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VIDEO - DUwHF #926 - Victor Martel
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AUDIO - DUwHF #926 - Victor Martel
Dr. Martel received his dental degree from the Rutgers School of Dental Medicine. He is a Fellow of the Academy of General Dentistry and a former President of The Atlantic Coast Dental Research Clinic and the Past President of the Florida Academy of Cosmetic Dentistry. Dr. Martel is former faculty with the Dawson Academy and former visiting faculty at Baylor University. His memberships include the American Academy of Cosmetic Dentistry, American Dental Association, Academy of Osseointegration and the American Equilibration Society. Dr. Martel is a nationally recognized lecturer of Implant Dentistry and maintains a private practice in West Palm Beach, Florida.
ADVANCED TRAINING: NYU, The Rosenthal Institute of Aesthetic Dentistry, The Dawson Center for Advanced Dental Study, TMJ and Occlusion, The Piper Clinic, The Seattle Institute for Advanced Dental Education. Has completed thousands of hours of advanced training including Functional Aesthetics, TMD, Occlusion, Cosmetic and Implant dentistry.
- Owner, Founder and Instructor of Martel Academy
- Founder and Developer of Straumann Mini Residency Program
- Former Program Director of Aesthetic Advantage of The Rosenthal Institute
- Former Clinical Instructor for The Rosenthal Institute
- Former faculty of The Dawson Center for Advanced Dental Study
- Former Visiting Faculty at Baylor University, Anterior Aesthetics. Occlusion, Implants
- Featured Speaker 2015 Rocky Mountain Dental Convention
Howard: Well, it's just a huge honor for me today to be podcast interviewing Dr. Victor Martel, DMD, FAGD, all the way from West Palm Beach, Florida. He received his dental degree from the Rutgers School of Dental Medicine. If you're old like us, that used to be UMDNJ, University Medicine Dentistry New Jersey, but they changed to Rutgers.
Victor: Yeah, they did. About five years ago now, yeah.
Howard: Yeah. He is a Fellow of the Academy of General Dentistry and a former President of the Atlantic Coast Dental Research Clinic and the Past President of the Florida Academy of Cosmetic Dentistry. Dr. Martel is formal faculty with the Dawson Academy and former visiting faculty at Baylor University. His memberships include the American Academy of Cosmetic Dentistry, American Dental Association, Academy of Osseointegration and the American Equilibration Society. Dr. Martel's a nationally recognized lecturer of implant dentistry and occlusion, and maintains a private practice in West Palm Beach, Florida. He has advanced training at the Rosenthal Institute of Aesthetic Dentistry, the Dawson Center for Advanced Dental Study, TMJ and Occlusion, the Piper Clinic, the Seattle Institute for Advanced Dental Education, has completed thousands of hours of advanced training, including functional aesthetics, TMD, occlusion, cosmetic and implant dentistry. I'm a big fan of yours for years and I'm so glad that you came on the show today. How are you doing?
Victor: I'm doing great. Let me tell you say a couple stories, Howard. First of all, I don't know if anybody's ever told you this, you may have heard it before, you're probably the James Brown of dentistry, probably the hardest working guy I've ever seen. Absolutely! And I told your son this a long time ago, it's amazing what you accomplish. I know my schedule and I don't see how you do it, and what you probably, I guarantee you, you don't remember ... let me ask you a quick question. When did your VHS tapes come out on 'The Business of Dentistry'?
Victor: Okay, well, before that, when I was the President ... right after that, when I was the President of the Florida ... the Atlantic Coast Dental Research Clinic, you were the first national speaker that I invited down for a full day program to try to bump up the membership, which we already had about five hundred dentists at the time. But, to this day, I remember it because I was the guy in charge and I had the idea, "Listen, if you want to get more members, you've got to invite people down here to drum up the membership and get a national speaker. And to me you were amazing because, not only did you understand dentistry, you understood the business of dentistry, and it blew my mind, because I'm one of these kind of guys that probably - and I listen to a lot of your podcasts, in fact I just got off listening to your one with Omer Reed, which, you know, to me a god in dentistry, and a lot of the people that you talk to, I'm very humbled to even be here, because they're amazing, amazing guys. But, what you've done for dentistry today in 2017, is what they're going to look back and, when you're 84 or whatever it is, they're going to be interviewing you for the same thing. So, I really, really appreciate what you've done for our profession.
Howard: Oh, you're too kind! And when I was podcast interviewing Omer Reed, I kept thinking, you know, there were so many, like, legends that never made it to the Internet, like Bob Barker.
Howard: And when I talk to these kids and they don't even know who they are, it's like, if you're not on YouTube - and that's why I put these podcasts on YouTube and iTunes and Facebook and everything, because you're right, a hundred years from now, they need to listen to Omer Reed, and these kids today need to be listening to Bob Barker and he's not there.
Victor: No, and the reality of it is, you know, and literally I re-listen to it today as I'm driving home, what Omer said doesn't change. It's people, it's emotion, it's how people ... it's how you learn, and the reality of it is, human beings don't change. You know, technology may change but human beings are the same, and it's just to me, I love the fact that you're one of my - even though I'm a little older than you - you're one of my contemporaries and you're right there, because, you know what, somebody's got to deliver this message at a point where they get it, and you're delivering it where ... you're meeting them where they are, and I really, really admire that.
Howard: Thanks, buddy, and you're too kind. You know, when those VHS came out, 'The Business of Dentistry', they were $500 a set, and I sold a gazillion of them and that was the money that funded the programmers for Dentaltown. So, yeah.
Victor: And that was cheap back then, right? I mean, think about it, you know, in '98 ... I mean, granted I spent a lot on education but $500 was a lot of money for the dentist that was just out of school or whatever it happens to be, you know, and I don't know, I don't even remember, it must have been back then, mailer's, right?
Victor: I mean, how else would I have found out it?
Howard: Yeah, a direct mail piece.
Victor: I had the whole set, and I probably watched that set of tapes ten times, and ...
Howard: And what's interesting about those tapes is, like you were saying, what Omer Reed was saying was timeless, those went out at in '98, so, I put them on YouTube and iTunes, they're still downloaded like 5,000 times a month! And when I get comments for them, I say, "Well, you know, did you realize that was twenty year old information?" They said, "Yeah, you weren't so short, fat and bald. I could tell you were ... I thought it was a hundred years ago!" But everybody says the same thing, I mean, return on asset, return equity, business, staff, H.R., none of that stuff is going to change much in the next century.
Victor: You know, and I didn't even know they're up on YouTube, because I'd be ... I still ... you know what? I don't have the VHS tapes because I don't have a VHS player anymore, and I'm going to go back and listen to it now, because that's the reality of it. It's just ... it's incredible.
Howard: You're doing the Straumann implant mini-residency. Tell us your story. How did your journey end up with that?
Victor: You know, to make a really long story short, just like, you know, I've watched you and your career over the years, I think dentists that want to make a difference in their profession, they want to learn, and they're constantly learning, but the reality of it is, you not only want to learn, you want to share. And what I did, you know - and on a side note or a tangent – I, actually, you know, still today, I get guys coming up and saying, "How do you get to be a speaker?", and things like that, and I say, "You know, I did it for free for ten years." You know what I mean, and I just did it because I enjoyed it and it was part of my passion. So, I started speaking for a long time and, of course, you saw that, you know, I became a part of the Dawson Academy and I worked with Rosenthal and KOISand everything like that, and then I started getting heavily into to implant dentistry, and here was my jest - and, you know, you can agree or disagree and be glad to tell me - every time I would go to an implant lecture, I would always say the companies, you know - and a few years back, ten years ago, Biomet is in my backyard, literally five miles from my office, Zimmer Biomet now, was Biomet, was 3i before that - and every time I would go to a lecture, I'd say, "You know what? I don't get it. I don't relate." And the reason is every time they had a dentist, it was a prosthodontist, and the average G.P. would come to the lecture and go, "Yeah, they can do that, but I'm not a prosthodontist. I don't have that training", and stuff like that. So, you know, fortunately for me or whatever, I'd already had my speaking training, 'cause I'd been speaking for free for a lot of years, I said, "You know what? The average G.P. wants to relate to people that are on their level", and I had a few patients that were part of Biomet, and I said, "You know, you're never going to get guys like me to come, because they don't relate." I said, "You need to have a bunch of G.Ps that know a lot about implant dentistry." And, sure enough, after a certain point, the Vice-President of the company calls me up says, "Why don't you come up here and do an interview?", and things like that. So I did, and we started doing these other programs that were pretty much a similar format of the mini-residency, but the basic idea was there, and then that took off so well that after about nine years or so, and when Zimmer Biomet merged and their education department wasn't growing as it was, Straumann heard about me through the grapevine - just like everything else in dentistry, it's a small world - and the reality is, they called me up and they said, "Listen, we know these programs with Biomet and things are really, really popular because they educate dentists about implant dentistry and comprehensive dentistry and things like that", and I spent a day with them up in Andover, Massachusetts, and between the Vice-President and the President of the company, I spent eight hours talking to them and they looked at me, you know, a few years ago, they said, "We want to do it", because they understand that, listen, the best way to attract new patients and teach dentists things is through education, you know, not necessarily didactic education, but literally get them to understand their treatment before they do it. And that's how it all started to begin with and now it's just growing like gangbusters.
Howard: So, they can find out all about that at Martel Academy? Your last name, Victor Martel.
Howard: And it's martelacademy.com?
Howard: What are my homie's going to find at martelacademy.com? And is that the site for your Straumann implant mini-residency, or is that a different site?
Victor: That's a great thing. Well, the good news is and, you know, from a business side you'd appreciate this, when I decided to partner with Straumann, was at a point where I was busy enough doing these same types of programs through Martel Academy, but the reality of it is I still had a lot of friends that weren't, you know, really partners with Straumann and stuff, and I said, "One stipulation is, I still want to be able to teach the material and not necessarily be sponsored by an implant company. I just want to be able to be free to say, you know, this is how I comprehensively treatment plan. This is what I do." So, they can reach me either through Straumann or Martel Academy, and the good news is if you came to one of my programs, it's not a sales pitch. I don't talk about parts and pieces and why one implant is better than another implant. The reality of it is, I'm trying to teach you how to plan cases, whether it be implant or not. Comprehensive dentistry, how to communicate to patients about big cases or smaller cases, the things that we don't, as you know and I know, get in dental school. A lot of what Omer Reed said today, you know, listening, communication, talking about fees, and literally talking about big picture dentistry at a level where the average G.P. that's really in a lot of debt right now and having some issues, can kind of take a step back and go, "Listen, you know, let's try to treat a patient holistically and look at it from a big picture", and hopefully their practice is changed based on that.
Howard: I'm 55. How old are you?
Howard: 59. So, most everyone listening to us is under 30. So, I already know what they're saying. They're driving down the street and they're saying, "Dude, you don't get it. I just walked out of Rutgers and I didn't place one implant. How do I go from zero to one?" And then also, as far as Straumann, I mean, Straumann is the largest dental implant company in the world. I think the last report I saw, I think for the current year they'd already - or maybe it's 2016 numbers - they had sold two million implants, and the next was Nobel Biocare at one million, and then there was literally seven hundred companies. I think Italy has over a hundred dental implant companies. So, obviously Straumann is the motherload of implants. They own the biggest one in Brazil too - what's the one in Brazil? Neodent.
Victor: Neodent, right.
Howard: And in Israel they own MIS, for 'Make It Simple'. So, Straumann is amazing. I mean, if they chose a Straumann system, can they pretty much do everything from A to Z? Or do you think today's general dentist needs two or three systems?
Victor: You know, that's a great question. The reality of it is for me - and this is just my own anecdotal personality and philosophy is - if I were doing it today, I would stick to one system, and get to learn that system really, really well. Now, you know, don't get me wrong, I heard Marco Gadola's interview with you, and I understand the process, and the reality of it is, you know, in some ways titanium is titanium - it integrates. Everybody, I think, probably agrees to some level with that. The reality of it for me, being on the prosthetics side of things, I need to look at things from what's prosthetically friendly, what gives me a lot of choices when I want to finish the case, and then ultimately deciding, as a dentist, you know, which kind of cases you want to do as a general dentist or restorative dentist, and which kind of cases do you want to refer. Ultimately, if I was a general dentist - and I don't place, I literally just restore - if I was a general dentist and I was learning this, the good news is I'd probably want to use the company at first that, probably, has a lot of ... at least for the first couple of years ... has a lot of the research and science behind it, even from a medico-legal standpoint. I mean, the reality of it is, I want to use whatever is best and until my skills increase where I'm really comfortable. Ultimately, you know as well as I do, it's what's best in your hands. Straumann is a fantastic company. It has, as you probably already know, an incredible amount of research behind it. It's a Swiss company. They're very meticulous in what they do and ultimately, it's a situation where, you know, at first, I would go with whoever is the best, whoever I can learn with the most, whoever supports me the best, and then, ultimately, if I need to expand on that, I do. I think 'keep it simple, stupid'. Use one system, learn it really, really well, and move on from there.
Howard: Well, you know, you said that you wanted to have a name brand implant company for even medical, for legal reasons.
Howard: You're an expert witness. You've been defending dentists for over a decade.
Victor: I have, yeah. It's really, you know, an eye-opening experience and I, kind of, years ago tripped into it and now I probably read at least a half a dozen cases a month, and the reality of it is, I see what's out there, and I have a really fortunate job. I get to read the chart, read your records and decide: Howard didn't do anything wrong. Howard did something wrong. And I get the luxury of just getting paid by the hour to read the case, review it and say, "Listen, his records are great. He didn't do anything wrong. Don't settle the case." And, on the other hand, I see the other side of things. So, interestingly enough for me, I see the little stuff that people sue patients over, sue doctors over. I see what attorneys will go for and what attorneys don't. And, ultimately, it's all about who do you have behind you from a shared liabilities aspect to help you through the process. Not that I want you to get in the process, but I think it's something that if it happens to you, if you're unfortunate enough for it to happen to you, then the company or the people or the research behind you helps tremendously.
Howard: Now, do you think that was an influence of why you don't surgically place the implants and you just restore?
Victor: You know, good, great question. For me personally, it's a completely personal decision. I don't enjoy surgery. You know, my expression is: anything that raises my blood pressure or pulse rate a little bit, I probably am not comfortable with that much, so, maybe I shouldn't be doing it. That doesn't mean it's right or wrong in either sense. My personal philosophy - and I even ... I have two boys, I know you have three, right? - my first philosophy is, even with my sons, I say, "Listen, learn what you learn. Do it as best you can, and you'll be a success at it." And, ultimately, for me, I decided to learn occlusion and prosthetics and aesthetics really, really well and find, over thirty years, thirty-three years of doing this, a team that surrounds me that is the best - much better than I am - at it, and ultimately that helps in the planning, case planning, treatment presentations and shared liability. So, that's me. It doesn't mean that I would tell G.Ps not to place implants. I don't think that's a correct thing, but, on the other hand, I would say, "Listen, if something's over your head, then just, you know, nothing wrong with shared consultations and shared liability." I think that's a really good way of looking at.
Howard: I did a podcast with the CEO of Straumann, Marco Gadola.
Howard: It was so cool because he was in Switzerland, right?
Howard: And I was lecturing ... I'm an American, and I was lecturing in the capital of Canada, Ottawa - it was just so cool - and it was taped in front of a live audience and it's the only one I've ever done at a seminar. I'd like to start doing a podcast every time I lecture, because ...
Victor: That's a great idea. I enjoyed it, actually, because I listened to it and told Ryan, even though it was your first one - it was a little noisy - the information was incredible and the feedback from both sides, from the audience and from you, is a whole different, you know, atmosphere. I thought it was great.
Howard: Well, go down the ... g*d, I wish you'd write an article for Dentaltown on everything you've learned from your dental defense. So, do work for like a malpractice carrier or someone?
Victor: Yeah. What happens in that situation - and it ended up over years being word of mouth - but what happens is, let's say you're an attorney hired by a malpractice carrier, and pretty much, let's say for example the State of Florida where I'm at, it's a very - just like in dentistry - it's a very small grapevine and ultimately what happens is, after they start hearing your name a few times and you do a few cases for them, and hopefully you're successful at it, the reality of it is any time a case pops up they say, "Hey, can you review this chart and tell me whether or not we have a case, or not have a case?" And that's how it all turned out and now it's ... and then when one law firm hears about you, the next law firm hears about you, and the next one. I will tell you this, in probably, you know, 99 percent of the cases that I've done, it's probably been, you know, to defend a dentist. I was asked a few times, because there were a few attorneys out there that, through trial and in front of juries, we actually defeated, which I was happy to do, but, you know, they called me up and said, "You know, would you consider doing the other side?" I said, "Listen, all I can do this. I'll read the case. If it's blatant, I'll tell you my opinion, and that's all I can do. I'm not going to judge it on either side. I'm going to judge it on records and what I thought the patient was." So, maybe three or four cases in the last ten years I've been on the other side of things and they were just really, really blatant things, but, for the most part, you know, I would tell you that the defense of dentists is two things. Number 1: bad records. You know, bad charting, bad, you know, just not keeping track of things, not writing everything down. And then, lastly, just bad relationships, you know what I mean. Or it's about money. That's basically it: money, bad relationship, or bad records. And those are the things that will get you in trouble. You know, for the most part, if I see that you really did everything well and you kept your records well, there's really no reason why cases can go any further than that. The problem is cases tend to drag out a long time: three, four, five years, and that's very injurious to your stomach lining as a dentist, even if you win. It's a very stressful time in your life, and if I were to tell anybody if you can avoid it, I would certainly try to do it.
Howard: Well, you know, it's not just bad records, it's sometimes they delete, they alter the records after the case, and I've seen Arizona State Board of Dental Examiners looking at a case, but then finding out the doctor had altered the records, then turns it over to the Attorney-General, and now it goes from a Board case to a criminal case. I mean, they ...
Howard: .... just panic.
Victor: Yeah, interesting that you said that. I had one case in my career that it was actually on the plaintiff's side, and it was blatant. It was just some really obvious stuff that the dentist unfortunately did incorrectly, and I actually gave a deposition for that case, unfortunately, right in front of the patient - and his wife, who was an attorney, which was a little uncomfortable - but after the deposition, he goes back, and he alters the records. And, unfortunately for him, after about two weeks, I get a call from the attorneys who said, "The case is settled. We felt we proved that he altered the records." Over. Done. And he's very, very fortunate that he still has his license, and he does. So, yeah, altering records is probably the largest mistake you could ever make.
Howard: And I saw another study, it was with medical malpractice, and they were noticing that it seemed like the same people were the ones getting sued over and over and over, and they looked deeper into it, and that's what they said - it was a horrible chairside manner.
Victor: Yeah, and you know what the thing is, and it's really interesting, you know, there's people in Florida that, you know, obviously I wouldn't name names, that I bet you I've read six or seven cases for, and, you know, you and I fortunately - knock on wood - I've never even had that issue, because it's mostly about relationships and things like that. But, it's unfortunately very common. It's harder to lose your license than it is to get sued, you know, in a good way or bad way. But, just, it's way more common than we think, and I think the average - especially the Millennials - because, you know what, when you and I were both young, you never think anything's going to happen, right? And the reality of the situation is, yes, it can happen. And once it does, you know, when I give a lecture, I always talk about liability - very briefly, maybe about an hour of my three-day lectures - but what I tell them is, "Listen, you know, for the cost of an extraction - whatever you charge, whether it's $200 or $500 - and if it's something that you did something incorrectly, you would pay me 50,000 for it to go away. And the reality is, stay within your wheelhouse, stay where you belong, keep a good relationship, and never make it about money, and you won't run into a lot of those issues."
Howard: Well, you know the reason I think I've stayed out of court for thirty years is because the third thing you said. You said bad records, bad relationships, and money. I mean, Wal-Mart, I learned this when I had just opened my office, that Wal-Mart refunds about 1 percent of sales, and these guys do billions of Dollars a day, and they have 'no questions asked'. I mean, you could bring a sleeping bag back to them, covered with mud and dirt and leaves, and show them a rip, you know, and they're not going argue with you. They're just going to take the sleeping bag back.
Howard: And I just, you know, anytime anybody was upset, and they said they want their money back, I just gave it to them. I thought, "G*d, what do I want to do? Do I want to go down to the Board, cancel patients, hire an attorney, stomach lining, stress?" And people, I think, at least 20 percent of Americans are completely crazy, and you can't fix crazy. I mean, I think, it's the 80/20 rule. I think 80 percent of people have pretty much got their sh*t together, and work, and try to be productive citizens, but 20 percent, at least one in five, are insane. And, so, just don't argue with them, don't lose sleep, just, you know, give them their denture back. In fact, I refund the money and let them keep their dentures. It's like, well, I'm not going to wear it.
Victor: You know, of course, we all love making dentures to begin with, right? I mean, that's one of the few things that it's a lose/lose. You know, you're married to that person for the rest of your life for really a little amount of money. And that's exactly what I would do. I would give them their money back. I'd say, "You can keep the denture and God bless you." But, you know, I think the other thing that you probably do instinctively, that a lot of dentists don't do is, over years you learn how to read people really well, and when you learn how to read people, you stay away from things that maybe you shouldn't go there but unfortunately you and I don't have the burden of, you know, three, four, five hundred thousand Dollars in debt and I don't know how I'd react today. I mean, you know, that's as honest as I can be. You know, the reality of it is, for me I came to a point where I said I only want to do what I do well. I don't want to do those other things. And if I have to sacrifice a little bit to get there, that's fine, but I can't do things only for the money.
Howard: Yeah, I've got a guy up the street from me who's got his fellowship in the Academy of Cosmetic Dentistry and he's all in that stuff and, my g*d, when I get ... it's always the lady who's past divorce, getting fixed up to go back on the market, and when she comes in there with these crazy eyes and she's, you know, fifty, trying to look twenty-nine, and she tells me everything she wants. I mean, she can't even get 20 percent through that list and I've already written down the dentist's name, and then I call him, I say, "You know, I feel really bad. This lady's crazy!" And he's like, "Man, that's my job. I love crazy." It's kind of like a pediatric dentist. I mean, if you want to be a cosmetic dentist, you've got to be an armchair psychologist with a bunch of post-divorce women that are trying to go out and get married again.
Victor: The minute I always ... I tell guys, because I used to teach a lot of cosmetics, the minute a patient walks in with a picture of themselves twenty-five, thirty years ago, you don't ever measure them, okay.
Victor: Run! Or, you know ...
Howard: So ...
Victor: ... [00:25:08] [INDISTINCT] [0.1] go away.
Howard: So, is that a bias of mine. I mean, you see all these defense suits and everything, is there ... can you help these young kids? I mean, are they usually, you know, you hear things like they're usually women forty to fifty. A lot of times they have some background training in healthcare, like they're a nurse or they're in healthcare somewhere. Do you see that or is that just a bias? Or is it just 50/50, men, women, random ages?
Victor: I think I really do. I think the reality of it is, I think it is a lot of females, unfortunately, and I hate ... I don't want to sound gender-biased, but that's just been my experience. Probably the majority of the cases over ten years I've read are, you know, female.
Howard: What percent, would you say?
Victor: Oh, probably 70/30, easily.
Howard: Yeah, yeah.
Victor: But don't forget, you know, the majority, just like in your practice - what's the majority of your patients? I mean, usually the women in the household make the appointments and then their husbands come later, right?
Victor: They're the ones who come in and do everything and then they make the appointments for the families. But then the other one that I think is huge is the danger of a little bit of knowledge. It's that situation where, you know, and I think maybe a nurse is a good example, but I'm sure there's other ones, where they think they know more than they do, or, unfortunately in this day and age, which you and I didn't have to deal with, is Web M.D. and all the internet stuff, where they think they know something because they've read a few articles. And the reality of it is, you're either sitting there re-educating them or you're figuring out how to 'disinvite' them to your practice. Maybe that's the word.
Howard: And, you know, it's not a gender bias if there's facts, like, let's do ... is it a male bias that 82 percent of the U.S. prison population is men?
Howard: And the other 18 percent were usually doing something with some guy that has been in and out of jail before.
Howard: I mean, you know, it's 82 percent men. They usually didn't graduate from high school. They usually live below the poverty line. They didn't finish high school, live below the poverty line, have a substance abuse issue, and that's pretty much the entire U.S. prison population.
Victor: Yeah, I mean, it is true. I mean, and that's really, you know, I could probably be guessing if I was only doing it one or two years, but after about ten years of doing this, at least 70 percent are female and a lot of them are, in some form or fashion, in the medical field. And, you know, it's unfortunate, because you would think that they would be the ones that have the, you know, most generous personalities for it, but it's not the case.
Howard: One gender bias that I was ... you and I were formerly taught thirty years ago in school that turned out to be wrong is, everybody kept saying that TMJ, TMD, whatever you want to call it, migraine, said it was almost all women. And it turns out, thirty years of chasing down - was it estrogen, was it progesterone? - turns out that it's just that the women are the most likely to go to the doctor ...
Howard: ... and that the TMJ and the TMD and the migraines and all that, I mean, you see it all the time. I've got a couple friends that are emergency room physicians, they say men are horrible. I mean, they come in almost passed out and they'll show them something, and they'll say, "Well, when were you first aware of this?" And Grandpa will say, "Oh, about three years ago." And it's like, "What the hell did you wait till you collapsed in Safeway?" I mean, you know, why? But a woman will go get help. They seek directions. I see this with the consultants too. As far as Millennials, it's like only the women Millennials are raising their hand and hiring $50,000 consultants to build a million Dollar practice. The men are all going to do it by themselves, you know, they don't want any help.
Victor: Well, you know, they don't need any directions, right, to get to any place and they don't need a map or GPS.
Howard: I think that was the only time I saw my mom melt down. We drove from Wichita, Kansas, in a station wagon, all the way to Disneyland and my dad was so lost in L.A., and he wouldn't stop and, you know, go to a filling station to ask directions and, oh, my mom finally just like lost it. You know what I mean?
Howard: Yeah, men just ... but, just one last thing on that legal deal, what advice would you give to the kids? I mean, is it certain procedures, is it, you know, what are the top reasons why the people are ...?
Victor: Well, let me give a really simple example that really stands out because it was such a simple procedure, but the reality of it is, it really kind of hung the dentist out to dry. It was a female dentist, which doesn't mean anything in this case, but it just happened to be, and she was taking out Number 30. So, you know, an extraction where there was decay through the furcation, her downfall was she actually in some ways made notes too detailed, and here's what I mean: I'm reading her chart, and I'm not allowed ... first of all, I'm not allowed to talk to you as the defendant. I can't have a conversation with you. All I can do is go by your records. That's all I can do. And she writes in her notes that Number 30 needed to be extracted because there's was decay through the furcation, and she really makes detailed notes, like she attempted to elevate the tooth and it didn't move, and she tried a 151 first and it didn't move, it didn't become mobile at all. And then she writes in her notes that she takes a set of cowhorns out and tells the patient that, "Hang on, I'm going to put all the force I can on this", and unfortunately for her, she cracked the lower mandible in half, literally.
Howard: Holy moly!
Victor: Literally through and through. Well, unfortunately for the patient, she sends it to the oral surgeon, the jaw has to be reset. After that, the jaw got infected, had to be sent to the University of Florida and lost the complete inferior alveolar nerve in that area. The patient was without any kind of feeling for the rest of their lives in that area. Now, what I looked at, and I'm looking at, and what an oral surgeon or whoever would take that tooth out is, the question, my first question after reading is, why didn't you just section the tooth? It sounds something very simple, and, ultimately, in her deposition, when she was asked that, she just said, "Well, I didn't think I needed to." It's just a bad judgment call. You know, sometimes it's just a bad decision. It doesn't necessarily mean they did something blatantly wrong. Unfortunately, you have a human being at the other end that has a lower right numb lip for the rest of their lives. Well, that's an unfortunate thing, because the reality of it is, I made a phone call and said, "Settle the case and try to get from it with the least you can." And, you know, you're going to find, you know, everybody asks about - and this is a real common question - "Are you held to the standard of a specialist?" Well, technically you are only in this sense, I guarantee you the attorney is going to get oral surgeon to, you know, give a deposition on that and when you're in front of six jurors, they're just regular patient human beings, and when they hear that the oral surgeon says you could have sectioned the tooth and you didn't, you're going to have a problem. And, unfortunately for the dentist, they ended up settling the case and she's left dentistry, unfortunately. Those kind of things ...
Howard: Oh, my g*d, it's [00:32:18] [INDISTICT] [0.1] that she left dentistry.
Victor: Yeah. So, other than that, it's just, you know, the most, I think the biggest thing is, two things: bad judgment calls, maybe, and then very non-specific records. Anything you do, anything you say, should be either written in their chart or with informed consents and things like that, so that when I read your chart, I know exactly what happened that day. And you know the old adage which is very true, if it's not in the chart, it didn't happen. That's just the way it is.
Howard: You know, I never really understand oral surgeons. I think my training was so unique. I went to UMKC and we had a guy named Mathias Horrigan, and he was an oral surgeon. He lectured all around the whole United States and the world on oral surgery. But, his big deal was, when he was in the military and he was in Korea, they only gave you a small and large elevator and a 150 and a 151. And when you were in the oral surgery deal with the other two oral surgery instructors, Dr. Charlie White and Brett Ferguson, you could use all this stuff, but when you were with Matt, he only gave you the two elevators and you had to come to him if you needed a forceps and, you know, to this day, I mean, I still pull 99 percent with a small elevator.
Howard: And, in fact, when it's like upper wisdom teeth, I call it the 'Stevie Wonder approach', because you don't need to go in there and get vision, you're just going in there and feeling with that small elevator and you're just working it up, and then you're just ...
Victor: You know, when I got out of school in '84, I immediately went to work for a senior dentist, I was an associate, and great, great surgery, even though he was a G.P., great surgeon, and what he taught me was, if it's not lose, don't take the forceps out, take your elevators out, get it to the point where pretty much all you have to do is grab it and take it out, and if you didn't do that, you probably didn't get it loose enough. And ultimately, the problem today is, you know, in a lot of ways we want to keep a lot of things in-house and I can't blame dentists for doing that because you make a profit, you know, increase your bottom line and increase production because of the debt you have, but the reality of it is, you know, what you and I did, and maybe you know this more than I do, what you and I did over all those years is we made it a point of finding people like Omer Reed and Pete Dawson and all the people in our lives that became mentors for us, and ultimately spending a lot of money. You know, one of the things I heard Omer Reed say, in fact I re-listened to it today, that I thought was brilliant. It never clicked with me. He says, "These guys are $400,000 in debt anyways. You're already in debt. How about just making it 500,000 and go get a tremendous amount of education when you get out, and you'll be so far ahead of the game in two or three years that your practice will change." But, you know, Millennials don't necessarily hear that. They want Internet. They want these things and, you know, there are certain things you can learn that way and there's certain things you need to be there and present for.
Howard: And another thing on that oral surgery, whenever you're elevating a tooth and it doesn't budge, you create this massive trauma, inflammation, whatever, so, if you elevate around a tooth really, really good, and maybe use a [00:35:26] [sounds like: periosteal] [0.3] to push the tissue away from it, not because the tissue's going to hold it in but just because you start the swelling, and then you go do a hygiene check or two, or go in the next room and do a filling and come back. Now that whole area surrounding that tooth is all inflamed and swelling and it's pouring, you know, fluid and serous fluid into the area, and it's just amazing. That's one of the biggest tricks Mat Horrigan taught us a long time ago.
Victor: Well, I'll tell you an interesting story. The way I got into - I didn't you this, I'll make it quick - how I got into this expert witness stuff is, I had a partner years ago and he was simply elevating a wisdom tooth. Well, it felt like it was ankylosed, and he said, "I think you need to go to an oral surgeon", because it wasn't budging, and he had just done what you just said, elevated it, put a periosteal elevator around it and the patient didn't go. Well, over the weekend, it got infected and he ended up going to the hospital and spent about three or four days in the hospital, and he tried to sue my ex-partner years ago. And, of course, my partner didn't do anything wrong. It was, you know, the situation where the guy just failed to follow up. And that's how I met the defense attorney, who we would talk to over the months and then eventually this all happened, so, even things like that. It's a situation where follow through, make sure patients follow through, make sure they ... you know, in my office, if I were to ... if you were a specialist, I actually have my staff call and make the appointment for you. Now, I can't help it if you don't show up, but I'm going to make sure it happens, or at least try my best. And that's how this whole expert witness stuff started. Something as simple as that, where a patient got infected just because he was, you know, elevating a tooth a little bit and didn't get it to go and it got a little bit infected, so.
Howard: You keep mentioning about, you know, a lot of these kids want to keep it in-house because they walked out with $350,000 of student loans.
Howard: So, they want to, you know, and so they want ... especially if they go buy a practice, you know, if they come out with $350,000 in student loans and go buy a practice - average practice price in America is 750 - and they're a million Dollars in debt, they're going to attempt all their molar endo, they're going to attempt all their extractions. But following that you're 350 in debt, you just bought a practice for 750, what technology do you think is a return on investment versus what is just boys and their toys?
Victor: You know, that's a great question, Howard. I've never been a toys person myself, you know. For example, if you were to ask me today, do I own a digital scanner? For me - and the answer is no - and for me, my chair time and my efficiency or chair time makes much more difference to me. Meaning kind of like what Omer Reid says, "What can I do that's going to increase my bottom line?" And, you know, if I'm sitting there - and my practice might be different than the average G.P's - if I'm sitting there prepping ten teeth and I've got to scan ten teeth, as opposed to taking an impression, even two impressions in two to five minutes, it makes no sense to me. I'm not, I don't have that kind of practice that is a high volume; I have a low volume, high fee practice. So, those types of technologies for me don't make sense, for me. Everybody's a little different. Now, granted, does a crown probably fit better if scanned. Absolutely. But am I willing to spend the thirty, forty thousand or hundred thousand on milling my own crowns and things like that? I'm not going to do it as well as my lab gives. So, I look at my chair time as, how do I do the best I can do and get out of there quick and good, or quick and great, instead of keeping things in-house. So, I'll be honest with you, I'm not a big toy person at all. I don't have a laser, I still use [00:39:08] [sounds like: electrosurge] [1.2] when I need to. Do I have intra-oral cameras? Sure. That's educational. That probably adds to my bottom line. Do I have, you know, scanners and things? Not at this point, because I want them to be super-efficient, really quick, and do it as well as I can do it as far as time wise I can. So, I mean, I don't know, what do you think is a good toy that's worth it today?
Howard: Well, do you have a CEREC machine?
Victor: No, I don't. No, I don't at all.
Howard: How about a CBCT?
Victor: I don't have a cone beam, but I don't do a lot of surgeries. Now, do I have good digital panorex? Sure, but I'm looking for wisdom teeth that I'm going to refer to my oral surgeon. I'm looking for tumors. I'm looking for things like that. You know, I've had digital x-ray since 19..., oh, my goodness, probably 1990, '92. I got one of the first DEXIS systems a long time ago. But for me, great x-rays, less radiation, quicker to take, I don't have to develop film, that, you know, digital x-rays I think is a fantastic adjunct to your practice. But, for the most part, other than that, I don't really see myself advancing as quickly as others. I'm not an early adapter. Let's see, I don't go out and buy the iPhone X tomorrow. I'll wait until it's out about a year or two and then tell me where it's at. I'd rather actually spend my money on the education, learning occlusion, learning prosthetics, learning things like that, and then once I have those things, those will be supplement from my knowledge base.
Howard: Every person I know who's placed over 10,000 implants, placed their first 9,000 with a 2D pano.
Howard: Never had a surgical guide. So, you can always make a case to spend money. I mean, Warren Buffett always talks about how 95 percent of CEOs just, all they do is try to figure out ways to increase their overhead, and 5 percent of CEOs try to return profit back to shareholders. And these dentists, I mean, they can just justify anything. I mean, they can take a $15 Impregum impression from 3M, send it to the lab where the guy's made 10,000 crowns, and then they have an idea and next thing you know, they've bought a $15,000 True Def scanner and now they ... and then they decide they're going to buy a chairside milling machine and have their assistant mill them, who's never made a crown in her life. I mean, they just ... every time a hundred dentists have an idea, ninety-five of it is to raise their overhead. And then when you go in these guys that have 50 percent overhead offices, they use Impregum. They don't use CAD/CAMs and digital scanning - they use panos.
Victor: I have five employees. My overhead below 50 percent. I see patients when I want to see them. I still take impressions. And I think that the illusion of 'technology is going to get you more patients', I would say, you know, to a young dentist and, you know, unfortunately a lot of them don't want to hear this because it sounds like old-fashioned, I'd say, "Learn your dentistry really well. Spend your money on learning occlusion, learning prosthetics, learning all those comprehensive treatment planning, and all the other stuff is going to come." But they don't ... you know, people sometimes want a quick fix and I'm kind of like, you know, it's not ever quick.
Howard: And they always try to figure out how to spend more money. Like there's five hundred courses on Dentaltown, by some of the greatest people in the world that don't even cost a $20 bill, but they're like, "Oh, no, I've got to go to the airport. I've got to go to the Miami airport. I've got to fly across the country. I've got to drop $3,000 staying in a resort", and then then they come back with two pages of notes. It's like, "Dude, you could have stayed home and just gone on YouTube!" Just YouTube. I mean, my buddy up the street, Jared Pope, he learned how to place implants from just YouTube. Every night he'd come home from work, he'd go to YouTube, type in 'dental implant surgery', and he'd watch YouTube videos for an hour. You know, he had on his iPhone with Apple TV, you throw it up on your big screen. He'd just come home from work, sit there in his front room, right there on his big screen, watching implant surgeries and he says, he said, after he watched about a thousand hours of these videos, he said he felt he had it. You've also treated probably thousands of TMD patients.
Victor: Yeah, yeah.
Howard: Is that just because you're a glutton for punishment or ...?
Victor: Yes! Yes! You know, it's funny. After taking all of the Dawson courses, and I'm sure you heard of Mark Piper, who is a renowned oral surgeon who actually does a lot of TMD surgeries, but, you know, I took all his courses - who, by the way, is really right up the stairs from Dawson -it's more like the advanced pain patients and things like that. And the reality of it is, here and everyplace else, there's a certain percentage of the population that are ... there's very few people to help them. And, you know, the first thing I tell dentists is, "Listen, treating pain patients for TMD is not a money-maker. It really, really isn't." The good news is, for me, fortunately I've, you know, taught a lot of the general dentists in town and they tend to refer those types of patients to me, because I help them. Am I, you know, something special? No, I just have a little bit more advanced education, a postgraduate, and ultimately, it's a situation where I help them because I'm getting patients out of pain or helping them get out of pain and it makes it very rewarding, but, on the other hand, I work it up. I look through MRIs, you know, I do the entire work-up on them, and I know what I'm getting into before I start the treatment. So, yeah, I'm a glutton for punishment, and it's something that I do strictly because it's more rewarding, because it certainly isn't a huge profit center in my office. But when you're the only game in town, you do it because you do it.
Howard: So, how's Mark doing these days?
Victor: Mark's doing great. You know, he's ... you know, my philosophy is TMD surgery is kind of like back surgery. It's like it's a last resort, you know, and I will tell you this, over fifteen years I've probably only sent him three, four, five patients because it's a very ... Number 1, of course, you probably already know this, it's not covered under medical insurance, which is a whole another, we could have a whole talk about that alone; and Number 2, it's very, very expensive and things like that, and my philosophy is I'm going to try to treat you conservatively unless you are screaming in pain and you're asking me to go for surgery. But, since he has this not only nationally but international patient base, he has more than enough severe pain patients to do well and his education is going well. But, you know, it's a different niche of education. You have to really want to be able to learn and treat pain patients or don't take the course. It's a tough course, but I enjoyed it. So, everybody's different in what they want to do.
Howard: So, he's mostly treating TMJ with a surgery?
Victor: Yeah, he's pretty much at a point where he's the last resort, and these patients - and I've literally had patients in my practice say, "If you don't fix this pain, I don't know how long I'm going to hang around." And when you get to that point, you know, that's life affecting stuff. That's when those patients, I send out. I try to treat them, amorize, conservative splint therapy, things like that, and just settle everything down. I'm never going to make the jaw better, and they know that, but ultimately, it's a situation, if I can keep their symptoms down where they can have a normal lifestyle, that's all I really care about. And then if I can't, they go there. But, you know, they're far and few between.
Howard: So, are you ... you are also interested these days in sleep dentistry?
Victor: Yeah, you know, that's another thing, Howard, that I would tell you, you know, dentists are always, you know, and the ones I hear and, you know, haven't told you this, those programs that I do with Straumann and things, I'm gone like thirty-five, forty weekends a year lecturing and, you know, they always ...
Howard: But I can't find those thirty to forty weekends, I mean, on your Martel Academy there's no dates, and when I went to the Straumann website, I can't find the dates, how do my homies find these dates where you're lecturing?
Victor: Well, the Martel ... well, let me explain how my system works at this point. For me, what happens is, let's say Howard Farran happens to be an oral surgeon in Phoenix, Arizona, and you have twenty or thirty referrals. You might hear of me through Straumann, and they book it on their side. But what you would see, only if you went to the Straumann website, you would only see a mini-residency program. You wouldn't see Vic Martel, because I actually have trained six to ten speakers below me that are doing the same types of programs. So, and I've done some in Phoenix for some people I'm sure that you probably know. But the reality of it is, that's how that is. The Martel Academy is when they want to learn, if you decided as a surgeon that you want to do the same program but you're not necessarily a Straumann customer, you just want your company, your business to do this type of mini-residency so your referrals can learn about comprehensive implant training or implant dentistry itself. Then you hire me independently. We don't post those dates because the reality of it is, that course of five sessions is booked through the surgeon and not open to anybody but who he invites, so everything's by invitation only. My site originally, my goal - still today but I'm getting so busy that I don't have time for it anymore - is I was planning on having dates where people come to West Palm Beach and they come to see me. But at this point between thirty to forty weekends a year of being gone, I don't even have the time or the facility to do them on my own anymore.
Howard: Yeah, and that's hard, man, living on the road is tough, man. I've done that. I've done that since 1990, I mean, and now it's 2017, I mean, twenty-seven years.
Victor: And you go internationally, which I don't know how you do it. I just don't know how you do it.
Howard: I mean, it's crazy. I mean, I remember one time I got off work on Friday at five, went to Sky Harbor for a six o'clock flight to L.A., lay over, seventeen hour flight to Sydney, Australia, got there at six in the morning, lectured eight to five, and when it was over, went back to the airport for eight o'clock flight back to L.A., and then back to Phoenix, and then I think I got home like at midnight on Sunday, and I had patients at 7 a.m. the next day. I mean, it's just ...
Victor: Oh, my g*d! Well, that's the James Brown dentistry right there. That's exactly it.
Howard: Oh, my g*d, and like every time I go to New Delhi, it's a five-hour flight from Phoenix to New York, then a layover, fifteen hours New Delhi, then you lecture for eight hours, then the next day fifteen hours back to New York, and then five hours back to Phoenix. By g*d, when you get out of the taxi at your home, you almost just fall out on the street.
Victor: A lot of the speakers, you know, a lot of new speakers or people that want to be speakers, they think it's a, you know, really kind of like luxurious life, and I said, listen, it's a lot more work than it is, you know, something ... the teaching, when everybody's asked me about it, I love the teaching - the travel stinks. You know, the coming back and forth is very, very tough. But if you love what you do, and I know you do, you do it because you want to give back and that's, you know ...
Howard: Yeah, I tell people I get paid to travel and I lecture for free.
Victor: There you go. That's exactly right.
Howard: But that's why I love these podcasts. This is my new hope, my new hope. We've been doing this for, what? Nine hundred days in a row now and, I mean, it's just so ...
Victor: I can't believe you do it every day.
Howard: What's that?
Victor: I said, I can't even believe that you do it every day. I thought you would do it, like, once a week. When I said to Ryan, "Ryan, he does this every day?" And I go, "You've got to be friggin' kidding me!"
Howard: But, you know, it's only one hour out of twenty-four, but when you look at the data of the reach, I mean, you know, I see these downloads in, you know, Katmandu and China and Indonesia and Malaysia, and I just keep thinking of those fifteen-hour plane flights. And it's like, it's just so cool to be talking to your buddies in Katmandu and Vietnam without having to fly, you know, twenty hours each way to go talk to them. I mean, it's just ...
Victor: But you're still doing that! You were just in Australia, right?
Howard: Yeah, yeah, but, you know, it's crazy. So, you're also into something that ... ketogenic diet. Now, you know, that's kind of like TMJ. I mean, there's, I mean, I've lived through so many diet fads. I mean, g*d, I mean, you're down there in Florida. There was the South Beach Diet from, wasn't that Florida, South Beach, Florida? But, so, why are you onto this ketogenic diet, and is it just another one of the last thirty diet fads, or is this one different?
Victor: No, no, actually, and you know what? It stems back to what you and I just talked about. Tell me when you travel, you don't eat like crap? I mean, the reality of it is, you know, you're in the air, you're in airports, you're places where you're always having dinner meetings, you're always things like that, and over about ten, fifteen years, I thought I was one hundred and eighty pounds for like ten years, and then, about two years ago, a year ago, I get on the scale at the physician’s office, and he goes, "You weigh 202", and I go, and I literally said this, "Your effin' scale is broke!" And he says to me, "No, it's not broke!" And it was 202, and I always thought I was 185, I just thought my wife was shrinking my clothes, you know, silly stuff like that. And I made a decision to do it and I was really fortunate that my physician at the time was not only a nutritionist, a bodybuilder and all that stuff, and he said, "The only way, you know, let me explain something to you, the only the way you're really going to accomplish this on a permanent basis is reduce your carbs, increase your fat, and you're going to drop weight." And I didn't believe him, and I started, you know, probably like you do or what I do, I started researching it, looking at the literature, doing all this kind of stuff, and it made a lot of sense. Unfortunately, the average physician doesn't know anything about nutrition - by the way, they get about two hours of nutrition in four years of medical school, which is a stretch for most of them. And I did it and in about nine months I lost thirty-five pounds.
Howard: In how long?
Victor: About nine months. I was on a beta blocker and a hypertensive medication. I'm completely off anything. I take no medication or anything.
Howard: So, you went from 202 to what?
Victor: I'm 167.
Howard: That's what I weighed when I got out of dental school!
Victor: That's exactly me, right.
Victor: And what happens is, life hits you, and the reality of the situation is I started reading books - and not fat books, medical books written by physicians and nutritionists and things like that - and the reality of it is, it worked so well for me, and now it's not something that I literally do on a paid basis but when somebody ... and, you know, just like you, me, my patients look at me, they've been seeing me twenty five years, they go, "What did you do different?". And, you know, some friends of mine that are in the dental field, I've coached them through it. They've lost thirty, forty, fifty pounds ... and the reality of it is, it's so simple and it's so science-based. There's nothing ... I don't have any sports drinks, I drink no diet drinks, I buy no special foods. It's just the way I eat. And all this has made a drastic difference in my life. So, now, just like you and I do, when you learn something, you want to share it, and I share it with patients. I mean, literally, these diets have been known to reverse Type II diabetes, get people of hypertensive medications, all the things that you and I deal with on a daily basis with our patient base. So, you know, when we start seeing these things and the patients want to hear about it, I tell them about it. I can't treat patients for these types of things, obviously. That's something up to their physician. But the reality of it is, I can tell them what I do. And you know as well as I do, when I heard you talking about sugars for the most part, with a lot of your podcasts sugar is poison in a lot of ways, let alone for your teeth and for your body. And it just turns out that that's how I've lived my life and now it's become ... it’s kind of like a way of eating more than it is a diet. This is just how I eat. If you became a vegetarian, you don't eat meat, right? Well, for me, I'm what they call ketogenic, which just means very low carb, high fat, high protein, high meat, and the weight stays off. I literally haven't gained an ounce in probably four, five, six months. And, by the way, and I know I shouldn't tell you this - zero exercise. Zero.
Howard: So, tell us how you eat.
Victor: Okay, well, in the morning ...
Howard: And, by the way, that exercise - when people say they're going to join a gym to lose weight, it's like they just need to watch NFL.
Howard: I mean, those linemen, they've worked out six hours a day for the last ten years and they're morbidly obese. I mean, six packs are made in the kitchen, not in the gym.
Victor: You know what, you know, when people say it's 80 percent. No, it's 95 percent of what you eat, you know.
Howard: So, tell us how you eat.
Victor: Okay, so, when I get up in the morning, I probably eat two eggs, either sausage or bacon, no bread. You know, sometimes I eat - and this is another thing, you know the old adage: you need to eat six meals a day? Forget it, it doesn't work. It's just not the science behind it. And then, for lunch - if I eat lunch, sometimes I'm working through patients then I don't, and I don't worry about it - is I might have leftovers from the night before, but the reality of it is, for dinner, I mean, my wife will make me a bone-in ribeye with butter on top, and I'll eat some asparagus or eat some broccoli or I'll eat some cauliflower, and that's my meal. And then I don't eat after dinner. If I had lunch, let's say I went to a restaurant, like you probably have a meeting at lunch sometimes, things like that, I'll have a burger. I'll have a burger with bacon and cheese on it and no bun, a side of vegetables, and literally, all you're really doing is eliminating the carbohydrate count in your diet. And what happens, and what most people don't understand if you really look at the literature and if you ever wanted to I'll send you the, you know, offline I'll send you the places where you can look up the literature and the science about it - what you're really trying to do is shut off your sugar burning content and turn on your fat burning content. And the reality of that is, you can't do that until you get to a point where your glucose levels are low enough, where your insulin levels are low enough, where what most people don't understand with diets is, insulin actually decreases or inhibits your fat burning. So, the higher your insulin levels, the slower you burn fat. Well, obviously the opposite is true. The lower your insulin levels, the more you burn fat. So, ultimately, what I tell people is, try to keep your insulin levels low and flat throughout the day, you're constantly burning fat and, ultimately, the situation is you start dropping weight. I'll just give you a funny example. I just talked to my ... I was on vacation in Portland, Maine, with my brother-in-law and sister two weeks ago. He sees I lost all this weight - 'cause he's in Ohio and I live here. He sees how much weight I've lost. I'm telling him over dinner what I did. In two weeks he's lost ten pounds, and all he did is change. He didn't ... no exercise, just decided to greatly reduce the carbs and ultimately, it's a win-win, right. It's better for your teeth. It's better for your blood pressure. It's better for your Type II diabetes. So, yeah, no, it's worse than TMD, it's definitely not a moneymaker, but I truly believe, and I'm sure you do too, when I treat the patient, I'm treating the whole patient, you know what I mean. And whether it's TMD, whether it's sleep apnea, whether it's all those kinds of things, I'm just looking at a patient and trying to help them in every way I happen to know how to do that, and if that helps them and it puts more loyal patients into my family base, I'm good with that.
Howard: So, do you do those ketone strips when ...?
Victor: You know, that question, yeah, I mean, at first when you first try this, for the first like three or four weeks, you should. And the reason is, what it's telling you, those ketone strips are telling you is, the minute you ... or the day or whatever that all of a sudden you've gone from burning glucose to burning ketones, because what happens is, you'll have ketones appear in your urine the minute you go into what we call ketosis, right, which is meaning fat burning. The problem with the ketone strips is, after about three or four weeks, they become highly inaccurate. And the reason is, after a certain point, the ketones aren't getting into your urine any more after they through, they go into your bloodstream. So, now you'd have to test your blood and you'd test for a completely different chemical. There's three chemicals: it's acetone out your breath, okay; there's the ketone strips; and then what the bloodwork is testing is Beta-Hydroxybutyrate. That's when you're really into it and you want to know after, like me, if I were going to test my urine now it probably wouldn't give me a very accurate reading, because it might even look like I'm high, but the minute I test my blood, because most of it's spilling over into my blood, now I would see, oh, yeah, now my ketones are really high because most of it's going into my bloodstream. So, three or four weeks it's a perfect way of monitoring how you're eating, and then after about three or four weeks and after you've gone through the ketosis, now you probably need to test your blood - or the easiest way nowadays they actually have these things that you test your breath and they test for acetone. And when you test for acetone - it's really simple, you blow into it. If it appears red or blue, you're in ketosis. If it appears green, you're not. And, you know, that's how I test it now. I don't test it that much anymore because I'm in a maintenance weight, you know I mean? I don't need to lose any more weight. And now I just know how I eat. But I think it's a wonderful way. I've known patients that have actually lost ninety, a hundred, a hundred and twenty pounds by doing these things.
Howard: So, liquids, what do you drink? What do you never drink?
Victor: Great question. Don't drink. Well, of course, I don't drink any sugary sodas, but I didn't do that beforehand. Here's the luxury of this diet. You want a vodka and ice. Great, go for it. You want a bourbon and ice. Go for it. Because, what most people don't realize is, the minute you distill a liquor, there's no sugar in it anymore.
Victor: Yeah. Literally the carbs are gone.
Howard: Vodka doesn't have? I thought vodka ...
Victor: I drink vodka every day, Howard, every day. Okay.
Howard: But, I mean, that goes against everything I've ever learned. I've always been told that liquor, especially like vodka, is just all sugar.
Victor: No, it's actually what you - and this is ... I'm going to send you and Ryan the site that you can go on. It's written by an M.D. from Switzerland. No sponsors. He's not in it for the money. He's just ... it's just education. They sell no products. Nothing. It's just a pure educational site. And ultimately, he goes on there, and you can watch educational videos from physicians, from Ph.Ds., from nutritionists, and the minute you distill a liquor, the sugar is gone. So, if you were to look up vodka and look up the carbs, it would say zero carbs. Okay, yeah. Now, if you put something in it, right. You want to put vodka, I don't know what you'd, you know, soda, that would be fine, but, g*d forbid, you put whiskey and Coke, okay. Now, the mixers are the problem. So, the reality of it is, now, for example, a glass of red wine, a normal-sized glass, three carbs. Okay, big deal, right. A glass of white wine, four or five carbs, so.
Howard: But that's not ... even that's not sugar, though, you're saying.
Victor: No, I'm saying that's sugar, but if I were to tell you ...
Howard: So, the wine has got sugar in it?
Victor: Yeah but let me give you an example for you. The average American, the standard American diet, if you ate the standard American diet, you eat about 300 grams of carbs a day. And what I mean by carbs is fruit, vegetables, everything. Count everything. If I were to tell you, if you called me up and said, "Vic, I want to lose fifteen, twenty, twenty-five pounds." I'd say "Okay, Howard, I want you to eat fifty grams of carbs today. And that from that point on you can only eat fifty." Now, let me give an example of what that is: a piece of white bread is fifteen, okay, a bagel is forty-eight, a banana is twenty-five. So, what people are eating that they think is healthy, what they're doing, all they're doing is spiking their insulin levels, decreasing their fat burning process. So, I would say to you, that first - this is exactly - I've coached people via text and I'd say, "Listen, eat fifty grams. Look at everything. And if you stay to that fifty, you are going to drop weight off like crazy, and I'm going to tell you this, don't count any calories. Zero. The only thing you're going to count is the number of carbs you have in a day. Now, here's the only thing you can't drink alcoholic-wise: beer, because beer is high in wheat. It's not distilled as much as a hard liquor and ultimately there's going to be carbs", and you can look on every beer bottle and tell what, you know, the carbs are that are in it. But if you looked up any hard liquor, distilled liquor, zero carbs in any of those. So, you know, and I'll tell you this, from the day I lost the first pound to today I've never not had. I come home, my wife has a Chardonnay, I have a glass of vodka with ice. I've never not had it and I've lost thirty-five pounds, so.
Howard: And, if you drink that vodka drink, it wouldn't make your ketones trip?
Victor: No. Absolutely doesn't kick you out of ketosis at all.
Howard: Hah! G*d, I love my own show. I do. I love my own show. I'm the only person on earth who's listened to every one of my podcasts. And I think I do this for myself. But I' want to stay on this because ... tell me what you never eat. Are there things that, ever since you went from 202 to 167, that you just gave up like a drug, like I'm never going to smoke pot again, I'm never going to ... what are you going to never eat again?
Victor: I don't eat wheat, rice, potatoes, you know, any wheat-based product, any, you know, all the things that you would consider a carbohydrate, meaning rice, mashed potatoes.
Howard: What is your ethnicity? What is it?
Victor: I'm Puerto Rican. So, what was I raised on?
Howard: Yeah, what were you raised on?
Victor: Rice and beans.
Howard: Okay, beans. That's a great question. What about beans?
Victor: Beans are not good.
Howard: 'Cause it's a plant.
Victor: And I'm going to throw you another one. The majority of fruits are bad. Here's the fruits you can eat, write this down.
Howard: Write it down, Ryan.
Victor: Blackberries, blueberries, strawberries, raspberries. Those are the ones you can eat; avoid all the rest.
Howard: Say it again. Blackberries?
Victor: Blueberries, strawberries, raspberries.
Howard: Now, see, I would think those are all high sugar because they're all sweet.
Victor: Believe it or not. Well, in comparison, for example, if I gave you a cup of raspberries, maybe four carbs. Don't forget, you're only totaling up for fifty for the day, right. So, what you're doing is you're ... now, here's the other advantage I'm going to tell you. I want you to take those blueberries and raspberries and put a whole big glop of fat, whipped cream on top and enjoy it. See how counter-intuitive this is to the standard American diet? It's so counter-intuitive because ... I'll give you an example, I'll say this one story real quick, because I know you don't have a lot of time. I went and got my bloodwork done by my physician, who happens to be, oh, by the way, about fifty pounds overweight, and my cholesterol was a little high and I had already lost this weight. He runs my bloodwork. My cholesterol is 259, and he says, "I'm putting you on statins", and I go, "No, you're not", and he says, "What are you talking about?" I go, "You're not putting me on statins. I'm not taking a statin", and I said to him, he goes, "Well, let's talk about this." I said, "That's fine. Let's talk about it." I said, "Let me ask you a question. What's my HDLs, which is my good cholesterol?", and I said, "What's good for somebody my age?" He says, "What's good for somebody your age is 50 HDLs." Mine was 88.
Howard: Nice. Do you think it was 88 when you weighed 2O2?
Victor: No, no! I had already, I had my bloodwork done before I started. I was pre-diabetic. My numbers were all over the place. That's why I kind of had this moment in life where, like, I go, "That's it. I'm changing everything!" I said to him, "What's a good number for my triglycerides, for somebody my age, 59?" He goes, "Well, 150." 79! And I said, I literally looked at him, because I knew him really well, "Why in the hell are you trying to put me on a statin?" He looks at me, he goes, "Never mind", and I go, "Thank you."
Howard: Because they're just robots, they just walk into a room, "What's going on?" "Oh, I can't sleep." "Here's a sleeping pill." "I'm depressed." "Here's a, you know, whatever." They just ... they're pill junkies.
Victor: Well, here's the problem too, Howard. They're on this protocol where legally, medico-legally, remember we go back to that, right? If they're told, "You put somebody on a statin at 240, 250", their number and they don’t, and you have a heart attack, they think you're going to sue them, or they can take their license away for not following the protocols. So, they're robots. It's exactly right, they're taught this. By the way, I want to give you - maybe you probably already know this, because you know a lot of statistics - take a guess how much money they've made out of only Lipitor, just Lipitor, not any other statins?
Howard: Oh, billions. Billions.
Victor: A hundred billion Dollars, a hundred billion Dollars. And the side effects of statins are ridiculous. Memory loss, muscle fatigue. Many, many side effects of statins. If I had a friend, if you and I were sitting in a room and you told me you're on a statin, I'd say, "Here's what I want you to do. Go on this diet and then slowly get your bloodwork done and get your ass off of statins, period." And believe it or not, there was a physician on that website I'm going to tell you about, she was on it because her physician told her to do it. It took her two years to get rid of the symptoms. That's how powerful those medications are. So, and I was on a beta blocker and a hypertensive medication, and they wanted to put me on a statin. And now I'm on nothing.
Howard: Yeah, and, you know, that's what's so hypocritical about dentists, because, when you're on Dentaltown and you talk about alternative medicine or holistic medicine or anything like that, the dentists are all like, "Oh, that's wacko cracko! You know, those are crazy people." And then when that person gets put on a pill by conventional medicine, by this sacred cow, M.Ds, and say, "Here's five prescriptions you need to be on", the dentist scratches his head and says, "No, I'm going to change my lifestyle. I'm going to change my diet. I'm going to start work it out." It's like, oh, so now you're a holistic hippie from Berkeley, you know, at a Janis Joplin concert, when it's you, but, my g*d, when it's your patients, then it's just the end, and that's, I mean, I have more faith in alternative medicine. I'll tell you one thing I've found very interesting in my career is, I'm in Phoenix. So, it's warm weather, so, we have these, you know, we have a lot of retired people that live here year round, then we've got about 400,000 that just come down for the winter, called 'snowbirds', and my whole life, thirty years, every time it was a man and he was like ninety to a hundred and five or whatever, they all had one thing in common. They didn't ... their health history was nothing. They didn't take any pills, but it was proactive. I mean, they were conservative farmers, they were small grains farmers from Canada, North and South Dakota. "Yeah, my doctor, he always wanted to put me on this thing, you know, but I'm not going to take a pill", and it was these ... and then you go back to the last century, the original hospitals were called sanitariums, they didn't have a germ theory, they were delivering your baby after they just amputated someone's foot, and the mortality rate in these sanitariums was off the charts. Now, we're sitting here a century later, 200,000 Americans are killed in a hospital each year.
Howard: 200,000. And these people just want to go to hospitals and take all their pills. And I've noticed for thirty years, all these conservative, redneck farmers from North Dakota who won't go to the doctor, won't take a pill, won't take a prescription, and now they're sitting in your chair and they're eighty-eight years old, they're ninety, they're ninety-five.
Victor: I mean, my mother-in-law is ninety. She hadn't been to the doctor in thirty years, and if you saw her, you'd think she's seventy, and you know what, I'll be honest with you, I have it. When I go to a doctor, I have white coat syndrome. I'd be the first one to admit it, because it seems like every time I go to a doctor, they find something to give me a pill for, and I get to the point where I don't want to go anymore. You know, it's at that point where I got to go, you know what, maybe some things I need to take in my own hands and be my own advocate for, because they're just going to follow the normal protocols of, you know, medicine.
Howard: Yeah, and what was embarrassing for me is, when I'm talking to my friend who's a physician, and when I turned fifty, now I'm fifty-five, I said, "Well, who should I go to? Maybe I should go to a cardiologist and get checked out." He goes, "Dude, I can't even ... I don't even know who I could send you to, because you send any fat, bald guy to a cardiologist and they're going to be immediately place stents, want to do a bypass. They're just going to want to attack you. You're going to be on all these pills and stents and this and that. It's like, you know, I don't know who I trust that could actually just look at you and say, 'No, you're okay. Go home or whatever', you know", he says. It's the American healthcare machine.
Howard: 17 percent of the GDP. I mean, it's a crazy machine, but, hey, I just ... I'm sorry. Were you born in Puerto Rico?
Victor: No, no, no. My parents ... where I was born in Jamestown, New York, south of Buffalo and raised in West Palm Beach, but since I was about ten.
Howard: I just lectured in Jamaica last week and I heard so many Puerto Rico stories from that hurricane.
Victor: I still have family down there and it took us three weeks to even get in contact with them.
Howard: Oh, my g*d! Some of the Jamaican dentists had actually been over there and they just said, I mean they just threw their hands up and they said, "My g*d, it's leveled! It's just leveled."
Victor: I mean, if Florida would have got that, we'd have been in tremendous trouble. You know, that was, you know, hopefully you don't see very many of those in your lifetime.
Howard: And what my Puerto Rican dentist friends are sad about is the ... now a lot of people are giving up on Puerto Rico, and I think 80,000 have moved to the United States since the hurricane without any intention of going back.
Victor: Yeah, they're coming through Fort Lauderdale.
Howard: What's that?
Victor: They're coming through Fort Lauderdale.
Howard: Yeah, I mean, if you don't have electricity or running water and sewage and you got an old grandma and a two year old baby, I mean, at some point you got to say, "This isn't a camping trip anymore."
Victor: And you know what? They're more than welcome. It's a situation where, you know, you've got to help people that are in trouble no matter where it is. And, you know ...
Howard: Well, that's the biggest dichotomy in economics that I've always talked about Ryan with, is the fact that if you ask any person in America, you say, "What made America great?" and they go, "Immigration. Ellis Island. I mean, all the greatest people in the world all moved here from all over and built the greatest nation in the world", and in 1914 they pulled the plug on immigration, then you say, "Well, why don't you just get rid of the Department Immigration and go back to Ellis Island? Just let another bunch of millions come in." "Oh, no, no, that's bad." It's like, how does every American agree that immigration was the best thing and built this country and now they all disagree. I mean, if this country wanted to explode its GDP, get back on track, they would absolutely go back to the days of Ellis Island. Anybody that wanted to come over here and join your team ... and you look at the stats, one in four immigrants starts a business, but only one in thirty born in America starts a business.
Victor: Absolutely. I completely agree.
Howard: It's a brain drain. The lazy ones stay home, but the guy that travels around the world to come join your team, that guy's more ambitious than your kid playing with the Xbox on the couch, eating Cheez-Its.
Victor: Absolutely. My father only finished ninth grade. They got married at nineteen. My dad was nineteen, my mom was eighteen. They came here. He put four kids through college. I'm a dentist and, you know what, I look back at him - and they've passed away - but I admire those, what he did for me and our family and what he did for the United States. I can't even imagine doing what he did.
Howard: And look how skewed my view is of the brain drain. Like, I have so many Mexican friends in the United States.
Howard: And I know all ... 'cause I'm on the border, so I know these people, but when I go travel into Mexico - I mean, you can tell clear as a bell that we stole the cream of the crop.
Howard: I mean, the ten percent of Mexicans who were the hardest working, most ambitious, wanted to start their own company, wanted to be all they could be, they all came north of the border, and you can see south of the border, you can see the brain drain when you go to those towns, those people are less ambitious, less hard working on the average than the ones that live in Phoenix, Arizona. I mean, who is this kid that comes ... I mean, look at all the startup companies, I think of the top thirty startups last year, I think nineteen of them were born in Asia.
Victor: Yep, yep. I mean, well, look at here, and you don't probably have this example like we do here, the Cuban American people here, you know, the Cubans that came in the 1950s and '60s, all of them, for the most part, majority of them are successful, hardworking, own businesses, contributed to South Florida to the level where no Americans did. I mean, to be honest with you, and the only son I've met of yours is Ryan and I admire him. He's such a hard worker, because the reality of it is, our generation, our kids, maybe they had more than then than we did, and the reality of it is, I don't know if they have it like that. I don't know if they have the hunger and the drive and the things that these people have that allows them to contribute to society.
Howard: And follow that deal. Think of every Cuban American you know in Florida, then go visit Havana. Now, Havana is open, Southwest Airlines go there.
Howard: You can tell less of the Cubans want to be all that they can be and start a business and start all this thing, because the most ambitious ones jumped on a raft over the last fifty years.
Victor: Yeah. I had a dental assistant and, you know, this is a quick, little story. I had a dental assistant for about three or four years, that she came over in a nineteen-foot boat, escaped from Cuba, one of the best assistants I ever had, and the only reason she left is she went to hygiene school. I mean, and I'm like you can't teach that, you know. I don't know if you can.
Howard: No, I know. You know, if they want to make America great again, we'll go back to Ellis Island.
Victor: There you go.
Howard: Anybody that wants to travel from around the world, to leave their home - I couldn't imagine leaving my home and going to another country. I mean, you'd have to have really big ideas, big dreams, big ambitions, and if they want to travel around the world and come join the team, you should meet them with roses at Ellis Island. But, man, we went twenty minutes over. I love talking to you so much.
Howard: My gosh. Seriously, if you ever want to write an article for Dentaltown magazine, I mean, there's so many things you can write on. I like that legals deal. You know, Socrates said we only had two emotions: greed and fear.
Howard: And greed is I want to do the second molar or place an implant; the fear is I don't want to go to court and get my license taken away. But, if you've ever got any spare time on your hands, and thanks for the best news in the world, that vodka doesn't have sugar in it. I guess, I'm going to ... I think it's Christmas. Is this December 25th? My g*d, I always thought that drinking a vodka was like having a Dr. Pepper.
Victor: I'm going to have one right after I get off with you, so we're good.
Howard: Yeah, d*mn, that is amazing. That's what I always feel when they tell me, "Well, dentist, that's not a real doctor." I say, "Well, neither as Dr. Pepper." And, but, hey, seriously, Vic, thanks for coming on the show. Thanks for all that you can do. That's just amazing.
Victor: And, you know, and seriously, I don't mean to ... I'm not blowing smoke. Thank you for everything you've done in dentistry. You have no idea how much I admire you, so.
Howard: Ah, thanks, buddy.
Victor: And if you want any information, have Ryan give me a call.
Howard: And what's your favorite vodka?
Victor: I like Grey Goose, but, you know, I'm in between Grey Goose, Stoli. Which one do you like?
Howard: Grey Goose.
Victor: There you go.
Howard: I like the Goose. All right, buddy, have a rockin' hot day.
Victor: Thank you.