Dental or Nutritional Issue with Dr. Daniel Chapman

[00:00:00] Welcome back to Untold Physio Stories Podcast. I'm your host, Dr. Erson Religioso III with Modern Manual Therapy and Edge Mobility System. Today, I have a guest, Dr. Dan Chapman. How's it going today, Dan?

[00:00:08] It's going well. It's going well. It's good to be here. Thank you for having me.

[00:00:11] Yeah, we pop up in each other's LinkedIn feeds, and this is how these things happen.

[00:00:15] That's exactly right. Yeah.

[00:00:17] Right. Dan had some issues, and I think it's just another valuable lesson and an interesting case, and hopefully listeners can learn something from your case or at least think about something else, like a differential diagnosis.

[00:00:30] Do you want to give us a quick intro and then tell us what happened?

[00:00:33] Yeah. Yeah, yeah. So my name is Dan, and I run Summit Physical Therapy in Baltimore, Maryland. And we're an out-of-network clinic here, and we are in-network with Medicare, so I think technically that makes us a hybrid clinic.

[00:00:47] But, you know, it was—

[00:00:49] Because no one can be out-of-network with Medicare, you mean?

[00:00:51] Sorry, say again? Because nobody can be out-of-network.

[00:00:53] Yeah, right.

[00:00:54] Exactly. We don't have that choice.

[00:00:55] Every out-of-network clinic. I guess that would include me as well.

[00:00:59] That's right.

[00:01:01] But, yeah, you know, it was an odd thing. I have a—you know, I promise I'm not one of those people that goes around talking about being gluten-free, but it does actually relate to this story where I get canker sores in my mouth whenever I eat wheat or gluten.

[00:01:17] Okay.

[00:01:17] And so usually, you know, if I—

[00:01:19] How long did it take you to figure that out?

[00:01:22] Decades. Like, I went to dentists, different types of providers, and they're always like, you know, this is just kind of what happens.

[00:01:28] And to me, it was, you know, these things take usually two weeks to heal, and then I would go maybe five to seven days without having one, and then I'd get another one.

[00:01:37] Like, years and years and years.

[00:01:39] I was like, this is not normal, right?

[00:01:40] This is not your average canker sore.

[00:01:42] I changed my toothpaste.

[00:01:43] I mean, you name it, I did it.

[00:01:46] And then I actually ended up cutting out wheat for a different reason because I suffered with—I'm sorry, eczema for a very long time.

[00:01:55] I cut it out for that reason, and then like that, my canker sores went away after, you know, 10 plus years of having them.

[00:02:03] How about your eczema?

[00:02:04] Eczema is significantly better.

[00:02:06] Yeah.

[00:02:07] So, you know, whenever I tell my dermatologist this, they're like, you know, we don't really know about nutrition, and so who knows, man?

[00:02:14] But like, it seems to work for me.

[00:02:17] It seems like really no one does in a way.

[00:02:20] Exactly.

[00:02:22] Yeah, so, you know, that's just kind of how it came about.

[00:02:25] But I was traveling—this was maybe a couple months ago now—I was traveling, and usually I'm pretty good about my diet, but then suddenly, you know, when you're traveling, it's not always easy to find those gluten-free options.

[00:02:36] And then I just broke.

[00:02:38] And woke up the next day, I had a canker sore right on that like right cheek area where, you know, you put your tongue into the side of your cheek.

[00:02:46] That's right where it was.

[00:02:46] But I got to interrupt you, though.

[00:02:48] Was it something—I always tell patients, if you kind of cheat, especially when it comes to your diet, you got to make sure that it's something you want.

[00:02:54] Was it something that you wanted, or is it something that you haven't had in a while?

[00:02:58] Yeah, no, it was like a big Impossible Burger Whopper, like the big Double Whopper or whatever at Burger King.

[00:03:06] The Impossible Burger, though, you're still just better off getting like normal beef.

[00:03:09] Yeah, so I also don't eat meat.

[00:03:11] I don't eat anything, man.

[00:03:12] It's just like air and water.

[00:03:14] But like, yeah, so I—

[00:03:15] No, I mean, I get it.

[00:03:16] I used to be 100% plant-based for a while, and then we were gluten-free for my son's constipation.

[00:03:21] Yeah.

[00:03:22] Severe constipation for like maybe eight months.

[00:03:24] So I get it.

[00:03:25] I've given up things before, but I gradually like start introducing them back in and see.

[00:03:29] It's like an anti-elimination diet.

[00:03:31] Yeah, absolutely, man.

[00:03:32] It's like traveling is like—you know, it has made me a more creative cook, for sure.

[00:03:38] You know, and—but yeah, so I did break.

[00:03:42] And lo and behold, the next day I woke up.

[00:03:44] I had that canker sore right in the cheek.

[00:03:45] And within probably a day, I just had this pounding headache that was, you know, up to my temple and then a little bit above my right eye.

[00:03:56] And it was kind of just with me throughout the whole day.

[00:04:00] And then—but I did notice it would get—you know, I'm a PT, so I'm kind of thinking, okay, what makes it worse?

[00:04:04] What makes it better?

[00:04:05] You know, talking and eating, right?

[00:04:08] I was on the phone.

[00:04:10] It gets worse.

[00:04:10] I'm talking with patients.

[00:04:11] It gets worse.

[00:04:13] And I was trying to figure out what it was.

[00:04:16] And, you know, obviously, I started digging into my masseter here in the jaw, and it just exaggerates the headache significantly.

[00:04:23] But that manual pressure, that hands-on massage, then would calm it down for a short period of time, right?

[00:04:29] Maybe I'd get like a couple hours of relief, and then it would come right back.

[00:04:35] And so I kind of realized I was putting two and two together.

[00:04:39] I got this canker sore.

[00:04:42] I can do some manual work to try to calm down the muscular tension here.

[00:04:46] And, again, it was like right into that masseter.

[00:04:48] But I kind of had a feeling in the back of my head, as soon as this canker sore goes away, I'm going to be fine, right?

[00:04:55] And lo and behold, a week later, the canker sore starts to calm down.

[00:04:59] Headache goes right away.

[00:05:00] And to me, it sounds like a really, really basic, okay, what's the clinical significance of this?

[00:05:07] But if you think about it, it's a headache caused by a soft tissue referral pattern that is a musculoskeletal irritation that's generated by a non-musculoskeletal source.

[00:05:20] Right?

[00:05:21] Right?

[00:05:22] So there's a bit of a chain here about how this headache came across.

[00:05:32] But, you know, for me, I see this a lot, right?

[00:05:36] I see it with radicular pain, right?

[00:05:38] You have people that have like a hot radicular pain going down the posterior thigh, wrapping around to the peroneals.

[00:05:46] Once you calm down the nerve pain, if you go back through that soft tissue, those peroneals are irritated.

[00:05:53] The hamstrings are irritated.

[00:05:55] The posterior lateral soft tissue around the hip is irritated.

[00:05:58] And so, you know, there's two thoughts in my mind going on when I try to break down this kind of what happened here.

[00:06:07] And on one, it might be what I think in the pain neuroscience world, they kind of call it noisy neighbors, right?

[00:06:12] You have pain in an area and then it creates tension and pain in the muscles and structures around that area as well, right?

[00:06:19] So you have a masseter muscle that's irritated by the canker sore and the pain there.

[00:06:23] But then also there's the thought of even though I didn't realize or think about it,

[00:06:28] I may have just been chewing and talking differently, trying to avoid the pain in my cheek,

[00:06:33] using the masseter differently, using the muscles around my jaw differently and putting a new undue stress on those muscles that they're not used to, right?

[00:06:43] But either way, I thought it was an interesting kind of clinical thought process to talk about pain,

[00:06:50] talk about musculoskeletal referral sources because we get those all the time when it comes to headaches, right?

[00:06:55] Whether it be from the neck or the jaw.

[00:06:58] And yeah, just a goofy case of a headache and what caused it.

[00:07:04] No, it is interesting.

[00:07:06] It's funny though.

[00:07:07] I'm trying to think if it was a patient, you know, it would be harder to say, oh, well, you have this history.

[00:07:13] So let's just say, I'm just, well, let's just wait to see for when it goes away because someone would want like,

[00:07:19] it's almost like you'd have to mash around a bit on perfectly sensitized tissues just to get that buy-in or the therapeutic alliance.

[00:07:27] Because if you just said, wait and see, even if, even if you said, hey, this happened, unless you said the authority,

[00:07:33] like you pulled the authoritarian kind of, oh, well, this happened to me.

[00:07:36] I have a very similar history, very similar medical background.

[00:07:39] And, you know, coincidentally, this happened to me last year.

[00:07:42] And when the canker disorder went away, this also went away.

[00:07:45] Yeah.

[00:07:46] You know, but, but otherwise, if this hadn't happened to you and if I was just saying like, hey, let's just wait and see.

[00:07:52] Because I heard about, I heard about a case, you know, from the journal anecdotal evidence, I call it.

[00:07:58] And let's just wait and see.

[00:08:01] It's, even when you said like the perennials and the hamstring and everything, I think the, the tendency,

[00:08:08] the erroneous tendency would be, well, these things are tender.

[00:08:10] Let me mash around on them a bit because obviously it's some sort of issues in the tissues, but it's really not.

[00:08:16] Right.

[00:08:16] It's, it's a, that was more like that.

[00:08:18] Like you said, noisy neighbors or it's secondary, secondary excitation of the nervous system rather than from some sort of actual trauma or, or true.

[00:08:30] Right.

[00:08:31] Inflammation.

[00:08:32] Yeah.

[00:08:32] And so to me, when it was going through my head, I was like, is this something that I seek out care for?

[00:08:37] For me, no, because I'm pretty sure it's going to go away in a week.

[00:08:41] But if someone's already in my office, I'm going to do everything I can to explain to the fact that like, I actually think their pain is a cause of something else, but there's still things that we could do.

[00:08:49] Right.

[00:08:49] There's manual work.

[00:08:50] I can teach you how to do your manual work.

[00:08:52] I can teach you how to stretch these muscles and calm them down.

[00:08:56] But we also need to make sure that when someone is coming in with headaches, that we're not just checking the posterior neck or the lateral neck, you know, the upper traps, obviously the levator, like all those are very common referral sources.

[00:09:09] Checking the jaw, but then also going a little bit further because it might be the jaw, but it might also actually be a dental issue.

[00:09:16] For me, it wasn't, you know, but if someone-

[00:09:20] It's kind of a dental issue, but I mean, a lot of dentists would say, oh, you probably Brux at night or, you know, especially me, I get a lot of canker sores in my cheek, but it's because I have a malocclusion.

[00:09:29] And I'm always, you know, it's like even when I was 100% plant-based, I wasn't because I'm always biting myself.

[00:09:34] Yeah.

[00:09:35] Yeah.

[00:09:35] Oh, and then it just gets inflamed.

[00:09:37] And then you bite it again.

[00:09:38] Yeah.

[00:09:38] Then you just bite it again.

[00:09:40] It's like this vicious cycle of my, now my cheek is pretty much permanently shaped like my teeth.

[00:09:44] Yeah.

[00:09:44] You know, but it's always sticking out and I can't not bite it.

[00:09:48] I have to basically would not, maybe if I did a no-chew diet, like I tell my severely sensitized TMJ patients, no-chew diet for two weeks or something.

[00:09:55] Give that time to cut it down.

[00:09:57] But yeah, it's rough.

[00:09:58] You know, it's funny you mentioned that because that is the exact example that I give to, or, you know, when you're talking with patients, you're trying to explain pain and, you know, or whatever it is that they have going on.

[00:10:07] Now, one of the common examples I usually use is literally that exact biting the inside of your cheek for nerve pain where it's like, hey, you know, you know, there's certain pains that you want to lean into.

[00:10:18] Let's just talk about maybe like a tendon-related pain.

[00:10:20] We want to work into some of that tendon-related pain.

[00:10:22] With nerve pain, a lot of times we actually want to back off because the more you poke it, the more irritated it gets.

[00:10:29] And it's just like when you bite the inside of your cheek, right?

[00:10:32] It gets inflamed.

[00:10:33] You bite it again.

[00:10:34] It gets more inflamed.

[00:10:35] And all that thing is doing is trying to calm down and heal, but you just keep making it worse.

[00:10:39] And that's that typical runner that comes in with hamstring pain, and they just keep stretching and stretching and stretching, but it's actually, you know, a sciatic pain, and they just keep irritating and irritating it over and over again.

[00:10:51] It's just funny you brought that up.

[00:10:52] That's like literally the exact example that I use.

[00:10:55] I'm glad you say that with nerve pain, too, because back when I took David Butler's first explained pain course in 2002,

[00:11:03] I don't even know if you were like practicing or alive or whatever.

[00:11:06] I don't know.

[00:11:06] Some people are so young.

[00:11:07] I'm going to come on my podcast now.

[00:11:11] I may or may not have been practicing for already four or five years, but anyway, he had said that, you know, we're starting to move away from nerve tensioners and starting to go to nerve sliders for extremely sensitized conditions.

[00:11:23] And I'm just like, well, if it's any kind of nerve problem, I don't stretch it at all.

[00:11:26] Right.

[00:11:26] I might do the test to sensitize to see if median or radial ulnar or sciatic or femoral is sensitized, but I'm not going to stretch it just because it hurts.

[00:11:35] Right?

[00:11:36] Yeah.

[00:11:37] Yeah.

[00:11:37] Exactly.

[00:11:38] Yeah.

[00:11:38] All right.

[00:11:39] Every now and then I do find someone who benefits from that, but it is not my first go.

[00:11:44] And it is very rare, you know?

[00:11:46] Yeah.

[00:11:47] But yeah.

[00:11:48] Especially if it's like a perfectly sensitized nerve.

[00:11:51] They usually don't need stretching.

[00:11:52] Yeah.

[00:11:53] Yeah, absolutely.

[00:11:55] But yeah.

[00:11:55] All right.

[00:11:56] It's just a fun.

[00:11:57] That's a great case.

[00:11:58] Yeah.

[00:11:58] It's interesting.

[00:11:59] I mean, now I have another thing to ask for, you know, like this is why I do this podcast.

[00:12:02] Someone else had said that they had a patient and it ended up being their student figuring out that this patient was severely constipated because it was just like the student was just going through these like random list of questions that they were just supposed to ask.

[00:12:15] And it's not something that we asked, but it was like, yeah, severe what appeared to be mechanical low back pain.

[00:12:20] And they were just like severely, severely constipated.

[00:12:24] Wow.

[00:12:25] Okay.

[00:12:25] See, now I just learned something too.

[00:12:26] See, it's just another thing.

[00:12:27] Like I said, but it's exactly that example.

[00:12:29] I don't usually ask people, hey, you have ulcers.

[00:12:31] You have canker sores.

[00:12:32] Totally.

[00:12:33] Yeah.

[00:12:34] Yeah.

[00:12:34] Because I've had people with severe tooth infections that also mimicked masseter pain.

[00:12:38] Yeah.

[00:12:39] But so that's something I asked for.

[00:12:41] Have you gone to the dentist recently?

[00:12:43] But I haven't asked for that.

[00:12:44] And it's important.

[00:12:45] Yeah.

[00:12:46] But it is interesting about how gluten causes that.

[00:12:48] Because I've also had patients who eliminated gluten, their headaches went away.

[00:12:51] They have a little bit of gluten, their headaches immediately come back.

[00:12:55] This is even after a head and neck trauma.

[00:12:56] This patient in particular, she hit with a softball and she had like very severe occipital pain.

[00:13:02] You can see like he hit by a softball like this twice.

[00:13:06] But nothing ever made it better, including a ton of retractions and soft tissue work and everything other than her giving up gluten.

[00:13:11] And that's before I knew anything about nutrition.

[00:13:13] Very interesting.

[00:13:14] Before, back then, I used to just say, hey, why don't you try giving up gluten?

[00:13:17] Now I just say, hey, let's try going plant-based, then gluten, then elimination diet, and then put things back in.

[00:13:24] So I'm a bit more scientific about it because I actually studied nutrition.

[00:13:27] But back then, when I knew nothing about it and I was like, let's see what happened.

[00:13:31] And then she came back.

[00:13:31] She's like, you know what?

[00:13:32] My mom has celiac disease.

[00:13:33] She doesn't have celiacs, but with a history, you know.

[00:13:37] Absolutely.

[00:13:38] Yeah.

[00:13:38] Yeah.

[00:13:39] And I think the other trigger is when I looked it up on UpToDate.

[00:13:43] My mom's a nurse practitioner, so I get those.

[00:13:45] She gets to send me like the UpToDate things.

[00:13:49] It's gluten and dairy are the top two triggers for the canker sores, just for any of the news out there.

[00:13:54] Of canker sores, but also I would say anything.

[00:13:57] Yeah, lots of things, right?

[00:13:58] Things that just make you feel bad.

[00:14:01] Things that sensitize your system.

[00:14:03] Yeah, absolutely.

[00:14:06] Thank you for having me on, Erson.

[00:14:07] This was great.

[00:14:07] Yeah, no problem.

[00:14:08] Thanks for coming on.

[00:14:09] Hey, is there anywhere people can find you that can connect with you on LinkedIn?

[00:14:12] Yeah, yeah.

[00:14:13] Please find me on LinkedIn, Dan Chapman, dbt.

[00:14:16] And then also danchatman.dpt is where I'm at on Instagram as well.

[00:14:21] All right.

[00:14:21] You guys hiring her or anything?

[00:14:23] We did actually just hire.

[00:14:24] It took a year to find someone.

[00:14:27] And I found someone amazing, so I'm pretty stoked about that.

[00:14:29] But he's already full, which is great.

[00:14:32] That's good.

[00:14:33] Because last time I was at the Baltimore area, the person I know who owns like maybe four or five clinics, she has like 50 or 60 employees.

[00:14:40] She had a ton of people from India and other countries because she said, like, I can't find anyone to take these positions.

[00:14:49] It was so, so hard to find someone.

[00:14:52] Yeah.

[00:14:52] I had one applicant before him, and it was just someone who worked at McDonald's and was not a physical therapist.

[00:14:58] Like, that was the only applicant I got for the job.

[00:15:00] For a physical therapist job?

[00:15:02] Yes, sir.

[00:15:02] He's like, hey, I want to be a physical therapist.

[00:15:04] Look how I'm doing, man.

[00:15:06] Yeah.

[00:15:07] This has got great, way better benefits and pay than McDonald's.

[00:15:12] Yeah.

[00:15:13] So, no, it was rough.

[00:15:14] Wow.

[00:15:14] That is a side of our times right here where people who without degrees are now applying for.

[00:15:19] Yep.

[00:15:20] Professional jobs.

[00:15:21] Yeah.

[00:15:21] Yeah.

[00:15:22] That was.

[00:15:22] That's almost, I mean, that's almost a story in itself.

[00:15:24] I'm sure it's not a very long one, but that's hilarious.

[00:15:28] All right, Dan.

[00:15:29] Thanks for coming on.

[00:15:30] Thank you so much.

[00:15:31] Have a good one, Erson.

[00:15:32] Yeah.

[00:15:32] Hey, if you guys learned anything from this podcast, you want to connect with me or Dan, check us out on LinkedIn.

[00:15:37] Please rate Untold Physio Stories five stars wherever you listen to podcasts, especially Spotify and Apple.

[00:15:43] That just helps our discoverability.

[00:15:44] That goes for you too, Dan.

[00:15:45] Yeah, I'm not right now.

[00:15:46] When I tag you on LinkedIn.

[00:15:48] Or yeah, just look it up and please rate me five stars.

[00:15:51] Perfect.

[00:15:51] I got you.

[00:15:52] All right.

[00:15:52] Hey, have a great day.

[00:15:53] Are you, Erson?

[00:15:54] Goodop.

[00:15:54] Okay.

[00:15:54] Thank you.