Dr. Kandula Podcast

SPEAKERS

Brett Scott

Brett Scott  00:01

All right, everybody with me here is Dr. Ken doula. And he is an EMT and a Laron. How do you say it Laron?

00:11

No. Not like that.

Brett Scott  00:14

Aaron geologist,

00:15

very ago. There you go. Yeah. Oh, laryngologist. It’s awful. It really is. But yep,

Brett Scott  00:20

that is gonna call you an en t on the show today.

00:23

That is, that’s the easier version. It’s what most people know is is so yeah.

Brett Scott  00:27

So the reason we’re having Dr. Ken doula on today is the fact that in our practice, as a physical therapist, it’s one of the last things people expect they’re going to be told or see. But we see a lot of people with breathing problems from the fact that I had a patient the other day that came in, in what we ended up finding was a lot of his orthopedic problems of headaches, neck pain, upper back pain, all came from the fact that he was a mouth breather and didn’t know how to breathe properly with his diaphragm with his nose. And that was a big piece of it, as well as when we’re looking at the human and not just body parts. But who are you? What are you trying to do with your life? Are you a competitive athlete and whatnot, especially if you’re a bigger individual, we see a lot of people that have poor sleep patterns, sleep apnea, issues with snoring, not getting the best night’s sleep, which I wish I could say I have magical hands, and we can do all these things to get you better. But we can’t actually out rehab, poor recovery, poor sleep. So that on top of the fact that I am someone that has personally been going through some issues with my airways and sinuses, sinus infections, and just, I really can’t breathe well through my nose at all, typically ever. So I want to have Dr. candle on today. He’s someone that is really seeming to be out there, trying to change the game of what EMTs do, how they treat the human being. There seems to be this piece where he’s trying to get more involved in getting dentistry and the ante community together. As I’ll I’ve already put in the intro that he’s he’s done a lot with his company Advent. So Dr. Kendall, thank you for coming on the show. And I’ve got a lot of questions for you today.

02:27

No, thanks for having me. All right.

Brett Scott  02:30

Thank you. So one of the first things I want to start off with is, you know, just breathing in general, it’s something everyone takes for granted. If I just come and tell you your breathing is part of your problem here. Even people typically are gonna say, I’m breathing. I’m alive. I’m fine. Right?

02:49

Yeah. Well, I mean, part of that is the reality that no, nobody talks about this stuff, honestly. And it’s really just been recently that people really have been, when I say recently, I’d say the last five years, probably, I think there’s been awareness slowly prior to that, but nowhere near what it is, like these days. And the and I honestly think we just are scratching sort of the tip of the iceberg as far as how common these issues are, and how profound the impact is. And here’s how I know it to be true, because we see it every single day in all of our clinics. You know, this is all we deal with all that we deal with our nose and throat issues, specifically breathing issues. And, you know, it’s, I think what I’ve found is, as we’ve kind of put the flag up and put the bad signal out is that you know, and it’s hard to quantify the numbers, but I, in my opinion, from what I see, it seems like more people have these issues than don’t. So this isn’t like you’re like in some minority of Gosh, I’m having a hard time breathing. And then when you just run the numbers, you say, Well, half the half the population snores 20% of the population has sleep apnea, you know, 40% of the population as we call it allergic rhinitis, but allergy issues, you know, you sort of you bang out a list of these big pockets of individuals, and you add the numbers up, and the tally gets close it close and then potentially beyond even what I’m describing. And and I think part of the issue too, is that not only does nobody talk about the you know, nobody talks about these issues, nobody really does anything about these issues. And you know, kind of all of that coming together means there’s a lot of people walking around with airways that aren’t working properly, and they almost have to be lucky to find themselves in a place that that recognizes that. And then when those conditions are are identified and addressed, only when those conditions are identified and addressed. Can anything else really be properly taken care of because life itself starts right at The front. So right, it’s your nose and throat. And if those errors aren’t working, nothing downstream is going to work properly.

Brett Scott  05:07

So what? What symptoms or signs will someone have that they have a breathing issue?

05:15

It can be, you know, run the gamut, I’d say the most common, the most obvious, or is basically somebody just being challenged to breathe through their nose, whether it’s day, whether it’s night, physical activity is an obvious obvious one. And meaning that, I think, if you push yourself past a certain point, yes, you’re going to your body is going to hunger for air, and you’re going to drop your mouth open. And that’s okay. They the more that folks study that though, the more that they understand that, the the want to do that. And the reality for most folks is they drop their mouth open way too early in that process. And so what they found is for endurance endurance athletes in particular is nasal breathing, as a primary and only, you know, breathing methodology, when you’re working out is the right way to do it. And, you know, there is a point where you kind of your body’s feeling like it’s fighting itself. And if you can train yourself through that point, you’ll be a better athlete. But I guess back to your question, I’d say, you know, the simple reality is, if you cannot take a full clear breath through your nose with your mouth shut, day and night, that’s a problem. If you’re snoring when you’re sleeping at night, that’s a problem. If you’re stopping breathing, when you’re sleeping at night, that’s a problem. Headache issues can be a variety of things. But I’d say many folks have sinus headache issues. Many folks have tension headache issues that are interrelated to the fact that they’re not breathing properly, you know, so forth and so on. And then I think downstream from kind of the obvious that your nose and your throat are all the conditions that develop when the body is struggling to breathe. And that’s where it’s tricky. I mean, there are people who have anxiety issues, who’d have no upper airway, airway issues. So that happens. But I will guarantee you that if for anybody, that we create issues in those areas, even if it’s just temporary, especially if it’s temporary, if somebody has got normal, say they have normal breathing passages, they’re, they’re used to a normal life, and all of a sudden, we restrict those passageways. And we do that temporarily, it will 100% guarantee that that person, the first sense, they’re going to feel as a sense of anxiety, because they’re the most primal instinct in our body is to breathe. And when those areas are challenged, the alarm bells go off, all the signals or hormonal signals go off through the body, that we’re we’re under threat. And so that that’s a byproduct of this as well. So I guess sort of going, I can go on and on and on is not everything is related to this stuff. But you know, I think the sad reality is if somebody has conditions that are related to this stuff, the only way to get to the root cause is to fix it at its source and the source. For the area’s, the conditions that we’re treating is the nose and the throat and mainly the nose.

Brett Scott  08:06

So someone breathing like this. Right. That’s a problem. Sound like me, you have a problem. Correct? Yeah. And that’s, that’s why we’re here today. Yep. And so, as we talked about behind the scenes there, James nesters book brief has been one that I I’ve, I’m about halfway through, but there’s some very interesting information in there. Especially about, you know, why we’re seeing so many of these breathing issues coming down to the Industrial Revolution. And some of the things about the food we eat now, being at this different consistency. And foods aren’t hard enough. We’re feeding children like, you know, Cheerios, and noodles, versus carrots. And so, so how did all that happen? What What are these things that are making breathing issues? Such an issue these days?

09:04

Yeah, I mean, I think a lot of that stuff is theoretical, because we, the reality is, nobody knows 100%, for sure, but kind of what you’re getting at is the shape, the shapes of our faces, have changed over time. And really, specifically, if you go back, sort of industrial revolution, pre industrial revolution, you’ll see that our ancestors actually look different. And, you know, everybody’s looked at old pictures. I don’t know that people are conscious of what they’re seeing when they look at those pictures. But what you’ll see, you know, our great grandfathers and great grandmother’s had airways that were proper, and we think that part of the reason why that was is that, you know, they didn’t baby them from an eating standpoint, when they were developing so, you know, meaning that soft foods cause your jaws, your jaw muscles and your facial structures to not develop properly. mouth breathing is is is, is a, I was gonna say death sentence, it’s not that harsh but it’s a mouth breathing is a guarantee that your as a child, your mouth breathing as a child, when you’re developing is a guarantee that the rest of your life is going to be stunted 100%, you cannot have a child whose mouth breathing. And when I say mouth, right, it doesn’t have to be 24 hours a day, I mean, any, any significant segments during the day, that child’s airway will not develop properly, their face will not develop properly, they will not look as physically attractive as they’re supposed to look, they will not breathe as they’re supposed to breathe, they’re going to be much higher likely to have sleep apnea, you know, so forth and so on. And so, you know, I think most people don’t recognize that, you know, kind of that snout area, that nose and throat, the middle of your face, is the center of reality for you. And that’s that’s those are the passage we call the breathing triangle, which are the two nasal passages in the throat, those three areas in all areas the body can breathe through. Breathing should start with a nose. And if it is starting with the nose, the mouth is shut. If your mouth is shut, then all of the structures in that area develop properly. If your mouth is open, everything kind of collapses down. And you know, those things we know to be true, because we see them happening all the time. As far as what happened, we think what happened is we for, you know, I guess, because we were developed and we’re smart, we think of making life easier for our children. So let’s make the food really soft, let’s make sure you know, they don’t choke on things, those sorts of things, which some of that sounds good. But the problem is, is if you’re not developing those, those areas, they don’t develop. The other part of that we think is that there’s just more irritants in the air and more allergens in the air, we’re more sensitive to those things. And so the lining of the nose stays inflamed. And it starts that way at an early age. So when the passages are restricted through the nose, and you’re in are eating things that develop the jaws and develop the muscles and the bones that kind of form those structures, then you create the perfect storm, which creates human beings that are walking around that have airways that are compromised as the common theme. It’s not an anomaly. And I’d say my specific example of this is for everybody who’s listening who has has their wisdom to that teeth out. That’s not normal, like the our ancestors didn’t have oral surgeons to take their wisdom teeth out, they had airways and jaws that were big enough to handle all of their teeth. So the fact that it’s it’s the normal course of business these days, that for anybody in an industrial world to get their wisdom teeth out isn’t normal, it’s a sign that something’s not right. And I’d say a very similar sign is all of the people who need to be in braces. That isn’t the way things used to be. So all those crooked teeth are basically jaws that are have been formed that are too small, and teeth that are trying to fight their way in there. And there’s just not enough room. And so what ends up happening is you end up trapping yourself with an airway, and it’s just not working properly.

Brett Scott  13:02

Amazing. And what is the cascade of things that can happen from metabolic diseases and issues that create all these, you know, downward health cascades, that that can stem or have a route in breathing, that I think a lot of people don’t see. And in traditional medicine, we’re just been adding all these symptoms like diabetes, high blood pressure, obesity with with other things, and no one’s really looking at breathing. It took me myself to realize I should probably seek out an en t, because of my breathing issues, even though I have six sinus infections a year that lasts three weeks at a time. Sure, sure. So why why is that? What are what happens with all these different things? Yeah,

13:47

I mean, you mentioned quite a few of them. I mean, I think and the most obvious connections are for folks who have sleep apnea. So sleep apnea is when the throat shuts down when somebody’s sleeping at night. Some folks do that hundreds of times, or 100 times or more every single hour, every single night. If you can imagine that which is miserable, you know, situation to be in. So for folks who have obstructive sleep apnea, that is of any significant severity, the end product of that will be high blood pressure is likely to be depression, diabetes, heart disease, strokes. These are all they all get tied in together and kind of the core why is that is that at the very time that your body is trying to rest and recover, which is when you’re sleeping at night, instead of doing that your body is forced to fight fight for its life every single night. And what ends up happening is your body stays on constant guard. So it’s never your fight or flight mechanism gets turned on and it’s constantly turned on and it there’s never a respite. So it’s almost like when you’re awake during the day is the time where you’re up Right, and your airway is the most open. And then, but you’re tired, because your body has been dragged all night long. And then then you kind of drag yourself through the day, go to bed at night, and you’re fighting again. And you know, I mean, it doesn’t take, you don’t have to have a vivid imagination, to kind of see how one night of that. I mean, literally, for somebody who doesn’t sleep at have sleep apnea, and you give them one night in the body of somebody who does have sleep apnea. And that person will have, you know, a vivid description of nightmares that you’ll you know, maybe because they have something to compare it to, it’s kind of what I was saying before, if somebody has breathing, it’s normal or somewhat normal. The only way for them to appreciate what life is like for all of the millions, the hundreds of millions of people out there who have airways that aren’t working properly, is somehow to step away into those folks bodies. But the flip is sort of also true is if you have these issues, and you’ve always had these issues, you don’t know what life is supposed to be like, and and so it becomes this abstract thing of, like, I know something’s not right here. Is it really that bad, your bodies become accustomed to that over time, how much harm is being done, and I’m here to tell you, a lot of harm is being done. And the sooner you’re able to kind of take or defuse that ticking time bomb, better you feel and you know, everybody’s life is going to end someday. And the more runway you have in front of you, the more important it is to get these issues treated, is sort of the reality. The other part of that is the earlier identify these issues and the early, you’re able to treat them, the the less harmful. These things are meaning, you know, if your body’s breathing properly, then all of a sudden, we see this all the time is for our folks who come in who have high blood pressure, we find that they have an airway issue. But if we fix their airway issue, now, this doesn’t happen overnight. But over the course of usually months, sometimes maybe even a year or two, what we’ll see is that that blood pressure that was elevated because their airway was broken, now gradually is able to find its way down. And it’s in that’s one component of that if somebody’s got high blood pressure, that that’s likely a sign that there are other things going on behind the scenes that are also sort of hyped up. And, you know, I guess traditional medicine doesn’t do a good job, period, end of sentence. Traditional medicine doesn’t do a good job of connecting the dots. Traditional medicine does a horrible job of understanding the impact of the airway. And so that the problem is is there folks like you who have to kind of go on your own search about figuring out gosh, you know, what’s going on with me what’s going on with the patients that you’re treating? This doesn’t seem, you know, this seems like we’re slapping band aids on things. And it doesn’t have to be like that.

Brett Scott  17:49

Yeah, so I want to get to my story in a little bit. But some other things I want to get through first. So one of the other things, too, is just that breathing issue, it might not just cause one issue, but you know, for example, couldn’t you know you have an obstructive airway, you end up with sleep apnea, you’re not getting a good night’s sleep. So now we end up with metabolic diseases, or, you know, the high blood pressure, you’re not sleeping well, you make poor decisions, you’re kind of depressed, you end up with diabetes. And, you know, everything else. So yeah. And then we ended up with strokes, all kinds of other issues that, could we have just solved that with breathing? It’s like, Why? Why isn’t seeing an EMT and screening these things, part of, you know, general care, and maybe even not that EMTs are going to be in general practices, you know, your annual physical, but you want someone to be looking up our airway, if this is something that could be preventative to so many other issues.

18:50

Um, you know, I hope so I mean, that really is basically my life’s mission at this point is trying to bring these things front and center, I will say that I’m proud to be an EMT, though. My specialty has not champion these issues in the way that we should. And I’m trying to pick the baton up and drive it forward and getting, you know, some of my colleagues to kind of see the importance of it. But yeah, I mean, the reality is, is these issues are foundational, they’re fundamental, they’re so commonly off track. And if the single metal medical, especially that is designed to focus on these issues, isn’t an advocate for the early care and treatment for these issues. It should be no surprise that that nobody is an advocate for these issues. I don’t expect I guess, I don’t expect my primary care colleagues to get it if my en t colleagues and myself haven’t haven’t gone out and talk them about how impactful these things are. And so I think there’s I mean, I don’t like to I mean, I like to do something I don’t like to point blank Amen. So I am doing something about this. And I will do whatever I can do to make sure that the word gets out. And I will do whatever I can do to make sure that people recognize how important these issues are. But yeah, I mean, it, I guess I’d say this one is, I mean, again, everybody knows kind of how screwed up the healthcare system here isn’t this is in this country. But this one in particular is not just in this country. It’s kind of worldwide. But it is. It’s like the first domino and for many people, so like, what you just described is we spend, it’s a lot of time, money, effort, frustration, disease, and death, that are tied back to these dominoes that have been tipping for years for people. And nobody goes to the very, very first domino and points the finger back and says, you know, what, if we just pick that one up? Or what if we held that one up, and that is the start of the airway, that is the breathing triangle is what we call it. And, you know, if you’re suffering in life where those other dominoes have tipped, it’s never too late to go back to the beginning. You know, I think many people have kids. And I’d say, you know, the younger you are, the more the earlier are in the process. And it’s easier to kind of go back to that first principal, that first domino and pick it up. And I guess the challenge is, is right now there’s a status quo, dismisses these issues, the status quo doesn’t know what to do with these issues. It’s not even on the radar screen, really. I mean, I as much as I like to think that people are becoming more aware of these things. They’re not I mean, they’re not yet I hope to make it. So. But until everybody recognizes how important it is to breathe properly, there won’t be the resources that that people are looking for. It’s kind of this it’s a circular argument to and I know you’ve you’ve sounds like you’ve seen any anti looking at these issues, but I will say, I mean, the other problem, I guess, and I’m, again, I’m i I’m doing something about this not just pointing fingers is that most of my auntie colleagues, or even my end colleagues are not aware and adept at identifying and addressing these issues, they don’t get it either. They don’t understand, I guess they don’t understand the power of the conditions that they can treat. Because if they did, they would be doing more to treat those conditions earlier and in a more effective manner.

Brett Scott  22:41

So let’s go back for a second. So what is the actual job of the nose? I think a lot of people don’t know that. And so something I tell my patients actually, it’s like, look, breathing is an issue. And it’s like, you know, you’re still breathing great. But I think we take is it 20 million breaths a year,

22:57

or 20,000 a day, so I don’t, I can’t do that math, but we’ll go whatever.

Brett Scott  23:03

Don’t take my word for it. But we’re taking 20 million breaths a year sub optimally, that adds up to a whole lot of stress on the whole body. Right. So what is the job of the nose to do? Ideally, yeah,

23:15

I mean, it is your, it is the H vac system for your body, meaning you know, you can, you could breathe. So basically, you have three holes in your body through which you can breathe your two nostrils and your throat, you could bypass the nose entirely and survive, you will never you couldn’t you cannot bypass the nose entirely and thrive, you will suffer 100% And even if that’s happening during part of the day, your body or body is suffering. So what are you missing when you’re when you’re breathing through your mouth, you’re missing the humidification function of the nose. The the warming of the nose of the nose is meant to condition the air that you breathe. So when you when when air moves through the nose, the lining and the structures in the nose, warm that air add moisture to that air create actually it’s a it’s a beautiful process. i For me, it’s beautiful Dominos doctor but you know how airflow comes through into the body comes through into the through the nostrils go goes up. In an ideal world the sinus passages are open. So some of that airflow is sort of exchanging with air that’s up in the sinuses, and then heading on back and then moving down in the lungs and that that’s where your body actually exchanges oxygen for co2. The other part of that beautiful system that happens in the nose and sinuses is you know, there are and we’re discovering more and more of these things over time. But there are gases that are trapped up in the sinuses. They’re not trapped but they’re they’re made in the sinuses that when your body takes those things in theirs, they it is it. It provides your body with a sense of health and well being which sounds kind of woowoo and Zen but it’s true. So your body knows and says and signals to the rest of the body when you’re breathing through your nose properly, and it knows when you’re not. And yes, you can get by and survive with without breathing through your nose. But like I said, it’s it’s the air that’s coming into your body is not conditioned properly. So it’s hard on You’re harsh on your body harsher in your lungs, and then you’re losing all the benefit of the nose by itself. So it’s possible to live like I said, without breathing through the nose properly, but it’s not possible to thrive.

Brett Scott  25:28

Yeah, and if you look at the book by Nesta there, there’s, there’s a lot he goes in into and and we learned about this in school to is the biochemistry and physiology of what happens with breathing and respiration, where, you know, we’re changing the acidity of the blood and the makeup of co2 and OTU. And the myriad of things that can go on with or without those proper exchanges, of driving anxiety, and all kinds of other things. So, you know, we need to take care of our noses there. So as far as that goes, so, big things we see. And you know, I’m a movement guy. We see movement affected by all kinds of different things. One of them being breathing. So with anxiety, you know, it’s like, which came first the breathing issue or the your anxiety? And what should someone try to do about these things?

26:30

Yeah, well, and that is, I mean, I get nervous. Some people have anxiety, they don’t have breathing issues. If you have anxiety, whether you have breathing issues, or not one of the, if you follow this line of thought, What is a core tenant of treating anxiety? If you’re having any sort of a panic attack or anxiety disorder that’s getting ramped up, it always comes back to breathing, always. And why is that is that it’s the same thing. Breathing is primal. When somebody’s feeling anxious, you don’t have to have anxiety disorder, you don’t have to have panic disorder to be everybody’s felt anxious. What happens when you feel anxious? Your respirations speed up, your body starts breathing shallow, and it starts breathing quickly? Which how do you how do you how can you remedy that? You start taking slow, deep breaths, and you start doing that through your nose is how you’re supposed to do that. So it’s, it’s it, I guess, many times you can figure out why something is wrong, when you think about what we do to get it right. And I’d say, in these sorts of situations, the various mechanisms that we’re using to get things back in order, for some people are the same mechanisms that got this thing started to begin with. So you know, another way to say that, and Esther did this in his book is that when people plug their noses, and he did this on purpose, it is an experiment. It’s a miserable experiment. But he did it. There were all these physiological things that got off track. But the other thing that got off track was it was his mental health. I mean, he writes about this, he’s sort of, as he writes, he’s, he’s almost writing kind of these fever, dreams, sorts of things of the things that are going through his head, because he can’t breathe properly through his nose. And yet, I mean, I don’t know how he did it, but he’s able to put up for that with that for a long time. So, you know, at the, the core truth is, is that there are so many people walking around with conditions that are connected back to the fact that they can’t breathe properly. And many people go their entire lives that way. And so the, this happens all the time, and people don’t know about it. So I don’t know how that’s the thing that drives me crazy personally, because because as as a practice, what we do is we provide simple office based solutions for these issues. That’s what we do. So we don’t, you know, we we typically don’t have to take somebody to surgery to treat these conditions. And so we can do in the office under local anesthesia in just a few minutes, something that profoundly changes something somebody’s life, yet there are millions of people walking around with conditions that we can treat so easily. So that’s what kind of drives me and both drives me and frustrates me is that though most people don’t have access to our types of services is just the reality. And I’m trying to change that. But But that’s kind of where things stand right now.

Brett Scott  29:19

Yeah, and so those are a lot of pieces to it in. So as far as you know, we talked a little bit like the allergens in the air or something that we can sometimes do something about. And I’ve heard different things going back and forth on that as far as like some environments, we try to keep our air to clean and we’re not exposing ourselves to certain irritants and allergens or pollutants. But the other piece is there is posture in the physical environment we’re living in to so you know, we weren’t created to sit at a desk all day or be at a chair as a student all day we were, you know, designed to Walk Run squat do to movements. So, do you see posture playing a role, especially these days? I know for us as a practice, I think in 2020, and 2021 60% of my patient injuries were, they didn’t know it, but related to poor work, home stations, being neck pain, everything else. So have you seen a correlation there between people’s posture? And I think we should define here too. I look at a lot of dysfunctional breathing patterns, leading, they don’t know how to get a full inspiration or exploration. However, have you seen changes with people’s airways as well?

30:41

Yeah, I mean, you know, the position of a body that is struggling to breathe his head forward, head forward means that bowling ball that your body carries around on top of your neck, is all of a sudden straining the neck and straining everything, you know, the back, all those are all the structures that are supporting that head forward is on also, unfortunately, the position that we all get into with when we look at our phones, and you know, that kind of thing. So even there, it’s like, both like, it’s like two chickens and to eggs is like the, the places we’re putting our bodies is not that, you know, as you said, workstation, you know, the lack of awareness or appreciation of the, the strain of that is problematic. The problem then is compounded by the fact that, like I said head for, like, again, there’s a few conditions that can happen as an emergency, where you can get an inflammation in your airway. Epiglottitis is one in particular where the textbook, like what does somebody look like when they’re when they suffer from that they call it the tripod position they’re leaning for, they’re trying, they’re trying to open their airway up. So like, we are trained as EMTs, if we walk into an ER, and are asked to evaluate the patient, a patient who is who’s you know, who’s kind of in a panic leaning forward, that, you know, be very cautious because they may be on their last breath kind of thing. And so you don’t have to have an acute episode like that, to find yourself in the same position. So most people who struggled to breathe properly through their nose, or sometimes it’s both areas, the nose and the throat, are putting themselves in positions during the day that, you know, add insult to injury for a lot of the conditions that you’re treating, you know, musculoskeletal that kind of stuff. And then, you know, again, I go back to this whole, it’s like a perfect storm. And then at night, when your body is trying to rest and recover, Ul, there’s no time for that, we’ve got to actually fight to keep that airway open. So I think when you think about that, it’s like 24/7 365, your body’s needing to contort itself to simply try to breathe, and the end result of that is going to be seen and felt throughout your body. And most people don’t wreck it, they don’t, they don’t recognize it and appreciate it. And again, I can guarantee you that the typical, the healthcare system doesn’t recognize or appreciate that either. They’re happy to see you for you know, your degenerated discs, or your you know, your your conditions that are a byproduct of this. But they don’t know what to do, they wouldn’t they don’t even know yet how to connect it back to that to the get go. Which is a shame.

Brett Scott  33:23

Yeah, for sure. Now, something else too, is the brain and cognition. So we know a poor night’s sleep, we’re going to be tired, the other, you know, the next day. But Nestor actually talked about in the book, too, that they were finding like excessive ADHD in children as well as delayed brain formation where they put these rats so they restricted their breathing and the rats that were restricted, they couldn’t find their way through the maze as fast as the rats couldn’t. So I think there’s a lot to be said for making sure our, our youth are breathing proper, properly and in a healthy manner, but is there things we can do as you know, parents of kids to help with that?

34:10

Yeah, I mean, there’s, I think being aware of it is the first thing Yeah, to know that it’s a possible problem. And then, you know, at an early age, so some cultures do this as a, just a pass down habit, which is they, you know, when when they have babies in their societies, they it they make it a point to anytime they see that mouth drop and open that they’re they’re making sure that it’s shot, which sounds I don’t know how you say this, it that’s, that’s a good, good little habit for society to have, you know, because it starts very early, but you know, and if it isn’t checked very early, then sometimes it’s just, you know, to the water under the bridge, there’s not much you’re gonna be able to do about it, but recognizing that this is an issue. If you have a young child that you’re seeing his mouth breathing through during the day or at night, seeing if you can do what you can do to say, you know, I mean, sometimes it doesn’t unfortunately, require nagging or being kind of annoying is just seeing if they can, hey, you know, can you, whatever, however you want to say, phrase it to the child, but you know, can you close your mouth and breathe through your nose, that sort of thing. Unfortunately, a lot of times, by the time somebody is recognizing it, it’s already too far gone. And so meaning that if the structures are already too tight through the nose, where they shut their mouth, and they can’t get enough air through their nose, they’re just gonna drop their mouth back open. And I think the challenge there is that there are simple things that we can do, as EMTs to get those airways back open. But I go back to but unfortunately, most of my colleagues aren’t really aware of how, how impactful this this condition will be. And so you know, even if you’re lucky enough to see an E and T with for a child that is struggling by with mouth breathing, it’s unfortunately unlikely that that auntie, unless they’re sort of enlightened to these issues is going to do much about it. So I think that’s my, it might my challenge, unfortunately, is, is it sort of like be aware of these conditions, try to try to prevent these conditions in an early age, seek help if if a child is simply unable to breathe through their nose properly. And then when you find help, know that that helped, may not be as aware as you are of these issues. So keep looking until you find somebody who kind of appreciates understands and can do something about these issues.

Brett Scott  36:33

So with duct duct taping a small child’s mouth shut help them. I would avoid that. That’s want to know,

36:40

yeah, don’t do that. Yeah, but not taping in an adult or anybody whose nose is working properly? Not it’s not it’s a bit it’s kind of a it’s kind of become a bit of a fad here these days. I’d say if you, you’re if you’ve grown up enough to know that you can breathe through your nose properly, then you can experiment with that some of that stuff. Do not do that to a young child. You will you’ll regret that. So yeah.

Brett Scott  37:08

I’m just joking guys out there.

37:09

Don’t do that. Yeah. But that does bring

Brett Scott  37:13

something up that I want to go over too. So Nesta kind of talks about, he always had these breathing issues. And he makes it sound like in the book, that there is something we can do on our own proactively to change what is happening to our airways. Do you agree with that? Do you not is there some gray area there? There’s, it’s been so there’s bony anatomy, like I’ve learned there’s, you know, there’s the the bones of the nose and the airway and everything else. But there’s a lot of soft tissue in there, too, that contract shrinks, expands all through the day. So someone like me that can’t breathe? Do I have hope to possibly do some of these, you know, take my mouth shut, force my knows to be the one to expel and inspire air and see progress.

38:08

You could try it. You know, you can try it as you just said it depends on what’s going on. So you know how I phrase it is if somebody’s got to go, somebody’s got to know his problem. They either have an anatomy problem or a lining problem or both. And so, you know, then it’s a if it’s an anatomy anatomy problem, it’s a if it’s a deviated septum, or their structures in the nose called turbot, it’s what your humidifiers if they’re too big. You know, if the sinus passageways are blocked off, you can sort of close your mouth and try to breathe through that nose as much as you want. And you’ll you might inch the ball forward a bit, you’ll never create open, truly open anatomy through there. That’s that’s the reality, you cannot change, shut down, you know, bony or cartilaginous nasal anatomy by mind over matter not going to happen. If if you’ve got some, you know, if it’s passable, like it’s, it’s kind of open, and maybe you’ve got a little bit more of a lining issue than an anatomy issue, then yeah, keeping your mouth shut. You know, just so everybody knows what what, what position should your body be in as far as breathing goes, your mouth should be shut your lips should be touching your teeth should be gently touching your tongue should be should be plastered to the roof of your mouth, there shouldn’t be any air between your tongue and the roof of your mouth. So that’s how your mouth should be held. And then you should be able to breathe comfortably through the nose. If you practice breathing exercises, part of what you’re going to do is put your mouth in that proper position, but then you’re at the mercy of the passageways that you have. And you know, I think with true back breathing exercises, some people can make things more tolerable, maybe a little bit better. But if the true issue is anatomy, you’re kind of fooling yourself if you think that the end result of that is going to be a truly proper airway, it’ll be an improved airway from what you had. But it won’t be what it’s supposed to be. And again, in the book and Nesta talks about this as he’s got, it sounds like he’s got a deviated septum, turban or hypertrophy, he’s got some sinus issues based on my on my recollection of what he’s describing. And, you know, well, yes, while he went and did some of these breathing exercises, I will never seen him never seen the skin. But I’d say I will guarantee that with simple maneuvers, we could make that anatomy much more open. And to me, the right order is get things open, they don’t have to be perfect, but they need to be, you know, they need to be functionally open. And then do the breathing exercises, you could try them on the front end, if you don’t have access to sort of the simpler solutions to get some of these airways open. Or these areas open. You could try with breathing exercises. But don’t be surprised if you end up frustrated. And I mean, at the end of the day, most people who are doing things that aren’t giving them results end up stopped doing those stop doing those things after a while. So it sounds great. But why would you do something that isn’t giving you the results that you’re looking for? And I would say for most people, unfortunately, it doesn’t. If for those that are advocates of these sorts of things, you know, I guess I’d say they’re fortunate that these things are doing more than they do for most.

Brett Scott  41:34

And so talking about the lining versus anatomy, right. So you know, there’s all kinds that you go to CVS, and there’s this whole, you know, display of 1000s of items on the wall there. And so, you know, a couple of years ago, I literally couldn’t breathe through my nose at all with a sinus infection. Like it was like a struggle to just be awake. And I discovered Afrin. And it was like, Oh, my God, this is what life is supposed to be like. Sure, sure. Yeah. And even now, if I get one, like I basically have to use that to function through the day and just be able to talk to my patients and not have my eyes feel like they’re blowing out of my head. So in that case with that, if something like Afrin works for you not that it’s good for you. But does that put you more in line if you have a lining issue versus a an anatomy issue?

42:30

No, it’s my short answer. So Afrin is a powerful decongestant. Most of the time when I say you know, my party line is that if you have a lining issue, that’s what the medications are for. That’s what they’re trying to treat. So the allergy medications, allergy, nose spray, those sorts of things, they’re mainly you know, they take the edge off of influent, inflamed lining Afrin is a decongestant. So what Afrin is doing when you spray that in your nose is the turbulence, which are the humidifiers, which most people don’t, most people don’t know that term anybody has ever suffered with the nose that stuffed up nose, the misery of having turbulence that are too big, some people have turbulence that are too big chronically. So if you are in that condition, you spray Africa, in your nose, it’s going to shrink the anatomy down temporarily. So you’ll get it, it’s it’s meant to be 12 hours, the more often you use it, though a lot, the shorter the duration is. But the airflow that you experience when you spray afternoon your nose is is is what he says it’s as close to what you might feel if the anatomy were opened, like it’s supposed to be that you get that you bet you can’t but you can’t get but but the Afrin Yeah, it’s it’s a band aid, you end up you end up, you know, chasing your tail on that. But that basically I’d say that whatever that feels like. And for many people, it feels like an epiphany, like, like, you know, the hand of God has touched them and your breathing like, you know, freely, that’s normal. Like, that’s what most people who have normal airways free will feel like. So the fact that for you, it feels like you know, God has come down and touch you on the shoulder is a clear sign that you aren’t built properly. And so, you know, for us, you know, we don’t need the hand of God, we just need our simple, you know, tools in the office and for us to reduce the turbulence and make them smaller is something we can do. You know, like I said, under local anesthesia, it’s a 10 minute procedure and we can create that effect create that open anatomy on a permanent basis. So anyway, yeah.

Brett Scott  44:36

Okay. They’re very interesting. Now, snoring is another big one. So snoring. I’m pretty sure it’s highly correlated with sleep apnea. But that there’s plenty of people that snore that don’t have sleep apnea, correct.

44:54

Yeah, that’s true. Yeah, exactly. Everybody, pretty much everybody has sleep apnea snores most people Who’s North don’t have sleep apnea, you can’t know which category you’re in. If you don’t have a sleep study, you can think you know, but you don’t know. And it’s so easy nowadays to do a sleep study, we do them at home, you do them just in your bed. You know, there’s no reason not to get that information. But you know, while sleep apnea definitively is, it can be deadly. It always is going to create some other issues that are there. Snoring by itself is isn’t necessarily deadly. But it does cause harm to your body. So snoring, I mean, it’s certainly annoying for you and those around you. So there’s that aspect. But you know, the sound of snoring is the sound of your throat vibrating. And then for some folks who have sleep apnea, it goes to the extreme where everything’s shut down completely. But that shouldn’t be that way that that the way I describe it is snoring. Is this is the sound of your airway crying, when you’re sleeping at night, your airway is crying, it wants to stay open, but it can’t stay open. And then you know, sometimes it will shut down on you.

Brett Scott  46:01

And so even snoring itself probably isn’t the most optimal thing like to experience as a person. It’s kind of, you know, it doesn’t sound relaxing. I actually have a sleep app on my phone now. And I’m like, this does not sound like I’m restfully peacefully sleeping and getting a good night’s sleep.

46:19

Yeah, absolutely. Well, I mean, I guess on all of these subjects, is there anybody in the world who if given the choice would snore and be a snore? Because I don’t think so. I think that that population is zero, yet, half of the adult US population snores. So you know, there’s a disconnect there, where if you follow the ball there, if somebody’s sleeping next to somebody, so almost everybody in the adult US population is either personally suffering from snoring, or being affected by snoring in the bed, meaning the person next to them. So like, it’s a very, very common condition, and nobody likes it, nobody wants it. Yet, I think, obviously, given the fact that is so common, and that nobody’s, you know, been able to, to, or is accepting it the way it is, people have just just sort of saying, I guess this is how life is supposed to be, it’s not normal, and it definitely is disruptive. It will just drop you’re asleep, you’re the person who’s snoring will disrupt their sleep, although many, many snores say nicely, fine. You don’t say fine, you just you you think you sleep fine, because that’s the only way you know how to sleep. But if you slept without snoring, not only would you be happier, the person next to you, and those maybe in the next room, next year would be happier, too. I mean, this is where it’s kind of a weird concept is most many people, when if you live in kind of the human meat sack that we all live in is that over the course of your life, you’re going to have medical conditions that develop in various aspects of your body, and you’re going to need care and treatment and all those sorts of things. And I, I can’t think of another one, but I’ll say this, and maybe you can, but I’d say snoring is the one condition that I know of, that not only affects your body, it affects those those around you and really can be a is a wedge in relationships, people literally get divorced because one of the partner stores or you know, that kind of thing that happens all the time. And the sad truth is, is nobody wants to be a snore. Nobody. Nobody wants to be a snore. Nobody wants to sleep next to a snore. And, you know, what other medical condition does somebody get? ostracized for the fact that they have this medical condition? I mean, there probably are some halitosis or maybe, you know, there’s some of these things, but snoring is one of those. Like, who you like, normal, polite people don’t call other people out because they have diabetes is a specific exam. You’re not like that doesn’t happen. But I guarantee you that right now somebody’s getting getting called out because they are snoring. And they you know, they didn’t ask to be a snore. It’s not what the condition they want. But it’s what they got. And it’s that is a weird dynamic with that condition.

Brett Scott  49:04

tell you all about it right now. Here we go. So, that being said, so with snoring too. So say I use Afrin I’m like, Okay, I’m gonna I need a great night’s sleep. I’m gonna have some Afrin I’m breathing great. I think my airway is open. I put my sleep tracker on, I’m still snoring like a chainsaw. Why

49:28

will the sound of snoring is coming from your throat, that’s where the sound comes from. Your airway starts with the nose. I don’t know. I don’t know the truth for you. But I would imagine that when you use the aspirin, you feel like you’re sleeping better than you would if you weren’t using the aspirin. But if the if the snoring is still persistent, whether you do or don’t need, use the Afrin then your throat is shutting down. It’s too small for the body. So I mean, the the start of your airways, the nose and your throat needs to be open when you’re sleeping at night and And in an ideal optimal world, noses and throats open, you’re sleeping peacefully, quietly, that’s where things are supposed to be. If you’ve got both of those things in play, and we get the nose working better, let’s at least half of the weight off of your the system, but you still got this throat issue. So generally speaking, like in a condition like yours, we would, we would just sort of evaluate the whole situation, what’s going on nose and sinus wise, what’s going on throat wise, typically do a sleep study and make sure we know exactly what’s going on there. And then, you know, there are simple things we can do nowadays, to get the nose and sinus areas open, that don’t involve surgery. And, again, with the throat, it just depends on this situation the most, there are simple things we can do there. There’s something called an oral appliance, which is like a retainer that you can wear while you’re sleeping at night, that just basically gently keeps your mouth shut, pulls your lower jaw for your lower jaw is attached to your tongue. So when we pull that jaw forward, your tongue gets out of your airway. So a nose that’s that’s breathing properly, combined with a throat that’s open is generally speaking, a quiet and peaceful sleeper and a happy household.

Brett Scott  51:06

And now, could it take time to because I feel like could snoring be like a learned behavior over time where say you say I go get a sinus surgery or the turbinate reduction? Whatever? I could, should I ideally, if it’s just my nose, that’s the issue and blocked? Should I stop snoring right away? Or is this something we should? Do? There’s some practice of maybe, you know, mouth taping and things like that to get rid of those habits, essentially?

51:38

Yeah, it depends. But yeah, both, even though he says in that situation, you know, we would get the nose open, our approach is typically to do a sleep study up front. So we know the extent of the throat issue. So meaning we all know, or have a very high degree of predictability, whether we think getting the nose working is going to likely get you out of this situation, or whether it’s going to be a one two punch, kind of a thing before we do anything. But let’s just say it’s sort of borderline or we’re not quite sure on the throw part, then yeah, we would get get the get the anatomy open in the nose and sinus airways, get you landed on the back end of that, and then see what the results of that are. And yes, some folks do need to kind of train their bodies to breathe through the nose, because they’re just they’re not used to it. And so you got, you know, what I you know, how I typically describe it is that somebody develop the habit out of necessity, when we take the necessity away, you’re still in the habit. So we’ve got to we got it, we have to create behaviors that are tools that get rid of that habit, which can happen. I mean, you know, people can learn how to breed, you know, get back to the earlier question we were talking about, which is if you have the proper tools, if you have the proper tools, then absolutely do what you need to do to learn how to use them breathing exercises, keeping the mouth shut, mouth taping, all good. If you don’t have the proper tools. It’s a waste of time, effort and energy to try to breathe through a nose that just doesn’t have enough passageway. I mean, this isn’t like, you know, high level physics, physics or rocket science is pretty just simple. Like, if the passageways Oh aren’t open. It’s not gonna work for you. So yeah.

Brett Scott  53:26

And so the other thing and you’ve discussed this on other podcasts as well, and something I know a lot of people have CPAP machines. What are your thoughts on those a lot of people go they have a sleep study, you have sleep apnea, it seems like they’re just handed a CPAP machine.

53:45

Yeah, I got nothing against CPAP machines. Generally speaking, I do have something against CPAP machines that are used as a weapon, which is the situation that you’re describing. So and that’s the typical situation. So let’s just be real here, which is that you know, sleep centers that are the most common places for sleep apnea be to be treated, have zero connections, zero ability to do anything for noses. And so what kind of they how that game is played as you come in with snoring they do a sleep study, sleep sleep study shows you have sleep apnea, the only option they’re going to give you is a is a CPAP machine. And and add insult to injury, the there are two routes that machine could use to push air into the back of your throat, you could use your nose, that means you need your mouth shut or you could just put a full face mask on, which is sort of assuming that you’re gonna be breathing through your mouth. All studies show that the best route for CPAP is through a nose it’s open. Every but there’s that is I mean, I don’t like to use the term settled, the science is settled. The science is settled and you don’t I mean, you don’t have to get you have to be a rocket scientist to understand those concepts. Yet, by far the most common masks that are delivered to folks who have sleep apnea are full face masks. Why is that? Because most people are the sort of follow the ball here 100% of folks who have obstructive sleep apnea, they have a throat that’s too small for the body, that’s where the condition is happening. Almost all of those same individuals have nose or nasal airways and sinus airways that are also too small for the body. And so, you know, if people know that, but they can’t do anything about the nose and sinus part of things, what they’ll do is they’ll just bypass the nose. So the put a full face mask on you. And I can guarantee that if you already have a challenged airway, the last thing that your body wants to see when you’re trying to rest at night is something that’s going over your challenged airway. So if somebody is already struggling to breathe, you’re going to put somebody something on their body, which is going to send a you know, red alert to their brain that says, we’re struggling to breathe, and yet they’re there, they’re taking away our airway, even though the machine is trying to help you. So the machine is trying to help but the system is sort of rigged against you. And so what ends up happening is two thirds of people who are prescribed CPAP machines don’t use them. Those are horrible odds, like what in what other situation in polite society? Would you accept 1/3 success rates? You wouldn’t? I mean, you just it’s abysmal, it’s an abomination. And it doesn’t have to be that way. And I guess, what’s the alternative? The alternative is, let’s recognize the fact that we’ve got a throat situation, if somebody has sleep apnea, let’s start them off with an airway that’s working. When I say that, I mean, let’s make sure their nasal and as anatomy is open, and then if CPAP is the right option for them, we’re going to have them off on the right foot, and we will have their success rates, you know, flipped around with the success rate should be in the high 90% range if your nose is working properly. And then lo and behold, you know what, CPAP isn’t the only option for you. There’s another option, which is an oral appliance. And that oral appliance for met most people who have sleep apnea are would be a good candidate for an oral appliance, almost nobody hears about that option. That option is sort of hidden away in the dental community. The so if given the choice, more people would choose an option that’s just more conducive for their lifestyle, which is an oral appliance. It’s just unfortunate. Most people don’t have the choice.

Brett Scott  57:13

So you’re talking about the the Mad device the mandibular adjustment? Yeah. So I want to talk to you about that, too, because that was something really interesting that I heard you speak of before is and like, this is where I’m at with physical therapy and the Allied Health Professions and in primary cares is there’s no communication between the two fields. It’s very hard. Like I actually went with a patient to a surgeon’s office to represent him. And they were like, Can concerned that I was there?

57:46

I can picture it. Yes, I would imagine. Yes. Yeah.

Brett Scott  57:49

And it’s there. Like he was boyfriend. I was like, No, I’m not. It’s boy. I’m just this physical therapist. Like, okay, but anyways, you’re trying to bring the dental community, any anti together, it sounds like and I think that’s awesome. And I think that, you know, the mouth, like we said, nasal breathing, mouth breathing, they’re related. So what is it about tying dentistry in the teeth into the ear, nose and throat.

58:18

I mean, you know, we’re neighbors, meaning that the teeth and the jaws, you know, if you think about the anatomy in there, you think about your upper jaw, and those upper teeth and the roof of your mouth. Well, that’s, that’s the floor of the nose. And that actually is the key, we call it the Keystone, this the upper jaw. If that ear if that if that particular area is formed properly, your airway is likely to be nice and Peyton open all good if that area is not formed properly, everything else kind of collapses down. And so it in an in an ideal world, it is a collaborative effort between the end community and the dental community to make sure that noses are open. And in my in my you know, from my lens is in as simple and effective as manner as possible. And make sure that throats are open and same thing and Is it as simple and as effective manner as possible. So that really does require the two specialties to work together in a way that we that isn’t typical. But we’re trying to kind of change some of that the other dynamic too, just to kind of go a little bit sort of deep on the dental side of things is that in kids especially, but even in adults, there are ways to re configure the jaw so you can use it in a child you can use what’s called an expander, which is basically a retainer that goes in that’s pushing the palate more open. So and when you push the palate more open the teeth now have more room to live and then you the body has more room to breathe. And so that’s something that is you You know, just massively under utilized. But and that, you know that that there’s a perfect example of if there was proper collaboration between these two specialties, then if it if, as an example, if a child needed a turbinate reduction to make sure their noses open properly, let’s do that. And then if their jaws have have formed where they’re too small, let’s make sure they get into a dentist that does the oral expansion so that their airway is more open. And then you’ve done in a simple and elegant manner, something that will profoundly change the arc of that child’s life. But that involves us being able to work together and be collaborative. That doesn’t happen very often, unfortunately, I’m trying to change that I’m trying to there is a wall. I mean, there’s a wall between sort of, I call it the house of medicine, there’s the house of medicine, and there’s dentistry, and it’s on the other side of the wall. Here’s how that works, is the house of medicine built that wall, like my my physicians built that wall, I’m trying to tear that wall down, or at least blow a door through there to reach my hand out to dental community, dentists would love to be able to kind of come through a door or a pathway so that we can work together. But they can’t do it with that they can’t do it from that side of the wall. So you know, long story short, my folks have built the wall, I’m trying to tear that wall down, I’m one person. So I can I can chip away at that. But you know, I think if I can get more of my end colleagues in particular, to be recognized and be aware of these issues, they can join that sort of fight to kind of chip that wall down. And I think that that’s possible. That’s not like a dream state. That’s something we could do in you know, by what I expect is over the course of my career, I expect that I will help to contribute to breaking that wall down and establishing that collaboration. And that will really just be the start of the next phase of things. Somebody else can kind of take the baton and carry it from there. But it’s that’s what I’m trying to get done.

Brett Scott  1:02:07

And so if people are having all these, these, you know, issues with their sinuses and nasal passages, should they be going to see a dentist too? And how do we know if we’re seeing the right dentist that can do these things? Is there?

1:02:21

Yeah, this is where I mean, unfortunate. I mean, it’s a good question. It’s a straightforward question, I’m going to give you my shrug and like it. The reason it’s I can’t give you a straight answer is the reality is in throughout this country, you almost have to get lucky to find yourself in a geography with somebody who’s knowledgeable about these issues and can do something about them. And that’s the truth. So like I said before, if you if you’re suffering with these issues, and you show up at your job, your typical EMTs office, they’re more likely to brush your brush you off than they are to offer you something specific and helpful. If you show up, if your general dentists office who isn’t aware of these issues, they will definitively brush you off, it’s a versus doing anything. So you’ve got to you have to do the work of finding yourself or figuring out a way to get in front of somebody who is at least aware of these issues. And and then you’re likely if you can get yourself there, then those same individuals are likely to be able to either do something to help you or to point you in the right direction and connect you with somebody who can. But you, you have to actively seek that out, it’s not going to you’re not going to walk into your dentist office. And, and thing, don’t I guess don’t walk into your general dentist office and think they’re gonna have an appreciation for these issues. Don’t walk into your auntie’s office and think that they you’re gonna have an appreciation for these issues. Don’t walk into your primary cares office, don’t walk into physical therapists office, most people most most trained medical professionals, they don’t know about these issues, don’t care about these issues. You know, and, and that’s the truth. So I don’t mean to be discouraging, I just mean to be real. And so like, because I guess the last thing I want to do is put out a false sense of hope. And so somebody is hearing this and they have these issues, and they think I just need to make an appointment with my auntie and it’s gonna be all good. That’s not true, you’re gonna need to do a little bit a lot more legwork. You might need to do a little bit of travel, like you may need to go a little out of your, your geography to find, you know, either practice or clinician who’s able to deal with these issues. Which, you know, and that’s just the truth. I mean, unfortunately, it’s the reality we live in.

Brett Scott  1:04:39

Yeah. And so what about so the Mad device seems like something I’ve seen around this. I tried one from Amazon. It didn’t really fit it was super uncomfortable, like cut the inside of my mouth open. But are there certain types of dentists that do that or like a training certification we could try to find to find one of them or just

1:05:00

Yeah, I mean, so the the over the counter those devices, I mean, you get lucky, you might get it to work for it a little bit that but it you need one fitted, even fit in. So your teeth are very unique to each individual. And so there are precision, we call them oral appliance therapy. So precision precision oral appliance therapy devices that require a special type of scanning to get them constructed. So instead of like loosely trying to pull on your jaws, they’re tightly fit around your teeth. And those work really well. They’re all are certain dentists that can provide those sorts of appliances. There’s a sleep dentistry board that if you look that look for those sorts of folks, you know that that’s those are the right individuals to help you there. We in my practice, we do those we provide those are all appliances, ourselves. So we make it can we try to make it as easy as we can for our patients. So you don’t have to go find a dentist just come and does we’ll take care of the nose, we’ll get get you in an appliance, if that’s the right fit for you, you know, kind of get you moving forward. But it isn’t. I mean, we are where we were in the Upper Midwest, most, you know, we’re trying to grow as fast as we can. But I’d say most people, you know, unless you live in sort of Wisconsin, Illinois, Indiana, Minnesota, we’re happy to serve you. But if you don’t, you’re likely going to be better served by our by our dental colleagues.

Brett Scott  1:06:27

And do you find that patients have good adherence with those devices, because I’ve heard they can be quite uncomfortable, as well.

1:06:34

They do. I mean, if you if you have one that’s fit properly, and you go through the titration phase, the compliance rates are very high, if you have one that’s not fit properly, and you don’t go through the titration phase, the compliance rates are really low. So it depends on who you talk to. And that’s the challenge is is, you know, it’s probably it’s going to be almost impossible to know, you know, which appliance Do you have, and you know, so forth and so on. But, but it really the the the new devices, and they again, they call them precision oral appliances, because they are much more precise, down to the millimeter like fraction of a millimeter kind of precise. Those Those are very highly effective. And, you know, so those work, I mean, that’s the problem with a lot of things is they’re sort of, you know, in this particular instance, there’s the over the counter things that don’t work very well. There’s the sort of kind of custom things that don’t work very well. And then there’s the true precision, custom oral appliances that work very well. And most people end up in with something in the first two categories. And when you talk to people they’re talking about, it’s like apples to watermelons, it’s like no, you know, you’re talking about something you’re putting in your mouth. But what you’re describing and what you’ve been trying to use is something entirely different than the thing that we’re talking about. So yeah, I mean, it long story short, I’d say it’s very highly successful. For most people, the compliance rates are really high, given the right appliance.

Brett Scott  1:08:00

And seeing an allergist is another thing, so I went to my auntie. She basically told me try this spray, or these two different nasal sprays for six weeks. I did it didn’t do anything for me. I came back, they we did a CT scan, and she did the endoscopy there. And then I came back I said yep, still can’t breathe. Shit. Okay, well, you can see an allergist, but we could do surgery too. But I think you should see an allergist. And so I looked up things on ologists Yeah. And it sounded like, you know, I want to stop the suffering now. Sure. And the allergist things I found online was a lot of people were saying, I went I got treated for these two different allergies that they found. I did it for two years or three years and it did nothing. Or yeah, maybe it did help.

1:08:56

You know, I simply go back to and this is my construct. So I’ll forgive the unity that you saw. Because they don’t have this construct but healthy nose, nasal anatomy nasal airways that are paitent or open is another way for us to say that so nasal airways that are open sinus airways that are open and aligning that’s calm the only way to get those passageways open are you know our procedures so in her hand she she has the tools in her hands to get those those areas open. What does an allergy going to do? An allergy is going to do an allergist cannot do anything to the anatomy like zero doesn’t mean they’re bad people it just means they’re not surgeons. So that’s just a reality. Where can they help the situation they can help the lining. Now how can they help the lining the way that they can help the lining is with allergy shots or allergy drops. Which you know it’s hard to say I’ve never I haven’t examined you I mean you know I don’t know what things look like but I just heard what you’re suppose it nasal airways sound like allergy can treatments are not going to fix that. That’s an anatomy issue. I can hear it, you know, so I don’t I mean, there are times where allergies can be can be helpful, but Allah just can’t do what they can’t do. And so they can’t treat the anatomy. So like in your situation. I guess another way to say this, too, is that if you had, so let’s say you have both an anatomy issue and aligning and a lining issue. If that’s true, then the sprays that she had you try should have helped to some extent to some extent, and because they’re treating the lining. So if you try these medications that treat the lining, but they did nothing for you, then why would you go further down that treatment road to now get allergy testing to do allergy shots, to try to treat the lining, when you really have an anatomy issue doesn’t make any sense. And so doesn’t mean you can’t do that. But it just is a head scratcher as to why wouldn’t you just simply get things open in your case. And and this is where and again, we kind of go, I can go in the weeds on a lot of things. But I’d say most EMTs don’t have that kind of clear paradigm that I do in my in my my practitioners do that paradigm helps us immensely because we we don’t like to waste time and we don’t learn to light, we don’t like to waste our patients time. And so sending people to do things that are waste of times. That’s not what we do. But in that when you follow that paradigm, the other kind of reality is if you’ve got an anatomy issue, then then there are things that we can do to open those things up. Most EMT practices don’t offer office based procedures to get nose or nasal airways open and sinus airways open. That’s really all that we do pretty much in my practice. So for a situation like yours, our default thought process is would be to listen to you look at you, if you’re a candidate to get the get the passageways open in an office based setting. We’ll do that and, and go from there. If if things are so bad that we really need to think about surgery, we’ll consider that too. But that’s rare. And I’d say based on kind of the clues I’m putting together from your story, given what you’re describing with your nose and what I hear, given the evaluation you’re describing, given the fact that you have a CT scan, given the fact that Auntie is sort of hemming and hawing about whether to do something or not you I mean, again, without looking at you in like without looking at the nose and sinuses, I’d say almost assuredly, you would be the likelihood that you would be a candidate for office based procedures to get the your nasal airways open sinus where airways open is extraordinarily high. I cannot guarantee results. But I will say Our results are consistently outstanding. And if we if we find the right folks who have the right situation for us to put our our expertise on, you know, it’s high 90% range where we get somebody you know where they want to be. So anyway, like kind of going off on a tangent, but I’d say I don’t I guess the thing that I guess the reason I’m kind of a little fired up on this one is because like every it the story you just described is the story I described to my practitioners it as as an example of a story. That’s, that’s that is the standard of practice and a boggles my mind how my EMT colleagues can dismiss people like that. And I’m not I don’t I’m not speaking bad. I don’t know her at all. I’m just saying that that it goes back to the point I was making before, which is ELT, as a specialty. Has blinders on as the as to the impact of these situations that people find themselves and my colleagues have blinders on as to the profound impact that it has on somebody when they can’t breathe properly. And, and I’m trying to take those blinders off. And, you know, someday I’ll succeed. But right now, unfortunately, your story is the common story. And it’s it’s not not a good one.

Brett Scott  1:13:55

Yeah. And so, as we spoke before, a lot of people are looking to have these surgeries, like a turbinate reduction or a septoplasty. And a lot of people just I’ve talked to, it’s like a 5050 Draw of, hey, this worked really well for me, or that did nothing. It was a waste of my time and my money. So one of my big questions, too, was, and one of the things I told me as well, you know, we could do the surgery, but we don’t know if it’s going to work and those turbinates can grow back.

1:14:27

I’m 5050 is not the 5050 if you’re having me just got this right. It’s just what it seems like to me. Yeah. And I’m not this I don’t disagree. But that it’s not that isn’t the way it should be. The these conditions are straightforward. Generally, the tools and technology that we have these days are extraordinarily effective. So it generally speaking, if somebody has, let’s say, turbine or hypertrophy And we adequately reduced those turbulence. The it should be almost a never event where that person feels like that. It’s not what they were wanting, or, you know, those sorts of things. And as far as it going backwards, it’s possible, but it’s very, very rare. So, you know, so I guess what I’m saying is, what you’re hearing is accurate to sort of a it’s accurate. I don’t disagree with that. That isn’t those aren’t the odds, if you’re in the hands of somebody who is treating these conditions, day in and day out? Those are not those should not be the odds. They just shouldn’t. I mean, this is these are conditions.

Brett Scott  1:15:45

But are they? What’s that? But are they the odds? They shouldn’t? What are they?

1:15:50

I don’t know. It depends on who you’re saying. I guess if somebody, here’s what I’d say if somebody’s hemming and hawing and about I guess all I can say is what kind of the field that you’re getting, when you went in and got an evaluation? If somebody said to me, Well, we could do something, it could come back, maybe you should see an allergist is somebody who’s trying to dance and when somebody’s trying to dance, they’re not comfortable and confident in what they’re doing. And I would say I would walk somewhere else, or drive somewhere else. That is not the attitude that you should be getting from your surgeon. And especially in this area, I’d say I can speak confidently in this area, because I know this area, because it’s all I do. It’s a different strike. Kids speak about if you your appendix is inflamed, and maybe they’re going to be hemming and hawing about this. But like, this one’s pretty simple. The passageways are too tight, the option is to get them open or don’t get them open. If we do our job, right, we’re going to get them open. If things are open, how can they not be functioning properly? You know, I’m saying like if either you’re going to get them open, you’re not going to get them open. And I go back to the paradigm, if it’s an anatomy issue, and you get the anatomy open, problem solved. If it’s an anatomy issue and aligning issue, and you get the the anatomy open, well, we might have a lighting issue that we need to treat, but at least we’re off on the right foot. And we should probably treat that whether it’s with the nasal sprays, or maybe we’ll consider allergy testing. But there shouldn’t be this sort of dancing around with this. There’s no period, I guess I’ll end the sentence there. Because it, it annoys me because, unfortunately, it’s the typical story. And I bought and I think that I simply cannot, like, I don’t understand why that has to be the typical story. We have the tools, we have the technology, we can deploy them properly, there is a better way. So I don’t understand why people still have that mindset, meaning when I say people, surgeons still have that mindset that they they can’t do something and maybe just maybe in their hands, they can’t. But I all I can say is the tools that we use. And the techniques that we use are simple, reproducible and effective. And there’s nothing special about me, I can tell you that. So you know, but but there is something special about a mindset and a framework that works. And a process that works I guess back to kind of where I’m going with this is human beings, there’s all sorts of human beings, physical therapist has all sorts of different physical therapist was awesome. Dad says, find me, show me a physical therapist who’s excellent and their trade. And I will and I, you will be showing me a physical therapist who has protocols and processes that are reliable and effective and efficient, because that’s how they’re a good at what they do. Show me a physical therapist who’s bad at what they do. And they’ll be hemming and hawing about it could be this, it could be that and they’ll be reluctant to offer treatment. And I guess sort of my counsel to anybody’s listening is that when you’re seeking help from a medical provider who is not confident in what they’re doing, then go to somebody who is is my strong counsel. And if you find somebody who’s competent in what they’re doing, maybe it’s a false sense of competence. So that’s possible. But I’ll say 100% of the time, if somebody if there’s a surgeon, or a therapist, that is good at what they do and can get deliver consistent results, they’re using processes that are effective, and I’ll trust a process over a person every day a week. So I guess what I’m saying in this in this particular instances, you know, people shouldn’t have to go search like search around for like the special surgeon that knows how to get noses open find someplace that has a have processes that work and and they’ll get your results.

Brett Scott  1:19:47

Cool. Yeah, I definitely agree. I mean, it’s the same of there’s there’s a lot of parallels between me and you have the physical therapy and EMT world that sounds like because I have many of the same for traditions and in our industry as well. Well, there’s a there was a lot there, I think you know is Is there anything else you want to add to this I, we kind of got through everything I had on here. The only other thing I had questions on actually was you were the one of the first doctors are the first doctor in Wisconsin to do the balloon sinuplasty. And this is something I asked my doctor about as well. And it seems like it’s kind of the new big thing to be on the up and coming of the EMT profession. But I called the office that they sent me to. And they’re like, well, we don’t do it, but we’ll refer you out for it if we can, as okay. And then I asked her, she’s like, No, you’re not a candidate for this, like, okay, but it sounds like this is something you do an awful lot, it’s very helpful for people. So, on that side of things, like, is it much easy, it’s, I assume it’s much easier to do a balloon sinuplasty than go in and cut someone’s bone and soft tissue out? It’s much easier for you the patient, right? How many people like qualify for these things? Or should? Can we make more aware of these things? Because it doesn’t sound like for my short search on the internet, there weren’t a lot of providers around me that are doing it yet.

1:21:18

Yeah. And you may not know that this the answer to this question was the EMT that you saw was that EMT employed by a hospital or hospital system? Do you know

Brett Scott  1:21:28

is there part of so it was their part it was lol General Hospital, which is now part of they could just got bought up by tufts.

1:21:37

So that means to me that says highly likely that they are. So here’s the here’s the dirty little secret I’m going to reveal right here. If you’re seeing if you are seeing an EMT who is employed by a hospital system, or an academic medical center, they are not allowed to offer balloon sinuplasty in the office. So they’ll tell you, you are not a candidate, they’ll tell you so forth and so on. They’ll tell you, they’ll refer you down to somebody else. But they’re not able to offer that. And here’s the reason it’s like, Well, why would that be? And here’s the deal is because those hospital systems will they want you in their operating room, because that’s how they generate their revenues. They don’t generate the revenues by doing a procedure in the office. So that’s, that’s the deal with balloon angioplasty. I can’t tell definitively whether your candidate or not without seeing a CT scan. But I’d say the fact that you’ve been told that you’re not a candidate does not in fact mean that you’re not a candidate, it just means that you’ve saw somebody who can’t offer it, and therefore is going to diminish it as an option. So what I will say definitively is if you have sinus airways that are not working properly, either you’re getting recurrent sinus infections, chronic sinus infections, so forth and so on, then you have an anatomy problem, those passageways are not open, there are two ways to open the anatomy, we can use a balloon, which is what we’re talking about balloon sinuplasty, we can find the natural sinus passageway, take a balloon, place it in that passageway, inflate it to dilate the opening, deflate it and take it out. So we’ve opened the passageways without removing any tissue. We haven’t made any cuts. It’s a beautiful, elegant thing. The alternative option would be to take you to surgery gets you to sleep. And do side of surgery. Sorry. What does that look like? With that we’re actually, you know, still elegant, but we’re cutting and removing tissue to open. So instead of dilating the passageway to open, we’ve got to cut bone and soft tissue to open things up. If you’re a candidate for either one of those things, which which option do you think most people would choose, they would choose the balloon option. Unfortunately, most people are never presented that option. So sorry, it’s similar to what I was saying with the CPAP, or the oral appliance. It’s the same dynamic here with balloon sinuplasty. And sinus surgery. If you see somebody that whose only option is to offer you surgery in an operating room and cannot offer you balloon sinuplasty, you will not hear about the balloon sinuplasty option. In fact, what you’re going to hear is, you know, that doesn’t work. It’s kind of new, it’s experimental. You know, I don’t know, I’ve seen some people who hadn’t get good, didn’t get great results with it, and so forth and so on. And all of those words are a lot of you know, verbiage around, I can’t offer that to you. I feel weird about saying that to you. I don’t know if it works or doesn’t work because I don’t do it. But and that’s what I’m gonna say to you. And I don’t know. I mean, I’m getting you know, older each year, but I did the first balloon sinuplasty case in Wisconsin in 2006 2006. You know, George W. Bush was president. This is before the iPhone before the iPad. I seem to think this is around the time that you know, Google was just sort of becoming something face you know, I’m saying like that’s a lifetime ago. And so for my colleagues to have the gumption to say that this is new and experimental, is a mind boggling head scratching situation. And yet here we set in 2023. With technology that’s been around for 20 years that people find new and fascinating. Again, if you want to sort of understand why the healthcare system is screwed up, in so many ways, follow the ball and some of the things we’re talking about. And you’ll, you’ll see that the, the system isn’t built for you as a patient, the system is built for the system, and the system will do whatever it takes to keep the system going. And you’re just sort of the, I don’t know, you’re kind of the fuel that they throw in to keep the thing going. But nothing is built for you. And so I guess that’s where, like, you know, I got a lot of a lot of things that get me going, but this one is another one where it’s like, no, no, no, like, I guess, like, like, let’s sort of speak truth and knowledge to things. And in this situation, it’s a balloon. sinuplasty is not magic. It’s not the panacea, it’s not going to like, you know, it isn’t, you know, something that it isn’t. But it’s a simple, effective tool to get sinus airways open, that works, and it works consistently. And all studies have shown that and nobody questions that. And if somebody is suffering with conditions in the sinus areas, then the that’s either an anatomy problem or lining problem and in the sinuses is actually a little bit more clear cut in those areas, from a treatment option, the primary treatment option is to get the anatomy open, there isn’t much we can do for the lining of the sinuses, because because of the anatomy is shot, you can’t get medications to the lining. So it’s almost even easier than the nose. So it’s like, well, let’s get the anatomy open. And then it’s like, Well, why don’t we get the anatomy open in a simple manner, like with a balloon? And then maybe like me, and then I’d say, Well, you know what? I don’t, I’m just gonna, I guess my general approach with medicine is I have sort of strong beliefs, but they’re loosely held. And again, at the end of the day, I’m not, I am not the decision maker here. You’re the decision maker. And so I’d say, hey, why don’t I put these these options in front of you? And why don’t I have you tell me, I’m going to educate you, I’m going to tell you, if they’re if they’re valid, both reasonable options, I’ll tell you that if one is a little bit better than the other, I’ll tell you that. But lo and behold, if you if you present with an even hand or with even hands, for somebody who has sinus issues, these two options, almost everybody like I’d say 99% of people are going to choose the office option. Because you know, what if it What if it does worst case scenario, what if it doesn’t work? Can we go to surgery? Yeah, we can go to surgery. Well, why wouldn’t we try that option before we go to surgery? That’s right. Why wouldn’t we try that option? Before we go to surgery? That’s what I would want. If that was that’s what I would want done unto me. That’s what my wife, my parents, my kids, same thing. That’s what they mean. But yet, it still isn’t widely accessible still, you know, 20 years later?

Brett Scott  1:28:08

That’s crazy that we have these obstacles and road bumps and practice that just don’t seem to make it easier for our patients. No, it is. Absolutely. Yeah, I’m sure the insurance companies don’t help with that to make things easier for patients and more cost effective, either. They don’t,

1:28:26

although we I mean, honestly, you know, we as a practice, fight those battles with insurance companies on behalf of our patients. In this situation of being, you know, how do you say this? I mean,

Brett Scott  1:28:39

that, Oh, the line? Well, no, no,

1:28:41

I mean, I think in this situation isn’t the insurance companies so much that are getting in the way of progress, it’s the it’s the it’s the system, it’s actually the Eat my end specialty, is what’s getting in the way of people having access to balloon sinuplasty. Because from an insurance standpoint, when it Most insurers who kind of get it and say, Gosh, here, here’s two options, we can have this person do an office procedure, we can have this person to go to surgery, it’s much more expensive for everybody to go to the surgical route. So insurance companies would prefer the office route. The problem is they just don’t have that much access to practices that offer the office route. So most sinus surgery that’s done in this country, when I say most I mean 95 or higher percent is done in the operating room, no balloon, just, you know, standard old techniques. So for people who are fortunate to have access to all practices that offer balloon sinuplasty insurance companies generally are good with it, and will approve it, you know, which is a good thing. So, you know, it’s, I think various aspects of the healthcare system are messed up. And then I think, if you’re going to look to make a difference, you just need to figure out what specific part of things is messed up and then, you know, for me, I’m tend to be a disrupter. And then it’s like, okay, that’s the target. That’s what I’m going to, you know, sort identify and push out of my way. And so in this instance, it’s not the insurance companies who have an issue. It’s not my patients who have, well, they have an issue that we’re trying to treat. It’s my colleagues at colleagues who sort of are trapped in hospital systems that want to keep them stuck back in the 20th century. We have, you know, 21st century medicine we can apply. And so it’s, and again, I’m not my job in life is not to convince all my auntie colleagues to do the right thing. It’s to do the right thing, show them that this is the right thing. And then I do believe when they see, you know, see what happens when you do the right thing, which is you get good results for your patients, that more of them will follow. So that’s my hope.

Brett Scott  1:30:41

One more question for you. Sure. Fitness, wearables and sleeping. I just had an advocate or she sits on the council for whoop Allison Breger. She was my sleep neurobiologist. She’s awesome. We talked about a lot of different things as far as tracking sleep and everything. As far as sleep apnea. Like I said, like I’ve got my Apple Watch, I’ve been doing some, you know, listening to my eat my rather not restful sleep. Can you kind of do Is there anything you can do to kind of do your own little self sleep studies to see if you might have sleep apnea? Before going in, you know, or any Inklings you would get from some type of fitness wearable? Like I know, the new Apple Watch, I don’t have it yet. It actually tracks or Oh to saturation,

1:31:28

right. So that would be that that’s what I was gonna say. So the Apple watches that do that I wear an aura ring that does that too. You know, if your oxygen Sats are dropping, if you have an accurate way to measure your oxygen SATs or your SATs are dropping, when you’re sleeping at night, you have sleep apnea, it’s I mean, it’s not a definitive diagnosis. But that’s, it’s that’s what’s going on. There’s no other reason your ot SATs will be dropping in that situation. You know, all there’s many ways to track snoring in particular. So you know, if you’re snoring consistently at night, you’re the likelihood of you having sleep apnea is significant. home sleep test these days are super easy, like I mean, almost easier than wearing a wire, I mean, there’s a sleep test that will offer our patients sometimes, it’s just a little device that you take on your finger. And it’s a sleep study, it’ll give us all the information we need. So we’re not talking about we’re talking about is kind of what has gone before technology has come a long way. And even, you know, whatever you want to call it. insurance covered medical with FDA approved, sleep tests are super slick these days, give us all the information. So I guess what I’m saying is, if you’re wearing if you’re struggling, if you’re snoring, you you know, getting into a place that can that can get you a home sleep study in a simple manner is worth doing. You can continue to gather data on your devices, and it’ll help but it will likely just be confirming that, you know, if you’re snoring every night, okay, some nights are better than others. And it’s just cutting to the chase and getting the true knowledge about what’s going on. So that you can do something about it is the bottom line.

Brett Scott  1:33:21

Okay, cool. Well, thank you, Dr. canula. This is a very informative podcast. You know, I gotta say, I love your passion for this stuff. And getting into it with me, it’s been pretty cool, because there’s a lot of parallels to and a lot I think we both see, between seeing patients and things that are dealing with it, no one else is looking at or bothering to look at. As well as just, you know, it’s another great way. And another great resource for patients to have that are maybe in similar shoes to mine, where I feel like there are a lot of people in similar shoes to mind that haven’t gotten treated the way they want. And, you know, maybe went to the doctors and just like me, who is an educated medical professional. Yeah, and I’m still questioning like, what I’m supposed to do now with the way the information was given to me and handled and it’s a scary thing for me to think of patients that don’t have a seven year doctorate degree to a medical office, right and try to make sure they’re doing the right thing for themselves that’s going to benefit them in the long run.

1:34:22

I agree. I mean it that’s the thing. I mean, I mean I’m fortunate to have my education and be knowledgeable and obviously I’m you know in the specialty that I’m in but I guess me seeing and hearing you know secondhand firsthand sometimes the stories that my the struggles that my patients go through just very much the same that you’re describing. Makes me wonder how somebody who doesn’t have the benefit of that medical education has any chance in in this system. I really and I don’t mean that to be discouraged. I just mean that to be honest. And to me, it’s just proof positive of, you know, kind of how dysfunctional things are, and how important it is for each individual to take hold of their medical fate. Because if you don’t do that, like if you go, and this is what I think more, most people who go and touch the healthcare system do so still in a trustful manner, in a passive manner, and that that’s just a recipe for disaster. And so the way to approach the medical system is in an active manner, and with a sort of determined mindset, that if you’ve got a problem, that you’re looking to get a solution for that you keep going until you get a solution. And if it doesn’t feel like you’re getting the right information, finding somebody who can get you the right information. The challenge is, sometimes that’s that’s a long drawn out battle. And most people are worn down, you know, in the first round, it was some of that stuff, and I get it. But, you know, I think the challenge, and it’s as much as I mean, when I think about it, and I talk about it and dwell on it, it’s really depressing. When I instead focus my efforts and energy on doing something about it, which is what I get to do on a daily basis. It’s energizing, and invigorating. And so I while I need to recognize the reality of the situation around me, the good thing with what I’m doing with what you’re doing is that you can, you know, one step at a time, one patient at a time, change the system in a way that sort of pushes it towards the positive, which is, it’s all we can do, I guess, is sort of the bottom line. And I guess things like this, that I’d say, we can do good work on a daily basis. But then I think providing people with good information, or maybe some thought provoking information so that they can go, you know, they get to me, sometimes I’ll kind of think about it about it is if I can inform people and arm people with the proper information, they can go out and be a foot soldier along with me to fight some of these battles. And I think the battle that I’m fighting on the breathing triangle, and these airway issues, is just merely one battle amongst all the different battles that exists within the human body about, you know, mental health, physical health conditions that need to be treated. But if I can push on this one, and I can get other people to recognize how messed up things are, and they’re pushing too, I think we can tip this thing over. And then I think you can just kind of keep going marching on to the other, you know, you know, whether, whether it’s physical therapy, or orthopedics or other things that are, I’m sure, similarly just a screwed up.

Brett Scott  1:37:44

Absolutely. So we’ll cut it off there in an hour and 38 minutes. But Dr. canula, where can people find you and your practice and your social media stuff, too? There’s a lot of good stuff on there.

1:37:57

Yeah. You know, Advent knows.com Is the is my practice of Adventure Medical Practice. Advent knows either way can ows or NOC is the medical practice. I’m most active on LinkedIn. So folks who use that it’s just under my name, some of them can’t do a, I don’t think it’s live yet. But I we’re aggregating some of my social media stuff onto my personal website, so mother can do it was nada en que en de ula.com. So that that should be live, you know, any day now. So any of those places? And hopefully, this was some good information.

Brett Scott  1:38:33

Yeah. And we’ll be sure to share your contact stuff in the show notes there. So, again, thank you for coming on. It was a pleasure having you and, you know, I hope I can figure out my notes here. And now that I have, we just took about an hour and a half to do a differential diagnosis. I think I feel a little more confident with what I know and don’t know now. So thank you.

1:38:56

Yeah, absolutely. No, I think we’re off right.

Brett Scott  1:39:02

We gave me 123 And

1:39:05

I screwed that up for you.