E6 EZ EE THE WASHINGTON POST.TUESDAY, MARCH 1 , 2022
James Sparks, an Oklahoma
dentist who is president of the
American Association of Dental
Boards, said he wasn’t aware of
any similar laws. He added that he
personally would never bring an
animal into his practice. “I can’t
take the chance of a dog jumping
up while I do work,” he said.
Atkins, who is 6 years old,
received 600 hours of training
from Paws4people. She and Kuc-
era then trained together for an
additional 50 hours. There was no
charge for Kucera to get Atkins,
but she had to commit to raise
$10,000 for the foundation. Al-
though Atkins lives with Kucera,
she is owned by Paws4people.
On the days Atkins works at
Charlotte Pediatric Dentistry, a
sign in the reception area alerts
patients that a dog is on duty. If
someone has allergies or a fear of
dogs, the staff puts Atkins in her
kennel in a back room.
For the youngest patients, At-
kins jumps into the dental chair
and models behavior. She gets her
own clip-on napkin and holds her
mouth open while Kucera checks
her teeth with a mirror.
When patients want Atkins in
their laps, Kucera uses a dispos-
able drape to create a barrier
between the patient’s clothing
and the dog so the patient doesn’t
go home covered with dog hair.
She said that she’s never had a
problem with Atkins disturbing a
dentist’s work and that many
families request the pooch for
every appointment.
Levi said that’s his plan, too.
“It’s just really helpful,” he said.
“Everyone should have one.”This article was produced by Kaiser
Health News (KHN), a program of the
Kaiser Family Foundation, which is an
endowed nonprofit organization that
provides information on health
issues to the nation.cuddle with a cockapoo named
Charlie, for instance, while those
at a practice in Nashville visit
with PeeWee, a French bulldog. In
Cornelius, N.C., Whalen Dentistry
advertises that a goldendoodle
named Beamer will “make any
appointment a little less...RUFF!”
Yet the proliferation of dental
dogs highlights a surprising lack
of regulation. In most states,
nothing prevents a dentist from
bringing in an untrained pet and
calling it a comfort or therapy
dog, possibly putting patients at
risk for an infection or a dog
attack. Patients with allergies or a
fear of dogs might also have con-
cerns.
In North Carolina, complaints
from patients concerned about
sanitation and safety prompted
state regulators to approve a rule
allowing only certain types of
highly trained dogs in dental
exam rooms. It took effect in June
2021 and is thought to be the first
regulation of its kind nationwide.
As many as 1 in 3 Americans
experience dental anxiety and
fear. For them, a visit to the
dentist can be terrifying, and re-
search indicates dogs can help. A
small study published in the jour-
nal Animals found that patients
with a fear of the dentist who had
a dog lie on their laps during
treatment experienced a decrease
DOGS FROM E1 in their stress and blood pressure
levels.
Other research shows animals
in health-care facilities can re-
duce the perception of pain and
boost patients’ moods.
The Americans With Disabili-
ties Act allows people with dis-
abilities to bring a service dog
into health-care facilities, includ-
ing dental clinics. Such animals
do not pose a significant risk of
transmitting infection in a den-
tist’s office, according to the Cen-
ters for Disease Control and Pre-
vention.
The North Carolina State
Board of Dental Examiners pub-
lished an initial rule that would
have allowed only service dogs for
patients with disabilities in den-
tal exam rooms, effectively ban-
ning “rehabilitative facility dogs”
like Atkins. In response, dog lov-
ers and dental patients flooded
the board with emails, said Bobby
White, the board’s CEO and legal
counsel.
The board then proposed also
allowing facility dogs in dental
offices.
Facility dogs get the same in-
tense training as service dogs but
learn tasks to help many people,
rather than just one, said Kyria
Henry Whisenhunt, executive di-
rector and founder of
Paws4people Foundation. The
North Carolina-based nonprofit
trained Atkins and three other
In North Carolina,
dogs are trained
for dental work
dental dogs in the state.
Facility dogs are trained to
work in specific professional en-
vironments, Whisenhunt said.
For instance, Atkins had to be
desensitized to sounds such as
the screech of the dentist’s drill.
The dog also had to practice lay-
ing her head on a patient’s lap and
staying still while a dentist works.
Other facility dogs work with
professionals in special educa-
tion, physical and occupational
therapy, and mental health care.
The new North Carolina regu-lation defines a “certified facility
dog” as one trained in a program
accredited by an organization
that promotes training standards
for assistance dogs, such as Assis-
tance Dogs International or Ani-
mal Assisted Intervention Inter-
national. It also requires the dog’s
handler to be trained and certi-
fied.
“Our whole goal was to make
sure the dogs are safe,” White
said. “There’s a lot of difference
between a facility dog that has
special training and a person whogoes on the Internet, buys a vest
and puts it on a Chihuahua.”
The Animal Legal and Histori-
cal Center at Michigan State
searched laws and regulations in
all 50 states for Kaiser Health
News and found that only Vir-
ginia, New Jersey, and Georgia
specifically prohibit animals (ex-
cept for service animals) in dental
facilities. Center attorney Rebec-
ca Wisch found no other guide-
lines related to dogs in a dental
office. “I think the NC regulation
is unique,” she said in an email.MICHELLE CROUCH FOR KAISER HEALTH NEWS/MICHELLE CROUCH FOR KAISER HEALTH NEWS
A Labrador retriever named Atkins sits on Levi McAllister's lap as he gets two teeth pulled. Atkins had
to be desensitized to sounds such as the dentist’s drill and had to practice laying her head on a patient’s
lap and remaining still while a dentist works. “The dog made me feel happy and calm,” Levi said.ISTOCKA woman and her daughter perform burpees at home during the coronavirus lockdown.
BY ILYSE DOBROW DIMARCOI recently spent 45 minutes
speaking to a patient about body
wash.
I’m a clinical psychologist spe-
cializing in maternal mental
health. The body wash conversa-
tion was with a mom of a toddler
who was agonizing over whether
she should purchase a natural
(read: expensive) product she’d
heard about on Instagram for her
child who has sensitive skin. Ap-
parently, she and her husband
had been arguing about this; he
didn’t think there was anything
wrong with the body wash they’d
always used. But she worried
about chemicals, fearing that
she’d been giving her child some-
thing that, according to a Mom-
fluencer she follows, would mess
with her kid’s body chemistry.
In the Before Times, I typically
saw parents who were anxious
about higher-stakes parenting
stressors, such as coping with the
effects of divorce. But since
March 2020, we parents have
been reminded every day that it is
our job to keep our kids safe.
While we were of course aware of
this pre-coronavirus, our experi-
ences with the pandemic have
amplified this feeling of responsi-
bility, to the point where many of
us are becoming overwhelmed by
minor daily decisions that have
nothing to do with covid-19 safety
— like what body wash to use, or
what to pack for school lunch, or
whether to let our child play on
the tall slide.
“Parents have been told that it’s
their job to protect kids from
covid, yet they also see, especially
during omicron, that it’s impossi-
ble to do this,” says Rebecca
Schrag Hershberg, clinical psy-
chologist and author of “The Tan-
trum Survival Guide.” “As a result,
they’ve started focusing on kid
safety decisions that they do in
fact have some control over.”
All this high-stakes decision-
making (on top of the unrelenting
covid-related decision-making)
has resulted in significant anxi-
ety, guilt and fatigue for the par-
ents I treat. Fortunately, cogni-
tive-behavioral therapy (CBT)
and acceptance and commitment
therapy (ACT) offer coping strate-
gies to help lower the parenting
stakes and put things into per-
spective.
Use logic to counteract cata-
strophizing. Much of the worry-
ing parents are doing about mi-
nor kid issues can be categorized
as catastrophizing, which Terri
Bacow, clinical psychologist and
author of “Goodbye, Anxiety: A
Guided Journal for Overcoming
Worry” defines as “overestimat-
ing the probability of danger and
underestimating our ability to
cope.” Unfortunately, advertisers
and influencers feed into our ten-
dency to catastrophize, convinc-
ing us that a processed fruit snack
or nonnatural soap will cause
harm to our children.To successfully de-catastroph-
ize, Bacow recommends con-
fronting our anxiety with logic. To
this end, she suggests we ask
ourselves two questions. First, “Is
there any evidence that what I am
worried about is actually going to
happen?” Take that Momfluencer
on Instagram talking about body
wash. Is there any reputable re-
search to back up her claims that
certain kinds of soap will mess
with children’s body chemistry?
The second question to ask is:
“If the ‘catastrophe’ were to occur,
how bad would it really be?” Ba-
cow cites the example of a parent
who worries about the processed
food their child eats at other peo-
ple’s homes. Will an occasional
cookie at a friend’s house really
impact their health in a signifi-
cant way?It can also be helpful to think
through the “catastrophe” and
make a mental plan for how you’d
cope with it. Say you’re reluctant
to let your kid play on your neigh-
bor’s coveted trampoline. “You
need to remind yourself that of
course you could handle it if your
kid fell on the trampoline,” says
Bacow. “It’s useful to recall simi-
lar situations that occurred in the
past — like other times your child
got hurt or sick — and think
through how you successfully
navigated those situations.”
Consider your values. Much of
the decision-making parents have
done during the covid era has
been fear-based; we’ve let our
anxiety about safety drive our
choices. This makes sense when
there is a clear threat, but doesn’t
when there isn’t evidence that
such a threat exists, as in the case
with the body wash. It can be
helpful, says Yael Schonbrun,
clinical psychologist and author
of the upcoming book “Work, Par-
ent, Thrive,” to consider what we
value, and let our values, rather
than our anxiety, inform our
choices. “We don’t have much
control over how we feel,” notes
Schonbrun. “However, we have
considerable influence over what
we choose to do out in the world
— even when anxiety is along for
the ride.”
One way to clarify your values
around different kid decisions is
to think about a parent you ad-
mire. Schonbrun recommends
asking yourself, “How would that
parent manage... i n a scary situ-
ation or in a moment when their
anxiety has flared up? How wouldI describe the way they show up,
even if they might be feeling anx-
ious?” You can also consider the
type of response you would want
to model for your kids. Would you
want them to see you avoiding a
feared situation, or approaching
it?
Challenge yourself (and your
children) with exposure. So
you’ve figured out that letting
your kid eat sweets/bathe with
regular soap/take their skate-
board to the park is values-consis-
tent for you. But how do you get
yourself to actually let these activ-
ities happen when you’re still
worried? “It’s best to use the prin-
ciples of exposure therapy,” says
Hershberg, “which involve plan-
ning to face situations you have
been avoiding due to anxiety.”
Practically speaking, this means
making a list of values-consistent
(but anxiety-provoking) situa-
tions and systematically working
your way through the list. If
you’re nervous about playground
equipment, for example, you
might make a list of different
playgrounds you’re avoiding and
assign yourself specific times and
days to visit those playgrounds.
You might start with a smaller
playground and work your way
up to the one with the biggest
slide (a.k.a. your kid’s favorite).
Hershberg stresses that the
goal of exposure is not to prove
that something bad won’t hap-
pen, but rather to grow more
comfortable with uncertainty.
“When you’re exposing yourself
to a values-consistent situation
that makes you anxious — say,
letting your kid go on that high
jungle gym — you’re exposing
yourself to the feeling of anxiety.
You’re practicing not going down
the rabbit hole of trying to predict
what will happen but rather fo-
cusing on the fact that whatever
happens, you’re a capable, loving
parent with the tools to handle it.”
Mindfulness can help you cope
with the anxiety you feel while
completing exposures. “It can be
helpful just to name how you’re
feeling,” advises Shonda Moralis,
clinical social worker and author
of “Breathe, Mama, Breathe.” “Tell
yourself, ‘Worry is here, fear is
here, it’s okay — I don’t need to be
driven by it. I don’t need to resist
it or push it away. I just need to
kindly and firmly stay the course.’
”
Parenting will always be a
high-stakes operation. Even
when omicron is no longer a fac-
tor, we’ll continue to be faced with
difficult decisions for our kids. If
we can de-catastrophize the low-
er-stakes decisions, it will free up
more space in our brains for grap-
pling with the important ones.Ilyse Dobrow DiMarco is a clinical
psychologist specializing in maternal
anxiety and author of “Mom Brain:
Proven Strategies to Fight the Anxiety,
Guilt, and Overwhelming Emotions of
Motherhood — and Relax into Your
New Self.”ON PARENTINGHow to cope with the added angstof keeping kids safe in the covid eraISTOCKburpee, think of it as an end-goal,
rather than the beginning.
“You’re much better off building
up slowly and steadily, rather
than overdoing it on day one and
potentially hurting yourself,” said
Vijay Jotwani, a sports physician
at Houston Methodist Hospital.
The risk of pushing yourself
too hard, too fast is that burpees
require a high degree of flexion in
the wrists, elbows, shoulders,
hips and knees, which can in-
crease the risk of straining or
injuring a muscle or ligament.
To build up slowly, focus first
on the individual components or
modified burpees. “Just because
someone does something one way
doesn’t mean that it is incorrect
to do it another way, especially if
you have particular needs in your
own body that you have to be
managing,” Crockford said. “Giv-
ing yourself a little bit of grace is
important.”
A gradual approach can help
avoid overtraining and injury. “As
long as someone is listening to
their body and slowly advancing
the intensity of their exercise, the
risk of injury is low,” Jotwani said.
If you are recovering from an
injury or have any concern, talk
with your doctor and work with a
certified fitness professional who
can suggest additional modifica-
tions. One of the challenges of
burpees is the quick transition
from a prone to an upright posi-
tion. If you are dehydrated or
recovering from an illness, this
can cause dizziness. Be sure to
hydrate well, and if the dizziness
persists, be sure to talk with your
doctor.
If you are struggling with one
or several of the burpee’s compo-
nents, work on them separately
until you are comfortable doing
each one. “The whole burpee can
be broken down and work-
BURPEES FROM E1 shopped,” said Cat Kom, a person-
al trainer and the founder of
Studio SWEAT onDemand in San
Diego.
Starting with individual move-
ments gives you the space to focus
on developing the necessary
strength. Combining them into a
single continuous movement has
the added benefit of getting your
heart rate up, which helps with
cardiovascular conditioning.
Moving from repetitions of a
single body weight exercise to the
combined movement of a burpee,
however, means adding in transi-
tions, most notably the jump into
and out of the plank position. “In
my experience, the jump-back is
usually the most fearful part of a
burpee,” Walker said.- Step-back burpees
One way of getting used to the
transition from a plank to an
upright position is to do a step-
back burpee. For this modifica-
tion, you step back into the plank
position, and then step forward to
return to an upright position.
Kom recommends bringing your
hands upward again, reaching
toward the ceiling, to prepare
yourself for doing the same dur-
ing a full burpee.
A step-back burpee will also
help with hip and ankle mobility,
which is needed for the jump.
“Because you are moving your
body from a horizontal position
back to a vertical one, there is
some extreme hip flexibility that
is necessary,” Crockford said.- Half-burpee
Once you have developed
enough hip flexibility to do a
step-back burpee, you can then
progress to a half-burpee, where
you assume a plank position,
jumping your feet forward and
then back again. - Half-burpee with squat
When you are comfortable
with a half-burpee, one variation
is to add in a half-squat after
jumping your feet forward. Then,
you’ll jump your feet back again,
returning to a plank position. - Half-burpee with push-up
To get used to adding in a
push-up, you can do a half-
burpee, for which you’ll just be
jumping your feet forward and
back, adding in the push-up right
after you return to a plank posi-
tion. - Squat jumps
One of the final components of
a burpee is to go from a squatting
position to a jump in the air, a
movement that can be practiced
separately.
Once you are comfortable with
all of these modified versions, you
can combine them for a full
burpee.
There are other ways to modify
the different components of a
burpee to suit your needs and
goals. “Every part of the burpee
can be modified,” Kom said.
“There’s a burpee for everybody.”
Up to your elbows in trying to master
the burpee? Here are s ome helpful tips.
“When doneappropriately, theburpee can be a high-reward exercise.”
Jacque Crockford,
Personal trainer and senior product
manager with the American Council
on ExerciseTo see videos of how to do
different kinds of burpees go to:
wapo.st/burpee_videos