Hi everyone and welcome back to Airway First, the podcast from the Children's Airway First
Foundation. I'm your host Rebecca St. James. Today we're continuing with part two of our
conversation with Dr. David McCarty. Dr. McCarty is a board certified specialist in sleep medicine
and a pioneer in the practice of patient-centered care for those who suffer from sleep disorders.
An award-winning educator, he is passionate about empowering individuals with knowledge that restores
confidence and personal agency as each patient navigates the landscape of disease and wellness
within an increasingly fragmented healthcare system. He is also the co-creator of Empowered
Sleep apnea, an innovative cross-platform educational project combining storytelling,
cartooning, scientific rigor, and quite a bit of fun, all in the name of helping individuals navigate
the fascinating but complex disorder known as sleep apnea. Launched in 2023, the project
comprises a website, a book, a blog, and a podcast. The Children's Airway First Foundation is proud
to partner with Dr. McCarty and Empowered Sleep apnea in an effort to help create more information,
education, and understanding around the subject of airway and sleep apnea. You can find out more
about Dr. McCarty at EmpoweredSleepApnea.com. And now let's jump into part two of our discussion
with Dr. David McCarty. And so when you're talking to a child, because I just don't see that you
go into, like every parent, my children are exceptional, so you could have had the conversation.
We're all of the children are above average. Right? Exactly. I just don't think any child,
if you walked in and said, how are you sleeping, you can't have that conversation with them.
It's very different worlds. So how do you approach this with children? I mean, it's a very different
world. It's got to be done by surrogate. And you have to be, the caregiver has to be observant
and has to be kind of the advocate for the child. And parents will be able to give you their sense
of their child's sleep satisfaction by how lousy they feel. If the kid is not sleeping well,
it's usually the parents who suffer. And I've heard that story many, many times. So parents
can usually give you a pretty good appraisal of what's wrong with the sleeping experience and
what's wrong with the waking experience. They can do some sleuth work to investigate the question
of whether snoring is present and how bad it is. And there are now the wearable technologies and
the bedside technologies that are available to consumers are, it's just over the top. So you
can get data. And the question is how to unpack this data in a sensible way so that you can present
it to your providers. So the structure that I just talked about, five reasons to treat,
you can certainly apply that structure to unwinding a child's case of sleep apnea too.
In many cases, the risk part of this discussion is more nebulous. Sleep apnea in kids, with
exceptions, we still have heavy children that have rip-roaring, bad, bad obstructive sleep apnea.
And I worry about heart failure. But for the most part, we're talking about the other four
reasons to treat. And the risk to the child is much more nebulous. Is this going to make the
child develop in a different way? Because they're breathing with their mouth open all night, is
their jaw going to be underdeveloped? Are they going to be back in school and have limited
potential because they're so tired all the time? Those are the risks that we're talking about for
kids. So you can tailor the discussion differently, but you could say, for example, well, the first
step of the five reasons monument is risk. I don't think this is the kind of sleep apnea that's
going to give you a stroke. But let's talk about the other four reasons. And then we can kind of
help people understand that there's still reasons to think about this very critically. And that
means we're going to take it apart with the many moving parts and choose the right treatment
for this individual. Not just say, well, here's what your insurance covers. Boom. Here's your
seat belt machine. You know what I mean? Or, all right, let's pull teeth and slap on some
retractive braces because that's what it covers. Let's not go there. So let's just get back at
that discussion. That's the other thing that is hard for a lot of providers to kind of talk about
these days is that many times these kids with crowded airways present with malocclusion, you
know, which means that their teeth are wonky and kind of crooked and weird looking. And when that
happens, if you go to an orthodontist that isn't thinking about the airway, the standard of care
might be to pull out some teeth to make room and pull those teeth backwards. And that has the effect
of making the oral vault smaller. There's no question about it. The big sort of consternation
and debate is, you know, the orthodontists that practice that way are feeling kind of defensive.
You know, they don't want to be accused of causing problems, but yet here we are. We're getting the
message that this phenotype of a smaller mouth is not really that good. And this orthodontist is
sort of moving people in that direction. So we got to think about these things critically with
our children and think about the airway when we're thinking about this, you know, wonky teeth issue
too. For sure. And this, and I swear I say this every episode. So this will be the point of this
one that I said for parents and providers, both to please hear the guilt. We got to let it go
because you don't know what you don't know. Y'all were taught what we thought was right.
Parents were doing what we thought was right. Here's the new evidence. It's okay. You know,
deep breath. This is an evolving discussion. I totally agree. This is nobody's fault.
This is nobody's fault. This is the way science develops is we're getting, you know,
a new signal that much of what we see as malocclusion is probably developmental rather than
genetic. And that means it has to do with the way we eat and chew and swallow from birth.
And it's just different than it was in pre-industrial society. We're eating a lot easier to chew foods.
We're bottle fed. And so that just makes the face develop differently, you know. And that's
a staggering reality to deal with that, you know, some of this that is affecting the label of sleep
apnea is a skeletal developmental problem, which is probably going to require a different set of
solutions for people. You know, this is the trajectory of what I call in my work, the sort
of the outlaw. These are the folks who are outside sort of Western medical traditions
who are pioneering this subject known as epigenetic orthodontia. And epigenetic refers to the elements
that define and help with development that have nothing to do with your genome. It has to do with,
you know, pressures from without. So the within, so the way the tongue is working, the way our
teeth come together when we chew, the way we swallow, whether it's a pursed lip swallow or
whether it's a normal swallow, all of these things can affect the shape of our face. And once that
sort of concept hits home, it unlocks a completely different way of thinking about this. This is
this is not a single issue problem anymore. No. So it turns out that many of the people who kind of
fit into that narrower face, smaller jaw phenotype, they're usually thinner than the typical
picwikian syndrome, heavy, snoring, sleepy person. And they usually present with these more autonomic
um, um, um, imbalance towards sympathetic stimulation. So they're jumpy and they're, they're
irritable, and they can't sleep. Completely different phenotype. That type of person self-selects
against going to a Western medical provider, right? Because they have an intuition that they're going
to be offered a CPAP machine, or they've heard from someone else, that that's what's going to happen.
So they self-select and they don't go. And this way they start going towards these pioneers in
another sort of silo of thought. And suddenly we've got two different realities that are defining
their reality with the same term. How confusing is that for, for patients? They've got two different
cultures. They've got two different ways of thinking about it and talking about it. And the
people who get caught in the middle are, are feeling the tension there. Because the, the, the,
the providers in Western medical don't understand what the outlaws are doing. And the outlaws are
kind of unhappy with the fact that many of the folks in Western medical have been left behind.
So now we've got two different professional organizations that can't talk to each other
anymore. And that's a terrifying place for the patient. Yeah. You know. So again, if that's you
out there, for the providers too. Yeah. Cause then, you know, it's sort of the human nature is to
adopt a defensive stance on how you practice. And then you can't really hear anybody anymore.
So, you know, to, to providers and patients who are kind of feeling like that, maybe where they
are, this is the purpose of the blue book, is it really helps kind of unify the conversation in a
way that deconstructs this for the patient. It's not really, railroading someone towards a specific
treatment. It's sort of understanding how all fits together. You know, right, right. And I'm,
I'm also going to put links to two previous podcasts with Dr. Becky Andrews and Stephen Hall.
They are two of these pioneering outlaws. And I think it's important for parents, if they haven't
heard it yet, to hear it, you know, in conjunction with this. And I mean, if you're up for it,
it makes sense to me to kind of tackle the five finger approach at this point, because
sure, sure. Yeah. You go through the risks and you talk about it. And, you know, now where do we go?
Well, the five finger approach is another complexity deconstruction tool. This one,
I actually came up with when I was still on faculty with the division of sleep medicine
at LSU Health Sciences Center in Streetport. And I'll give you a brief backstory for why this
tool was so necessary. It was early in my tenure as an attending there. And I had gone in to see
a patient who had several, you know, notes, annual notes, kind of a soap note, that's how they did
it back then, subjective, objective, you know, assessment and plan. And each one was the same,
you know, subjective patient presents for follow up of obstructive sleep apnea, AHI6. Objective,
patient appears no distress, doing well, no dermal irritation from, from mask. You know,
the subjective probably should have included patient states using device, you know, assessment,
obstructive sleep apnea on CPAP, doing well, plan, continue present therapy, follow up one year.
Okay. So I'm like looking through this paper chart because it was back when we still wrote on,
you know, cave walls with crayon, you know, I'm looking through this. Each note is the same,
you know, I'm like, okay, so I don't know this person at all. So I'm thinking this is going to
be a rapid visit, right? So I knock on the door, I walk in, I'm saying, how are you doing? And here's
this woman who looks so disconnected from her activity there. She's not making eye contact.
She's got this disheveled looking machine in her lap. I'm like, well, how are you doing with this
machine? She's like, all right. And I said, well, you know, is it doing you any good? And then finally,
she kind of looks me in the eye. She's like, I don't know. And she's, you know, a little bit
defiant, but not mean, but interested. Now she's paying attention because like I asked her something
important. And I said, well, it says here you snore. And she's like, I don't snore. And I was like,
I was about to say yes, you do because it says so in the chart, you know, because that was what
was listed on her sleep study report. But wisely, I think in the moment I said, I didn't say that.
And I said, Oh, tell me more. And she said, Well, I used to, you know, I was 20 pounds heavier than
you know, she presented with excessive daytime sleepiness, sleep disruption, and snoring. And
then she had her sleep study and it showed an AHF six. So she got herself the label, right?
Diagnosis of sleep. So I'm going to cut to the chase. Bottom line is this woman actually had
narcolepsy. Okay, different problem altogether. That was responsible for the complaints that she
had. When I got down into the weeds with her, I found out that she was using this only because
they told her to because they told her that it gave her, it would give her a stroke if she didn't use
it. And, and it didn't do anything for her that was perceptibly good. So, you know, she didn't
snore without it because she'd lost some weight. It didn't improve her sleep experience. And it
didn't improve her wake experience. And so when we sort of delved into those sleep wake complaints
again, we realized that there was an alternate diagnosis that was present that hadn't been
addressed. Because the thinking took a mental nap as soon as she got her label, and it became a
label based sort of propagation. And I thought, Oh my God, this is embarrassing. I mean, I was
terribly embarrassed. Because she's like, Well, why have I been using this all these years? And
the answer was they told me it would give me a stroke if I didn't. And I felt that that was kind
of mean. Because, you know, when we retested her, her AHI was too. And so it really wasn't that
flavor of sleep apnea, you know, it didn't deserve that scare tactic to get around therapy. And
yet there we were five years later. Okay, so the five finger approach was something that I worked
on for about two years after that event. And I, and I published it as a special article in the
Journal of Clinical Sleep Medicine. And it's it was designed as a memory tool and a teaching tool,
a collaborative teaching tool, so that we can involve our patients and keep ourselves honest.
And I broke it down into five different domains to think about. If someone comes to you with a set
of sleep, weight complaints, like we established earlier in the conversation, we had no what their
narrative is. Now we have to sort of sound off. Well, could there be many things going on? You
know, could there be several contributors? And the original title of the paper was beyond
Occam's razor, you know, because we're taught to find the one thing it's sort of conditioned into us
that find the one thing that unifies it all. And I think that's a contributor that myth that
there's going to be wondering. Yeah, and it's just not true sleep is complex. And usually people have
several things going on. And so the five domains are circadian misalignment is the first one.
And similar to the five reasons to treat, I put the most challenging one first, because it's also
fundamental to the sleep wake experience. Understanding circadian misalignment is kind
of easy. Okay, the idea is that there is a typically about an eight hour timeframe in our
circadian cycle that's permissive for sleep to occur. The two hours, roughly two hours before
that timeframe, we'll call that the circadian sleep phase. And for me, I'm a pretty regular guy.
My circadian sleep phase is roughly 10 to 6 10pm to 6am. Okay, so for me, from roughly eight to 10,
there is a timing of my circadian rhythm that actually amps up my internal alertness. Okay,
that's designed to help get you through to your finish line, while all of this fume like sleep
pressure is building up in your brain, you know, the desire to go to sleep can be kind of measurable
by how much stuff builds up in the brain that is sleep inducing, we call them sleep regulating
substances.
You're listening to Airway First with today's guest, Dr. David McCarty. You can find out more
about the Children's Airway First Foundation and our mission to fix before six on our website at
childrensairwayfirst.org. The CAF website offers tons of great resources for parents and medical
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As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician. And now let's jump back into my interview with today's guest, Dr. Dave McCarty.
Right now, what I'm getting into is a topic called the two process model of sleep wake
regulation. There's the fumes that build up in the brain because you're awake and doing stuff.
That's called process S. And then there's the signal towards alertness that's on a timer.
That's on a 24 hour cycle. Okay, that's called process C process S and process C, the two process
model. Okay, and got it. The issue is that process C, the circadian rhythm of your alertness
can be damaged by environmental stimuli. It can be delayed most typically. So bright like
yeah, lights and activity and socializing and all the things we do after dark, you know,
fourth meal. Okay, all the stuff we do after dark pushes our circadian sleep phase later.
And what that ends up doing is that burst of alertness activity, which the circadian rhythm
researchers call the forbidden zone. Isn't that cool? The forbidden zone is a timeframe in your
circadian cycle where sleep doesn't really tend to happen because it's when your brain is kind of
on full steam helping you stay awake. Okay, but when that forbidden zone gets also delayed on the
clock because you're shining lights in your eyes and you're suppressing your melatonin.
What happens is people end up getting into bed and they're like, I can't fall asleep. Okay.
Okay. The forbidden zone is to sleep. What a big giant unruly frat boy is to the keg of beer
sitting on top of it. Okay. And so it's, it's hard to fall asleep on top of your forbidden zone.
Okay. So all of this is to say that teaching this, these concepts to people is, is full of jargon.
And so it's kind of scary. And many providers don't understand it well enough to discuss it
with their patients. And so they don't do it and they don't consider it. And therefore it's not
problem solved. So the good news is for circadian misalignment, which is the thumb of the five finger
approach, the book gets into it and the podcast does too. It talks you, you threw it with imagery,
you know, so we talk about the fumes and the attic for the process C and we talk about,
or for process S, I mean, the homeostatic sleep pressure concept. And then the whole process C
element, which is kind of scary because it has this circular time, I created something called
the circadian rhythm wheel. And it's something that it's fun to look at. Cause again, it's like a
crackerjack decoder ring, but you can turn it around and you actually see where these events are.
And you can see how things can delay. So the dynamic aspect of the wheel allows providers to
show, you know, where's the forbidden zone happening now? And where's your sleep phase? And
what can we do about this? Well, it has to do with exposure to light. And, you know, you can also use
melatonin strategically to try and manipulate where your circadian sleep phase is. But again,
these concepts are complex, right? And, and getting them through in a way that's not terrifying is
job one. And, you know, there's a whole section in the book that talks about how to deal with
delayed circadian sleep phase. So just for transparency, the hand is on the other side
of the island and I am not there yet. So you have more questions when I get there.
You'll get there. You'll get there. But that'll take you through. The thumb, which is the thumb
of the five finger approach is the hardest one to talk about because it contains all that jargon.
And that's where the circadian rhythm wheel and the discussion of the two process model
can be very helpful. Because it's really discussion of those things that allows people to get their
hands around what we commonly call cognitive behavioral therapy for insomnia, changing how
you behave and how you think about it is the natural outcropping of understanding that complexity.
Okay. Normally speaking, CBTI, cognitive behavioral therapy for insomnia is given as a set of
instructions, you know, restrict the amount of time you're in bed. If you're not sleeping,
get out of bed. And it's these very, they're these hard instructions that feel hard. And they feel
like eat your vegetables and people have a hard time with that. And in my experience, empowering
them with the knowledge for why it all fits together puts them in a different decision-making
place and then they choose the behavioral and cognitive things that they're supposed to do
because I told them to. Gotcha. So anyway, that's the thumb. The second finger is a pharmacologic
influences. I put this second basically as a trigger for my fellows to do due diligence and
look at the med list. Many of you know, this came naturally to me, I'm a primary care physician
by training. So I started my career as a primary care internist. And my favorite thing to do when
a person would come to me as a new patient is to look at their med list. And let's talk about
what's not needed. You know, this, I don't think you need this. Let's simplify this. Let's get you
on something that's less expensive that'll do the same job that has fewer side effects.
You know, really trimming that list to be the sleekest and most effective thing was kind of a
point of pride. So alternatively, when your background is like, say, neurology or psychiatry,
you might not feel comfortable even sort of glancing at the cardiac meds, because it's somebody
else's specialty. I'm not supposed to talk about that. But there's a culture that you can't even
go there. But the problem is that many, many substances that we can take either illicitly
or recreationally or socially or by prescription can have adverse effects on sleep and or wake.
And it's not something that a lot of people know about. I'll give you an example. Beta block. Okay.
You familiar with the drug class beta blockers? Yeah. They block the beta receptors for adrenaline
and they help control heart rate and blood pressure. People use them for lots of reasons, you know.
Often it's for blood pressure, but in psychiatry, they're used to manage the side effects of
anti-psychotic medications. They can be used to manage anxiety, you know. So there's lots of
reasons why somebody might end up on a beta blocker. Sometimes they're prescribed for migraine
prophylaxis, you know. But what a lot of people don't know, beta blockers can cause insomnia.
Beta blockers can cause frightful nightmares and actually can bleed over into hallucinations
that intrude upon wakefulness in some predisposed patients. And you know, it's not
sort of on your cardiologist's mind that these sleep-weight complaints can occur. So the dots
might not be connected. And it's like, I'm having these terrible nightmares. And then all of a
sudden you've got nightmare disorder and somebody's trying to give you a different medication to
treat the nightmares, you know. So I call this swallowing the spider to swallow the fly, you know.
So a critical appraisal of the med list with respect to that person's sleep-weight complaints.
And you know, could this be related to something we're giving you or something you're taking?
That's what the index finger is about. And it would also be if you're talking to your
provider, just a quick question that maybe your provider doesn't have the background that you had
and this, you know, in your child or yourself has this list of things. Is this an okay time to say,
hey, can we call and consult or can you reach out to whoever and consult and see, can we change this?
Is this the right list? Is this? Arguably, that's where sleep medicine is supposed to pull their
weight. Okay. You know, so this language that I'm sort of putting forward is the ideal. And, you
know, I know that the reality is that there are many sleep clinics that are sort of Western medical
stamped of approval. And the way they practically run things is sort of a pathway to get started on
CPAP or a standard airway strategy. And these other issues may or may not be completely addressed.
And it's variable. It's totally variable by provider. In many cases, providers feel hamstrung
because, you know, CBTI, Cognitive Behavioral Therapy for Insomnia, isn't easy. You know,
people train to get certified in this and many providers aren't comfortable with the concept.
And so they will say, well, we can refer you out. But then that leads to a pathway that's usually
not covered by insurance because it's usually a clinical psychologist that provides these services
and that is often out of the scope of a health care plan. So there are often barriers to getting
this type of care. So, you know, once again, this is part of the reason of the empowerment project
is give people the language and the structure to understand where this fits together so they might
self advocate for these things. Gotcha. Okay. Perfect. All right. Number three. Well, for anybody
who's interested, there is an excerpt from the book that was included as part of the podcast
series that in episode five, The Mountain, which is our season finale, I call it Five Finger Approach
Mountain on the Island because it's the high vantage point to orient here from. But Five Finger
Approach Mountain is addressed in that episode. And there is a link to a handout about substances
that commonly affect sleep and wake. And that's, oh, okay, I'll make sure that we include that. Yeah.
Yeah. Yeah. So that's available. That's available through that. The show notes of episode five,
the mountain. Perfect. The third finger is the middle finger. That points us to the medical
problems domain. So keep in mind sleep wake complaints when we're dealing with these sleep
wake complaints, you know, feeling like your sleep is disrupted feeling like you're tired
during the daytime. These are inherently not specific. And there may be other things that
are disruptive to sleep that would fall under the medical domain. A common one is like chronic pain
issues. There's so much chronic pain out there. Pain can be disruptive to sleep. And so whether
pain is a major disruptor to sleep should be part of the calculus about how that pain is managed.
You know, perhaps the strategy of strategic dosing at bedtime just to allow some relief from that
pain so that the person can get some rest. You know, there's a big part of our narrative towards
chronic pain that's scrutinizing the overuse of opiates for good reason. You know, these are
dangerous drug class, but you know, we can't overshoot and stop caring about pain, especially
when it comes to sleep. You know, if we can restore sleep functionally with a small dose of
something that's not escalating that the patient can maintain dosing of, that may be the better
part of that risk benefit narrative, you know, for that individual. So anyway, the middle finger is
a free for all discussion about how are our medical problems being managed and could we get better
control over these medical problems to perhaps have a better effect on sleep-wake experience.
Okay, so that's what that has caused for. The ring finger is to call attention to the psychosocial
and psychiatric components of the sleep-wake experience. I'll give you a startling example.
A woman who comes in claiming to be anxious and can't sleep at night and feels tired in the daytime,
what happens when you find out that where she lives, there are gunshots outside and people
banging on the door and she has an abusive boyfriend that occasionally visits her at night.
So now we have a completely different language to explore for what's happening with this individual
with these sleep-wake complaints. Oftentimes, these mental health issues are scary to talk about
and so creating a safe space to explore that with our patients, that's what the ring finger's about.
Could we get this patient a better experience with referral to an appropriate mental health
professional or is there something unsafe at home we need to be thinking about? It allows us to
again move beyond the hard stop of a sleep-disorder breathing diagnosis and then moving along like
we did with the patient who inspired this approach. Someone, there's actually a blog
episode or blog entry for this backstory that talks about this on my website and perhaps if
listeners want to we can put a link to that. Absolutely. Fifth finger, I did this on purpose.
Again, this was a teaching tool for my fellows to make sure they made a methodical survey of
this patient before landing on something easy like sleep apnea like we did for the patient
who inspired this story. The fifth finger is going to be what I call primary sleep diagnoses.
These are fluid categories. There are ways to organize this in your mind, but this would be
something that you imagine would be labeled at a sleep clinic. Sleep apnea, restless leg syndrome,
chronic insomnia, idiopathic hypersomnia, narcolepsy. These are the labels that you're
going to get when you go to a sleep clinic. I put it last as a reminder to my fellows that yes,
it's important to talk about the sleep apnea, but when somebody comes in with a non-specific
set of sleep weight complaints, don't go there first. Let go there because let's say somebody's
on a CPAP machine and they say, I'm using it, but I'm not feeling well and I'm not sleeping well.
Let's go to the five finger approach mountain. Let's see if we can figure this out.
And it allows us to go back and critically appraise, is CPAP resolving the sleep apnea?
Are we doing a good enough job for that known diagnosis? Let's look at the data. Maybe your
numbers are bad. It just so happens that people can do well for years on a CPAP machine and then
like that, they flip into atrial fibrillation. It changes their circulation dynamics and now
all of a sudden, they have central apnea events on treatment. Their numbers on their device
out of nowhere go way up and to a provider that is unaware of the complexity of the moving parts.
They may say, oh my gosh, well, we need to increase your pressure and do something to chase after the
thing that they are holding onto that they still understand, that simple model. This is why simplicity
is not- But the core has changed. You've got to go back there. Yeah. So we got to go back and revisit.
So if we're saying, the fifth finger, well, you've got sleep weight complaints, could the sleep apnea
again be part of the problem? Let's critically appraise that. Let's go back and look at your
numbers. Let's talk about the comfort of your mask. Could we do a better job? Is this the best
option for you? So that's the stopping point for that. And when I do this, I'm not doing it in
secret in my mind. The point of the five finger approach is to teach it to our patients as we go.
And that way, when they understand what we're working on and they see how we break it apart,
I used to draw a hand on the paper on the exam table and the patient would crowd up next to me.
We'd sort of sit there and look at it together and I'd write on it as we go. Anyway, if I felt that
circadian misalignment wasn't part of the problem, I just cross out the thumb on my hand. I say,
go, I don't think that's going on. Let's talk about your med list now. And let's go through this.
And, you know, bit by bit, the patients engaged, they may start to think about their sleep in a
different way. And usually they go home with a few things that they can think about. And often
they come back and they say, you know, that bit about circadian misalignment, I started watching
my phone use and I put it on the warm tones and I did my proactive wind down time before bed with
the low lights and the chamomile tea and the soft music. And man, I fell asleep easier. That stuff
really works. Wow. You know, so it really can make a difference. And the difference is agency
and personal empowerment. You know, when I sign the books, I often write empowerment saves. I mean,
big explanation for it. I'm not being silly. Empowerment saves people from falling out and
from being left behind because they're a part of the solution and they're actively engaged.
The disempowerment of the label based system is again, it's hard to talk about, but I think
that's a major problem that we all need to get our hands around. And I think it's not just for
very existential of me, but I don't think it's just patience back to something you said earlier.
And I do think I'm labeling this podcast as empowerment saves because I think it's
saved the provider because what you're doing is giving them license to follow through on the
oath you took. The oath was to listen and to heal. It gives them the language to do that.
Yeah. If you're 15 minutes in and out, you're not empowered. You're not doing what you spend
all this time in school learning to do and care about doing. That 15 minutes can go so much more
smoothly if the provider and the patient share the language. Patient comes in says, okay, like I'm
ready for my coffee hut discussion. You know, I think I know what I want to talk about. And then
you don't have to sort of have this hour long Bay of Narrative discussion anymore. Now we've got
a common playing field and we can get into this together. And the provider who, no matter what
silo they're in, if the patient is not doing well, they're going to be encouraged to think about
the mechanics of this and break it apart into something more beautifully complex than their
simple little one solution. And that's the turning point. When a patient gets that complexity,
they become your medical assistant who works free of charge 24 seven. And they will help you do your
job to find the way towards healing because they're motivated to do it. They just needed the structure.
Right. Right. The tools, the tools. So at the end of every segment, I always
say, and the four back over to our guests. I see this a lot of time. Y'all are the experts. This
is this is your world. And there's been so much that we've covered. And I encourage parents,
please check out the show notes and teaser coming soon to the parents portal. Check it out because
we're working on some teaching stuff together. So what would you like? What message do you want
to leave with our parent audience and our clinician audience? The message is complexity is hard. And
talking about it is hard. And the discomforts that we feel with the system are no individual's fault
that arriving at a new solution to this complex problem means arriving at a new language.
And so the tools to unpack complexity that I want people to leave here with and
understand are the five reasons to treat and the five finger approach. The five reasons to treat are
discussed in, of course, our podcast and our book. And the five finger approach is actually a published
paper. So if you Google five finger approach sleep, it'll give you a free PDF of the publication that
I want to put it in here too. In 2010. And for providers, that's a good introduction to it. It's
a little jargony for patients, but it gives you an idea where this approach comes from. And if you
want it for patients and sort of non-sciencey people, just listen to the first season of our
podcast all the way through episode five, and it'll give you exactly what you need to have a working
knowledge of what to talk about. Yeah, I love it. And again, I cannot encourage parents enough.
I will put a link to it in the show notes. It's already on our reading list. Get the book, listen
to the podcast and empower yourself for your child's health span. Yes. Thank you so much for
being on today. I cannot thank you enough. I'm delighted to be here. Thank you, Rebecca. And
anytime you want me back, just let me know. I will. Thanks again to today's guest, Dr. Dave
McCarty for sharing his medical insight into each of you for listening to today's episode.
If you're new to our podcast, please don't forget to subscribe. And if you enjoyed today's episode,
leave us a review or a comment telling us about what you enjoyed most. You can stay connected
with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn,
and YouTube. Parents can also join us via our Facebook parent support group,
the airway huddle at facebook.com backslash groups backslash airway huddle. You can also find tons
of great content for parents and medical professionals alike via the parents portal and
clinicians corner on our website. If you'd like to be a guest or have an idea for an upcoming
episode, shoot us a note via the contacts page on our website or send us an email directly at
info at childrensairwayfirst.org. And finally, thanks to all the parents and medical professionals
out there that are working to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing everyone.
Bye.