Behind a Smile with Dr. Shauntel Ambrose
I host a podcast that shares the secrets behind some of the most resilient healthcare businesses worldwide, innovative products, savvy strategies and daily inspiration to reach your ultimate in your healthcare career. I interview the movers and shakers of healthcare who courageously push boundaries. Whether you a start-up, or needing a push to keep going or a family business or looking for mentorship without the business know-how. This is an all-inclusive, keeping it real, not for the faint-hearted, haters or the nay-sayers live your best life as a member of a global community in healthcare podcast!
Behind a Smile with Dr. Shauntel Ambrose
Elevating Life Quality through Collaborative ENT Care
Embark on an auditory journey with me, Shauntel Ambrose, as I engage in a riveting conversation with Dr. Karjieker, also affectionately known as Dr. K. Our discussion hones in on the importance of a multi-disciplinary approach in ENT medicine, revealing how it intertwines with our daily lives. Dr. K, an esteemed ENT specialist from Cape Town's Chris Barnard and Life Vincent Palloti Hospitals, shares his profound insights into how adult snoring, obstructive sleep apnea, and sinus diseases can significantly impact one's well-being. We converse about the vital role of collaborative healthcare in enhancing life quality and examine the ripple effects of ENT interventions, such as tonsillectomies, on breathing and overall health.
Prepare to connect the dots between sleep, breathing, dental health and holistic health as we traverse the intricacies of this relationship. Our spotlight on the intimate connection between these elements underscores the impact of allergies, dietary habits, and how they influence sleep quality.
Lastly, we navigate the managerial aspects of healthcare, focusing on the motivation of dental teams within the delicate framework of ENT surgeries. We unravel the selection process for stellar medical teams, designed to tackle the unpredictability of these complex procedures. The conversation then pivots to the ethics of patient management, paediatric care delicacies, and patient prioritization strategies.
Find Dr K at:
www.breath-right.co.za
drk-ent.com
I'm Shantel Ambrose and I'm a dentist and I host a healthcare business podcast that shares tips from the healthcare industry leaders. So whether you're a startup or needing a push in the right direction, a family business or just looking for mentorship, join us. I'm Shantel again and I have an important guest in our studio today. It's Dr Kajika. You know he goes by a very sort of he says, just call me Asghar, just call me Dr K Very, very personable nature.
Speaker 1:I want to talk a little bit about all of your expertise before we start. So you are a doctor that's specialized in ENT and you're working now in Chris Barnard Hospital as well as Vincent Piloti Hospital in Cape Town. You have had some experience abroad as well, and I'm singing your praises today because I am part of a group that you are at the forefront of in terms of new ways to deal with how teeth come into contact with breathing and how that changes the way we see and treat our patients at a collaborative level. So you're here today to talk about what your love jobs are, it looks like. So you specialize particularly in adult snoring, in obstructive sleep apnea, in sinus diseases, and you do a lot of medical surgical management CPAP management for general pediatric ENT, so welcome.
Speaker 2:Thank you very much and thanks for coming. I'm honored that you're here.
Speaker 1:So, dr, you know, listen, I would love for our audience to hear a little bit about how you got into medicine and what led you onto the journey of specializing for ENT.
Speaker 2:You know we all go through what we like and what is something that happened? I took the Q and A switch in one year BAC, two years in the room, four months somewhere and then I went into UCT. But for my client here this week is interesting. My first two months were in DET and no one else everyone gets to do so. People per year do that. So the first day I left morning and the registrar was not a profit, he tells me hey, let's do it Saturday morning, do the intern, you can go over a few Monday. I said this I like it was a Monday to Friday. I was first on call. I loved it, they told me a lot, I did a lot of updates and then the next year I went to UCT do some ENT work there and they allowed me to upload there. The thing was I was only called after midnight twice in 18 months. I said, okay, this is looking, I can live with this, put the lights down and then I got drawn to it.
Speaker 2:I ended up specializing and even after I specialised I worked in UCT for a couple of years and I was just dedicated to snoring. Not everyone was my colleague. He was like he didn't make it over here. I love snoring, I love helping people do better, I like to breathe and sleep better. In fact I'm more of a senior person. I'm sorting all the peripherals and a lot of things go unrecognised and I like picking up the line for this. But then I started. On the next day I went to the unranked course, I instituted some interventions medical, surgical, all the line and then you know, you are a person and the people must leave without the seeds, something dancing to them with their wealth. They might leave happier or feeling better than when they came into the rooms. That's basically me and my thoughts.
Speaker 1:Well, it's wonderful because I think that that journey has enlightened so many people. You know, I really admire the collaborative way you're going about doing your work and getting people involved. It is absolutely amazing what you're able to accomplish as a team and a team at large. So I'm really excited to have you on today and to talk about these. Really, you know, they've been around and people have been doing them, but not in a level of collaboration that you're able to do them in. So the discussion at large at a team to be able to evaluate one patient, you know, is quite significant. So how did you come across wanting to approach now ENT in this multi-disciplinary way and can you give us some of those benefits that you've seen for the patients and for your staff and for the teams at large?
Speaker 2:To share the array. So in the past I've used myself and the users to share the array and the makes an official decision and I found a whole lot of people and a lot of them didn't know what we did. If you go to the buy official security and when I come back to how they could help the array, then now I do With meeting you know about. Last week we all sat on the table. It wasn't about one person who did the program and we did everyone who comes to the same event and how they contribute to the array. Me it was fascinating but I thought that should be a bigger meeting and that's only a bigger, more educational kind of sympathy meeting in the new year. But I just found all these program things and colleagues now who can call on that extra house and that takes on the array.
Speaker 1:Listen, I think that your, your businesses that you've also associated with, is something that's so critical. You know we've had the experience post COVID that people seem to present more just in terms of private practice, with having really quite significant changes in the way they're sleeping In sinuses In we. You know I've referred more patients currently in private practice than I probably have within the last five to six years for tonsillectomies and just referrals to the ENT and I just wanted to know now what really are the benefits to having a tonsillectomy versus your adenoids out and does this improve breathing at all? Does it have any basis on that airway? What's your experience in that?
Speaker 2:So let's get back to the one other business name of our like catchphrase so now, but breathe right in. Right, I've also got eat right in here, right in the practice. Really that is something that is attention to the fact that mouth breathing is illegal. Never breathe in. Breathe in your mouth. You can exhale in as through the nose.
Speaker 2:So going attention that a lot of people learn about breathing. They had a kids mouth breathing for a long, long time without knowing the long. Then you end up having the interest to office on the braces and it could have been some prevention given a few years before. Some of the time they're going to be frustrated. I like to you know so if you see something or educate yourself and other parents are really about operations and obviously just you have to be ready. But you get a channel from example, you're putting with your mouth open the time of your time.
Speaker 2:Your teeth can't meet and your fusion is bad because your teeth gets skewed. Basically, you know you can have braces or the mastit underline code, otherwise the procedures aren't they still mouth breathing. Then it fail with your expensive long 18 months treatment. So it's a collaborative and so I don't get enough of this, to be honest. You know, get the GP to talk with a patient word of mouth. We see an area we can be a lot more the referral someday for being together. So this is a way of doing that.
Speaker 1:Yeah, you know, listen, when we do that referral where you're really just basing it on, for the main part, what the patient is telling us and you know how many infections they've had, and then we just move it on, but we don't really get involved at, you know, being able to really find out what the background of that ended up as, and I think that being able to speak together free and postpatients, we we're able to learn just so much more. We're able to support each other in that space. So can you tell us a little bit about breathe right and sleep right?
Speaker 2:Underline code. If I say you need braces, I'm gonna say you need braces, just get your nose with it up. You know so you're gonna link things to the end. Treat the underlying code so yeah. So if you think kids and adults people are about easy Majority of the people who have problems and had nodes, take them out, normalize it. It's just all nodes, even if they're not most info or improved the last 18 months. You've seen also COVID. All these users just have found it's really good. Even right now in the case the pollen can't be denied. It usually starts around March April and so this year it was March August. People started suffering. I suppose it's good for me because you know you get to see this. So the kids are easy. Admin is powerful. I've seen a lot more children with allergies now, but in the past, once the admin is gone, the year infected cleared up. You can see them again. Fantastic. Now they're actually kids with a year infection but not an allergy. But something has changed. We've stopped it without 18 months and then adults also have suffered.
Speaker 1:People don't like to do that.
Speaker 2:It's something like a nasal spurs. They can keep their nose in the console and people hear the big steal of words. With the steal I tell them look at, I use a spay, it's good enough for me, it's good enough for you and I suppose this is a really good period. But then, in getting used to the wake up, you should wake up with the dry mark. These are all impressions. You wake up, the dry mark, you're not tired, you get to react now. So these get activated by the shirt. But the average male shouldn't get up to you at night. That's a clue that the A way is the breathing starts and as a result of giving the steps, they don't breathe. That you don't breathe right. And then, if you add into that, you try it. So my summary is breathe right, eat right, sleep right. So if your nose is open medically or surgically, if you don't eat late at night, because if you eat and go sleep when the acid comes up, and it's interesting when you wake up while sleeping you think you're dying You're not expected to be flux. You breathe right, you're not expected to be flux. That's quality of sleep, then I just A lot of people on sleep inside, right.
Speaker 2:So Before you hit a sleeping tablet you must make sure you're not in intake stops. Just have been watching about is six or eight hours on how to Stop you folding a sleep. Make sure you get a clue. A lot of people will not ask that question if there's something from there and they aren't speaking. To have a Good morning coffee, a degree, stop the coffee actually. So I like to get this. My patients, you think it's worse. You pick no displays over the Intel. People don't need to let me. You can tell me that I kept in the education thing. You know I can do it actually. So, but by the time they come to me then I think I can go to the U of C or data, that is, simple tips or the thing that's absorbed. Either I eat, like Sleep, like how big out there in my primary Gbs and in this or anyone else who's interested in the way one.
Speaker 1:Yeah, just to educate people.
Speaker 2:They serve much, as a lot of people who people love a block may have given a little bit bad night's. Don't have to do this. They are simple things that can help you.
Speaker 1:I've seen that you you've also recommended a few ways to be able to observe these changes. Now we go about our daily activities and we see our patients and at the most Point we're moving from just not only Diagnosing what they coming in with in terms of their symptoms, but looking at course related, sort of being able to treat them at a basis of knowing what is causing and so, once you eradicate that, you're able to actually serve them at such a high level. You know, just even as a dentist, we're looking at decayed teeth or we're looking at crooked teeth, but it's never been a thought process that has, you know, taken a significant a part of your treatment plan to consider what the airway is doing. Where are they breathing from? Are they snoring while they're sitting in your chair, their lips closed? What does that wrist position look like? You know it's just even your. You know the parents will come. They have an idea. They have these dark circles under their eyes. They have an idea that there's an allergy, but they don't have any idea what they sleep was like and I'll say you know, listen, do you have a wet pillow and Pillow case? Where to do you have any spit? That's on your, on your pillow case. They see the, the signs, but it never really registers as something that we need to fix and that has anything to do with the teeth or any long term sort of disease.
Speaker 1:I think it can cause further issues down the lines and I can't tell you how many people we have that are now diagnosed with this ADD. Or just too tired? Yeah, we don't. We don't ask the questions any longer off, you know. So what does that sleep look like and what does the eating look like and when is the last meal? So what are the questions that we're missing, doc? What are the questions that really are gonna help us support our patients a little bit better and Just as parents if you're able to see that, then you also know that listen. Maybe I need to actually go and make an appointment and check to see if there's something that I can do about that.
Speaker 2:I think so attention, there's a lot of In. The adults actually are not sleeping, or quality point Right so you're very awesome about.
Speaker 2:Working up to the table's bedroom two times a night, because if you go to sleep better by the story Over time this is the peers and attention improves. So you can see this kids, they're all over the place. So, from the initial point of view, is all that? There's a bumping and violence. There's subtle things like that.
Speaker 2:Another clinical opinion when you guys are performance mark basically Is the gag, that is, the easy gagging is most likely to be plus I think it's really sensitive to that in the code. If they are Breaks while you're in the mouth, they can't be talking to a nose while working. So that's where I'm going to educate people about Becoming big clinicians of picking up is even spotting in the mile. So if you look at the paper and you see a line of the nation's that is called the allergic peace Call the allergic peace because they've been doing the allergic salute, which is that from a Each knows point of view Then you must like to see things around the eyes. But it's from clinic in Austin.
Speaker 2:So you look at the dry mouth. Just, you got high, so you so at least on for that. And one thing it's the point in from you I'm in the middle of the job issue tm very. You guys see it, I see it a lot, I see it. Lots of earache, right then, I just touched the drink of it. So in the links with your block, with mouth this is a link between block, nose, mouth, feeling it, so it's about one stone and Red flags or I want you to leave with red flags so you can't know Everything, I don't know anything about everything. But you pick up some red flag. You see a young male with high blood pressure.
Speaker 2:Nothing sleep after that and that and that you would ask the patient also, not just the medical GP. So it's really important that you both sleeping right, adults Disabilities in a sleep quality and sleep quantity see. Quality is the option in the family. Eating the beef socks and the blockers, not the sleep quantity will actually volatility enough hours, or they have some caffeine and they're not Fully asleep early but and then you get the more complex disorders which I know about. Where do someone who does See the problems? This is very big. You, it's the right, right, sleep right and it go what I?
Speaker 1:Yeah, I want to ask. Earlier on in the show I I had, um, somebody that was talking about taping when, with mouth breathing, now there's a tape that you can put over that will assist with the lip closure and Just assist with enough. You know forcing you to actually use your inhalation through your, your nasal passages and you know getting getting that process back. So what's your take on that?
Speaker 2:I would think about. Not natural, not sexy, it's not normal. Okay, so how do we store normal nasal breathing and put a tape in my mouth? It just doesn't make anything at all and you've got to have some Yourselves. And that's some of the like. Medical Interventions maybe fail or lack. Even I'm hoping for even to bring all the inputs, but they must be some scientific backup, otherwise you won't get a parking on the best of the medical fraternity. Cause you first, you work on Some sort of scientific basis. It's a strategy to be doing your own thing, and I do this in this. Have some science behind. Yeah, yeah, I'm.
Speaker 1:Listen. I appreciate that because it's nice to hear different opinions, because each of us teach and Treat our patients just based on on really our level of experience, what our special interest is and what you know our focuses. So I appreciate that. So I I'm wanting to know you know there's a lot of discussion that has gone past the point of post-COVID complications and them causing a lot of immunological as well as sinus related complications what do you experience being, since you know we've we've gotten back into the normal flow of things post-COVID.
Speaker 2:Yeah, I don't need to Co-invent the vials itself. People would in goes a lot for the environment strange and they can out again. But in the environment change and change it worse and that's just normal Evolution over time of what I think in the environment. I Lose much sleep about it. I think if people are a recognizing something and treating it, then I don't blame people on over the south or that means anything like that. I do stick to the idea. Now, if some, if the infectious disease Out of the stairs over causes this, does that, that is death. So I'll go to real estate and who's got the most knowledge so far? You know, no one city.
Speaker 1:Yeah, listen, I just had a flashback of you know. Early on in my career I was invited to a team that one of the ENTs that were close to our practice invited me to do some dental work for a patient and he was doing thyroid cancer at the time and it was my first real exposure to now doing dental work at that level and it was quite an expansive lesion.
Speaker 1:I was not expecting it, to say the least, and I must say the sophistication of being able to manage an airway when you have such a limited space is absolutely remarkable. I cannot tell you how impressed I am by what most of you are able to do. You know it is not an easy fate. People don't really realize how small the cavities are in which we are working in order to get this right. You know, with some level of predictability each and every time for every patient and each patient's sort of symptoms and what you require to actually treat them is so different.
Speaker 1:Now I want to know how do you bring that team together? Because I remember I was lucky, but the ENT that I was with, you know, was very supportive, gave me a little bit of space. He says you know, try this route because we just couldn't get enough access in order to get the dental work easily done. It was significant. Probably some of my most difficult work I've done in my 20 years within my career was at that case. So how do you get your team on board? How do you choose the right team? How do you keep them motivated and able to work together to come to that end goal?
Speaker 2:I don't think you always be confused unless you can look through yourselves. You must always be at the level of people who have similar interests and you must travel to the airway to get some access. And having to end up recently just for a conference in the middle of nowhere in Denmark because I knew five of the top snookers were there. So you must have a little bit of that, always be looking out for people and showing a bit of shine and what their interests are getting in and you want to do better and do something different. If you've four snookers, you're the right person and your job and your career and your former team In my practice it's solo, so in theatre it's a new approach.
Speaker 2:So we've got to fix the new initiatives we have with just the airways so we don't skook for much. We expect the worst anyway. You can imagine someone is going to lock up Billy Bigelow and go away. It can be crazy, but they're a good initiative and then you will try a few initiatives and just take the cruelest commerce tricks and it doesn't panic and that's the person you keep on. So our team of snookers are like oh, they don't want to lock up with no case like that, you don't have to back, but you're always looking at the people out here who want to do something different, and they want to do something different and to keep people motivated, they're in the office for them.
Speaker 2:I think as long as I could say that the team is leaving, you're consulting them, happy that something is missing or something is missing that keeps the vibe in the office and if you feel something positive is happening, you're going to get the head of the person down again. But if everything is not happening, you're immediately office office on it. Nursing staff can be at home because they keep changing updates and stuff all the time and you want the same person because when you want to put your hand out or finish writing a book, theory experience there and if you keep whispering to the manager, oh, this person is good, that person is good, they're in that, put in the same team and then you see things as well.
Speaker 2:But you want consistency in the team, for sure. You can't be shopping and training office staff. You just walk and you just go all the time. You want the consistency and the people just know that people are out here and they'll gravitate towards you.
Speaker 1:Listen, I have a bit of a background in ethics and I've been hosting workshops and speaking with ethics related information. We find that just to be able to choose your team right and communicate is such a big part of what we do other than just patient management. And I often ask the question of what would you love to receive from your dentist A dentist that's sending you a referral? What do you want that referral to look like? What do we need to really keep in mind? That is essential information to you. Just, I mean, this is really part and parcel. It's very different for each and every practice, but just from your perspective, what would be the ideal sort of referral letter?
Speaker 2:It's actually very simple. I'm telling you at the beginning mouth breathing is legal. You can't just either just use your mouth, use it with your tongue in some way or another and, whether they know it or not, it's a good thing. So maybe a little bit more often than I was laughing, since the bounty knows us many, many years ago. And then until I say, are you tired in the morning? You're exercising, you're not putting as much of it as you could, the answer I'd appreciate then to come along so you could just say just mouth breathing is legal, but feeling a bit more resistant can be that simple yeah.
Speaker 1:Listen, I think that we have a lot of demanding patients that we come across from time to time in Peds and sometimes we'll have very enthusiastic mums where they just have a little child and they themselves are not able to get on with their work and with their daily activities. And they'll sign the site now and the earache is really getting to them, but it's not enough for them to present themselves to go and get it checked out, you know. So they really look for that script or they look for can we not wait? You know how do you deal with this at large. You know when that's a good question.
Speaker 2:So now we've got criteria. We now need to look into these concerns Because both of the things go wrong and I've taken some of those to one infection only. Then I'm going to be able to follow the one you take out from the infection only. So if some of the people don't get mine, it must be fine. But more material. So you exchange the material, you add up the material and you include the infections. In one year wouldn't they enter the world? But you'd never see number four and you'll take it out.
Speaker 2:So we do buy the book and buy the numbers and most people change like that. For example, also the child's. No, the cancer that they've been now tell them because they're no symptoms and they're saying I'm not touching, I will just ignore the councils, even though they're huge. Also, for example, you're going to get a chance to find something and see if this can, unless you give it a second. But no, there's no amount of meaning, nothing. So I will treat the symptoms. Don't eat the scan so you can change some of the symptoms. That's the outfit. They must do include symptoms, no matter what the scan shows. So yeah, you've got to stick by the book, because medical legally means a lot to some of those people and things very solvent and healthy really go wrong, thank God. But you hold over the calls and you don't send them to the simple parts.
Speaker 1:I think that it's really necessary to be able to have that conversation and just let them know that these are the options for their safety. It's not really for anything else, even though it does cause the inconvenience of ups and downs in daily existence. Now I'm wanting to know we're talking a lot about children, but adults suffer with the same issues and maybe they won't come to us for adult orthodontics, but I often will get somebody sitting in my dental chair and saying my husband has kept me up all night snoring and I just can't cope any longer.
Speaker 1:So, are you able to help, even with somebody like that?
Speaker 2:So there's two things there. No orthodontics, patients are missing out on adults, if you don't, three stories almost as if you've been a piece of gold after folks again, so you can monitor that. Underline course, the smallest I can say the smallest, and I love getting this information. Mark 10A is very simple and A is a little spray, dirty light. In two weeks time you're going to stop snoring. It's really fantastic. You know what to do. You can see one of us and we'll get to the next level which can be.
Speaker 2:I can say this we're very fixed-minded. We become surgical, you know. Okay, I'm not a big fan of devices. It's a simple weekend research. You know medically Because I'm holding an academic class and if you look up to see that machine for the rest of your life, most of my patients will agree they don't want it, but certain people need it.
Speaker 2:It's the other way it's usually they need it. They get the part from as they need it. But I like how all the options work hand. Unfortunately, there's in that being did you get to see first. So if you get to see a position of medical person, they might say okay, go, stay for the sleeper. If you come to a hospital and you want to see more options? Do we have? And see that for sure. I explained them pretty well. But the machine is still on the weekend time at first, so I'll give you a little spend. You can see, and you can go to it and explain to them.
Speaker 2:Even if you go for the surgical, it isn't option Operation. I told them it's a little bit easier. How to see the room is not very normal. I'll give you super medication. The patient choose that kind of experience, so nothing is expedited. Also, but you must have a scientific method. So I can't even get into the situation and I'm in the personal flow. So are there someone else that I'm not doing it? Or are done the research as well? So yeah, but you must come to scientific resources, experience being a good clinician, and everyone has to be a good clinician from the general practitioner medical field.
Speaker 2:Just before the obvious signs, when I educate people, let's talk about giving the students a group. Let's talk about red flags. What do you got? What are the spots? And we can teach adults. It's very simple Plan, a use of brain, then you'll be amazed how much snowing it is just by not doing it. So, for example, you can sleep at 8am in 10 30, so you need to have water. Very simple what to do when you will sleep so much you can really go to the end of the night. Here's a cheetah. It's a little bit late. The cheetahs go to the end of the night, put on your sandgowns and go to sleep. Quite liquid you have to slug it off. The bed forms a lid over your food on the level and then it's kind of enough, and then you can listen to people.
Speaker 2:We didn't speak about that. This is a very nice app called Snow Lab. So you watch the world television also, but I like Snow Lab. So Snow Lab records your overall. You get to hear what you're doing overnight and you get to graph on how large you are, so generally at our patients. As a fourth matter to record, we record two weeks later they must be changing the graph if plan A is working or not. So then they watch that movie, this screenshot, and you can see how it goes through.
Speaker 2:The Snow Lab is a good one. The most important four tests are sleep studies, which will actually tell you how many times we're following this community of people that you can refer to and sort things out. But it means you end up keeping the patient holistic and that isn't very enough. So I, like I said, I'm amazed that we've got people to call on. So it's not just the other GP, the other GP who does not get my official kind of practice, it's everyone to call on the expertise communication and I like to think that it's my expertise to call on as well.
Speaker 2:So Snow Lab is going to run in. Most I can do things a little bit better. I can make those patients like a bit better, not just by making them smile better or smile better, but actually I think that whatever is happening here, when it's there, is that they sleep. So people do sleep right and agree with me. They sleep there. They do sleep with me, so at all circumstances they sleep.
Speaker 1:Thank you for your time and congratulations. I'm really excited for what you're starting up. So well done.
Speaker 2:Thank you very much.
Speaker 1:We have covered starting up and how to turn your vision into a business, and in our future episodes we look at leadership, we look at multi-practice success and I'm grateful for you and I would love to hear your ideas. What questions do you need answered? Please drop me a mail at behindasmile2atch emailcom. I look forward to hearing from you and remember you are heard, you are seen and on this platform, you are invited. Let's make it happen together.