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Tag: Sasha Klemawesch MD

The T(r)OOTH of the Matter

The T(r)OOTH of the Matter

By:  Sasha Klemawesch, MD

During residency, we had a DDS come do a grand rounds lecture. During it, he advised not rinsing after brushing. I paid no heed to his recommendation at the time since the idea of not rinsing your mouth out after you brush your teeth seemed so bizarre and gross (also probably I was too busy passing notes w my coresident to listen all that closely to a dental lecture – snore!).

The American zeitgeist writ large tends to reinforce the “normality” of swishing and spitting after brushing; picture every couple in every movie you have ever seen standing at the vanity together getting ready for bed; all of them brush, rinse, spit and then smile lovingly at one another (or glare daggers depending on the film).

However, apparently Hollywood and I have gotten it all wrong for decades. My personal dentist recently prescribed fluoride toothpaste and told me to not rinse, eat or drink for at least 15 min after brushing with it, preferrable 30, explaining that were I to do so, I would be giving the fluoride a few mere seconds to try and act before washing it away. You wouldn’t shell out 20 bucks for topical steroids or pain relievers to just immediately scrub them off post-application, would you? When he put it that way it made sense, but I was still Super averse to the notion of not rinsing after brushing; it just seemed so sticky and foreign! However, I assure you, in less than a week, not only did I get over the lack of rinse, but my mouth actually came to feel good and fresh by doing so, and now it’s second nature.

Two other tidbits related to teeth-brushing but non-dental in nature:

(1) Try using your non-dominant hand when brushing next time. Doing so will force your brain to work to establish novel neural pathways which can be especially helpful in delaying cognitive decline as you age.

Second, while the hand swap will benefit brain health, standing on one leg will help your physical health. While seemingly insignificant, if you really force yourself to balance on one leg at a time even for the minute you are brushing your teeth, you are working on balance, core, and leg strength, and those daily minutes will add up. 

I confess, the latter two are coming much more slowly and with greater difficulty than the no-rinsing thing, but I keep trying.

Finally, last teeth-related item; when you finish reading this article, look up and whoever the first person you see is, flash them a big toothy grin. I guarantee both you and they will immediately feel happier by doing so!

Sensitive – but timely and critical conversation for families to have

Sensitive – but timely and critical conversation for families to have

 Death. Unfortunately, in my line of work, it’s part of my daily life. If you’ve had an appointment with my dad anytime in the past year, you know that I recently shifted gears from an Emergency residency to a Critical Care fellowship. Having spent the last several years in the Emergency Department (ED), I’d forgotten what a different beast death is in the Intensive Care Unit (ICU). In the ED, death is swift, often unexpected and sometimes merciful. ICU deaths however, are frequently prolonged, often excruciatingly so – and in my experience, much more slow, painful experiences for everyone involved.

In the ICU, I often feel like I’m prolonging death and suffering rather than restoring life and vitality. My patients often have more organ systems that have failed than ones still functioning; death is being kept at bay by multiple forms or life support; ventilators, vasopressors, dialysis, ECMO (a form of partial cardiopulmonary bypass), etc. Very rarely is the person who emerges from that cloud of clinical contrivances the same that went into it. More commonly, they are frail shells of their former selves, often without all their faculties, and now condemned to the all-too-common narrative of discharge to rehab facility, where they will continue to linger until they incur one in a long line of complications and end up back in the hospital, often to do the whole thing all over again.

Now, you may say this is a very bleak representative of what the ICU is. Certainly, there are success stories, and not everyone is condemned to this fate. While that is true, those cases are not the impetus behind my writing this column. One of the reasons even frankly futile cases end up languishing on life support for days or months on end is their family’s inability to make complex medical decisions for the patient, which is why Advanced Directives (ADRs) are so important.

While it can be an uncomfortable or awkward discussion for many people to have, it is absolutely imperative that you think about and discuss your goals and wishes before you or your loved one end up in an unfortunate, unforeseen situation. Unless you’ve had a sick family member, or happen to work in health care, you likely have never heard of ADRs. Even those who have may not know everything that can go into them.

And while deciding if you want a breathing tube or CPR are certainly key decisions (described in the “DNR/DNI” portion of an ADR), advanced directives can go way beyond just that. You can make yours as personal and intricate as you want; e.g., blood transfusions, dialysis, feeding methods, surgeries, etc., etc. Or you can stick to the very basic DNR decision. There is a lot to think about and the time to do it is now. Making these choices by no means locks you into anything; you can change, update or rescind any decision at any time.

But where do you even start? Your primary care doctor is a good first stop. He/she likely has a social worker or specialized nurse who can help you through the steps or provide you with worksheets or information pamphlets. Or this person may refer you to a Palliative Care colleague. Family lawyers can be good non-medical resources to assist you through the process as well. Or you can do some research on your own— and are both excellent resources.

Guess everything needs a name, But really, EIEI-O and TWIT?

Guess everything needs a name, But really, EIEI-O and TWIT?

By Sasha Klemawesch – 


A recent article in the Annals of Emergency Medicine gave me both pause for thought and a good chuckle.

The researchers studied human behavior on escalators and moving airport sidewalks.

They observed that more than 90% of passengers in these conveyances failed to move by stepping or walking, despite having no one in their immediate path. Moreover, they observed fairly frequent startle responses when fellow “travelers” asked to be able to step or walk past.

A small percent of the time (10%), they observed individuals refusing to move over to allow passage. And in 3% of the time, persons actually stuck out their arms and legs to prevent passage.

Researchers named this – wait for it – “Transient Walkway-Induced Torpor (TWIT); and in cases seen on the moving stairways, “Escalator-Induced Extremity Immobility Obstruction (EIEI-O).”

Bet you’ll remember this when you ride your next conveyance.