Dr. Kanka

Hey all,

Not to much going on in my life.
I started watching Black Hawk Down and only got about 20 minutes into before I fell asleep on the couch. Not because of the movie I have just been tired lately.

One funny thing...I haven't told you I have started Marathon training. Now for those of you who have been with me for the whole time, I think, my marathon blog was the funniest of all of them.

Anyways we are about 2 months into our training. I am signed up to do the Marine Corps Marathon at the end of October and the Miami marathon at the end of January of '09.
We are slated to run 18 miles on Saturday morning at 4:15am. It just sounds crazy as I am writing it.
The funny thing is I have not lost any weight since the start of my training. Last year, as much as I ran, I never lost weight.
So I have always wanted to be about 10 pounds lighter to make my runs a bit easier.
So I found a guy that I run with and I noticed he is a little "puffy". So I asked him if he wanted a put a little wager on losing weight.
He was in.

$100 to see who can lose 5% of our body weight first. I am 200 (listen don't laugh, muscle weighs more than fat) , so I have to lose 10 pounds and he is about 170 so he has to lose 8 pounds.
This started about 10 days ago.
Okay so I am eating less, I have cut out all desserts, and I only drink water. At the end of the week I have lost 0 pounds.
Not one or a half pounds , ZERO pounds. I am eating 6 times a day like they say to do. I am drinking all the time.
I am eating a lot of fiber. All the stuff they tell you to do. I know it is going to take time but we are talking about a $100 bucks here.
So I talked to him on Saturday and he says he hasn't been feeling so well and he hasn't been eating either so he has lost 2 pounds.
Oh, crap, he is almost half way there and I have lost ZERO.

I know through hours and hours of running together that his weakness is MandM's. So I am resorting to Guerrilla tactics...I sent him two huge bags of MandM's today in the mail.
$100, as you may know I don't part with my money well.
That was low wasn't it.
If you can't beat them...cheat.

Okay on Monday.
I talked to you about John Kanka. This is a dentist/lecturer that is from Illinios. He has been around a long time.
I told you I like his passion and he was a pretty good lecturer.
We think a lot alike.
I told you he uses and pushes his own products.
I have a hard time jumping in with both feet when someone is pushing a product that they profit from.
So I wrote to the man at REALITY, Michael Miller. Don't think I am all that and a bag of chips, because anyone can write him. If you are a member you have the ability to use their forum.
But he moderates the forum. So I wrote him and he wrote me back in an hour. I asked him a question and he didn't know the answer to so he wrote the main man at 3M and he got back with me in another hour.
I was very impressed.
What an advantage for little guys like you and me. All I have to do is ask this guy and he will tell you the 411 on anything you want to know. He has NO vested interest in any product.

So I asked him about a couple of things.
I asked him about the Duralon thing. For all of you who didn't read on Monday, Kanka pushes Duralon for pulp exposures.
This is where he wrote to the 3M (the makers of Duralon) guy and his response was...3M doesn't even think that Duralon should be used for pulp exposures.
WHAT?!!
He even showed the article that Kanka uses to back up his claim and it says Duralon should NOT be used as a pulp cap.
Then I asked Dr. Miller what he thought of Surpass. This is the bonding material that Kanka made and now endorses.
He says that Kanka has not submitted it in to Reality to have evaluated.
Interesting!!
He went on to say that when Reality evaluated his last product, Simplicity, the results were very inconsistent. Meaning the product might not hold water, at least not all the time.

So Kanka has his own forum. So I wanted to give him the ability to defend what they were saying.
I went on Kanka's forum and asked him about the Duralon thing.
I was going to put the whole thing on here but it gets real long.
You can read it at your leisure.
You can tell by the way he writes that he kind of is an egomaniac (pot, have I introduced you to kettle?)
I am trying to get a straight answer out of him and he is being a smart ass to me.
Anyway you can read it yourself.

http://www.apexdentalmaterials.com/db/index.htm (if you do read it I would like to hear what you think)

Lastly, in another thread, I asked him if he has sent his new product to REALITY. And he just answered, "NO."
No explanation or anything.
I kept probing and asked him why.
He says, "I don't have a real good relationship with them (meaning they don't like me)" but he adds, "Gordan Christiansen and others liked it".

I have told you before that as a dentist it is hard to make heads or tails of products.
It is hard to pick products. You think you are going to pick a guru and use his products.
Then you see another guru and he says the first guru doesn't know what he is talking about.
This is a real problem in our profession.

I still think REALITY and CRA are the way to go.
But what if these guys don't agree?
I don't even want to think about this.

Have a great day and I will talk to you Friday,
john

AGD annual meeting.

Things are going pretty good at the Gammichia house.
Hilda is still up and down.
But doing pretty good.
Thank you all again from the bottom of my heart.

Charlie Wilson's War, very very good.
I told you I would like.
I only found one person that didn't like it but she is kinda weird anyway.

I saw a couple of people at the AGD annual meeting that I wanted to talk about.
First, I saw John Kanka.
He had an all day lecture on adhesive dentistry.
You know (....pondering.....) I really liked this guy. He thinks the way I do (or I think the way he does... It's my blog damnit).
He is passionate about teeth. He is passionate about filling teeth.
So what makes him so good, you ask? Well, first and foremost he is a clinical dentist. He is what they use to call a wet fingered dentist.
But, he does a lot of research...
I don't know if he has a lab in his office or he is affiliated with a school but he does a lot of research.
Like he was saying this certain technique is the best way. Then he would back this statement up, not by a bunch of bar graphs, but by cutting a tooth in half and showing the infiltration of die (or no infiltration of die in this case). Real research.
Very likable guy.
I saw him about 6 years ago and I didn't like him. I thought his ego was getting in the way of his lecture. I mean big time.
This time he kept it in check.
Maybe his ego is not as big. Because you all know that this profession (and life in general) has a way of knocking you off your high horse.
In this lecture, he broke down all his techniques and walked you through all his procedures.
He is a very good clinician and wants his audience to be good at it too.

He is my thing about Dr. Kanka.
He endorses products. I am totally okay with endorsing products that you are passionate about.
I am also okay with endorsing a product that you think is okay.
For example, when he talked about a product made by a company that you are being endorsed by (my opinion), he would say, "You should have a look at this product."
He didn't say, "This product is AWESOME you must have it" just "have a look at it."
I am totally cool with that.
It is when the lines are blurred is when I start having a problem with it.
For example, he owns or is part owner of a dental products company.
It is called APEX.
He has his own bonding material.
So what material do you think he talked about the whole lecture. You guessed it...HIS.
Now, it may be the best thing since etching but...
Then he talked about how he sat down with Gordan Christiansen last week (for those of you non dental people Gordan is close to the most trusted guy in product review) and Gordan loved the product.
So no documentation of this "sit down" or the studies that you guys did, I just have to take your word for it that Gordan liked it.
Oh, I almost forgot. He had another bonding material that his company made 6 years back and in that lecture all he talked about was how great this product was.
This time he talked about his old product with not nearly as much fervor.
So was it not so good then or is he just more excited about this product or does he make more money from this product?
See what I mean, blurred lines.
I really think his heart is in the right place but...

And the other thing about his lecture is things like this....
He talked about procedures that I have never heard before. I have seen alot of CE in my day (please see the FAGD at the end of my name) and I read quite a bit, and if I have never heard of it, I start to wonder.
For instance, what product do you use if you have a pulp exposure?
Dycal?
Vitrebond?
Just seal over it?
He says Duralon. Yes, I said Duralon. Like the temporary cement.
Then he flashes up a studies and some slides of pulpal response to Duralon.
One problem...the study was from 1978.
Now here is my thing. If it was so great, why are you the ONLY one advocating it.
And if it was so great, why hasn't there been any research on it since 1978?
I want to believe it. Trust me I want to be confident that I am doing the best thing I can for the patient.
But, here is the good thing. On his company website he started a forum.
He use to be a HUGE dentaltown guy and has since been turned off by it (I beat him by about 4 years).
He says he is the moderator of it and he answers all peoples questions about techniques and products.
The website has videos of procedures. Meaning if you buy his product you can watch a movie instead of reading instructions. I like that.

So all in all I liked the lecture and I like him.
About his bonding agent, I wrote to Reality (I told you about these guys before, a product rating company. Realityesthetics.com) and asked them about his products.
I will let you know what I find out.
If you get a chance to see him...check him out.

Hope you are having a good Monday,
John Gammichia DMD FAGD (it still is cool to write)

A trip to the doctor.

Wow.
You all have really been the hand of God for my family.
Thank you so much for all your emails and comments. It really means a lot.

As good as "this sucks" goes...it went pretty well.
We went to a hospital only for Women and Children, so the staff was very kind and empathetic.
My wife is doing pretty good. Still very emotional and a bit soar but pretty good.

Okay lets talk about happier things.
I finished Black Hawk Down and it was very good.
I moved the movie up the the top of my Queue. I saw it a lonnng time ago so I want to see it again.
I finished 10,000 B.C. I don't know about this movie. It was all right. I thought it was weird that people that lived 12,000 years ago spoke English, very convenient.
I watched a movie last night called The Last Battalion. It was about WWI. It was okay for those kind of movies. Not my thing though.
I started watching Charlie Wilson's War, I think this is my kind of movie.

I am going to talk to you about my Fellowship soon but my camera pooped out in the middle of the ceremony so I asked my friend to take a bunch of pictures and he has failed to mail them to me. So when he mails them to me I will write the Fellowship blog.

Because of something that happened to me, I want to revisit the Tier stuff again.
During the pregnancy my wife found another OB-GYN. Turns out her last OB wasn't delivering babies any more.
Is this a problem in your state? In Florida we are having a real hard time getting OB-GYNs to either stay in our state and/or deliver babies.
Two reasons...first, people want to sue these doctors for all the problems they are having with there newborn and second, because of the first reason insurance premiums are so high.
Can you imagine OB-GYNs not making any money? Well that is what is happening in Florida. We have had 5 pregnancies and 4 OBs.
So my wife went to this new OBs office for the first time. That night at dinner I asked her how her appointment went. (Well if kind of went like this, "Aren't you going to ask me about where I went today?"
"Yes, how did it go where you went today?"
"You don't even know where I went today, do you?"
"I am sorry honey, no I don't know where you went today. Did I tell you you look like you have lost some weight.")
So we started to talk about her first visit at her new OB's office.
"It was awesome." she said. "You are not going to believe it."
Then she went on to tell me how it went.
She checked in. Then she tells me that the office manager came out from behind the desk and introduced herself to her. The office manager told her that she has been there forever and plans to be there til the place closes down, so if she ever needed anything just to give her a call.
"That was nice" my wife thought.
Well, from then on it was more of the same.
The doctor brought her back on time and had reserved 30 minutes to be with her (in dental time this is like 2 hours).
He was very friendly. He joked with her for the rest of her appointment. He and her assistant joked and involved Hilda in their conversation. All in an attempt to make my wife more comfortable.
Then the doctor brought it all home with, "if you need anything, I am available to you 7 days a week for 24 hours a day." My wife just about fell out of her stirrups. She was impressed.

So much so that my wife came home and raved about this guy and his office.
She says to me that she is always hearing me talk about how to make my office better. She knows what a premium I put on how my staff treats patients. She knows that consumer service is neck and neck with being a good dentist on the most important scale.
I was so impressed.
I was so pleased to hear there is a doctor that cares I was compelled to write him a little note.
I told you I like the written word. I have these cards with my initials on the outside and I have them to jot a note to someone.
I got a card out and wrote him a note. I thanked him for taking such good care of my wife. I told him how impressed with what I heard about the office and that I was looking forward to meeting him.

So in all the hoopla this week, I had to go to this doctor's office with my wife.

I was excited to see the place. I imagined a very nice cozy reception area. Maybe some cappuccino and biscotties in the reception area.
I imagined all the front staff in business uniforms. The back staff in matching scrubs. I imagined warm tones and art on the walls that matched the theme.
My wife had built me up so much about the practice she didn't tell me anything about the plant.
When I walked in I was amazed. It was so BAD.
It was a reception room that was square. It had 15 or so chairs against the walls. White linoleum on the floor. NOTHING on the white or light pink walls, no art no information boards, no TV. NOTHING.
The staff where all in different scrubs.
It looked right out of the early 80's.
We were escorted back to his office. It was more of the same. Ziggy (yes, I said Ziggy) card holder on his glass desk. His circa 1970 diploma frames on the walls.

Now you have to understand my wife LOVED, LOVED, LOVED this office.
Now she knows what a warm office looks like. I am not tooting my own horn here but I think I have spent a great deal of time and money to make my office feel warm.
My periodontist"s office is so nice. My orthodontist's office is super warm.
She knows what warm tones are. Carpet and maybe a fountain on the wall. Art and uniforms and how an office can look profession.

But you know what? It didn't matter to her.
The people are what mattered.
I learned a lesson here.
You can have an awesome plant and if you don't back it up with the people you have lost. They can see right through the smoke and mirrors.
And...
You can have awesome people and have just an okay facility and your office could knock the socks off people.
A consumer wants to know that are being cared for. I can imagine that sometimes the facility might get in the way of that.
Something to ponder.

Interesting, huh?
If you have any thoughts about this, I would like to hear from you.

Have a great weekend,
Because I took yesterday off, I am working on Monday.
Talk to you then,
John Gammichia DMD FAGD (How do you like that? Has a nice look to it doesn't it?)

Run Forest Run

Hi y'all,

Remember on Monday I had to cut the blog short because of a doctor's appointment. Well we went.
For the new to the blog people, I will give you a quick up date.
My wife is pregnant and everything was going pretty good.
About 4 weeks ago (at about 11 weeks into the pregnancy) we were hit with the news that something was wrong.
The baby had something called a Cystic Hygroma. This was an accumulation of fluid on the back of its neck. This was not all that great. The prognosis was such...25% chance everything was going to be fine, 50% chance there was going to be some sort of chromosome problem with the baby, and 25% chance the baby wouldn't make it.

Now since I have told you the original news, we have gone again and things were about he same.
Heartbeat was good and the baby was growing but the Hygroma was still there.
But also we have received some news from some experts that we know.
Our OB stated that, in his 30 year career, he has never seen a Hygroma before. This means that by the time he takes his first ultrasound (about the beginning of the second tri-mester) they have gone away. This was encouraging.
Next bit of news was that the word from another specialist was that if it was a chromosomal problem, that 95% of the baby's had Turner's syndrome. This is a syndrome that the female individual is sterile. They are usually a little shorter in stature and can't have babies, but other wise normal.
Also very encouraging.
So as Christian people we didn't really know what exactly to pray for.
I told you that my wife was praying for complete healing of the baby. That our baby would fit in the 25% of the kids that are born totally fine.
I was praying that God would things would be okay but if not then I was just praying the strength to be obedient.

So back to doctors appointment on Monday.
It is still kind of a stressful deal. I mean you are going in for an ultrasound and it is going to tell you how things are progressing.
I kept asking Hilda, "How are you doing?" She was always fine.
So they brought us back and the ultrasound woman began the sonogram.
There is a tense minute or so as she looks around and you know she is looking for things and clicking the buttons but not saying anything. It is eerily quiet.
I guess too quiet because Hilda asked, "Are we suppose to hear a heartbeat?"
The woman said, "Yes". There was no heartbeat.

Our baby was no longer living.

As I was watching the woman do her thing, clicking all the buttons and typing, I forgot the most important thing, the heartbeat.
Of all the things we were praying for, of all the things we were thinking. We forgot of the 25% chance it wouldn't make it.
This blindsided me. The woman said, "I am sorry guys, the doctor will be in a minute".
So it was Hilda and I in this dark room, it was tough.

But this is not the worst of it.
We had a miscarriage last July. This was not so traumatic. We found out we were pregnant and I week or two later they couldn't find the heartbeat.
Hilda had a D and C and that was it (men if you don't know what a D and C is ask your wife and if you are single look it up on the Internet, or ask your mom).
In and out of the hospital and she was in no pain, just a little sadness, and we went on with our life.
This one, because the baby died after 13 weeks, is too big for a D and C.
She has to deliver the baby.
We are going to the hospital tonight so Hilda can be induced.
Yes, like a real delivery. THIS SUCKS.
Then they went on to say that they can take footprints for you and if you want you can spend time with the baby before you leave the hospital.
Did I say, "This sucks" yet?
I wont get into all the gory details but the nurse at the hospital says she has seen this take 8 hours and she also has seen it take 3 days.
WHAT?!!
If all the stuff doesn't come out (maybe I am not sparing you the details) with the delivery, then they have to do a D and C.

So there it is.
So do me a favor, if you pray, pray for Hilda. As you can imagine it is tougher for the woman, very emotional, maybe a little guilt. Pray that everything goes well today and tomorrow and that she will heal inside and out.

Thanks,
john

photos

As promised...Photos.
Here is the pier at low tide.

Here is the pier at high tide, this is the scene of the rescue.

His is what I looked like when I went into the water.

It wasn't 5 seconds after I hit the water that I had all kids on me.

So there was no floating in the water enjoying a cool libation.

Hang, dunk, hang, "throw me dad". It was awesome, just not restful.

This water was at the Dolphin hotel at Disney. This was not the grungy pool at the Colony.

I could of sworn I took some photos of the resort. I took a picture that had an extension cord (the cheap white ones that come from Walgreens) coming from a breaker box. The breaker box was open. Only one more problem, there were three extension cords coming from the first extension cord.

And I didn't get any good photos of the 80's furniture in the room.

I will talk to you tomorrow.

Now if you get this blog as an email, I don't think the pictures show up.

So you are going to have to go to blogger.com

Have a good one,

I will talk to you tomorrow.

Its the little things.

How the heck are you?
Well I am back from vacation. As you already know I was in the west coast of Florida from Sunday to Wednesday, then home for one day, then off to the AGD annual meeting from Thursday to Sunday.
Wow do I have a lot to tell you.
Well, we are home now. We are broke and tired and I have to go to work tomorrow.
Tell me why we went of vacation again.

We went to a place called the Colony in Longboat Key.
In its hey day the Colony was the country's #1 rated tennis resort of about 10 years running.
We went there about 10 years ago and were very pleased.
This time was a bit different.

The place was obviously resting on its laurels.
This was a place that thought it was a Tier IV resort that was giving a Tier II product and service. See Tier Dentistry blog.
The rooms were very outdated. The carpet was old and the furniture was old. Awesome 70's pastel colors on the walls. You know, it just needed a little updating.
Not that we planned to spend a lot of time in the room but when it rains from 8am to 4pm you are kind of forced to be in your room.

Okay so the days we were not in the room (it only rained once) we went to the beach and pool.
The beach... well it was the beach.
I am being a little knit picky but the umbrellas were like 40 yards from the water. So we couldn't use the umbrellas and watch the kids. Not a big deal but...it's the little things.
Like the little things at our offices that we think of all the time to try to make a better experiences for our patients.

They advertise in there handout that there is snorkeling available, just ask.
I went to the little bar that you rent and reserve things from. I asked about snorkeling. Well, it turns out there is no guide and no set time. The snorkeling that we advertise is we give you a snorkel and mask and you go out and do it on your own.
Wellll, Okaaayyyy.
I guess I will take my two older kids out. I say, "Can I get three snorkels and masks?"
He says, "Well we don't have any masks or snorkels."
What?!!
Yeah, over the July 4th holiday they had a lot of guests and after the holiday they have been wiped out.
Not my problem. I don't care what you guys were doing a couple of weeks ago.
GO OUT AND BUY SOME.
The pool was grungy.
I mean, am I being unreasonable to want things that are advertised.
Its the little things.

It is a beach facility and there are condos everywhere. There are wood walkways everywhere.
I was walking on one of these decks and stubbed my toe on a nail sticking up about 3/4 of an inch.
I mean you have wood decks with screws in them. You have people walking in beach attire on these decks, which sometimes means barefoot. This is something that should be a concern for the maintenance people.
Its the little things.
There is more, but I have to go, the wife and I have a doctors appointment.
I took some photos that I want to show you. But I have my camera here but the cord is at the office.
I will show you these pictures tomorrow.

I watched Rambo last night. It wasn't bad. There was alot of killing but the movie was like 88 minutes long. I hate movies that are short.
I have 10,000 B.C. and plan on watching tonight.
I am more than half-way through Black Hawk Down. It is very intense. I find my leg shaking as I am reading it because I can't wait to get to the next line.
I will finish it soon. It is not as good as Lone Survivor. It is about 100 men as oppose to 4 men with Lone Survivor. So the book is all over the place and you forget who the characters are that you are reading about.
Maybe it is not suppose to take you a month to read this book.

Talk to you later, maybe tomorrow (with the pictures).
john

Associate's first blog

I am still on Vacation.
No movies, my stupid laptop will, for some reason, play movies.
We brought a bunch of movies to watch as a family and some for adults but now an error message comes up and won't let me play any video. I have 4 video players on my laptop and none of them work.
Have I told you I hate computers.

Anyways, we are having a very relaxing trip.

You all know that my father and I brought in an associate about 2 months ago.
It is so exciting to have a new dentist around. There are some challenges, as far as scheduling and what assistant is going to work with her. But we are working it out.
It has been a great experience so far.
I want you all to meet her so I asked her to write a blog.

It has been kind of crazy in my life so I am just going to put it in and you two talk.

“It Just Feels Right”

In 2006, Shelby called me to say hi. He went to dental school in Boston and had just graduated. He told me he was working on a case of multiple veneers. I asked him how he knew what he was doing (remembering that my University of Florida dental school education of veneers was minimal, and not until my General Practice residency did I actually do a veneer). He said he wasn’t exactly sure, but he just did “what feels right.” I guess that means he was just winging it and hopefully everything would turn out ok.

I’m not sure how Shelby’s case turned out, but I do think of him when I get in a situation where I’m not exactly sure what to do. Do I sometimes just do what feels right? Yeah, I think so. Given that dentistry isn’t a 100% clear cut science, sometimes that’s what you have to do. Clinical judgment isn’t something you learn much of in dental school. When you have professors there, you can just use their clinical judgment if you’re not sure. But what happens when you’re on your own?

Do you remove that last bit of decay, though you may expose the pulp, or leave it, hoping it will arrest? Do you keep searching for the MB2 canal in tooth #3, even though you are getting precariously close to perforation? Do you agree to do a single veneer on tooth #9 for a patient with extremely high cosmetic expectations? Do you remove a 3rd molar in very close proximity to the inferior alveolar nerve to help a patient in pain when the oral surgeon’s office is closed? Or what about the patient’s old crown which seems to have a small open margin on the on the mesial, yet it’s a retainer in a 6 unit bridge. Do you recommend replacement or just “watch” it? Will your professor give you some advice? Is he or she standing behind you and watching your every move? Nope! You’re all alone. You’re experience and thus, clinical judgment will give you the wisdom necessary to make such decisions.

I’m lucky to work at an office as an associate with 2 other dentists who are very smart treatment planners and exceptional clinicians (by the way, I’m John’s associate). So that means if I have questions, I have someone to ask, but ultimately every decision is mine and it is my dental license I have to protect. I wish that all of my boo-boos were limited to dental school and residency and now I won’t make mistakes. But, I know that’s not the case. Being 3 years out of school, I have gained a wealth of clinical judgment, but I think in order to learn all there is to know about dentistry I would need another 50 years of practice – and I surely won’t be working that long! So that means I will just “do what feels right” and hope my knowledge, clinical experience, and kindness will keep me from getting in trouble.

Nice talking to you,
Lets do this again sometime.
Regards,
Michelle Aliotti

See why we like her so much at our office.
I have to go. See you all tomorrow.
Even if you are not coming to see my little talk, please just come up and say "HI".
Talk to you Monday.
No blog on Friday, I AM ON VACATION.
john