry is a commodity" mindset to the consumers.

I am emphatically saying that it is not a commodity.  Dentistry is a blend of art and science executed with proper judgement and skill that only comes from our highly specialized training and experience.

There may come a day that one can choose a size 12 upper molar off the shelf -

Then again, there may not...

All this could be a moot point as clean teeth do not decay - AND - 95% of dental problems are preventable!

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

25 Things About Me

As my 46th birthday approaches, I decided to take a different approach to my usual rants here on my blog.

This was a facebook thing several years ago.  I retrieved my list from 2008 and updated it. It was a good reflection exercise for me.


Here are 25 things about me in no particular order -

1. I used to alter my mind with substances but found that it didn’t agree with my present or future plans…

2. I am inspired by positive changes in people, places and things...

3. Someone from my high school told me once that I when I grow up, I wouldn’t listen to heavy metal anymore….”F@%k -you old friend, I still do!”

4. My kids are exactly like my wife and I, and it is scary! We are raising our children Jewish…however, sometimes Sunday school interferes with our ski weekends and my mountain running “problem”…Sorry Rabbi Mo!

5. I love to run, bike, triathlon, snowshoe etc.… my favorite running partners over the years have been Gina, my Dad, my brothers and sisters, Gary Benson, Charlie Perez, Maggie Close, Liza Gualandi, John Stevens, Conrad LaPorte, Steven Griffith, Dave Lindeman, Brian Reick, all my Team-in-Training groups, my dog Kida and now Crosby.  Thinking back, Gary Benson has been sharing adventures with me for close to 25 years.

6. I love to run/play in the mountains. In fact, last fall I ran the Grand Canyon, South Rim to North Rim and back to the South Rim in less than 18 hours.  Other notable athletic accomplishments – Leadville 50 mile mountain bike race, mountain biked from Telluride to Moab, multiple marathons, trail marathons, and snowshoe marathons. (yes you read that right SNOWSHOE marathons)

Which segues nicely into….

7. My life is an adventure, just ask anyone!

8. I am a deeply spiritual person. I try to improve my faith every day. Sometimes I falter and my intentions don't align with my actions. I am human and there are lessons to be learned everyday….There is spirituality in imperfection.

9. I am excited to see so many friends that are on similar paths as I. I am proud to walk this path with all of you! You give me strength and hope when I cannot see it for myself.

10. I have an awesome dental practice, and an amazing team of people that I work with. (employees, patients, consultants, referring doctors, specialists, etc). I am proud of the lives that we impact through our dentistry. . I love being a dentist. I believe that the smile is the window to the soul. I do everything that I can to help my patients’ soul shine through.

11. Progressive music genre: “Complicated music for complicated people” – I think that Geoff Tate of Queensryche was speaking to me when he said that!

12. I would play guitar for a living if I thought it would support my lifestyle.

13. Two friends (Mike Ford and Pat Gibbons) died recently from complications of the flu.  Their lives were cut short, but their impact on the world was huge and their spirits carry on in so many lives that they touched.

14. My wife is a saint to put up with me on a daily basis!

15. I am glad to have reconnected with so many friends from the past on social media.  I am so happy for all of you who choose to share about your lives.  I hope to reconnect in person with you in our various travels.

16. The economy may not have a bright immediate future. However, our attitudes do, if we choose accordingly.

17. In October, 2007, I testified before the United States Congress on behalf of the American Dental Association. I was to explain to them about the ravages of methamphetamines on oral health. My true message was that there is a solution to the disease of addiction. Treatment works. Sometimes it may take a few times but it is the best solution going. And, it saves lives!

18. I am about to become the President of the Colorado Dental Association – I am nervous, excited, and amazed that any group of people would choose me to lead an organization.   I hope to leave the organization better than when I took it over.  I work with an amazing board and CDA staff that keep this train rolling in the right direction!

19. The best thing about being a father is that I get to live my childhood again through them. I am blessed to have a loving family to share their experience on how to do this thing! It is easy to father a child, it is an accomplishment to be a father.

20. Religious people are afraid to go to hell in the afterlife. Spiritual people have been to hell (here on earth) and don’t want to go back!

21. I have had many mentors in my life to which I am most grateful. They saw things in me that I couldn’t see in myself and then encouraged me to grow those gifts.  I try to pay it forward by mentoring others. Thanks to all of you, especially mom and dad....

22. My wife thinks that social media is weird but she is starting to warm up.

23. My dream house is in the mountains near a rolling, open meadow strewn with wildflowers and a stream running through it.

24. I played basketball in high school.  As a rebellious teenager, I began to hate it at the time. Looking back regretfully, I could have played at a higher level if I put the effort in.  Basketball has so many life lessons in it.  I took my son Max to the Coach K basketball camp two of the past three years.  Last spring, I reached out to my old basketball coach from high school (Ken Sartini). Over dinner we caught up on what had been going on in our lives the past 20 plus years.  I thanked him for being a great teacher and mentor to me.  I still talk to him often, what a gift!

25. One more….Chicago Cub’s, next year is now! Come on already!

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Who is John Galt? - Disruptors in Dentisty

Disruptors are innovators.  They are businesses that shift a mindset of how consumers think, purchase, etc.  thereby challenging established businesses.

Harvard Business School professor and disruption guru Clayton Christensen says that a disruptor displaces an existing market, industry, or technology and produces something new and more efficient and worthwhile. It is both destructive and creative.

Some examples of disruptors are companies like Apple, Netflix, Amazon, and Uber

I identify Apple - not for the computers that it builds, but another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes has changed how we buy and listen to music.  There are hardly any CD stores anymore other than those that sell used ones.  When I grew up, I would buy records.  The cover art would attract me to give new bands a listen.  I judged the band by entire albums that it recorded.  Today, we buy songs, not albums. They are instantly downloaded onto our computers.  No waiting in lines, no browsing through tedious shelves of records/cd’s.

 We create playlists with the drag of the mouse.  We use auto shuffle and the “genius” feature to create our own personal radio stations.  They connect to our cars, our phones, our tablets and all are stored on our computers.  CD players are becoming a thing of the past.  Music is stored on hard drives, jump drives, iPods, etc;

Netflix took how we rent movies to a new level.  For a low monthly fee we can have unlimited movies shipped to our house  - hassle free; or immediately available to  view on our computer or smart TV’s through an internet connection.  Blockbuster used to charge late fees, “you didn’t rewind the VHS” fees, etc.  I dreaded having to to pay this fine.  The buying experience was a hassle and expensive.  Netflix is easy, customized to my preferences and instant. Are there even any Blockbuster stores left?

Amazon capitalized on the fact that a book is still readable after it had been read, music is still listenable after it had been listened to, and anything should be able to be purchased on the internet easily!  They created a personalized buying experience based on your browsing and buying habits.  It greatly affected the big chain bookstores like Border’s or Barnes&Noble.  It also helps you find the lowest price for a boxed item and they deliver it right to your door.  If it wasn’t exactly what you were looking for, ship it back.  Hassle-free!

Lastly  -Uber is putting a huge dent in the taxi business.  With Uber, you can press a button on your phone app and a nice clean car will be at your location within 15 minutes. Yellow Cab gets to you when it gets to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share, challenged, and even ruined wildly successful businesses while reinventing the delivery of these services.  They have changed the consumer’s mindset and changed the paradigm on how these services should be purchased, used and consumed.  The consumer experience is exactly the way the consumer prefers.  We (the consumers) wouldn’t have it any other way.

Another commonality of these disruptors is that they didn’t just enter the marketplace and were welcomed with opened arms.  The status quo or “established” business model was not happy and tried to stop them. 

In reality, the status quo was asleep at the wheel.  They were lazy, and arrogant.   They felt they were too big to fail. Those established business models that survived disruption evolved their business models to better serve their consumers.

The question “Who is John Galt?” comes to mind from Ayn Rand’s book Atlas Shrugged! John Galt represents creativeness and innovation.  The status quo must constantly channel it's inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche and dentistry is definitely not immune.  They are here and they are aggressively working to innovate and change the status quo. 

Disruptor #1 - Large Group Practices are delivering dental services cheaper, quicker and more efficient than the typical private practice.  They are aggressively growing around the country.  They are aggressively hiring up new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  They haven’t perfected the consistent customer experience yet, but at some point that they will figure it out. 

There are some really lousy dentists that practice in this setting.  There are also really good dentists in this arena too.  To be fair - There are also some really lousy dentists in private practice settings.   There are also some really good dentists in this arena too.

The unfortunate reality with the large group practices is that they are being judged by the lowest common denominator.  For every bad patient experience, the entire organization’s reputation takes a hit. If these companies are going to take their disruption to the next level, they need to shore up some of the bad players in their organizations.  They need to do this from within.

A dental organization in the Pacific Northwest is self-regulating through a peer review process similar to the one used in organized dentistry.  I commend them for taking the initiative to self-regulate and get rid of the bad apples from their branches.   

Disruptor #2 – Dental Insurance has been a driving factor in changing consumer perception with respect to the dentist.  There is a mindset that if one doesn’t have insurance they can’t go to the dentist. 

Dentistry is equal parts art and science.  The product that we deliver is a unique service and experience every single time.  The dental insurance industry has been really good at “commoditizing” these services. They view all fillings, crowns, and other procedures as commodities.  They don't take into account level of the level of difficulty it took to achieve a positive result.  Dentists must impart the value of their services to their patients and that dental insurance is a nice benefit but it the cure all to their dental health.

On the flip side - Dental insurance does help with the basic preventative services - cleanings, check ups, xrays etc.  And many people go to the dentist because of the benefits that they receive.  

Disruptor #3 – New Technology is continually changing how we practice.  Film based x-rays are as antique as the horseless carriage.  CAD/CAM, digital impressions, articulations, etc are going to make dentistry more efficient and even more predictable.

Disruptor #4 – This past year, Metropolitan Denver Dental Society (MDDS) built the first and only dental learning center operated and run by and component of organized dentistry.  The new facility has 4 fully operating dental operatories that are being used for hands on learning opportunities.  They have functioning lab benches, auditorium and video streaming from the operatories into the various remote video-viewing stations.

The Metropolitan Denver Dental Society is dedicated to supporting its members, promoting the highest ethical practice of dentistry; providing continuing professional education, including a premier annual dental convention; and oral health education to the public.  This learning center, The Mountain West Dental Institute, will help them fulfill their mission.  Many dental associations around the country are very interested to see how this works.  Some people say they took a big risk....that is what disruptors do.

The Colorado Dental Association recently hosted a presentation in which approximately 100 dentists showed up in person and an equal number viewed the presentation remotely via live streaming technology.  This new use of technology will allow dentists from around the state/country meet, learn, network and communicate.

America is the land of opportunity.  Anything is possible with creativity, hard work, perseverance and a little bit of luck.  Every business must constantly raise the bar if it is to remain relevant and vital.  The business models must evolve to stave off the disruptors and to keep the consumers interested in their product or service.

Evolution is the survival of the fittest.  Those that can adapt and create change will evolve into the new paradigm and address the needs and desires of its consumers.

The status quo does not exist indefinitely.  It will constantly be challenged. 

“Who is John Galt?”

Disclaimer –I am not passing judgment on these disruptors.  I am just sharing my observation and thoughts.  I may or may not subscribe philosophically with various paradigm shifts.  Each serves a niche that is attractive to various people.  That is why they are growing/gaining the market share and shifting the perceptions of the consumers.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Grand Canyon - R2R2R

"The journey of a thousand miles starts with a single step" Lao Tzu - Tao Te Ching

The "before" shot - denial firmly set in...."This is crazy!"

While I'm convalescing on the couch, I decided to pass my time by recounting my recently completed run.

Last September, a group of friends and I went to the Grand Canyon to attempt a Rim to Rim to Rim run.  (R2R2R).  We started on the North Rim and bailed out at the South Rim.  A number of excuses - It was too hot, we had stomach issues, got too far behind our time goal, etc.  Even though we didn't accomplish our goal, I considered it the most amazing run - until now

We set out with a new plan, with some new players and armed with the experience of knowing the trail landmarks. We decided to do it in November - when the weather would be much cooler.  The heat really got to us last year.  We decided to start at the South Rim this time.  The North Rim lodging was closed and there were no support opportunities there.

I liken this strategy to when the explorer Cortez burned his ships upon arrival in the new world. No turning back! We are fully in or do not attempt.  

My partners were Gary Benson, John Stevens, Steven Griffith and Dave Lindeman. John had a few friends join us from Michigan to do the run (Jeff and Jerry) as well.  Dave wanted to experience the canyon and had no interest in running the entire thing.  His goal was to run to the bottom, turn around and run back up to the South Rim.  The equivalent of doing a Rim-to-Rim.  A huge accomplishment in its own right. Originally, there were several others that had planned to come but were unable to make it.

We arrived at the South Rim around 8 pm.  We met for dinner and discussed the plan/strategy for the run.  I have been doing crazy endurance events with Gary for over 20 years and was looking forward to accomplishing this with him.  I've been running with John for about 13 years - he is much faster than Gary and I.  Steven has done several ultra's and offers hours of unsolicited entertainment. Steven also is much faster than Gary and I.

At dinner, I said to John - "We should stick together for the first half - then do whatever feels right."  He quickly responded with "I think everyone should do their own pace for the entire run."

So it seemed that John had a time goal...

This is a 46+ mile run.  I had no idea how my body, legs and brain would respond to the stress of the run.  Gary is really good at keeping me moving at a sustainable pace.  Steven and John both think I am much faster than I really am.  I keep telling them that I am tall, not fast!  My goal was to finish - period.  I have a history of starting out too fast.  I was not going get sucked into my interpretation of John's challenge.

So Gary and I would pair off - Dave would join us as well.  John would pair up with Steven. Hopefully whatever John was thinking for time, doesn't hurt him in the long run.

Jeff and Jerry from Michigan would pair off as well.

We predicted that this would take anywhere from 16-20 hours to complete.  We took our obligatory group photos in the dark that, of course,  didn't come out.  With no announcer to get us revved up, unceremoniously we were off.  We hit the trail Friday morning at 4:15am.  John, Steven, Jeff and Jerry were gone pretty quickly.  I hoped we would catch up at one of the campgrounds ahead.

We started our journey at 7,000 feet on the Bright Angel Trail.  The steep trail descends quickly along the south rim wall through many switchbacks.  I have never been on this trail in the light and cannot comment on the views other than from the top.

Elevation Profile

I spent the first hour or so trying to arrange and distribute the weight of my pack so it was as comfortable as it could be.  I chose to use the same pack as last year: a Go-Light Rush pack that held a 3 liter hydration bladder with an add on Salomon front pack for easy access to food, camera and other necessities.  I used super-light hiking poles to help assuage both the the uphill pulls and the downhill crashes on my knees and hips.

One thing that I have experienced with these long events, is that I also must manage the distribution of gas, liquid and solids in terms of bodily functions both upward and downward. Mis-management of any of the aforementioned factors can make for a really great or a really bad day!  This includes transit times of both liquid and solid fuel (by fuel, I mean food).  The goal with the gasses is to minimize the production of them at all costs as they can lead to problems with the other 2.  Some of us do better with this than others.

I tried to super hydrate on the drive from Denver and not get caught eating food that I know would come back to haunt me the next day during the run. The best laid plans....

All I can say is thank goodness there were several bathrooms the first 5 miles.  I think I visited at least half of them.  Still not satisfied.  My stomach wasn't unbearable, but it wasn't fully comfortable either. It didn't stop me from running so I marched onward with the hope that time would resolve my issues.

The sun started to come up at around 6 am.  The contrasting views illustrated by the changing light, shadows and textures of the landscape throughout the day were spectacular.

Sunrise at the bottom of Devil's Corkscrew

Downhill is the evil seduction of false hope. We were cruising along happy and steady.  My mind was feeling confident that today would be no problem.  As we approached the Colorado River, I ran ahead to get some pictures of Gary and Dave and the river as the light of the morning sun spilled over the canyon.

We entered Phantom Ranch at around 7:00 am. This is about the 10 mile marker and the end of the wonderful downhill. My stomach was feeling better, but I wasn't hungry and had to really force the food and the water.  I distributed some cargo from the back pack to the front pack for easy access to food.  I was cursing that I brought pants and a jacket as it was perfect weather for running in shorts.  I try to be prepared for anything, and I was worried about it being really cold on the North Rim.  We filled up our water bladders and re-packed our packs.

Off we went onto the North Kaibab trail.  Next stop was the Pumphouse Ranger Station, approximately 10 miles of gradual uphill.

Dave was doing great.  I thought he might be tempted to go the distance with us but after about another hour of running with us, he turned around to head back.  He probably did 25 miles. A spectacular run Dave!

We entered into a slot canyon for the next 5 miles or so.  The trail follows Bright Angel Creek and has amazing views, several bridges to cross and a completely different light profile in the slot canyon.  This part of the trail is called the "Vishnu Schist".

Gary and Dave crossing one of the many bridges

Throughout this section and the next, we started to encounter other R2R2R's.  There were maybe 10 others on the trail that day with the same goal in mind.

Waterfall at Bright Angel Creek

As we exited the Vishnu, the trail started to increase its steepness grade.  We made it to the Pumphouse Ranger Station ahead of the time that Gary predicted.  We were moving fairly comfortably.  I visited the outhouse once again, and this time I left very satisfied as I dropped some serious solid waste out of my bowels - Finally!

This was the last opportunity for water until we get to the North Rim - a steep 5.4 mile climb from 4,600' to 8,241' and back.  All of the services were closed on the North Rim for the winter. While we were refueling, I decided to keep my pants and jacket just in case the weather is bad on top.  I decided to leave one of my food bags at the campground so I didn't have to carry the extra weight on the climb.  This proved to be a good calculation as I did not need all that food for this section.  I took what I needed and we pressed on.

We started to wonder when the others would pass us coming down.  I figured it would be soon.

This next section was a bear.  It was steep and technical.  It was hard to run any but a few sections of this section.  As a bonus and something to take our minds off of the slow trudge, a completely different set of views unfolded in front of us.

Exiting out of the Pumphouse Ranger Station

Half way up!

As we were making progress, we still hadn't seen the rest of the group.  Both Gary and I thought that something went wrong and they were planning to bail on the North Rim.  I was thinking, I could bail with them, but I left my food bag down at the Pumphouse Ranger Station - I wouldn't want to leave that!  I felt tired and ready for the climb to be over.  I knew that for the return trip, I would have to dig deep to see what I had left inside physically and emotionally.

We finally ran into them at one quarter mile from the top.  They looked strong, regardless of how they were feeling, they looked really strong.  It turns out that both Steven and John ran out of water and went looking for a refill on the top. This diversion cost them about 30 minutes.

Steven tried to talk us into turning around with them and joining up for the rest of the run. We declined as we have yet to make it to the top and didn't want to have any doubt that we did the entire thing.  Also, I needed a break!

2 switchbacks later, we made it to the North Rim at 12:45.  8.5 hours into the run.  

North Kaibab Trailhead sign.

It was beautiful weather on top - I was happy, but mad that I had to drag my jacket and wind pants up that climb for nothing...We sat, ate and got busy back down before we talked ourselves out of continuing forward.  We stopped for 15 minutes.

Selfie at Supai Tunnel

Supai Tunnel

As we descended, it was very steep and technical.  This was the most dangerous section of the day. We were tired and didn't want to trip, fall, stub a toe, etc.  So we descended carefully and purposely.  As the afternoon wore on, the sun laid new shadows and contrasts that were stunning.

Me at the Coconino point overlook

Gary at the Coconino point overlook

A view, I never want to forget...

We made it back down to the Pumphouse Ranger Station in about the same amount of time that it took us to climb to the top.  I spent more time taking it easy and documenting the landscape with my camera phone. Gary ran out of water on the way down so we shared what I had left until we could refill.

I proceeded to visit the outhouse again at the Pumphouse - I promise you that it earned its name pumphouse for a reason!  Again feeling very refreshed as my GI issues were gone, we laid out all of our food on a picnic table, and started eating and eating and eating.  

Up walked a runner dressed in a kilt and a rainbow hat with a propeller attached to it.  He looked pretty out of it.  I urged him to take some food from me.  After he initially refused, he finally took some.  I didn't want to carry the extra food anymore anyway.  We bid him good wishes and we pushed forward.

In my mind, it was a quick run to Phantom Ranch.  I forgot it was nearly 9 miles.  Gary led the way alternating running and speed walking.  (in fact, Gary led the way the entire day).  It was a perfect pace.  I mentioned to him how good I felt but didn't want to jinx anything...2 hours later I wasn't feeling so good! 

As were running through the Cottonwood campground, we were talking about if we were going to call this run our first 50.  I thought it was a great idea, but I'm not sure that I want to ever do another....A group of campers overheard our conversation and asked us if we were going to the "Tonto".  I stopped and asked what that was.  He explained that it was a two mile run between the Bright Angel and the South Kaibab trailheads on the South Rim.  That would give us the four miles that we needed to make it an official 50 mile run.   I said out loud that that wasn't going to happen.  The entire campsite erupted in laughter as we pressed on through.

The wheels are starting to come off....

The same waterfall at Bright Angel Creek

We were losing sunlight as we passed through Vishnu's and then into Phantom Ranch.  I was struggling to keep pace. The wheels were about to come off for me and Gary knew it.  As we entered the campground, Gary wouldn't let me sit down and made me eat and drink to refuel.  It was a good move on his part.  If I sat down, it would have been very hard to get going again.  

As we repacked our bags, the realization that we have about 10 miles to go - mostly uphill in the dark.  I got my headlight back on and started to move on.  Running with headlamps is an interesting phenomenon for me.  

It allows me to focus on just the spot of light in my focus.  When we were climbing the North Rim, it was mentally exhausting because I could see the top and it never seemed to get any closer. With the light, I am able to focus on just keeping moving forward.  (Dori from the movie Finding Nemo comes to mind - "Just keep swimming, just keep swimming...")  I can't see the top or anything else.

Eventually, I will get there.  Gary predicted 5 more hours and we would be done. I thought that sounded longer than what it would take.  I kept that thought to myself as he is usually right on the money with his predictions.  I was feeling much better after refueling.  I had the remainder of my food in my front pack for easy access and I had enough water to get to the Indian Garden's campground.  About 5 miles.  

We power hiked the climb and ran any downhills and flats that we encountered.  Gary would get ahead and I would just keep pace.  My mind started to get into a meditative state.  I was reflecting on how much fun it would be to take a few days to do this with Gina and the kids - when the kids are older.  We could do it like most of the people that experience the Canyon - on Mules.  It would be an amazing experience.  I hope we can.  

I became very grateful that Gina allows me to explore this part of me and continues to support my peculiarities ( a big word for 'craziness').  I am so lucky to have such an amazing supportive family.  I was thinking how grateful I was to experience this day with such amazing friends in Gary, John, Steve and Dave.  I was thinking how great it was to be alive and living each day to the fullest extent.  I was thinking about how blessed I am with all of the gifts in my life.  

As I pressed on with full of emotion, the climb didn't seem so bad.  We entered Indian Garden at about 2 hours.  We refilled enough water to get us through the final push. 4.7 miles to go.  

The final climb was steep!  It was broken up into 3 mile and 1.5 mile rest areas.  We set our sights for these sections.  We started to see a few headlights in the distance up the side of the cliff.  Gary figured it out to be John and Steven.  We started communicating through yelling.   I couldn't believe that they were so close! It gave us both bursts of energy.  I was emptying the reservoir of what I had left - which was dwindling fast.  

Ominous Warning which I failed to heed....

There seemed to be hundreds of switchbacks.  Gary was about a full switchback ahead of me and as we passed each other, he explained that each switchback was a victory.  So as we passed we acknowledged each other with a victory salutation.  Every few switches, I stopped to stretch and rest.  The trudge ends with a long relatively flat section to the trailhead.  I always get emotional at the end of a challenge such as this.  I passed those last 100 yards wiping my eyes. Thank God it was over.  Steven was at the finish to catch us up with his experience and to walk us to our rooms.  They were just 15 minutes ahead of us. Final stats - 46 miles, 17 hours 45 minutes

Everyone finished strong.  I'm looking forward to talking with John yet to hear how his day and his buddy's day went. 

We had an Epic Day!  I need a massage....

I enjoyed my trip and I didn't get bit!

Organized Dentistry

The Colorado Dental Association is starting a public relations campaign to promote who we are and what we do.  For as long as I have been a member of organized dentistry, I have felt that we are the best-kept secret both to our members and to the patients who we serve.

                                       Click here to view the commercial

Why the PR campaign?

We are at a critical juncture.  There are many entities that are marketing their positions in the dental world.  As a result, dentistry is becoming a commodity and the general public doesn’t really know who to listen to with regards to oral health. 

In the near future, we will be updating the dental practice laws in Colorado.  We are positioning ourselves, once again where we belong, as the dental experts.

For years, we have not done much.  We dentists don't like to talk about ourselves.  Through our non-action, these entities have taken over the public's perception while we have been quiet.  

We are not going to be quiet anymore.  

What does it mean to be a member? 

By being part of organized dentistry, we are part of a bigger whole.  There is the local component - for me that is the Metropolitan Denver Dental Society.  There are several local components that all funnel into the state - the Colorado Dental Association -which I am currently President-Elect.  Every state has both state and local organizations.  We are all part of the national entity, the American Dental Association.  

This is who we are and this is what we stand for:

Our Colorado Dental Association core values:

Effective Leadership, 

Open Communication, 

Ethical Behavior, 

Moral Courage, 

Strong Advocacy, 

Fellowship, and 

Teamwork

Our Mission:

To provide the Colorado Dental Association membership and the public with superior service and to demonstrate effective leadership in advocacy, education, communication, and quality products and services that enhance member practices, professional growth, and patient care.

Dentistry, like all healthcare, is a profession in flux.  The delivery models are changing.  The business models are changing.  Access-to-care is expanding in Colorado. 

The one constant has been organized dentistry.  We have been around for over 100 years, preserving the integrity of the profession of dentistry.  The work that organized dentistry does today is to preserve the integrity of the profession.

Who would you like to be your dentist? 

Please choose one that is a member of organized dentistry.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Obamacare - How will it affect dentistry?

I was recently asked by a friend how do I think that the Affordable Care Act (ACA or Obamacare) will affect dentistry.  This took some thinking on my part.

I have spent the past 5 years going to Washington DC to discuss dental care with our legislators. When the ACA was being discussed prior to becoming law, we did everything we could to get a seat at the discussion table to very little avail.

The year after the ACA was passed in Washington, we had a political pundit,  Dr. Frank Luntz ask us the question, "Are you happy with the results?"

No one could really answer because no one really knew or understood what was being thrust upon us as dental practitioners.

Frank's dad was a dentist.  As a child growing up, he recalled the animated stories his father would share about his patients. He was truly a caring practitioner. He loved the practice of dentistry, but he loved the relationship that he had with his patients even more.  Improving the health of the patients that he cherished is what he looked forward to every day that he practiced.  This is what I look forward to every day that I practice too.

Tragically, I see this style of practice on the decline.

From his personal experience, he went on to say that dentistry, as a profession, should be thrilled that it was basically left out of the ACA.  He reminded us that -

Dentistry is the last free market health care system that is working in this country.  

The reason - We keep the doctor patient relationship sacred. For more elaboration see my blog from July, 2011 The Sacred Cow.

In all aspects of health care there is trending consolidation of providers.  This means that private practices are joining up with hospitals or large groups called medical service organizations (MSO's). Included in these MSO's, hospitals are joining up with other hospitals and insurance companies to improve efficiency and improve access to information and resources.

As with any new paradigm, there will be some confusion from both sides of the fence as this takes affect.  All-in-all it should improve health care delivery as long as the doctor patient relationship is kept in the forefront. I hope that doctors are allowed to treat patients like they know best as opposed to management making decisions based on financial impact.

I expect many people to be upset at the changes from what they are used to with how they received health care in the past.  I also expect many people to be thrilled with the heath care that they are now eligible to receive.  The old adage comes to mind - "You can't please everyone, all the time".

There are many (including me) who are upset how the bill was passed and what was promised to the citizens.  I don't think that the legislators knew or could predict the extent of the problem at hand.  Therefore, they couldn't predictably fix the problem with the ACA bill.  What our legislators on both sides of the aisle knew was that our health care system needed to change.

The ACA is a start to solving the problems, it will evolve over time but it will never solve everyone's problems, expectations or needs.  We must accept this fact.  It will cost more and provide less than what we are used to.  We must accept this fact too.

I personally trust my physician to recommend the finest care to me.  Whatever he needs to do to evaluate my health, I expect him to recommend.  This should be in a "patient bill of rights".  I am cautiously optimistic that this style of practice will continue.

The insurance industry is the real winner in the ACA as they will have 48 million more people in the system that are now mandated to pay their premiums.  As a small business owner, I have seen my own health insurance premiums rise significantly over the last several years.  I predict that they will continue to rise as the ACA is implemented.

My predictions on how the ACA will affect the dental profession -

  Please note that these are my views and my views only.

In dentistry, we are seeing consolidation in a different form - through explosive growth in corporate dental service organizations (DSO's).  They seem to be sprouting up everywhere.  They provide a niche for people who are looking for low cost dentistry. This could be either good or bad depending on the perspective of the experience.  This practice model has been around for decades. They are a safety net -providing basic dental services (cleanings, fillings, crowns, dentures, partials, etc.)

I am hearing that these corporate dental organizations are recruiting heavily at the dental schools to attract new dentists to work for them.  Many new dentists are taking jobs with these firms as it is very difficult for them to find jobs elsewhere that satisfy their needs - such as make a decent living and paying off their student loans (average $250,000).

There will also be a rise in Federally Qualified Health Care facilities (FQHC's).  This is also a safety net capturing those patients that are lower income and have medicaid as a primary coverage.  These offices also provide basic dentistry similar to the DSO's.

Dental insurance - There are health insurance plans that offer dental benefits as an add on.  These plans are what I refer to as "skinny plans".  They offer the absolute basic dental services such as cleanings and exams.  I hope that these companies that are offering these plans are being honest to their clients about the limited extent of these plans.

If the reimbursement rates to the dentists are too low, dentists will not participate with these plans
- making it hard for patients to find dentists that take their insurance.

If the insurance companies drive the costs down through lower reimbursements, dentists will evolve their practice model to accommodate.  Please note that most dental offices are small businesses and provide dental care to the community that they serve while providing jobs to their support staff.  As with any small business, they must be profitable to remain viable.

I bring this up because there is a precedent of insurance companies cutting reimbursements to dentists in several states including: Washington, Missouri, Idaho, New Jersey, and Connecticut.  To show how volatile the relationship between dentists and insurance companies are see Washington Dentists vs. Delta Dental.  

Episodes like this don't make dentists happy.  Dentists want to provide a service to their community.  At the same time, we wish to keep our businesses viable with minimal third party interference and regulations that affect the "sacred cow" (doctor patient relationship).

With lower reimbursement rates, dentists must either see more patients per hour or cut costs. This could affect the practice in several ways including less time with the patient leading to a less personalized service. The dentist could also choose to use cheaper materials that may not last as long or be optimal for the situation as what he/she is currently using.  

If there are not enough providers to fill this void, a new dental provider model has been making dental headlines over the past few years.  This "Midlevel" provider will be able to do irreversible dental surgical procedures with minimal training - usually 2 years after high school.  This scares me, but as with anything, survival of the fittest.  If this provider model can provide the care that dentists and hygienists currently provide, they will stay, if not they won't.

Again, this is a slippery slope that will create a potential two tiered dental system with a significant percentage of the population receiving care that is from a provider that is seriously under-qualified to perform.

There is a 2.1% medical device tax. It hasn't been defined yet on what is going to be taxed.  My prediction is that anything fabricated by a lab (crown, denture, veneer, etc) will be subject to this tax.  I also predict that this cost will be passed along to the patient in some way.  When we brought this up to our legislators, they weren't sure yet on what was going to be taxed.  The term medical device is not spelled out in the bill.  As much as we tried, this tax isn't going away.

Expansion of medicaid coverage to children.  All plans must include dental benefits for children up to the age of 19 (including medicaid).  This will put millions more children in line to have access to dental care.  I predict there will initially be a shortage of dentists that can provide proper care for these kids.

Expansion of medicaid benefits to adults.  The ACA is encouraging the states to expand dental services to adults.  I predict again that there will initially be a dearth of dentists that take medicaid.  Medicaid reimburses at around 30% of what the dentist's usual fees are.  Plus, medicaid creates a plethora of extra paper work and reporting to get reimbursement.  Again, not an incentive for dentists to participate.  Some corporate models have already stepped into this niche and I expect several more to adapt into this niche as well.

One potentially good thing the ACA incorporated is an increased focus on healthy lifestyle, and prevention strategies.  We dentists have been doing this for the past 50 years.  Dentistry can help lead the charge here. The goal of dentistry involves optimization of health and function.  The removal of infection that could potentially spread to other parts or systems of the body is imperative for optimal health.  The ultimate function of teeth is to chew food.  The best way to maintain optimal health is to have proper nutrition and lead a healthy lifestyle.  If you have no teeth, it is very difficult to get good nutrition.

Odds and Ends.  I hope that the ACA also consolidates the respect of all health care providers.  We all have an interdependent essential pieces of health care.  All health providers must learn to communicate better with each other and with our patients for the best interest to improve the delivery of healthcare to those that we serve.

Patient's responsibility. The ultimate responsibility of health lies on the citizen patient.  He/she must live a healthy lifestyle to remain healthy.  Many health problems are preventable. Many health problems are not preventable.  If the system is clogged with the health care problems of the preventable kind, there are not enough resources available to help those with the non-preventable kind.

With respect to dentistry - 

Clean teeth do not decay, most gum disease can be prevented with brushing and flossing! 

I welcome comments and perspectives on this.  I am no expert and would love to hear other opinions - especially if I am off base here.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK