Floss and Flip-Flops Episode 1

Let us introduce you to the Sanders sisters—Katrina Sanders, RDH, and Elizabeth Sanders, DPM! In this first episode of our new podcast, the sisters talk about the oral-systemic link and the impact it's had on their family.

Elizabeth Sanders, DPM 0:01
Hi, I'm Dr. Elizabeth Sanders a foot and ankle surgeon and assistant professor at Boston University Medical Center.

Katrina Sanders, RDH 0:08
Hi, I'm Katrina Sanders. I'm a registered dental hygienist, consultant, international speaker, and wine lover.

Katrina & Elizabeth Sanders 0:15
And we're sisters.

Elizabeth Sanders, DPM 0:17
I grew up looking up to my big sister, Katrina.

Katrina Sanders, RDH 0:20
And now I look up to my lady boss physician sister, Elizabeth.

Elizabeth Sanders, DPM 0:23
Together. We are working to unite the dental medical communities in unique and exciting ways.

Katrina Sanders, RDH 0:29
Welcome to Floss and Flip-Flops with the Sanders sisters, our monthly podcast...

Elizabeth Sanders, DPM 0:34
...where we unpack all things health-related from your mouth to your toes.

Katrina Sanders, RDH 0:38
So grab your flossy floss...

Elizabeth Sanders, DPM 0:40
...and slide on some flippy floppies.

Katrina & Elizabeth Sanders 0:42
And let's get on with the show!

Katrina Sanders, RDH 0:57
Hello, and welcome to the very first episode of Floss and Flip-flops. Yeah, hello. Are you excited for this?

Elizabeth Sanders, DPM 1:08
I am so excited.

Katrina Sanders, RDH 1:09
Oh my gosh, this is gonna be so good. So my name is Katrina Sanders. I am one of your co-hosts here on Floss and Flip-Flops. I am a practicing dental hygenist here in gorgeous, sunny Phoenix, Arizona. I work for EZPerio. We are the country's largest periodontal practice, and I work in the surgical suite with the doctors. My job is so cool. I don't see typical prophy or perio maintenance cases. I'm in the surgical suite with the doctors performing flap cases, laser-assisted osseous procedures, and helping the doctors with their new patient or their patients that are coming on in for post-op appointments. My job working clinically has been incredibly rewarding. And I love, love, love what I do so much so that I've decided to take it to the stage. So, I also in my free time—haha—travel nationally and internationally speaking on dental topics, things like periodontics, oral inflammation, local anesthetics, infection control, and of course our favorite the oral-systemic link, as a consultant, and a podcaster. It has been my pleasure to be able to share this knowledge with the dental community. But I've always had in my back pocket, for as long as I can remember, a secret weapon. And that secret weapon is my sister, Dr Elizabeth Sanders. Welcome, Dr Sanders to the pod we share a little bit about yourself for our fabulous audience.

Elizabeth Sanders, DPM 2:41
Yeah, thank you. Thank you for that intro. And I love being your partner-in-crime if you will. So I'm a podiatrist, a foot and ankle surgeon. I just finished being in private practice in Puerto Rico. And I am now practicing as a foot and ankle surgeon and assistant professor at Boston University Medical Center. So we do a great deal of obviously working on foot and ankle, anything with regards to foot and ankle pathology. But we also deal with it because we're in a University Medical Center, doing a lot of multidisciplinary research and multidisciplinary care on our patients. So, I have the benefit of working with a multidisciplinary approach. And because of that, I also do a great deal of research. And I think I've had a great deal of fun doing a lot of research projects with you, Katrina. We write a lot of articles together on the oral-systemic link. And we've found a really big passion for it. So. I'm really excited to begin this podcast with you.

Katrina Sanders, RDH 3:44
Yeah, I know, this is so exciting. And it's, you know, I want our listeners to know that this is really like a true Sister Act—we both are multi passionate people. And we both feel this massive push from the universe to use our voices to carry on, you know, a lot of deep messages. There's a lot of legacy within our family. So this is just, it's so perfect that we're doing this and I'm so excited to be able to be a part of this alongside you. This first episode is our introduction where you get to learn a little bit about who we are, and more specifically, why the oral systemic link is so important for us. I love that this is a conversation that we're having as a dental hygienist speaking to a medical provider. You know, it's interesting, we don't see a lot of these conversations happening. And I'm sure that you see this a lot, Elizabeth, in your professiom—that you guys have your conferences and podiatry are wound care, right? And you're talking about all of these different cases and it's so great because you all are collaborating. But the foot is one part of the body. And turns out there are a lot of blood vessels in it, and it's connected to the rest of the body. And ironically, we experienced the same thing in dentistry. You know, as a dental speaker myself, I show up to dental hygiene meetings or dental meetings. We're looking at cases and we're delivering this content, and I feel like I'm preaching to the choir. Or when I'm delivering oral-systemic content, it's like, everybody in dentistry, we want to kick up a seat to that table, like, we want to have the conversation about the oral-systemic link. And I think part of the challenge for us in dentistry is that we feel like the oral-systemic link is kind of falling on deaf ears. So, our interaction with the medical community is a challenging one. It is one where we want the medical community to acknowledge that if you have gum disease, if you have rampant decay, if you have pathology in your mouth, if you have an airway issue, if you've tethered oral tissues, if you have a TMJ challenge—these are things that we in the dental community are deeply focused on, that we are constantly screening for. And yet we run into a challenge where when we send a letter over to a cardiologist, or we send a letter over to an endocrinologist, saying, "Hey, we're seeing this patient...", and to an OBGYN, "We're seeing this pregnant patient. These are the procedures that we're going to be doing, is this patient safe? Do we need to be giving them antibiotics? Should we be withholding blood thinners?" That's really the vast majority of our interaction with the medical community as a whole. Yes, my hope is that there are people listening to this podcast that say, "Oh, not my practice. We're doing HbA1c testing, we're doing solidary diagnostic testing, we have a partnership with an endocrinologist, and all that." And that is terrific. And if that is you, please reach out to me because we'd love to have you on the podcast to talk about that. The idea being the vast majority of us in dentistry, we're still trained to standardize the fact that we need to take blood pressure pulse, respirations, and pulse ox on all of our patients. Right? So, that's part of our challenge in the dental community. And I guess my first question to you before we really dive into the episode, to really talk about the oral-systemic link is, where do you think that disconnect is in medicine? Where do you think the challenge is where we in dentistry feel like we're trying to put these Las Vegas flashing lights, saying, "Pay attention to us!" And yet we're struggling to really move the needle with medicine?

Unknown Speaker 7:34
You know, that's really interesting. Your question, I think, I would like to preface by saying that I was just at a conference in Puerto Rico and the president of the American Podiatric Medical Society came and presented to us and it was great to have him in Puerto Rico. And I think something really hit me hard when he said that his goal is to work to try to get podiatry to be considered equal to the medical community. So amongst MDs, DOs, his goal is to consider us part of that. So okay, he wants us to be able to take medical boards to try to be considered physicians alongside them. And he said, you know, at this particular point in time, the only real specialties that are not considered part of the medical field or equals to MDs/DOs are podiatrists and dentists. And he has a point to a certain extent. He said, "We're just not in their field, we're not considered equals," which is crazy. I mean, here I am, I was trained in residency and I did rotations on general surgery, plastic surgery, vascular surgery, medicine, rheumatology. So, the fact that, you know, now we're becoming more part of that medical community, I'm appreciating that more and more. And now we are able to take medicine boards, apparently to try to be equals to that, right? But then I do see where the dental community—it is very difficult, because maybe we're thinking because you guys are trained differently. I'm not sure. But I think you and I were just talking about this. I do think it's a give and take, right? I don't think you guys could easily say you know, dentists and dental professionals are not considered equals to medicine, because you guys don't see us that way. You know, we were trying to refer you to different specialties and you guys don't appreciate us that way. But it can also be a give and take where you don't believe in yourselves that your specialty is that important? And you and I, you know we wrote an article together and there are about 57 different diseases that are related to The oral-systemic link...

Katrina Sanders, RDH 10:03
57 different types of systemic diseases and conditions that have an interdependent link to periodontal disease.

Elizabeth Sanders, DPM 10:08
That's exactly right. And that's very important to understand and to know that your profession is very important in the medical community.

Katrina Sanders, RDH 10:16
Well, thank you for saying that. And you're right—it goes both ways. If we want, we in dentistry want to be seen as a medical providers, and yet, we're still trying to move the needle and getting people to take blood pressure, then the conversation has to be a collaborative one, a connective one. So I love that. It's important for me that our audience understand why the oral-systemic link is so important. Not just me, being a dental hygienist and you being a foot and ankle surgeon, but us as human beings, and more specifically as sisters. And that story begins back in 2018. In 2018, October 3, 2018, I remember the day I was working in clinical practice, and I received a call from home. Elizabeth and I are from a small town in the Midwest. And mom and dad, after raising 4 kids and sending us all off to college and, you know, hanging up their hat, so to speak, and getting ready to cruise into retirement, living their best lives on a golf course, somewhere, moved to central Wisconsin. So they were in Stevens Point, Wisconsin, and I received a call from home, a voicemail from dad telling me that I needed to call home that something emergent had happened. And Elizabeth and I come from the kind of town where home doesn't call you, you call home. So, this was a problem. I called back and dad relayed to me the information, you know the story of what had happened to him that day. Dad shared that, that he was going grocery shopping with mom that particular morning. They came home and dad was unpacking the groceries from the back of the car, bringing them into the kitchen for mom to unpack the groceries, he went out to grab the last bag and noticed that the birdseed was low in the bird feeder. So, he went out and refilled the birdseed and came back inside with the last bag, and found mom collapsed on the floor in the kitchen. Dad performed CPR for 10 minutes on mom while waiting for an ambulance to arrive. She was transported to a hospital in northern Wisconsin where doctors began running a gamut of tests to figure out what was going on—no heart attack, no pulmonary embolism, no stroke, they couldn't figure out what was going on. But they placed mom into a medically induced hypothermia to allow her brain to rest. You see, she had been without oxygen for several minutes, which was long enough to start to cause some damage to her brain. After she was placed into a medically induced hypothermia, it was decided to slowly bring her back and to see if she would begin breathing on her own without the use of machine support and if she would make it out. And of course, those of you who know us and know the story, you know that doctors had to sit down with my family and with dad and give him the impossible news and tragic news that mom was not going to make it—that she would likely remain in a vegetative state if we chose to keep her on life-saving measures, and that the humane decision would be to remove her from life support and harvest her organs and tissues and her eyes for donation. We're very proud. Many people are alive today, science has used mom's lung cells for research on the COVID-19 global health crisis. Quite honestly, we're very proud of that. But the reality remains that we had to say goodbye to our mom, who passed at 62-years-old due to an airway obstructive disorder.

The tragedy of the story continues to unfold. You see, the morning that mom collapsed in the kitchen. She felt like she was struggling to breathe. And so dad took her to an ear nose and throat specialist who scoped her throat and told her she had some scar tissue in the back of her throat, but other than that everything looked alright. Here's a Z-Pac, come back in 2 weeks. And the reality is that what was occurring in mom's situation was not normal, it was not okay. She should not have been given a Z-Pac and sent out for 2 weeks. This was a devastating error that was made by a physician who likely had several other patients with insurance plans X, Y, and Z on the schedule that day. And this was a massive oversight that resulted in tragedy. And so that amplified, it illuminated a light. Our mom was the kind of mom that when we fell down, after like running down to the bottom of the street and back or riding our bikes, we'd fall you know, skin or knee or whatever we'd have, like gravel like embedded in our knee. And we'd say, "Mom, we fell down," you were like, bleeding from the face. And she'd go, what would she say, Elizabeth?

Elizabeth Sanders, DPM 15:55
"Tell the ground, you're sorry."

Katrina Sanders, RDH 16:00
That's what she'd say. She was like, no-nonsense, right? So mom was one of those people that like you just didn't, you weren't a victim, you didn't pity yourself, you got up, brushed yourself off, and kept going. And who would we be to sit in this deep tragedy instead of talking about the realities of what's going on? And so we just aren't cut from that cloth. We are cut from the cloth of this is now our mission, this is our purpose. It is wildly unacceptable for somebody to trust their medical or dental professional; wildly unacceptable for those of us who have certifications on a wall and said an oath and wear a white coat with all of our credentials; it is wildly unacceptable for somebody to trust us if we're going to squander that trust and that responsibility. And so it really illuminated a lot for our family, we really, we rallied behind the state of Wisconsin Organ and Tissue Donation Foundation. Dad was, you know, a huge advocate, you know, we would go back to Wisconsin and go, you know, to the 5ks. And Elizabeth, you and I, that's when we really started to kind of get the message off the ground about this oral-systemic link. We were doing programmatic content and then donating the proceeds from those programs back to the state of Wisconsin. You know, things were really, you know, moving in a positive way.

Elizabeth Sanders, DPM 17:21
Yeah, it absolutely was great. And it was great for our family even. And I do remember, even when COVID had started, you know, we did the Wisconsin 5k virtually, and then we only we planned our own right? We planned a 5k. Anyone who wanted to contribute on behalf of mom, we contributed all of those funds to organ and tissue donation. And dad was really proud of that. He really, truly was. And unfortunately, because of COVID, we were not able to see dad very often, you know, he was kind of in the middle of Wisconsin and all his children were all over the United States. Thankfully, your work schedule, Katrina, allowed you to go and visit him every once in a while, which was amazing. But you know, that doesn't mean that our story ends. So a kind of deja vu occurred with dad. It was in December, the middle of December. And I do remember, I don't know if you remember this Katrina—he texted me with a picture of his toe on a Monday. And I go, "Oh, my gosh," I called him immediately because he had some bleeding from his toe. And I said, "Dad, are you feeling okay?" And he said, "Well, I haven't been feeling okay the past week or so. But I'm feeling better now." And I said, "Well, I mean, that's something it could be COVID toes," but I don't know how he would have been exposed to COVID at that particular point in time. And of course, it's December. It's getting really cold in Wisconsin. And he, you know, we have a dog Maverick. That's my mom and dad's dog, and he would take him for walks every single day, in the bitter cold in the wintertime. And I do remember, it was a Friday night when he called our sister and said, "You know, I'm really not feeling well. Is there any way that you could come and pick me up and take me to the doctor tomorrow?" And that's coming from our dad, right? That's not something that he wouldn't necessarily say. Then the next day, unfortunately, all of us tried reaching him and we weren't able to get in touch with our dad. Finally, our brother decides to call 911 and the police go in and they find him on the floor collapsed. He's conscious, but seems very, very sick, in a daze and out of it. So, they transfer him immediately to the nearest emergency room. I then got the phone call that he was in an arrhythmia and that he seemed very confused. I asked if I could speak with him over the phone. And unfortunately, because of COVID, they did not allow anyone to use the phone out of precautions. So we did have to shock his heart and intubate him at that time. Then he progressively got worse and worse and worse. And it seemed as if he was becoming septic because of pneumonia, he had left upper lobe pneumonia. Finally, after he failed dialysis, and it seemed his body was just not recovering, we had to let him go. The terrible part of this is that just about 2 or 3 days prior to all of this happening, he had his follow-up appointment for a small skin lesion that was removed on the back of his neck and was found to be a basal cell carcinoma. And they had just removed his sutures. And they said, "You know, there's no need for follow-up. Everything seems okay." So I think what we've learned from this is that when professions are so easily ingrained in their particular specialty, they don't necessarily tend to look at the patient in front of them as a whole, and other things that they may be complaining about. Which has really prompted us to move on and try to make all specialties equal.

Katrina Sanders, RDH 21:46
Yeah, the issue is the isolation. If my job is to only look at your sutures, Mr. Sanders on the back of your neck, and forget the fact that you probably had a fever and you were beginning to become septic from a walking pneumonia—never mind the fact that I have in your social notes that your wife died 2 years prior, and you live by yourself in northern Wisconsin and your adult kids live all over the country. So you're taking care of yourself, you know, who's watching you? Who's in charge of that? And, you know, I think the challenge becomes in, and those of you who have been a part of or have seen this tragedy unfold, dad passed in December of 2020, not from COVID, but from septic complications affiliated with pneumonia. I think it's important for us to remember that we, as providers said an oath on our graduation day, we promised for better or for worse, in sickness and in health, that we would serve the community to the best of our abilities. And it turns out with the beauty of research, with the beauty of science, with the beauty of technology, all the things that we have at our fingertips, serving somebody to our best has now been elevated. And it's important for us to understand this because episode 1 really is unfolding for all of you why the oral-systemic link is so important for the 2 of us. And it is important for the 2 of us because mom's airway issue was not just an issue for the ENT who saw mom that morning. That was an issue for mom's dental hygenist, who stared down mom's airway every 3 months when mom went in for periodontal maintenance, and never at any point in time saw the fact that mom had an advanced Mallampati classification; she snored; she slept with multiple pillows; she had GERD, and she had diabetes and hypertension. She was a perfect storm of somebody who had an airway issue. And nobody was talking to her about it. Right? We just assumed "Oh, you're seeing an ENT, so you're fine." Instead of sitting down and saying, "This isn't right." And so, I think the challenge and then, of course, being a dental hygienist and having my father pass from pneumonia, and we understand the interdependent link between oral health and pneumonia. I mean that there's a lot of pain, there's a lot of sadness, there's a lot of guilt there. But I'll be the first to tell you that mom and dad didn't raise us to squander our voices and to squander our hearts. This is not just our legacy, but the legacy of mom and dad's. And so it's important to us that the dental and medical communities begin to really start having a dialogue about the oral-systemic link and what our responsibilities are within that and how we can be better partners in that. I've seen some incredible data about, for example, the fact that the average primary care physician gets 9 minutes and 36 seconds to do a comprehensive exam on a patient. That's just not...

Elizabeth Sanders, DPM 25:05
That's unbelievable. There's not enough time to get through each system. Not at all.

Katrina Sanders, RDH 25:11
There's no way you can, right? So all you're doing is you're waiting for somebody to complain. And in dentistry, don't we do that? Don't we sit and ask the patient, "Anything bothering you?" And if they don't say anything...

Elizabeth Sanders, DPM 25:19
...you just put your hand in their mouth!

Katrina Sanders, RDH 25:20
We just shove our hands in their mouth. We just get going, right? Half of us aren't even I mean, Horowitz et al. said in 2005, that only 15% of people who present routinely to the dental practice actually get an oral cancer screening. The vast majority of us aren't even periodontal probing our patients. We just have data that says that only about 1 in 5 adults actually get routine perio charting done. I mean, it's the reality becomes, this is what's happening, we're waiting to identify something symptomatic. And if it's not, then we just cruise ahead, and we do what we've always been doing. And the reality is what we've been doing, has made people sick, and has squandered the trust that the community has in somebody who wears a white lab coat. So, I think it's important for us to really, you know, have this dialogue and to really unpack what this dialogue is doing, for not only our individual professions but also for the community. With that, we're going to wrap up today's episode, I know we have a lot to talk about, Holy cow! Sorry to be such a downer. Those of you who are driving to work or whatever you're doing listening to this, we're sorry that we're such downers. But my hope is, that if nothing else, that you hear this message, and you then return to your clinical practice, today, tomorrow, next week, and you see that patient in your chair and you see that patient is somebody's mom, or somebody's dad, or somebody's grandparent or somebody's wife. Because the reality is, while we look at the science, and we're going to talk a lot about that over the next several months in our episodes, the reality is these are human beings, and they're somebody's the loved ones, and we get the beautiful gift of being able to serve them. So, thank you for joining us today. As we brush up on some important information coming down about the oral-systemic link,

Elizabeth Sanders, DPM 27:09
we promise to keep you on your toes!

Katrina Sanders, RDH 27:28
Cheers. Thank you for joining us for another monthly episode of Floss and Flip-Flops with the Sanders sisters.

Elizabeth Sanders, DPM 27:35
Thank you for being part of the change we need to see in the medical and dental profession.

Katrina Sanders, RDH 27:41
Join us next month for another sister-to-sister chat about other unique, interesting, and perhaps provocative and disruptive health topics.

Elizabeth Sanders, DPM 27:50
Don't forget to like and subscribe and maybe even leave a fabulous review!

Katrina Sanders, RDH 27:56
And we'll catch you next month for another episode of Floss and Flip-Flops with the Sander sisters.