Hi everybody and welcome back to Airway First, a podcast from the Children's Airway First
Foundation.
I'm your host Rebecca Downing.
In today's episode, we continue our conversation with Dr. David McIntosh, a pediatric ENT
specialist with a particular interest in airway obstruction, facial and dental development,
and its relationship to ENT airway problems and middle ear disease.
Dr. McIntosh has undertaken advanced surgical training in ENT, and head and neck surgery
and pediatric training at Starship Children's Hospital in Auckland, New Zealand.
He has been published in peer-reviewed ENT journals throughout the world and has presented
on ENT topics throughout Australia and overseas.
He is also a fellow of the Royal Australian College of Surgeons.
Throughout his career, Dr. McIntosh has helped memberships with the Australian and New Zealand
Society of Pediatric Order Laryngology, Australian Rhino-Cological Society, and the Australian
Sleep Society.
He is also the author of Snored to Death, Are You Dying in Your Sleep?
You can find out more about Dr. McIntosh at entspecialist.com.au.
To hear part one of my conversation with Dr. McIntosh, check out episode 13 of the Airway
First podcast.
And now, here is the continuation of my conversation with Dr. David McIntosh.
So that's the brain in the nutshell, but what can we do that's objective?
Well, again, we have the research.
People have gone and taken a cohort of children and put them through brain scanning protocols.
It's not something we do on a clinical level, it's research-based, but what did they find?
Well, the parts of the brain that deal with concentration and behaviour are not working
properly.
The parts of the brain that deal with memory, so there's a part of the brain, particularly
called the hippocampus, is our sort of memory centre.
It's smaller.
The parts of the brain, what's called the frontal lobe that deals with behaviour, emotional
regulation and so forth.
It's not working properly.
The parts of the brain that deal with learning and maths, for example, it's not working properly.
The parts of the brain that deal with processing visual and auditory information, so what we
see and what we hear is not working properly.
We can physically get a window of perspective by looking at brains through imaging of these
children that are not sleeping properly, and those brains are not normal.
This is brain damage.
But is it correctable?
Yeah, this is the beautiful thing about brains at an early age is that these brains have
what we call plasticity.
So the proper term is neuroplasticity.
The brain just keeps sort of changing and developing, but we've got to realise that
we're asking the brain to change and develop and work around a problem.
And the brain will do its best, but again, there's a limit to where it's at.
And if you had a choice between relying on the brain trying to solve this or just relieve
the problem that it's trying to solve, well, getting rid of the problem is actually a more
beneficial outcome than relying on the brain being its own solution.
So again, that advantage of things, but we're using that advantage in the wrong circumstances.
So yeah, so there's a very good reason that we don't let a six year old drink alcohol.
Okay, at the end of the day, as much as we've socially accepted it, alcohol is a brain poison.
We know it's a brain poison.
We sort of might decide not to acknowledge that to sort of justify our social norms,
but at the end of the day, at a medical level, alcohol is a brain poison.
There is a reason that we do not let six year olds drink alcohol.
There's even a reason we don't let 14 year olds drink alcohol.
And you can make the argument that we probably shouldn't let anyone under the age of 25 drink
alcohol if we look at it from a pure science point of view in terms of brain development.
The brain development continues throughout life, but in terms of that crucial brain development,
it's sort of massive, massive, massive, massive early on, and then petering out and plateauing
usually from the age of about 23 to 25 onwards.
So any environmental insult that comes along that can affect the brain can leave its mark.
And then we see it manifest and it shows itself more and more down the road.
Now we have adults with all of these conditions that we could have.
Absolutely.
Yeah.
So is it ever too late to stop and help an adult?
It's never too late.
This is the thing.
It's never too early and it's never too late.
And the best time to fix a problem is when you find it.
Like when you find it.
Like any health condition.
You know, when should we fix this?
Now.
Right.
Oh, but aren't they too young?
They go, they're too young to have this problem.
They're not too young to get it fixed.
So and then we come into the cardiovascular thing.
So the cardiovascular we have the heart and the blood vessels.
So if we think about, you know, what are the sort of leading sort of causes of disease and death in adults?
Well, one of them is heart disease and that ties in with high blood pressure.
Well, guess what?
This is what happens in children.
You know, because we have a problem with the breathing, we have a problem with the oxygen supply.
The part of the response is that the brain and so forth is going, hey, I'm not liking this environment.
Heart pump harder.
Give me more blood.
Give me more oxygen.
Give me more blood.
Heart goes, all right, I'm going to pump a bit harder.
Going to pump a bit faster.
It's going to work just that little bit harder.
But what it encounters along the way is these changes also within the blood vessels that leads in children to high blood pressure.
So one of the, we'll talk about high blood pressure in adults.
We talk about what's called primary and secondary.
Secondary means it's due to something.
We can go, oh, they've got a problem with their kidneys, which affects their salt regulation,
which means that it puts up the amount of the volume of fluid that's in their blood vessels,
which as a result of that puts up their blood pressure.
So that's what we call secondary hypertension.
Hypertension means high blood pressure.
But in the majority, it's what we call primary.
We go, look, it just happened.
And if you think about that as a starting point, you just go, oh, it just happened.
Well, that's a kind of weird thing to do in the first place.
And if we then drill it back and we go, why did we have an adult that took some pathway of aberrant outcome
that led to high blood pressure, sleep disorder, breathing?
So in children, the vascular changes that happen that we see changes in the tone of the little muscle.
So within their blood vessels, there's tone.
So because we have to divert blood to different parts of the body at different times.
So for example, where I'm here at the moment, this is a conversation.
This is an intellectual thing.
So this is part of which part of my body is doing the work, my brain.
So that's right.
All right.
More blood needs to go to the brain.
It's morning time here.
I haven't eaten.
So blood flow to the gut.
There's nothing there.
Don't need to worry about that.
I haven't moved yet.
I haven't gone and done any sort of physical activity.
So muscles doesn't need anything there.
Needs the baseline, but doesn't need any extra.
But then if I then go and have something to eat, and people realize this, for example, when you have lunch,
you always just tend to feel that just that little bit flaky after lunch.
Just that little bit.
Right.
I just feel a little bit tired.
That's because the blood's going to your gut more than your brain.
Why?
Because you've got a whole load of food there that has to go through a whole digestive process.
And then it needs to be pulled out the gut and taken through your other body systems to be processed.
So it's just an automatic thing.
So the blood vessels have little muscles that basically can open and close to regulate the blood flow.
And they have a background tone.
But in this sleep-assorted breathing thing, because we have this stress response,
and part of this stress response involves basically just to keep it simple little adrenaline surges,
that adrenaline causes the blood vessels to constrict.
And it changes the tone such that there's a background tone that over time is elevated.
So that therefore then squashes the blood vessels, which squashes the blood.
And when you squash the fluid, the pressure goes up.
So that's in simple terms.
So we have children with high blood pressure and so forth.
So that's that side of things.
So we have this both cardiac and vascular changes, which again, that remarkably subtle but cumulative over time.
So we have this thing where, you know, I listen to a lot of sort of, you know, health and podcasts type things,
really trying to find pockets where I can try and put my hand up and say, hey, look,
everybody is talking about adults.
You know, they're talking about, you know, oh, you know, what are the background things, you know,
adults get these diseases and I'm listening to going.
But it started back here.
Have you looked at it?
It started in childhood.
Again, it's that silo thing.
We're talking about world experts, you know, world experts in high blood pressure in adults.
And, you know, they don't know about this other silo.
So, you know, 20 to 25 percent of kids, you know, have got these changes.
So how do we fix that? The silo, I mean, because it is, it's not just U.S.
It's everywhere. This is just how all medical systems work.
No, no, no, no, no, no. Look, I'm in Australia.
You know, it's just how it is.
So what happens, the way we fix it is you have people like myself that are anomalies,
that actually go, well, look, you know, I know E and T backwards.
That's what you'd expect.
But then when I come, you know, what I do different is when I come across this thing, I go, huh,
I want to dig the big deeper on this one.
I'm going to go a little bit of a deep dive.
And then as I do that, I just have this natural curiosity.
I just want to know more.
And it's also the one I want to know more.
I want to know what I'm doing wrong, you know, I, you know, because if there's something here that I'm doing wrong,
I don't have an issue with that, you know, psychologically or ego wise.
I didn't know it was wrong.
Right.
Now that I know, I can do it better, you know, and that's, that's, you know, one of the things is that, you know, success is founded on failure.
You know, you talk about, you know, your famous inventor, Thomas Edison, you know, that invention of the light bulb.
You said, I just found 10,000 ways that it didn't work.
Exactly.
You know, if he tripped over it first time, well, that would have been a fluke, but you know, it was entirely possible.
But, you know, as it turned out, it was like, no, that didn't work.
That didn't work.
You know, just like, just kept going.
So, you know, if we'd said, oh, what a failure, you know, took 10,000 guys to get it right, we go, what a failure.
We don't, we go, wow, invented the light bulb.
Like what he did.
So, you know, you sort of have that, that, that, that, that, you know, you know, you're going to be like,
you know, you've got that, that, you know, point where you don't look at the fad, you look at the success.
And I had the same thing ago.
Well, if only, if only I had known that, you know, I think this is the same thing.
So again, how do we fix this?
Well, we don't fix it overnight.
We fix it in small baby steps.
You know, and like I said, you know, here I am, you know, here.
And again, there's, even if it's only one parent, you know, you have a thousand people that listen to this and it's only one parent.
it won't be, it'll be 20 to 25% appearance.
Right, right.
And they might have more than one kid with this.
And then what happens is there's this cluster effect
because as soon as it's within a family,
it's not unusual that it's like, you know, the mum goes,
oh, that was me when I was a kid.
And, or it's dad is snoring too.
And so it's like, oh, yeah, dad's been getting a bit grumpy
and yeah, he's on antidepressants
and having some anxiety issues.
And they go, oh.
You really start unpacking everything.
And then it's just like, well, it's also my,
you know, I can see this in the cousins.
And this is what happens is that, you know,
I start with this sentinel case, you know,
which is the first one.
And then the mum or whatever, go, oh,
I've noticed that my three year old is starting
to show signs of this as well.
Should I bring them in?
I'm like, absolutely.
And then they're like, oh, well, all their cousins
like had their tonsils and had no idea.
And you go, right, it's in the family.
You've got the genetics.
You've got the environment.
This is confluence of factors that are coming together
and the disease is manifesting.
And then all of a sudden, you know,
I've started with the one case
and then I've got the family and the extended family.
Cause they're all, you know,
we start with the one kid that gets better
and everyone goes, oh my God, this is a different child.
And then everybody is lining up for the,
please fix my child, whatever you did.
Do, do it again.
Do it again.
This one.
Yeah.
So, so that's where this knock on effect, you know,
compounds itself over time.
But it happens slowly, but it's, you know,
it's a trickle effect.
So I don't think about, you know, you know,
how, how do you get a valley?
Well, you get a valley because initially there was a raindrop
that went over a piece of rock.
And then there was a second raindrop
and then there was a trickle.
And then that trickle just slowly over time built up.
And, you know, water created that valley,
just that natural effect of what we call erosion over time,
took a long time to happen.
Sure.
It got there.
So that's what's going to happen here too.
It's not going to be a flood.
It's just going to be a slow,
slow chipping away and erosion of things.
Do you think the parents are going to drive this
with the advocacy?
Is that what's going to drive?
That's what, if you think about who knows about this
more than anybody else, it's ironically the layperson,
you know, in terms of their numbers.
Why?
Because well, there's one of me and this year
I might fix 2000 kids.
Okay.
So if I fix 2000 kids, well, that's 2000 parents.
There's still only one of me, but that's 2000 parents.
That now know it.
Okay.
That now know.
And even if they just, you know, collectively,
if only 10% of those parents tell another parent,
well, that's 200 extra parents as a byproduct of it.
So just that word of mouth thing, you know, and so forth.
So then we start getting a compounding effect
because of those 200, well, say, if she was 10% again,
well, there's another 20.
And out of that 20, there's another two, you know,
and then they say, well, that's where it peed is out.
Well, we still ended up with more than the 2000
that I brushed against.
There's still only one of me.
Okay.
So, you know, we've got in Australia,
we've got say 500 ENT surgeons in total.
Well, if I fix 2000 kids, you know, and 2000 parents,
well, like I said, numerically, there are more parents
that then know about this than ENTs, just numerically,
you know, but you know, you've got other ENTs doing this too.
So, you know, you know, it's more than just my 2000.
It's everyone else's as well.
So, the majority of knowledge actually sits
at a community level.
What we need to do is have them be the advocates.
And they often will be, you know,
they're so astounded and delighted
that they just have this different child
that they have no reservations or hesitations about
just basically putting their nose into other people's business
or for the right reason.
You know, they might be at a mum's group
or they're at a, you know, they've just gone
and done their yoga and Pilates
and they're sitting around having their coffee or whatever
and so forth.
And, you know, one of the mums will say,
oh, sorry, I haven't been here for the past two weeks.
I've just been dealing with Sarah who, you know,
my darling little three year old just went through
this operation and just had her tonsils and adenoids out.
And they'll go, oh, is she getting lots of tonsillitis?
She'll go, no, no, no, no.
No, she was snoring and mouth breathing and stuff.
And she'll go, oh my gosh, you know,
I had no idea that this was a problem
because she wasn't getting tonsillitis
but she was just really waking up tired and so forth.
And, you know, we got her checked out
and then eventually ended up with an ENT
who took, noticed that they were too big and took them out.
And she's just like this different child.
And then one of the other mums will go, oh,
well, that sounds like my child.
Tell me more.
And, you know, what should happen, you know,
and this is the failure of the health system.
And there's many failures.
You know, we talk about, you know,
the Swiss cheese model of healthcare,
which is basically, you know,
where are the holes that people fall through?
Well, they fall through at the starting point.
You know, as soon as a child is born, you know,
we would make a massive healthcare benefit
if we had this basically just a simple booklet, you know,
and you got to make it simple.
You just got to fit on a page.
And anything that's longer than that
is not going to get absorbed.
Not every parent's going to be on board.
But just, you know, simple thing that says,
hey, look, here is a little indicator list, you know,
so that if over the development of your child
over the first few years, you notice these things
and we should put snoring and mouth breathing on that list.
You say, look, if your kid starts to snore,
they start to mouth breathe.
They're waking up tired.
That's the little red light that's turning on
that's go get things checked over.
But it should also be at a health screening level.
So that when these children, for example,
are going through their community health clinics,
it's not just, you know, we're not just checking,
you know, how are they growing and, you know,
what's their vision like, what's their hearing like?
It's like, what's their sleep like?
What's their breathing like?
It's not on the list.
What's their behavior like?
What's their school performance like?
Yeah, it's not on the list, you know,
and then, you know, we have the school health checks,
which, you know, I remember doing as a child,
what did they do?
They checked my vision and they checked my hearing, you know,
they were the two things that they did.
In the main, in the mainstay, if we look at why a child
will have a learning problem,
hearing is very rarely an issue.
An issue. Very rarely.
It's certainly on the list.
Vision, very rarely.
If you look at a group of children in the classroom,
how many of them are wearing glasses
because they can't see properly?
Not most of them, okay?
How many of those children have a breathing
and a sleep problem?
20 to 25% of them.
Right.
How many of those children were asked
as part of their screening process?
And, you know, none of them, you know,
when you fill out a form, you know,
the school wants to know about the background of a child
as part of the admission process, you know,
does your child have any physical issues?
You know, do they have a vision problem?
Do they have a hearing problem?
Do they have diagnosed behavioral problems?
You know, are they going to need education support
because of that?
No one asks, does your child wake up tired in the morning?
Because if you're waking up tired,
you're off to a bad start.
Yeah, you didn't sleep.
You know, something went wrong.
Either sleep quality or sleep quantity
or there's a major health issue underneath it all
is in the background.
But again, there's no little red indicator light
and no guidance.
You know, again, you know, it's on my screening thing.
I say to the parent, do they wake up tired
in the morning, they go, all the time.
You know, as if, again, you know,
and it's usually the mum just by circumstance,
the mum is exhausted with this going on
because they've got this child, you know,
that they need to get up and get moving
and get to school and get on time
because mum, she's got stuff to do too.
You know, she's...
But it's normalized.
They're kids, they're tired.
They don't like to go to school.
They don't want to get up.
This is what teenagers do.
I mean, we normalize.
Exactly, this is the problem.
We've normalized pathology, you know?
And it's just that no recognition.
It's just that, again, things just don't click into place.
It's like, you know, the jigsaw puzzle,
you've got all the pieces.
You just don't know how they fit together.
MUSIC
You're listening to Airway First
with today's guest, Dr. David McIntosh.
You can find out more about the Children's Airway First Foundation
and our mission to ensure that every child has access
to screening, evaluation, and treatment
of all children's airway disorders
before the age of six on our website
at childrensairwayfirst.org.
You can also find a ton of great resources for parents
on our website, including videos, blogs, recommended books,
comprehensive medical research, and more.
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, back to my conversation with Dr. McIntosh
and Dr. David McIntosh.
MUSIC
And then someone like me comes along and I go,
well, that clicks into that and that clicks into that.
And then all of a sudden it's just like,
huh, that's how you solve it.
So, you know, that's it in a nutshell.
So what we need to have with this in the background
is we need to have something that's useful
and constructive for parents.
And I can show off how clever I am
with this enormous amount of knowledge,
but that's useless if it doesn't translate into something
that's packed up into something that's a nice little package.
So what I sort of like in parents to have is a...
Just a little simple toolkit is like, all right, first up,
most of the time you actually don't know
what your child is doing at night
because you don't go look and listen.
Right, after the age of about one, you don't check anymore.
No, no, no, once they've gone down to bed,
they're usually down the other end of the house
because that's how we've constructed things these days.
And so there is a complete element of...
There's a disconnect.
...I'm not going to use to it all.
It's not a criticism, it's a reality.
So step one, you've got to go watch your child.
Every night for a week, random times,
five to 10 minutes, just make a small investment in time.
OK.
Are they snoring, are they mouth-breathing?
Are they stopping breathing at night?
If you got that, that's enough.
That's enough.
You got EMT right there.
Just keep it really simple.
Now, if you want to layer it up, then you go, look,
are they sleeping with their head tipped back?
So that's that position.
That is what we do when we do first aid
in terms of mouth-to-mouth resuscitation type things.
Right, to open the airway.
Unless it's an infant, we tip the head back.
Why do we do that?
Because it opens up the airway.
So if the child is sleeping with their head tipped back,
they're opening up their airway.
They're doing first aid on themselves
to try and breathe properly.
That's clearly not a good thing.
Right.
Are they sweating at night?
You know, they're going through those adrenaline surges.
Because they're having disrupted sleep,
are they tossing and turning a lot?
So when you sort of get there in the morning,
their bed is like a tornado went through.
Right.
Are they sleepwalking, sleep talking?
Are they got night terrors or grinding their teeth at night?
They're all aberrant sleep pathologies
related to not being able to breathe properly at times.
Are they waking up through the night and coming into your room?
They have disrupted sleep.
That's not normal.
OK, coming into the room, that's not normal.
It's been normalized, but it's normal.
OK.
Are they wetting the bed beyond a normal age?
OK, so is it five or six or seven or eight year olds
that they're supposed to stop?
There's a variety there where we draw what we think
is the line in the sand.
But are they still wetting the bed?
OK, so there's these sorts of things
that you can sort of add layers to
if you want to get more sophisticated.
But do they stop?
Just watch them.
Do they mouth breathe?
Are they stopping breathing at night?
Yes, all right, ENT.
The rest of it's window dressing.
We need to keep the ENT can sort the rest out,
but let's start with that.
OK.
So that's your simple parent screen
in terms of their breathing and sleep in a nutshell.
You know, and if they can just walk out the door
with just that simple screen methodology,
we're going to pick up 90 to 95% of these kids
that need seeing and help right there.
All right, but if we're tripping over them
through their daytime problems,
so they're having problems with their education,
their emotional issues, their mental and mental issues,
you know, and it can be just like exercise things.
So for example, they go out onto the soccer pitch
and they're running around with a group of kids
and there's no real reason, but they just can't keep up.
You know, they're struggling.
It's what we call exercise tolerance,
which is basically, you know, we do it like, you know,
for example, with people with heart disease,
we'll put them on a treadmill just to see, you know,
what they're having, you know, cope with.
You know, so that's what we call exercise tolerance.
Well, throw a group of kids onto a sporting field
and get them to running around, play with a ball,
or for, you know, for example,
well, what kids just go, go, go, and what kids looking at them,
you go, gosh, they're not very fit, are they?
Well, they've got cardiovascular problems
and breathing problems with the sleep-assorted breathing.
That might actually be what's going on,
but it's all about the perception of it
that then helps you understand the reality.
So that's that part of it,
but we also got to realize that, you know,
this isn't always about ENT either, okay?
Historically, it was about tonsils and adenoids,
but there's a few other things
that have crept into the conversation too.
One of them is nasal allergies.
So we call that hay fever, okay?
So with hay fever, we get sort of the runny nose
and the sneezing and the itchy eyes,
and, you know, and again, we've normalized it.
Why do we say that?
Because we have this term.
Oh, they've just got a bit of hay fever.
It's just hay fever.
They've just got allergies.
Right.
We've normalized a disease, you know?
We wouldn't go, oh, they've just got cancer.
It's just a bit of cancer, you know?
Sure.
You know, we've normalized a disease.
Hay fever is a disease.
We don't, we shouldn't, you know.
Why did you constantly get allergy,
or deal with allergies,
or have annual sinus infections, or?
Yeah.
So we just normalized it.
Normalized it.
You know?
We've normalized pathology,
but why did a hay fever, nasal allergies
trip into this conversation?
Well, one of the things it does
is it causes swelling within the nasal passages.
And if that swelling is enough,
it can block the ability to breathe through the nose
to the point that you then mouth breathe.
And here we are with mouth breathing again.
Okay?
So, and we look at allergies certainly in my country,
and I think it's probably similar in yours,
and there's not unusual across many other countries too.
In childhood, it's about 15%.
So that's one in seven children.
Forget about tonsils and adenoids now,
but then they never even exist.
One in seven children, nasal allergies, nasal obstruction,
breathing problems, sleep problems, from just allergies.
And what do we know if we look at it
just from an allergy point of view?
They don't do as well at school,
and they're more prone to anxiety.
Here it is again.
We're landing on the same doorstep.
Okay?
But without it necessarily being about tonsils and adenoids.
And guess what?
Some kids can have both,
but it doesn't stop there.
We talked about the adults that have the obesity.
Well, guess what's happening?
Our food is terrible.
Our lifestyle is terrible.
What used to be a disease of thin scrawny kids
is now becoming a disease of the adult pattern
with overweight and obesity too.
And again, what are we doing?
We're normalising it.
You know, we've got to just take a moment in time
where we've got to let political correctness
go to the side and say,
are we dealing with a health problem?
Go back and look at photos from the 1970s.
Try and find, you know, that crowd of people,
try and find the person that's overweight.
They're few and far between.
As a society, we have gone down a wrong, bad pathway.
But we have normalised it.
And we are now feeling like
it's an insensitive thing to do,
to highlight it and bring it to people's attention.
And in the process of doing that, by normalising it,
we basically are allowing illness to be okay.
Something that we could fix.
And unwellness to be okay.
Instead of going, you know what?
This is not how we are supposed to be.
This is not how we're supposed to look.
This is not... We are a product of our environment.
And in our environment, really, at the end of the day now,
is all one that's surrounded by us by privilege.
You know, we're not having to walk the 20 miles to the water well
to carry back those 20 litres of water every day.
Right.
You know, we don't have to do that anymore.
We just turn on a tap. It's there.
You know, that food, well, it's all in your fridge and freezer.
How did you get it?
Well, I got in my car and I drove down to the shop.
There's no physical effort in that.
There's no hunting or gathering.
And then working to the seasons and so forth.
You know, we're just not, you know,
engaging in something that we've done literally for thousands of years.
You know, we've made life easier for ourselves.
You know, majority of our transport is not by our own means.
It's something that has wheels.
You know, so, you know, there's all these things that our bodies are primed for,
but we just don't use them.
And, you know, we've engineered our way into problems here.
And I think we just need to just take a reflective moment and be honest with ourselves.
You know, stop making excuses for things that are not good for ourselves.
You know, and that's confronting, but it's a reality.
Right.
And what we're seeing in children now too is they're getting the adult pattern of disease because of being overweight,
because of being obese.
And then we have this other thing where jaw developments are a problem because, as I said, you know,
not all the adults necessarily are overweight or obese.
In fact, they're sort of the unlucky ones with obstructive sleep apnea because we dismiss them because they don't fit the stereotype.
They, they, they're just not on our radar.
We just walk straight past them.
And they have, you know, skeletal and developmental problems where their jaws haven't grown and developed properly.
So basically the jaws form the framework for them, you know, what's inside the airway.
And if their jaws are underdeveloped, well, their airway is smaller.
Right.
It's smaller.
But how do you get that jaw development as an adult?
Well, because of how it grows a child.
As a child.
Yeah.
You know, so, so 80 to 90% of your jaw development is done and dusted by the age of 12.
So whatever you've got it as an adult was basically the growth pattern up to the age of 12 in the main state.
So when can we find aberrant jaw and development problems?
Well, clearly in kids and who's going to find that predominantly the dentists.
And if we have a tooth focus where we have a look at, you know, are they brushing their teeth?
Are they flossing their teeth?
Have they got any cavities?
And that's all we're worried about.
And in the meantime, these jaws, which is what the teeth are connected to and not developing properly.
And they're, they're, they're just left to time.
Well, then we have that going on.
So instead of this airway, so industry.
Yeah.
Well, if you have underdeveloped jaws, then, you know, you again, you might have a resilience.
You might get away with that.
But if as an adult, you get allergies, well, there's your tipping point, or you may get overweight and obese.
There's your tipping point.
Or for some reason, if you're tonsils or adenoids player, there's your tipping point.
You know, anything that then comes along that, that basically in that, you know, you're, you know, a center of vulnerability.
And you just need something that's just the straw that breaks that camel's back.
And then you trip over into pathology and you've fallen off that cliff and, and, and there's nothing there to catch you anymore.
And we're back to something that could have been caught had we known or had we been looking for it back in childhood.
Absolutely.
And when we talk about obstructive sleep apnea as a society in the mainstay, our paradigm is in adults, you know,
Oh, absolutely.
It's a adult male.
That's what we think of.
Yeah.
We really focus on it's, it's an adult thing.
You know, that's, that's, that's where we dwell on it.
You know, and the fact that it could be happening in kids or it's happening in adults because of what happened in childhood.
What you are having to concede is that through the development of that adults life, the health system screwed up.
And again, we can either acknowledge that and admit a mistake and use that as a learning opportunity.
And an opportunity for growth and development, or we can put our head in the sand and say, Oh, no.
No, no, I've got my university degree from this prestigious place and I've been doing this for 40 years.
I know everything about everything because, you know, and then that's where the ego gets in the way.
So, so like I said, you know, I want to know what I don't know because if I don't know it and I should, you know, when I come to learn it.
I go, I really wish I'd known that 20 years ago.
Well, I'm grateful for the fact that at least I know it now.
Right.
And I, and I, and I utilize it and I implement it.
You know, and, you know, I've made my mistakes as many as anyone else, but I use them as reflective moments of growth rather than just going to ignore that.
I don't know.
Tell about affecting change.
How do we affect change?
Yeah, absolutely.
So, so look, I hope, you know, in terms of just trying to give certain people out there an opportunity to get a broad brushstroke into things and understand that, you know, it's not always about ENT.
Right.
You know, it can be about allergies.
It can be about diet and lifestyle.
It can be about jaw development.
So, you know, if they're going to the dentist and the dentist is going, Oh, their jaws aren't developing properly.
Well, that's got to be a red flag to saying, Well, okay.
So what do we do about it?
You know, you don't just find a problem and go, Oh, and then just walk past it.
You go, Oh, hang on, rewind.
All right.
So, so what are we going to do?
And go, Oh, don't worry.
We'll just let them grow there and look, they'll probably get crowded teeth and don't worry.
We'll just take those extra teeth out and so forth and we can straighten them up because they're all going to get a bit crowded.
That doesn't fix the jaws.
And that's back to that normalization again, right?
The extra teeth.
They're on her extra teeth.
Yeah, 100%.
You know, you know, why, you know, if someone was born with an extra finger and extra toe, we recognize that that's that's aberrant.
We know that that, but we're all effectively born with the same number of teeth.
Why are there extra teeth then?
There aren't extra teeth.
Now, there are sometimes where there are actually, there is actually genuinely are extra teeth, but you know, that's a pathology.
But when we all have the same in the main state number of teeth,
well, why is that extra teeth?
Why is it extra in that child?
The same child has the same number of teeth.
It's the other child.
Why are we calling them extra teeth?
And it's like, well, the teeth are attached to the jaw.
It's the jaw that's the problem, not the teeth.
The teeth are just fighting for the space that they've got.
And if the jaw is a problem for the teeth, it's going to be a problem with the breathing later on in the main state.
Yeah.
And so it's like, hang on, we're on a road to pathology here.
We got to get off this ride.
This ride doesn't end in a happy place.
No.
So that's where we need a multidisciplinary approach to the management too.
I can't fix jaws and teeth.
I get the allergy doctors to help me with the allergies.
I go looking for the allergies.
I can pick that up as an ENT, but I need the allergy doctors to help me then manage it in the long term.
And these children have aberrant breathing patterns. I can clear the obstruction, but then they need rehabilitation and so forth.
And they might have been chewing and swallowing properly either because having big tonsils or being mouth breather,
they have to work different ways to chew and breathe and swallow.
So we need male functional correction.
So this is where the male functional therapy comes into it.
There's this whole thing where basically you need a village of people that come in and go, all right, here's the plan.
So here's the sequence.
First up, you've got ENT problems.
All right, the sequence is ENT always goes first.
You've got ENT problems.
ENT always goes first.
Let's get that out of the way.
That may not be our full fix.
It may not be our permanent fix, but it's our quick fix.
And it's very effective.
And it's just going to pull us out of trouble.
So it's kind of like if someone's drowning, it's like, what do you do first?
Well, look, you want to pull them out of the water, but hey, look, at the moment we can't do that.
Let's throw them a life preserver.
Let's at least stop them from drowning.
So there's that.
They're still in the water.
They're still cold and so forth, but they're not going to drown anymore.
We've got them to a point and it's like, okay, what do we need to do now?
Well, all right, now we need to get these jaws sorted.
Okay.
And we can start some my functional rehab and we can start getting their allergies and calming that down.
And if we start getting all of those things sorted, then eventually we've, you know, got to the point where the helicopters arrived and the rescue team has dropped down and pluck that person out of the water.
And we've got them on board and we've warmed them up and we've saved them from drowning and we've saved them from hypothermia and we've saved them from being eaten by the sharks.
Okay.
But that took a coordinated effort of different things at different times.
It wasn't an immediate fix.
It wasn't just a one thing.
It was all these things that had to happen for that.
And work together and talk to each other.
It's the same with these children.
You know, if there are any problems, tonsils and adenoids, fine.
That's their only fix.
But if their only problem is allergies, fine.
That's their only fix.
But often these children don't have just one thing going on.
Right.
All right.
They've got a multitude of things going on.
And it can be, you know, the parents can be going, oh, you've got to fix all of this.
And you go, yeah, you got to fix all of this because, you know, if you've got a car with four flat tires, do you complain about the fact that you got to fix all four flat tires?
Or do you go and fix all flat type of all four, four flats?
You go, well, right.
All right.
We've got to fix all four flats.
There's no point fixing three of them.
Well, it made things better, but I still got a problem.
Well, this is the same.
You've got to fix all of this.
Right.
You know, and that can be a journey at times, you know, things can take a while.
But the outcomes, the health outcomes.
They're long term problems.
And things that we ultimately will never see because we won't see that disease in the pathology in that person.
That's a good thing.
You know, that's a good thing.
Absolutely.
So that, you know, as best as I can, you know, provide to parents at the end of the day, they're advocates, they're ambassadors.
They're the ones that are going to be standing up for their own kids more than anyone else and saying, no, I know that there is something wrong with my child.
You know, I'm not a health care provider.
I never went and did that university education that you've got and I'm not suggesting for a moment, you know, that, you know, that I necessarily know more than you, but I know my child.
Okay.
I spend more time with my child than I've had with the past five minutes I've been sitting with you in your room.
I'm telling you, there is something wrong with my child.
And I want to go and get it looked at and get it looked at.
And get it fixed.
And then, you know, especially those ones that have had the battle to get there, you know, and the challenges to get there and the frustrations of getting there.
And then they get fixed.
And it's just like different child.
They're like, right, this can't ever happen again.
And obviously that's where you know this foundation is founded upon is the journey, the journey that one child went through.
And that basically then had the parents that said, this can never happen again.
Happen again.
Correct.
I tell you now, it already is.
It happens time and time again.
But it's going to happen one time less every moment that a parent hears this message.
And then that one moment less is going to come one moment and just a little bit less because we got another advocate.
We got another ambassador and then it just spirals upwards.
And eventually in some concept of time, we're going to know that this is a pathology and that parents in the mainstay, the majority of parents actually know it's a pathology.
And also at the same time, the health care providers are going to know it's a pathology because that's where you run into problems too.
It's all well and good for me to know this.
There's a lot of health care providers and that includes ENTs, by the way.
This isn't even on their radar.
It wasn't part of their education and it's not part of their knowledge base.
And look, it may not be part of their focus.
I'm in the ENT, but I don't specialize in ear disease.
You can have major ear disease.
I don't do throat cancer.
You can get throat cancer.
They're both ENT conditions.
Now, I know about the disease to send it to an ES specialist, someone that focuses on the disease or send it to the throat cancer team.
I know that, but I don't deal with it.
But if you don't know that upper airway obstruction is the problem, no tonsillitis means no tonsillectomy, then you're not seeing the right type of ENT.
Just like if you had bowel cancer, well, you wouldn't go and see the breast cancer surgeon.
If you had a shoulder problem, you wouldn't go and see the knee specialist.
They're both orthopedic surgeons.
Just like we're all ENT surgeons.
So again, where circumstances prevailing means that you can go and see, if it's a child, the pediatric ENT.
If it's an airway problem, the airway focused ENT.
You'll get a different perspective and so forth there too.
And that's where it obviously then needs to layer up within the healthcare profession too.
It's all well and good to have these parents that know their child needs fixing.
But if they hit these brick walls of ignorance within the healthcare profession, then we also have a problem there.
So it needs to spiral up in more than one place.
But let's just start with the parents.
They're the ones that know that their child has a problem and it needs fixing.
Advocacy.
Absolutely.
Awesome.
Thank you so much for all this amazing information and putting it in just language that parents can understand
and really getting to the just such detail about what we're dealing with and why it's so critical that we address it now.
Yeah, that's my absolute pleasure.
Thanks again to today's cast, Dr. David McIntosh for sharing his medical insight and each of you for listening to today's episode.
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Take care, stay safe and happy breathing everyone.
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