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AUDIO - HSP 253 - Linda Douglas
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VIDEO - HSP #253 - Linda Douglas
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• Enhancing patient care through increased interdisciplinary collaboration between all medical and dental healthcare professionals.
• Education of the dental hygienist
• The future roles of the dental hygienist; how is dental hygiene practice likely to change?
• What I like about Dentaltown and Hygienetown.
• How Dentaltown and Hygienetown has sparked my professional growth.
• How my curious nature, and love of writing has enhanced my career
• Overcoming shyness, and fear of public speaking, (which was holding me back professionally).
• Rethinking views on retirement-when I was young, most women I knew retired at 60; as this draws nearer, I realise am enjoying my profession too much to think of retirement.
I am from London, England where I was an OR technician initially, then I decided I like patients better when they are conscious, so I switched to the dental field.
Since graduation from hygiene school, I worked for 8 years in periodontology, public health and general practice before moving to Canada in 1990, where I have worked in general practice. I also worked for our regulatory body, the College of Dental Hygienists of Ontario as a quality assurance assessor for 4 years.
I started writing articles in 2009, and began teaching continuing education in 2013.
I also completed my Bachelor's degree in Oral health promotion with O'Hehir University in 2013.
lindadouglas@sympatico.ca
Howard Farran: It is a huge honor today to be interviewing my buddy, I feel like you're my sister Linda. You've been on dental town since 2006 and have 7,000 posts. I don't like anybody can read 7,000 dental town posts and messages from someone and not feel like you're absolutely my twin sister raised apart since birth. You've added so much to dental town and hygiene town, you have two online CE courses, you did an amazing course on xerostomia, an overview on currently revolving therapies, you did another one fascinating facts on saliva, 7 strategies for xerostomia management and the future of saliva testing. You recorded that live at the towny meeting where I got to meet your adorable daughter. Is she going to follow mom into hygiene, what is she going to do?
Linda Douglas : She's a singer.
Howard Farran: She's a singer?
Linda Douglas : Yes.
Howard Farran: I got to tell you my one singing story. Singing is actually, it's not preference and when people sit there and say you just think that persons a good singer, you think it's not. When I used to sing to my newborn baby, I have four boys. When they were like 1 years old and I was just rocking them and singing, they would reach up and put their hand over my mouth and say no. No daddy, no. I'm sitting there thinking how does this kid know I suck, he's only 1, he doesn't even know music but they knew I was horrible at it.
You're an amazing hygienist. You're from London, England.
Linda Douglas : Yes.
Howard Farran: You started in an operating room and then you decided you wanted your patients to be conscious so you switched to the dental field. Since graduation from hygiene school you worked 8 years in periodontology, public health, general practice. Then you moved to Canada in 1990 where you worked at a general practice, the Regulatory Body College of Dental Hygienist of Ontario as quality assurance assessor for 4 years. You've been writing articles, teaching continuing education, you completed your bachelors degree in oral health promotion from O'Hare University which is the Trucio Hare, another good buddy of mine. What made you move from London to Ontario? Probably the weather didn't change much from London to Ontario it's about the same weather isn't it.
Linda Douglas : Yeah it's about the same but we thought there'd be more opportunity here for the whole family.
Howard Farran: For you in hygiene specifically or for your husband and daughter?
Linda Douglas : More for my husband and daughter.
Howard Farran: Really? More opportunity in Ontario, Canada than London, England. I think of London like the New York or the Hong Kong of Europe but you just thought there was more opportunity here.
Linda Douglas : Yeah. I have a brother here who's done really well so we thought we'd give it a try.
Howard Farran: The dental scene in England has probably changed the most of any country I've been aware of since I got out on. I mean when I got out of school in '87 it's like 99% of them worked for the government NIH dental system and now what would you say about almost a third to forty percent have dropped out of that system and going private fee for service?
Linda Douglas : Yeah a lot of them have opted out. Actually I kept in touch with a dentist I used to assist back in '81 and he came to us for a visit a few years ago and he said he had to opt out or else he would have gone broke.
Howard Farran: Yeah they think just to save money they just keep lowering the fees. I thought the most ridiculous hearing I saw was in California, they were having this government hearing on why the dentists weren't participating and they're like "okay, my office has 65% overhead and your feed is a 70% reduction." I mean do the math you can't suck blood out of a turn-up. At some point this stuff has to be paid for, your rent, mortgage, equipment's not free, your hygienists are volunteers, your assistants aren't candy stripers doing this in the evenings and weekends. It's every ones job and the government has a hard time realizing that you have to pay for it or you can't really get it. You can only squeeze margins so hard. What did you want to talk about, you can talk about anything. Did you want to ... you've done two CE courses on xerostomia, can we start with that?
Linda Douglas : Yes certainly.
Howard Farran: Let's start at the very beginning. I want to ask you one off the wall question that's ... you're a mother and you're a hygienist and I'm a father of four, I've got a granddaughter that's 3. Did you get a ... did you daughter make you a granddaughter yet?
Linda Douglas : No not yet.
Howard Farran: Okay so ... that's going to be the greatest gift that might come to you some day. This whole disease, our whole profession doesn't start until someone kisses a baby. I mean they're not born with streptococcus mutans, they'll never get a cavity, they'll never have to brush and floss, they're never going to get gum disease because they don't have p gingivitis. They're never going to get the oropharyngeal cancer because they don't have the human papillomavirus. Do you see in your, you're very visionary, after doing this for several decades do you ever see a future where babies will be born and not be contracting these diseases? Just like below the belt they're not born with syphilis, gonorrhea, AIDS, etc. Do you think stopping humans from kissing babies is just too great of a task?
Linda Douglas : I think that they'll be development of more vaccines to prevent periodontal disease and caries. Although we've been working on vaccines for caries for the past 40 years.
Howard Farran: Do you hear of anyone thinking that that's a strategy within 5-10 years?
Linda Douglas : I haven't no.
Howard Farran: Yeah. Look how far they've come with AIDS and HIV. Now when you get HIV if you live in a country with access to health care it's almost like a manageable chronic condition.
Linda Douglas : Exactly, yes.
Howard Farran: Xerostomia, what are your thoughts on xerostomia? How prevalent is it? What's causing it? What do you do when your patients have it?
Linda Douglas : It's becoming increasingly prevalent and I wanted to study it more because I had patients for several years who were always in great oral health and then they started taking meds for blood pressure, etc. as they grew older and then they started to get cavities. I wanted to help them and they were flummoxed because their oral care was always excellent and they were regular attenders. Management of xerostomias is multifaceted to address the different problems but there are a few products that will address more than one problem that are very useful. Particularly substances with calcium and phosphate like Novamin or Recaldent.
Howard Farran: What is, recaldent and what is the other one?
Linda Douglas : Novamin.
Howard Farran: N-O-V-A-M-I-N?
Linda Douglas : That's the one yes.
Howard Farran: Are these ... what kind of products are these, gums, mouthwashes?
Linda Douglas : Yes ...
Howard Farran: Toothpastes?
Linda Douglas : You can get toothpastes with novamin now, that's sensodine repair and protect. MI paste contains recaldent and certain gums, I think Trident Extra Care contains recaldent.
Howard Farran: Recaldent is a calcium phosphorous supplement?
Linda Douglas : Yes.
Howard Farran: Some people think that if you have a diet rich in calcium and phosphorous that that will actually show up in your saliva and have a remineralization. Have you read that?
Linda Douglas : I read a little about it but it's, I think it's quite limited unless you're producing enough saliva, the stimulated saliva has most of the minerals.
Howard Farran: I think the biggest tragedy in what I see in my zip code is about 5% of Americans will end up in a nursing home some day. All this care about nursing homes you know 90 ... if you're married half the spouses will die when their other spouse is alive. Half will probably die whether they still have a spouse. Only about 5% into nursing homes but when they go into nursing homes, everybody that I know that's studying geriatric dentistry or whatever are saying that they get a root surface cavity about one per month is the average.
If you're in a nursing home for 18 months, you get 18 new root surface cavities. How ... then you go into those nursing homes and they've got some poor little girl and I don't know why they ... it seems like all the girls in the nursing home are like 5'2 and 100 pounds and they got to lift this huge man or this obese woman and get her in and out of the shower and feed her and all ... she's got all these duties, getting around to properly bushing and flossing their teeth. It's just not gonna happen, would you agree with that?
Linda Douglas : Yeah. The carers have so much on their plate that the oral care is not really a priority unfortunately.
Howard Farran: Yeah I mean they usually have to call the fire department one or two nights a week just because big ol' grandpa fell down in the shower and this little girl and her other friend from the other wing can't even lift him back into the bed. Then the dentists are saying hey grandpa no ones flossing his teeth, it's like that's the lowest rank. What would you say to the hygienists and dentists listening to you when they have a patient tell you that their mom has Alzheimer's and dementia and she's now in a nursing home? What do you think they could do to help her avoid all this root surface decay?
Linda Douglas : I think they could start with a xylitol supplementation to reduce the, that will reduce the cariogenic bacteria and stimulate salivary flow. They need someone to visit at least a couple of times a week to brush their teeth really well for them. Also apply fluoride and also supplements with the calcium and phosphate.
Howard Farran: Would you switch their toothpaste to MI recalcident or novamin or MI paste?
Linda Douglas : Yeah MI paste every night.
Howard Farran: What would be your brand name recommendation for grandma in the nursing home? It'd be MI paste by Calcident?
Linda Douglas : Yeah. That's made by GC America. I've achieved very good results with that. It gives relief from the dry mouth, it also helps to reduce the acidity and improve remineralization.
Howard Farran: That's GC America and that's Japan. GCC General Chemical Corp of ... I believe it's Tokyo, Japan is it Tokyo?
Linda Douglas : I think so, yes.
Howard Farran: Then in America they're headquarter in Chicago, GC America. They have ... what's the brand name? MI paste or they brands recalcident and then you call it MI paste?
Linda Douglas : Yeah the product is MI paste ...
Howard Farran: What's the MI stand for?
Linda Douglas : Minimally Invasive. Like minimally invasive dentistry.
Howard Farran: Minimally invasive dentistry, and do you buy tubes of that like toothpaste?
Linda Douglas : I call it a night cream for the teeth, you apply it last thing at night after brushing.
Howard Farran: Night cream for the teeth ... that's a night cream for the teeth. Now that's a girl thing I don't think any guys, do any guys put night cream on their face?
Linda Douglas : Not to my knowledge.
Howard Farran: Night cream for the teeth. You recommend brushing with that before they go to bed?
Linda Douglas : No you need to brush with a regular paste and that's a treatment that you apply and leave on.
Howard Farran: It's not a toothpaste, it's a calcium phosphorous remineralization that buffers the acidity back up to more neutral where it's not cariogenic friendly. What's another brand? You said Novamin, who makes that?
Linda Douglas : You know I can't remember, it's in a lot of different products as I said now Sensodyne is including it in one of their products.
Howard Farran: Now Sensodyne that just got sold, what 10 years ago? Who bought Sensodyne?
Linda Douglas : I think it's Glaxo Smith Cline.
Howard Farran: That's right Glaxo Smith Cline, they bought it for a billion bucks about a decade ago. They have a .. their Sensodyne for sensitivity also has the calcium phosphorous remineralization?
Linda Douglas : Yeah the repair and protect.
Howard Farran: The repair and protect. Now is the repair and protect also the desensitization or is that a totally separate tooth paste?
Linda Douglas : Yeah it's also for desensitizing.
Howard Farran: The desensitizing with strontium chloride?
Linda Douglas : Now it's something else and I can't bring the name to mind right now.
Howard Farran: They have ...
Linda Douglas : Potassium nitrate.
Howard Farran: Potassium nitrate so they got ... so they have the potassium nitrate and the calcium and the phosphorous all in one toothpaste?
Linda Douglas : Yeah they have so many different formulations now because they ... actually it can get quite confusing for the consumer. When we first graduated there was just one Sensodyne paste but now I think there are probably about at least half a dozen.
Howard Farran: It's a big market and the fa ... what's funny is in the 20 richest countries the fastest growing market is women over 100, the second fastest growing market is women over 90, the third fastest growing market is women over 80, and I'm just sitting here thinking, "wish I was a woman." They say the male testosterone is very, very damaging on ... testosterone effects muscles so you got your skeletal muscle but then you got your smooth muscle which is your arteries and veins. Then you got your cardiac muscle which is your heart and you just have to look at body builders and see how that just, when they start taking high doses of that it just wrecks them very quick. All men are just kind of wrecked by testosterone.
Be specific, you're talking to a lady in your chair and she says "Linda my mothers now in a nursing home." What would you tell her? What would you tell her to go manual versus electric, what tooth paste, what night cream? What would you tell, what should hygienists and dentists be telling the baby boomers when they say they just put one of their parents in the nursing home? Knowing that on average they're going to get one root surface cavity a month.
Linda Douglas : Yeah I think they need to look at doable. Make it as easy as possible to care for the mouth. I think xylitol will play a significant part in that.
Howard Farran: What brand and would you talk about a sucker, a chewing gum, a candy?
Linda Douglas : I think as long as they get 3 to 5 exposures a day for 5 minutes it doesn't really matter. I think the granulated xylitol is very valuable because they can put it in their tea or coffee or even in the water.
Howard Farran: You're from London so, you're probably a tea drinker right?
Linda Douglas : Yes.
Howard Farran: Is coffee making an impact in London or is it still a tea drinking nation?
Linda Douglas : They like their coffee too. There's lots of Starbucks over there now.
Howard Farran: Is there?
Linda Douglas : Yeah.
Howard Farran: Now was ... you're originally, your ancestors are from Barbados, was that a British colony too?
Linda Douglas : Yes.
Howard Farran: Is that an English speaking country?
Linda Douglas : Yes.
Howard Farran: Are they tea drinkers too?
Linda Douglas : They're more rum drinkers.
Howard Farran: Rum drinkers? You can buy xylitol granuals and put a teaspoon in your coffee or tea or water 3-5 times a day?
Linda Douglas : Yeah.
Howard Farran: You think there's good research that if they're doing that in the nursing home it would reduce the root surface decay?
Linda Douglas : Yes.
Howard Farran: What do you say about the electric versus ... back to the senior citizen, would you recommend a manual brush or would you recommend an electric tooth brush? A lot of them have rheumatism, what would you think?
Linda Douglas : I think an electric brush would make it much easier definitely.
Howard Farran: Do you have any favorites on your electric tooth brush?
Linda Douglas : I like the sonic care.
Howard Farran: I like it because my dad. His business was sonic driving and it reminds me of a foot long chili cheese dog, onion rings and a cherry limeade but that's a whole another story. You like the sonic care because obviously grandma or grandpa in a nursing home isn't going to be able to brush like they could if they were, you know, 21 years old.
Linda Douglas : No.
Howard Farran: When people say well what is a better tooth brush, electric or brushing I would first start, well I'm sure if you're an Olympic gymnast and you're 16 years old you could use anything. I think as your mind and body and dexterity breaks down, it probably helps a lot to have this technology. You know some of these electric tooth brushes are connected to apps and one of my guests was saying that she thought the apps, the electric tooth brush apps were going to take off just because the kids would be able to monitor if it was being used. Just the fact that I could go in there and say "come on Linda, this electric tooth brush hasn't been turned on for a week." Then how did you brush grandmas teeth for a week. I would assume in game theory if a certified nurse assistant had 20 people on her wing and she new 3 grandmas were being measured by an electric tooth brush connected to an app, that'd probably be the first 3 that got brushed. Would you agree with that?
Linda Douglas : I think that's quite likely. That's a super idea.
Howard Farran: Yeah and I love the economist, I forgot the name of the guy he got the noble prize in game theory in economics. I just think game theory is huge and that's what I'm telling all my friends. I've gone in a dozen times, I've gone in and spent the second in a nursing home just to see, just hanging out. All you gotta do is bring them a dozen donuts and be friendly and hangout and say I'm just looking at this from a public health point of view. It's just a ... in fact it almost makes me glad I'm a man because there are almost no men in a nursing home. There's 100 women and just 1 man named Lucky. This is probably more of a concern to you. Then she brushes with her electric tooth brush, what tooth paste would you recommend?
Linda Douglas : I think, most of the leading brands are very good. That little bit of fluoride in the regular tooth paste is beneficial.
Howard Farran: Just any of your crest or Colgate?
Linda Douglas : Yeah I think so. My current favorite is repair and protect because I just like that formulation.
Howard Farran: That's the GC America MI paste? No, no that's the Sensodyne.
Linda Douglas : That's Sensodyne yes.
Howard Farran: By Glaxo Smith Cline.
Linda Douglas : Yes.
Howard Farran: That's your go to tooth paste, repair and protect?
Linda Douglas : Yes. Also actually Colgate has some very good ones. They have enamel repair formulas now with, I think it's calcium and arginine type of protein.
Howard Farran: You've been a hygienist, what year did you graduate from hygiene school?
Linda Douglas : Where?
Howard Farran: No what year?
Linda Douglas : When? 1982.
Howard Farran: '82-2015 you've been a hygienist. Where do you think hygienist has gone from the day you walked out of school until now and where do you think it will, it's headed over the next couple of generations?
Linda Douglas : I think we've changed from being a very task orientated profession that is like a tooth cleaning machine to ... and also being very focused on perio. I think we've come a long way in that we're, we've expanded our horizons to include the systemic link with oral health. For example in the seniors homes another good example is that if their mouth is overloaded with bacteria, they are more at risk for respiratory infections and there's also a correlation between the number of categories and cognitive decline. Although it's not established cause and effect but it's quite compelling.
Howard Farran: I agree completely. What do you think these young hygienists over the next 10, 20, 30, 40 years, what oral diseases do you think they'll be looking for in the mouth, the oral systemic health connection?
Linda Douglas : I think they'll be more aware of the connection and will be a lot more effective at oral cancer screening in particular. Things like signs of malnutrition, signs of eating disorders, you can even see signs or diabetes orally or things that would suggest it.
Howard Farran: Linda you have 7,000 posts on a ... is that dental town, hygiene town combined or ... if you post on dental town does it change your post on hygiene town or vice versa?
Linda Douglas : Yes.
Howard Farran: When you're a member of hygiene town does that automatically make you a member of dental town or do you have to be a member of both separately?
Linda Douglas : To tell you the truth I don't remember now, I did it so long ago.
Howard Farran: Yeah I think it's separate but what's the difference, for a hygienist what's the difference between hygiene town and dental town for your user experience? Do you go, I see you posting on both, what's the difference between the two?
Linda Douglas : I like dental town because I get some insight into the management side of dentistry and I like to, and to gain a bit of empathy for what the dentist is thinking about their staff and about the things that they worry about when they're running their business. Hygiene town has change a lot over the years actually. There are a lot of great members who have really raised the bar so it's a bit more, it's become a bit more scientific I think. A lot more interesting.
Howard Farran: I always loved the fact that so many research articles that I just didn't see or I didn't read. I mean there's so many journals, it's not just so many journals, there's so many countries. I mean you just ... people are just posting these great articles, whether it be business or research or whatever and they're coming from literally 100 different countries. I just love to see what ... I also love to see, what blows my mind is someone will post a study and I'll read it and then I'll look at the comments and it's like half of the time I'm like oh wow I didn't even think of that or I didn't even look at it like that. It's amazing how, it's amazing how every human being sees something differently.
I equate it to the supreme court, you notice you know you have a constitution in the United States that goes back to 1776 or so it's a several hundred year old constitution. All the words are explained and then they put a law there and then almost all of the decisions are like 5 to 4 so I mean, you would think if they're lawyers they went to school for 8 years, all the words are the same, all the words have meanings so you'd think they'd always all agree but they almost never agree. It's always like ... the same thing with dental research it's amazing how it will say in research oh I'm thinking this, and then the first comment you're like oh I see your point now I'm thinking the other way. Your head just goes back and forth and it really takes your mind out for a run. Do you think dentists would benefit going to hygiene town to see how the hygienist think?
Linda Douglas : Definitely I think it would be good for them to gain more insight into what we're thinking.
Howard Farran: Yeah. Another exciting thing I'm noticing here at hygiene town is you go back to 1998, hygiene town was all women, and now some of the biggest rock stars in hygiene town are men. My office manager is a man, I have four assistants, two of them are guys and ever since the ... America started this free trade thing and lost 50 million manufacturing jobs, men are just pouring into health care because it's .17 cents of ever dollar in the economy. I just was in the hospital just recently for the third time for a kidney stone about every 10 years I drop a stone, I couldn't believe it was almost half men in the emergency room section.
Linda Douglas : Yeah.
Howard Farran: Very, very changing. What else, what do you think about all the talk about hygienist practicing independently. You're up in Canada where they want to have expanded duty assistants go onto Indian reservations. What do you think about all the expanded duty functions, independent practicing, all those hot political topic buttons?
Linda Douglas : They were originally mandated to improve access to care for ... there are still sections of the community, a significant number of people who don't have dental insurance and particularly the elderly and also newcomers to Canada and children. I think we do need expanded access to care. Unfortunately what I've noticed is some hygienists they're doing a great job actually in independent practice visiting senior homes, etc. but there are still some who have set up shop in the city near to other dental offices, where you can't really say there's a problem with access. I think it is valuable, it has it's place and actually I would like to see, say a hygienist in a building with, surrounded by other dentists offices and the dentists outsource their hygiene services to the independent hygiene offices.
Howard Farran: You would like to see that?
Linda Douglas : Yeah.
Howard Farran: Why would you like to see that? Tell me your vision.
Linda Douglas : I think it could work. I think it's one less thing for the doctor to worry about in their office. It's just the logistics of having someone who's going to go to one office to see the dentist and another to see the hygienist but I think if they're in the same building it could work very well.
Howard Farran: I think its a ... I think you have to remind dentists all the time that they have to be patient centered and not doctor centered. They all believe in their heart, they all look in the mirror and believe they're doing everything patient centered but then when you show them things like gravity, math, physics, like their office hours are Monday through Thursday 8-5 in the city of Phoenix Arizona. You have a tooth ache evenings, Saturday, Sunday I mean you're almost completely helpless. I think too many times they talk about any of these hygiene issues or expanded care are etc. they're not realizing this is a huge country and there are a lot of poor people that don't have access to care and the way they talk it seem like it's to do a lot more with money and a lot less with poor people. You've lived in a, have you spent much time in the United States? I mean I've seen you in Vegas a couple of times, have you traveled much of the United States?
Linda Douglas : Very little actually.
Howard Farran: Very little? I've been to 50 countries and I can't think of three bigger melting pots than England, Canada and the United States. Those are about the only three countries where there's someone from every country, everywhere you go. All the other countries, I mean you got to Vietnam, they're all Vietnamese, you go to Korea, they're all Korean, you go to Japan, they're all Japanese, you go to Poland, they're all Polish. Who do you think is the bigger melting pot, do you think the United Kingdom, Canada, and the United States are about the same? I actually think Canada would actually be more melted than U. K. I'd rank it Canada, U. K. then United States. I mean it'd be a tight race but is that how you see it?
Linda Douglas : Yeah I think they're very close definitely. [crosstalk 00:32:34]
Howard Farran: Go ahead.
Linda Douglas : It would be hard to say actually.
Howard Farran: What's your favorite city to visit?
Linda Douglas : My favorite city, well actually I still have a soft spot for London.
Howard Farran: Oh yeah but, with a caveat, it has to be during the good weather. You don't want to get caught up in the North Sea in February when there's 11 foot waves and a storm rolling in. I mean that is one cold place in the winter, would you agree?
Linda Douglas : In certain parts of England but I actually like that little bit, that steady drizzle. I quite like that.
Howard Farran: Really?
Linda Douglas : Yeah.
Howard Farran: I think you're the first person I ever met on the planet that ever said that. Do you just like the beauty of it or just wakens you up, what do you like about it?
Linda Douglas : I think it started when I was in an overheated office building in Toronto and there was a bit of drizzle outside and I felt so good when I went out. It reminded me of home.
Howard Farran: What I like about London, last time I went there spoke to Royal Canadian College of Dentists and took my son Greg is just every block there's a restaurant you haven't tried, a food you haven't eaten, the bands are from every corner. It's just the ... I always thought that the rock-n-roll explosion in the '70's where all the major bands were from London, I always thing that it was because those musicians that were exposed from sounds from every corner of civilization and they were just kind of wrapping them all up together and just having their unique sound. How did you, you told me that you originally were shy and you overcome shyness and started later on in your career, started writing articles and public speaking. You've lectured for us at towny meeting and your reviews were just amazing, your CE courses are amazing. What was it like growing up shy and how did you overcome shyness? Talk about that part of your journey.
Linda Douglas : I definitely needed a little push, I had to have a push from somebody else to ... before I over came it and that was the invitation to speak at the towny meeting actually.
Howard Farran: Who pushed you?
Linda Douglas : Trisha.
Howard Farran: Trisha O'hare?
Linda Douglas : Yes.
Howard Farran: Aw how adorable. I love Trisha. I don't think she has any shyness of speaking ...
Linda Douglas : No.
Howard Farran: Did she ever in the beginning?
Linda Douglas : She never mentioned it to me but actually when I was preparing for the towny meeting I contacted all the speakers whom I admire in our profession and most of them said that they were shy and nervous still about speaking.
Howard Farran: Well you didn't contact me so you ... I must not be one of the speakers you admire.
Linda Douglas : Yeah I should have asked you too actually, I don't know how that happened.
Howard Farran: What did the speakers tell you? Was everybody having the same shyness?
Linda Douglas : Not necessarily shyness but definitely nervous before speaking and they said that if you're not nervous before speaking then there's something wrong, you're too complacent.
Howard Farran: Well, I mean they say that in sports if you're not a little nervous before the big game or the big sporting event that's not a good sign. They always say in boxing if a boxer crawls into the ring and he doesn't already have a sweat going he's probably going to get knocked out in the first round, he's not even ready. I can see how the pre-jitters works up. Now how many times have you lectured since, or how many times have you lectured total?
Linda Douglas : Probably about a dozen times now.
Howard Farran: Is it getting easier?
Linda Douglas : It is actually. I really enjoy it a lot now, I find it's like talking to a group of friends. It's a lot of fun.
Howard Farran: What secrets or advice would you give to someone who's listening to you right now on their commute to work that has often thought about maybe speaking at their ... maybe breaking the ice and speaking for their local study club or their local state meeting and become a speaker but they got butterflies in their stomach. What kind of motherly advice would you give them?
Linda Douglas : Speak about what you know and prepare very well and take a public speaking course or join toast masters.
Howard Farran: Did you do that?
Linda Douglas : Yes.
Howard Farran: Well tell us what you learned, what's the low hanging fruit from toast masters. It is just getting more opportunities to speak and getting over it or did they actually give you sound tips of speaking?
Linda Douglas : Both actually. I learned a lot from them. Fondly enough I also learned, I went to a toast masters that's near to the University of Toronto so their were a lot of young people and I thought this is a nice place for singles to meet too. I was a bit of a match maker too.
Howard Farran: You were fixing people up at the toast masters club? You were pairing off the singles?
Linda Douglas : Well in my mind I was. Yes it's a great place both for the opportunities to speak it regularly and get feedback from your fellow members. They also teach you good techniques.
Howard Farran: What are some of those good techniques?
Linda Douglas : Actually they have somebody called an Uh Counter who counts the number of times you say um, uh. That just gives you an awareness of how you project your voice and how you speak and communicate.
Howard Farran: I think them, what was that book outlier where Malcolm Gladwell said that all the experts basically spent 10,000 hours before they got to the top and the average person 10,000 hours was about 10 years. I've noticed that speaking, I've spoken a lot since I was 27 I think about 1,500 times and what I've noticed is the three times in my career that they ... you know back in the day you had these slide carousels so you had this big suitcase and you had 6 racks of slides and all this crap and your suit was in there and your fancy shoes and all this stuff. You travel comfortable in sweats and everything, all three times they lost my luggage and I'm sitting there in Nike tennis shoes, and sweats and a sweatshirt and you're thinking this is just the end of the world. At the end of the seminar, those were the three best seminars I ever gave in my life.
I always look back as those tragedies that if I was talking to you about your daughter, your daughter is 31, she's the love of your life, I met her in Las Vegas, she absolutely has your beauty, your karma, she's just a doll. If you and me were going to talk about her for an hour you wouldn't need power point, you wouldn't need to put on a dress suit, you wouldn't need Sunday shoes, you wouldn't need a mani pedi and we would just be sitting there. I always looked at it as if you just go there and talk about, like you say some thing you're already passionate about, something you don't have to study about, something you don't have to memorize.
This is all from the heart passion, if that's what you're talking about get rid of all the slides. It sucks because the way these dental meetings grade you, well did they have proper handouts, did the lecture follow the slides? It's like the whole critique of the seminar, it's like whoever is writing the critique obviously is not even a speaker because ... and that's why I do stand up. Stand up I think is the ultimate performance. You don't get to take power points and slides and toys and props, you're just up there with the microphone and you crush it or you bomb. You learn in stand up that everything around you is a crutch and the best speakers are the ones that are just holding the mic and talking to you like you're a friend. They can explain the concept and you can see it in your brain without some power point or some slide or some handout or some sample. You know what I mean?
Linda Douglas : Yeah.
Howard Farran: That's why, I also think I like to do stand up because it gets all the performance juice out of you so when you go to dental you can concentrate on dental. Instead of joke telling and cracking up the audience because so many time you walk out there you just want to make them laugh for 8 hours, they're not at a comedy club they're at a dental convention so get your yahoos out at a comedy club and then go try and talk about dentistry. It's hard to keep my mind focused on dentistry. What's going to be your 3rd dental town CE course, I know you have another one in that amazing brain of yours, what topics are your passionate about now? You've done xerostomia, you've done fascinating facts about saliva, 7 strategies for xerostomia management. If you did a 3rd online CE course someday what do you think it would be on?
Linda Douglas : Well I'm speaking at the towny meeting next year and I'm going to speak about care of patients with eating disorders.
Howard Farran: That's anorexia nervosa, bulimia?
Linda Douglas : Yeah.
Howard Farran: The dental diseases caused by them, vomiting an acid vomit over their teeth and dissolving their enamel?
Linda Douglas : That's right and I think most of us are aware of those things, but there are a lot of early warning signs which I wasn't aware of previously until actually one of, this is about 10 years ago, one of my patients said to me her daughters recovering from an eating disorder and could I be vigilant for signs of relapse. I said yeah sure, then I realized I didn't really know that much apart from the erosion. I did a lot of reading about it and had a couple of articles published earlier this year and so I decided that should be my topic for this convention. Also, we have a very important part to play in dentistry in secondary prevention of eating disorders. We're often in a better position to spot the early warning signs than a physician. Then we can refer them to get help.
Howard Farran: What are those early warning signs?
Linda Douglas : There are things like with bulimics, they might have an abrasion on their knuckle.
Howard Farran: On their hand knuckles?
Linda Douglas : Yes, from inserting their fingers to induce vomiting. They might have certain skin conditions that suggest malnutrition or their demeanor might reveal, they might be a bit dazed because of electrolyte imbalance or dehydration. There are lots of things we can look out for.
Howard Farran: What is, is anorexia nervousa very different than bulimia?
Linda Douglas : There is a bit of overlap. Some people with bulimia were formerly anorexic and some had a problem with binge eating and were obese and then they became bulimic. Some anorexics also purge. They main difference between an anorexic who purges and bulimic is a person with anorexia is severely underweight where as bulimics are usually more of a normal weight or slightly over weight.
Howard Farran: Is it still, no offense with any of this but is it still mostly a woman disease, a female disease?
Linda Douglas : It is but there's an increasing number of males with the disease. Males also seem to tend to have problems with muscle dysmorphia where they might think they're really puny when they're actually very well built. They perceive themselves as very puny.
Howard Farran: Is that, do those guys, are those the ones doing all the steroids in the gym because they see body dysmorphia and they just keep injecting?
Linda Douglas : Yeah.
Howard Farran: When I go to the gym I look at some of those guys and it's like you really look at them and you think there must be a mental disorder. I mean why would you be giving yourself a shot of that in your glute, because they'll talk about it openly at the gym I go to. It's like why would you take a shot of that in your ... you already look like you can't touch your hands behind your back. You already look like you've lost half your flexibility. You look like you're morbidly obese but with muscle and I ask all my friends that are women down there, I say do you find that attractive and all of them say, I think it's gross and there's something wrong with you to want to look like that. Do you not agree?
Linda Douglas : I think definitely if they go to such lengths to achieve this extreme muscle max that yeah there is a problem. If they're going to sacrifice their health to do it. The whole point of working out is to be healthy.
Howard Farran: Yeah, so body dysmorphia that is, they say, I always see that cartoon where a fat man is looking in the mirror and then the mirror shows an image of a body builder and then a beautiful woman's looking in the mirror and it's showing an image of an overweight lady.
Linda Douglas : Yes.
Howard Farran: That's probably not because of a boy or girl probably because of the way our society objectifies women.
Linda Douglas : Yeah definitely social factors are very significant in eating disorders.
Howard Farran: Also ...
Linda Douglas : The average fashion models about 6 feet tall and 117 pounds, which is like very few people can look like that. Actually I've seen a few models around town near my office and in person they're like a different species. They're very tall but they're very small boned, they're just elongated. It's just like a specific kind of genetic type.
Howard Farran: what do you do for the erosion on the teeth? Are they usually sensitive, is the anorexia nervosa purging or the bulimic, are they complaining to the hygienist that their teeth are sensitive from this or do they openly admit it ... if you just ask this patient is she most likely to admit it or deny it?
Linda Douglas : Most of them don't admit it. They'll say they have a lot of food allergies or something like that so they can justify their restricted diet. They're very concerned with the appearance a lot of the time. They'll end up going to the dentist because they're concerned about their appearance.
Howard Farran: What about sensitivity? Are they complaining about sensitivity?
Linda Douglas : Yes quite a few are complaining of sensitivity.
Howard Farran: What do you usually recommend for that? Back to that Sensodyne or?
Linda Douglas : That can help but the main thing, it's quite a dilemma for us actually because a lot of them are quite secretive. You can make them, if they're open about their condition you can make them a guard that they can wear to protect the teeth during purging so that the acids don't, to minimize that. Yeah they need similar remineralization and desensitizing protocols.
Howard Farran: Also it helps with the girls that I've talk to is that right after you purge the acid has softened your teeth so that is exactly not the time to go take an abrasive tooth paste and start scrubbing your teeth. Go neutralize that with water and swish with water and try to wait as long as you can and maybe take some xylitol or mouth wash but don't get in there with Colgate and crest, an electric tooth brush on that softened enamel.
Linda Douglas : Exactly, yeah. They can rinse with water with baking soda to neutralize the acid.
Howard Farran: Then I also want to say something to the young kids, their coming of out school and they look at someone like me and Linda and they say I'm going to go work for this guy or this gal because she's going to retire in a couple years. It's funny because I can tell all the young people that when everybody says they're going to retire, when they get up to the retirement age they usually don't retire. Your, what are your thoughts on retirement now that you're getting closer to these magical dates where people say you're done, hand up your shingle and retire. Do you want to retire?
Linda Douglas : No! Actually now it's like those numbers are quite meaningless to me now because I'm enjoying, I think I'm enjoying the profession more than ever actually and I feel I have, at this phase in my career I think I have a lot to offer to patients and to my colleagues.
Howard Farran: Yeah and I also will turn to a 25 year old and I say what would you think of never earning a paycheck again. They're like what I can only survive 2 weeks. Well it doesn't matter what you make, it's what most humans spend and I never find a 60 year old or a 65 year old dentist who says yeah I don't need any more money. Even if they have a lot of money, even if they're debt free, if you're debt free and you have a lot of money you still, you just have bigger grander goals. They'll want to go here for a month or they'll want to go to the safari or they want to help their kids or their grandkids. I don't ... I think that's the basis of the entire economy is that 7 billion people wake up with wants and needs and since everybody wakes up with wants and needs, that's the economy.
Until, I don't know what a magic age does to where a human wakes up and says I don't have any more wants and needs, I don't need any cash. I just want to sit around and watch Oprah Winfrey all day on TV and watch Jerry Springer for two hours in the afternoon. I think they finally get really good at their profession, I mean you've done it 10,000 hours, you've done that 2 or 3 times. You get really good, your money gets better, you still have wants and needs and so whatever you think your retirement goal is, its not going to happen for a myriad of reasons.
Linda Douglas : Exactly.
Howard Farran: I know dentists who got jobs with dentists that were 60-70 years old who was telling them they're going to retire in 2 years and that guys still working 20 years later.
Linda Douglas : I think that's great.
Howard Farran: Yeah, I do. I think wanting to retire is a sign of burn out or depression too. If you say you want to get out of dentistry and then go start a whole another career that's exciting. If you just say you want to get out of your profession and just not do anything, I think that's a, I think that could be a red flag.
Linda Douglas : Yeah. Nowadays retirement means something different. Nowadays it means just a change of pace or a slight change in direction but not ceasing to work.
Howard Farran: What are your hobbies then, what do you do to be well rounded?
Linda Douglas : My hobbies?
Howard Farran: Is your daughter still home or has she moved out and flown away?
Linda Douglas : No she lived in Japan for a while but now she's back.
Howard Farran: She was singing in Japan?
Linda Douglas : Yes.
Howard Farran: Did you go and visit her in Japan?
Linda Douglas : No I didn't, the year went so quickly and then my mother was ill in Barbados so I didn't get to Japan unfortunately. Yes I would love to go there.
Howard Farran: Do you visit your mother a lot in the winters, do you leave that cold Canada, go down and visit your mother in the Caribbean?
Linda Douglas : Yeah, once or twice a year.
Howard Farran: Is that still home to you?
Linda Douglas : No I've never lived there because I was born and raised in England so...
Howard Farran: Your mother and dad were both from Barbados?
Linda Douglas : Yeah but they lived in England for a long time and then they retired and went back to Barbados.
Howard Farran: That's were they were born?
Linda Douglas : Yes.
Howard Farran: Yeah I think that's a huge impact on people. My mother has two kids now living in Phoenix, me and my sister Shelly but she was born in that Wichita, Kansas and I think you're just, no matter how cold it gets, no matter how long the over cast, no matter how brutal the winters that's just all she knows. Could you see yourself retiring in Barbados?
Linda Douglas : No.
Howard Farran: Why not?
Linda Douglas : I, well I can't see myself retiring for a while yet and I like Canada, I could see myself spending a couple of months in the winter in Barbados but not to live there all the time.
Howard Farran: What's the different, do you ever pop your head in a dental office or talk to dentists or hygienists in Barbados, what's the difference really what's different about oral health and delivery in Barbados versus Canada?
Linda Douglas : Well less people have insurance so I think it's nearly all fee for service. There is no insurance kind of middle man and I think that the public health coverage is very limited.
Howard Farran: You would say on your observation as much complaining as there is about insurance and Obamacare and medicare and delta and blue cross, all the whining and complaining about the insurance, you do think that over all on a macro level countries with more dental insurance have a more robust dental industry? Would that be fair to say?
Linda Douglas : Yes.
Howard Farran: Or do you think it just comes down to economics that it's a more poor country?
Linda Douglas : That well, that's also a factory. I think definitely people having insurance coverage definitely drives a lot of the industry.
Howard Farran: Yeah so Barbados, that's close it's right by Trinidad, Grenada, South of St. Lucia. That's on the, on the Caribbean cruises they have the East, West and the South pack tour and you hit that on the South pack tour correct?
Linda Douglas : Yeah. It's the most Easterly island. It's furthest into the Atlantic.
Howard Farran: It's the most Easternly.
Linda Douglas : Yeah.
Howard Farran: Yeah right above Venezuela. I'm excited now that Cuba's opened up. Do you have any interest to go into Cuba and see what their dental schools are like?
Linda Douglas : Yes I would like to actually.
Howard Farran: I am just itching. I mean that society has finally opened back up with the United States. It's about time, long overdue. I would just love to go down there and see some Cuban dental schools. Do you think you might be doing that?
Linda Douglas : It actually hadn't occurred to me. I was thinking more of the beach.
Howard Farran: You were thinking more of the beach? How many, do you know anything about any other dental hygiene schools or are any in Barbados?
Linda Douglas : No, there's, they have the University of the West Indies so I think most of the islands have a campus. The dental school is in Jamaica, they have a couple of dental schools there. I don't think they have one in Barbados.
Howard Farran: No dental ... how many people live in Barbados?
Linda Douglas : About 300,000.
Howard Farran: 300,000 and the dentists are from Jamaica?
Linda Douglas : They're from all over. A lot of Barbadian dentists who study in the U.S. or Britain or Canada and then they go back.
Howard Farran: Did you notice this or not or is this completely unprofessional to say that a lot of times when you're down in the central, south American or the Caribbean and you find an American born in America, went to dental school in America, born and raised in America and practicing down there, that usually they had their license taken away?
Linda Douglas : Oh no I don't know about that.
Howard Farran: I mean I can name a dozen off the top of my head.
Linda Douglas : Oh no I didn't know that.
Howard Farran: They just said they're tire of the game, they're tired of all that and ... but anyway 10 for 10 thought it was the best thing that happened to them because they would never go back home.
Linda Douglas : Oh that's scary.
Howard Farran: You're going to be lecturing at the towny meeting? What is the date of that April ... do you know the date off the top of your head?
Linda Douglas : March 30th to April 2nd.
Howard Farran: I think that's sad that you know the date and I don't. Say it again it's March 30th ...
Linda Douglas : To April 2nd.
Howard Farran: You're going to be lecturing at that time?
Linda Douglas : Yeah I don't know which day yet.
Howard Farran: Linda seriously I don't know what to say to you, 7,000 posts. I mean I think I've read every single one of them since 2006. 9 years, 7,000 posts you share so much energy and karma and knowledge and love and respect and I've seen you cheer people up and educate them. I just think you're just a phenomenal person from your head to your toes. Thank you for all that you've done for dentistry, for dental town, for hygiene town, for towny meeting. Thank you for everything.
Linda Douglas : Thank you so, thank you. Dental town and hygiene town has sparked my professional development and help me to get my dental hygiene mojo back.
Howard Farran: Well you got it back in spades because you got it more than anybody I've ever met. Tell your husband and your daughter I said hello.
Linda Douglas : I will.
Howard Farran: Okay bye bye.
Linda Douglas : Lovely to see you.
Howard Farran: Lovely to see you.