1 00:00:00,000 --> 00:00:22,280 Hi everybody and welcome back to Airway First, a podcast from the Children's Airway First 2 00:00:22,280 --> 00:00:23,280 Foundation. 3 00:00:23,280 --> 00:00:27,180 I'm your host Rebecca Downing. 4 00:00:27,180 --> 00:00:33,200 In today's episode, we continue our conversation with Dr. David McIntosh, a pediatric ENT 5 00:00:33,200 --> 00:00:38,640 specialist with a particular interest in airway obstruction, facial and dental development, 6 00:00:38,640 --> 00:00:43,160 and its relationship to ENT airway problems and middle ear disease. 7 00:00:43,160 --> 00:00:50,000 Dr. McIntosh has undertaken advanced surgical training in ENT, and head and neck surgery 8 00:00:50,000 --> 00:00:56,280 and pediatric training at Starship Children's Hospital in Auckland, New Zealand. 9 00:00:56,280 --> 00:01:00,400 He has been published in peer-reviewed ENT journals throughout the world and has presented 10 00:01:00,400 --> 00:01:04,960 on ENT topics throughout Australia and overseas. 11 00:01:04,960 --> 00:01:10,280 He is also a fellow of the Royal Australian College of Surgeons. 12 00:01:10,280 --> 00:01:14,880 Throughout his career, Dr. McIntosh has helped memberships with the Australian and New Zealand 13 00:01:14,880 --> 00:01:21,320 Society of Pediatric Order Laryngology, Australian Rhino-Cological Society, and the Australian 14 00:01:21,320 --> 00:01:23,600 Sleep Society. 15 00:01:23,600 --> 00:01:28,320 He is also the author of Snored to Death, Are You Dying in Your Sleep? 16 00:01:28,320 --> 00:01:35,520 You can find out more about Dr. McIntosh at entspecialist.com.au. 17 00:01:35,520 --> 00:01:41,280 To hear part one of my conversation with Dr. McIntosh, check out episode 13 of the Airway 18 00:01:41,280 --> 00:01:43,840 First podcast. 19 00:01:43,840 --> 00:01:50,800 And now, here is the continuation of my conversation with Dr. David McIntosh. 20 00:01:50,800 --> 00:01:56,120 So that's the brain in the nutshell, but what can we do that's objective? 21 00:01:56,120 --> 00:01:59,160 Well, again, we have the research. 22 00:01:59,160 --> 00:02:05,640 People have gone and taken a cohort of children and put them through brain scanning protocols. 23 00:02:05,640 --> 00:02:11,920 It's not something we do on a clinical level, it's research-based, but what did they find? 24 00:02:11,920 --> 00:02:18,600 Well, the parts of the brain that deal with concentration and behaviour are not working 25 00:02:18,600 --> 00:02:19,640 properly. 26 00:02:19,640 --> 00:02:24,360 The parts of the brain that deal with memory, so there's a part of the brain, particularly 27 00:02:24,360 --> 00:02:27,680 called the hippocampus, is our sort of memory centre. 28 00:02:27,680 --> 00:02:29,320 It's smaller. 29 00:02:29,320 --> 00:02:35,440 The parts of the brain, what's called the frontal lobe that deals with behaviour, emotional 30 00:02:35,440 --> 00:02:37,400 regulation and so forth. 31 00:02:37,400 --> 00:02:38,980 It's not working properly. 32 00:02:38,980 --> 00:02:45,320 The parts of the brain that deal with learning and maths, for example, it's not working properly. 33 00:02:45,320 --> 00:02:50,080 The parts of the brain that deal with processing visual and auditory information, so what we 34 00:02:50,080 --> 00:02:54,920 see and what we hear is not working properly. 35 00:02:54,920 --> 00:03:03,280 We can physically get a window of perspective by looking at brains through imaging of these 36 00:03:03,280 --> 00:03:08,560 children that are not sleeping properly, and those brains are not normal. 37 00:03:08,560 --> 00:03:11,240 This is brain damage. 38 00:03:11,240 --> 00:03:13,560 But is it correctable? 39 00:03:13,560 --> 00:03:20,160 Yeah, this is the beautiful thing about brains at an early age is that these brains have 40 00:03:20,160 --> 00:03:21,480 what we call plasticity. 41 00:03:21,480 --> 00:03:24,920 So the proper term is neuroplasticity. 42 00:03:24,920 --> 00:03:28,880 The brain just keeps sort of changing and developing, but we've got to realise that 43 00:03:28,880 --> 00:03:33,400 we're asking the brain to change and develop and work around a problem. 44 00:03:33,400 --> 00:03:37,560 And the brain will do its best, but again, there's a limit to where it's at. 45 00:03:37,560 --> 00:03:44,640 And if you had a choice between relying on the brain trying to solve this or just relieve 46 00:03:44,640 --> 00:03:48,600 the problem that it's trying to solve, well, getting rid of the problem is actually a more 47 00:03:48,600 --> 00:03:55,480 beneficial outcome than relying on the brain being its own solution. 48 00:03:55,480 --> 00:04:07,080 So again, that advantage of things, but we're using that advantage in the wrong circumstances. 49 00:04:07,080 --> 00:04:12,360 So yeah, so there's a very good reason that we don't let a six year old drink alcohol. 50 00:04:12,360 --> 00:04:19,640 Okay, at the end of the day, as much as we've socially accepted it, alcohol is a brain poison. 51 00:04:19,640 --> 00:04:22,200 We know it's a brain poison. 52 00:04:22,200 --> 00:04:28,280 We sort of might decide not to acknowledge that to sort of justify our social norms, 53 00:04:28,280 --> 00:04:31,920 but at the end of the day, at a medical level, alcohol is a brain poison. 54 00:04:31,920 --> 00:04:35,640 There is a reason that we do not let six year olds drink alcohol. 55 00:04:35,640 --> 00:04:39,560 There's even a reason we don't let 14 year olds drink alcohol. 56 00:04:39,560 --> 00:04:43,480 And you can make the argument that we probably shouldn't let anyone under the age of 25 drink 57 00:04:43,480 --> 00:04:52,440 alcohol if we look at it from a pure science point of view in terms of brain development. 58 00:04:52,440 --> 00:04:57,560 The brain development continues throughout life, but in terms of that crucial brain development, 59 00:04:57,560 --> 00:05:04,720 it's sort of massive, massive, massive, massive early on, and then petering out and plateauing 60 00:05:04,720 --> 00:05:08,160 usually from the age of about 23 to 25 onwards. 61 00:05:08,160 --> 00:05:18,240 So any environmental insult that comes along that can affect the brain can leave its mark. 62 00:05:18,240 --> 00:05:21,920 And then we see it manifest and it shows itself more and more down the road. 63 00:05:21,920 --> 00:05:26,240 Now we have adults with all of these conditions that we could have. 64 00:05:26,240 --> 00:05:27,040 Absolutely. 65 00:05:27,040 --> 00:05:27,600 Yeah. 66 00:05:27,600 --> 00:05:31,200 So is it ever too late to stop and help an adult? 67 00:05:31,200 --> 00:05:32,400 It's never too late. 68 00:05:32,400 --> 00:05:33,200 This is the thing. 69 00:05:33,200 --> 00:05:36,880 It's never too early and it's never too late. 70 00:05:36,880 --> 00:05:39,680 And the best time to fix a problem is when you find it. 71 00:05:39,680 --> 00:05:40,720 Like when you find it. 72 00:05:40,720 --> 00:05:42,320 Like any health condition. 73 00:05:42,320 --> 00:05:44,800 You know, when should we fix this? 74 00:05:45,840 --> 00:05:46,160 Now. 75 00:05:46,800 --> 00:05:47,200 Right. 76 00:05:47,200 --> 00:05:48,480 Oh, but aren't they too young? 77 00:05:48,480 --> 00:05:51,040 They go, they're too young to have this problem. 78 00:05:51,760 --> 00:05:53,200 They're not too young to get it fixed. 79 00:05:55,120 --> 00:05:57,520 So and then we come into the cardiovascular thing. 80 00:05:57,520 --> 00:05:59,760 So the cardiovascular we have the heart and the blood vessels. 81 00:05:59,760 --> 00:06:06,720 So if we think about, you know, what are the sort of leading sort of causes of disease and death in adults? 82 00:06:06,720 --> 00:06:11,040 Well, one of them is heart disease and that ties in with high blood pressure. 83 00:06:11,040 --> 00:06:12,160 Well, guess what? 84 00:06:13,040 --> 00:06:14,480 This is what happens in children. 85 00:06:14,480 --> 00:06:19,040 You know, because we have a problem with the breathing, we have a problem with the oxygen supply. 86 00:06:19,040 --> 00:06:25,840 The part of the response is that the brain and so forth is going, hey, I'm not liking this environment. 87 00:06:26,480 --> 00:06:27,920 Heart pump harder. 88 00:06:27,920 --> 00:06:28,800 Give me more blood. 89 00:06:28,800 --> 00:06:30,000 Give me more oxygen. 90 00:06:30,000 --> 00:06:30,800 Give me more blood. 91 00:06:30,800 --> 00:06:33,440 Heart goes, all right, I'm going to pump a bit harder. 92 00:06:33,440 --> 00:06:34,720 Going to pump a bit faster. 93 00:06:34,720 --> 00:06:36,720 It's going to work just that little bit harder. 94 00:06:37,760 --> 00:06:46,720 But what it encounters along the way is these changes also within the blood vessels that leads in children to high blood pressure. 95 00:06:46,720 --> 00:06:51,040 So one of the, we'll talk about high blood pressure in adults. 96 00:06:51,040 --> 00:06:54,080 We talk about what's called primary and secondary. 97 00:06:54,080 --> 00:06:56,240 Secondary means it's due to something. 98 00:06:56,240 --> 00:07:02,320 We can go, oh, they've got a problem with their kidneys, which affects their salt regulation, 99 00:07:02,320 --> 00:07:08,320 which means that it puts up the amount of the volume of fluid that's in their blood vessels, 100 00:07:08,320 --> 00:07:10,480 which as a result of that puts up their blood pressure. 101 00:07:10,480 --> 00:07:13,360 So that's what we call secondary hypertension. 102 00:07:13,360 --> 00:07:15,120 Hypertension means high blood pressure. 103 00:07:15,120 --> 00:07:18,000 But in the majority, it's what we call primary. 104 00:07:18,000 --> 00:07:19,760 We go, look, it just happened. 105 00:07:19,760 --> 00:07:24,320 And if you think about that as a starting point, you just go, oh, it just happened. 106 00:07:24,320 --> 00:07:29,360 Well, that's a kind of weird thing to do in the first place. 107 00:07:29,360 --> 00:07:40,960 And if we then drill it back and we go, why did we have an adult that took some pathway of aberrant outcome 108 00:07:40,960 --> 00:07:45,600 that led to high blood pressure, sleep disorder, breathing? 109 00:07:45,600 --> 00:07:55,600 So in children, the vascular changes that happen that we see changes in the tone of the little muscle. 110 00:07:55,600 --> 00:07:58,400 So within their blood vessels, there's tone. 111 00:07:58,400 --> 00:08:02,560 So because we have to divert blood to different parts of the body at different times. 112 00:08:02,560 --> 00:08:06,880 So for example, where I'm here at the moment, this is a conversation. 113 00:08:06,880 --> 00:08:08,320 This is an intellectual thing. 114 00:08:08,320 --> 00:08:11,920 So this is part of which part of my body is doing the work, my brain. 115 00:08:11,920 --> 00:08:12,560 So that's right. 116 00:08:12,560 --> 00:08:13,040 All right. 117 00:08:13,040 --> 00:08:14,480 More blood needs to go to the brain. 118 00:08:14,480 --> 00:08:16,080 It's morning time here. 119 00:08:16,080 --> 00:08:17,200 I haven't eaten. 120 00:08:17,200 --> 00:08:18,960 So blood flow to the gut. 121 00:08:18,960 --> 00:08:20,000 There's nothing there. 122 00:08:20,000 --> 00:08:21,760 Don't need to worry about that. 123 00:08:21,760 --> 00:08:23,440 I haven't moved yet. 124 00:08:23,440 --> 00:08:27,120 I haven't gone and done any sort of physical activity. 125 00:08:27,120 --> 00:08:29,760 So muscles doesn't need anything there. 126 00:08:29,760 --> 00:08:32,000 Needs the baseline, but doesn't need any extra. 127 00:08:32,000 --> 00:08:38,800 But then if I then go and have something to eat, and people realize this, for example, when you have lunch, 128 00:08:38,800 --> 00:08:42,080 you always just tend to feel that just that little bit flaky after lunch. 129 00:08:42,080 --> 00:08:43,040 Just that little bit. 130 00:08:43,040 --> 00:08:44,640 Right. 131 00:08:44,640 --> 00:08:47,040 I just feel a little bit tired. 132 00:08:47,040 --> 00:08:51,040 That's because the blood's going to your gut more than your brain. 133 00:08:51,040 --> 00:08:51,760 Why? 134 00:08:51,760 --> 00:08:57,040 Because you've got a whole load of food there that has to go through a whole digestive process. 135 00:08:57,040 --> 00:09:02,080 And then it needs to be pulled out the gut and taken through your other body systems to be processed. 136 00:09:02,080 --> 00:09:04,480 So it's just an automatic thing. 137 00:09:04,480 --> 00:09:09,600 So the blood vessels have little muscles that basically can open and close to regulate the blood flow. 138 00:09:09,600 --> 00:09:11,200 And they have a background tone. 139 00:09:11,200 --> 00:09:16,160 But in this sleep-assorted breathing thing, because we have this stress response, 140 00:09:16,160 --> 00:09:24,160 and part of this stress response involves basically just to keep it simple little adrenaline surges, 141 00:09:24,160 --> 00:09:28,160 that adrenaline causes the blood vessels to constrict. 142 00:09:28,160 --> 00:09:36,160 And it changes the tone such that there's a background tone that over time is elevated. 143 00:09:36,160 --> 00:09:40,160 So that therefore then squashes the blood vessels, which squashes the blood. 144 00:09:40,160 --> 00:09:43,120 And when you squash the fluid, the pressure goes up. 145 00:09:43,120 --> 00:09:45,120 So that's in simple terms. 146 00:09:45,120 --> 00:09:49,120 So we have children with high blood pressure and so forth. 147 00:09:49,120 --> 00:09:51,120 So that's that side of things. 148 00:09:51,120 --> 00:09:59,120 So we have this both cardiac and vascular changes, which again, that remarkably subtle but cumulative over time. 149 00:09:59,120 --> 00:10:06,160 So we have this thing where, you know, I listen to a lot of sort of, you know, health and podcasts type things, 150 00:10:06,160 --> 00:10:12,160 really trying to find pockets where I can try and put my hand up and say, hey, look, 151 00:10:12,160 --> 00:10:14,160 everybody is talking about adults. 152 00:10:14,160 --> 00:10:20,160 You know, they're talking about, you know, oh, you know, what are the background things, you know, 153 00:10:20,160 --> 00:10:22,160 adults get these diseases and I'm listening to going. 154 00:10:22,160 --> 00:10:24,160 But it started back here. 155 00:10:24,160 --> 00:10:26,160 Have you looked at it? 156 00:10:26,160 --> 00:10:28,160 It started in childhood. 157 00:10:28,160 --> 00:10:30,160 Again, it's that silo thing. 158 00:10:30,160 --> 00:10:34,160 We're talking about world experts, you know, world experts in high blood pressure in adults. 159 00:10:34,160 --> 00:10:40,160 And, you know, they don't know about this other silo. 160 00:10:40,160 --> 00:10:46,160 So, you know, 20 to 25 percent of kids, you know, have got these changes. 161 00:10:46,160 --> 00:10:50,160 So how do we fix that? The silo, I mean, because it is, it's not just U.S. 162 00:10:50,160 --> 00:10:54,160 It's everywhere. This is just how all medical systems work. 163 00:10:54,160 --> 00:10:56,160 No, no, no, no, no, no. Look, I'm in Australia. 164 00:10:56,160 --> 00:10:58,160 You know, it's just how it is. 165 00:10:58,160 --> 00:11:02,160 So what happens, the way we fix it is you have people like myself that are anomalies, 166 00:11:02,160 --> 00:11:06,160 that actually go, well, look, you know, I know E and T backwards. 167 00:11:06,160 --> 00:11:08,160 That's what you'd expect. 168 00:11:08,160 --> 00:11:12,160 But then when I come, you know, what I do different is when I come across this thing, I go, huh, 169 00:11:12,160 --> 00:11:14,160 I want to dig the big deeper on this one. 170 00:11:14,160 --> 00:11:16,160 I'm going to go a little bit of a deep dive. 171 00:11:16,160 --> 00:11:20,160 And then as I do that, I just have this natural curiosity. 172 00:11:20,160 --> 00:11:22,160 I just want to know more. 173 00:11:22,160 --> 00:11:24,160 And it's also the one I want to know more. 174 00:11:24,160 --> 00:11:30,160 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, 175 00:11:30,160 --> 00:11:36,160 I don't have an issue with that, you know, psychologically or ego wise. 176 00:11:36,160 --> 00:11:38,160 I didn't know it was wrong. 177 00:11:38,160 --> 00:11:40,160 Right. 178 00:11:40,160 --> 00:11:46,160 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. 179 00:11:46,160 --> 00:11:52,160 You know, you talk about, you know, your famous inventor, Thomas Edison, you know, that invention of the light bulb. 180 00:11:52,160 --> 00:11:56,160 You said, I just found 10,000 ways that it didn't work. 181 00:11:56,160 --> 00:11:58,160 Exactly. 182 00:11:58,160 --> 00:12:04,160 You know, if he tripped over it first time, well, that would have been a fluke, but you know, it was entirely possible. 183 00:12:04,160 --> 00:12:08,160 But, you know, as it turned out, it was like, no, that didn't work. 184 00:12:08,160 --> 00:12:10,160 That didn't work. 185 00:12:10,160 --> 00:12:12,160 You know, just like, just kept going. 186 00:12:12,160 --> 00:12:18,160 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. 187 00:12:18,160 --> 00:12:22,160 We don't, we go, wow, invented the light bulb. 188 00:12:22,160 --> 00:12:24,160 Like what he did. 189 00:12:24,160 --> 00:12:27,160 So, you know, you sort of have that, that, that, that, that, you know, you know, you're going to be like, 190 00:12:27,160 --> 00:12:30,160 you know, you've got that, that, you know, point where you don't look at the fad, you look at the success. 191 00:12:30,160 --> 00:12:32,160 And I had the same thing ago. 192 00:12:32,160 --> 00:12:36,160 Well, if only, if only I had known that, you know, I think this is the same thing. 193 00:12:36,160 --> 00:12:38,160 So again, how do we fix this? 194 00:12:38,160 --> 00:12:41,160 Well, we don't fix it overnight. 195 00:12:41,160 --> 00:12:43,160 We fix it in small baby steps. 196 00:12:43,160 --> 00:12:46,160 You know, and like I said, you know, here I am, you know, here. 197 00:12:46,160 --> 00:12:54,160 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. 198 00:12:54,160 --> 00:12:57,840 it won't be, it'll be 20 to 25% appearance. 199 00:12:57,840 --> 00:12:59,160 Right, right. 200 00:12:59,160 --> 00:13:01,920 And they might have more than one kid with this. 201 00:13:01,920 --> 00:13:04,900 And then what happens is there's this cluster effect 202 00:13:04,900 --> 00:13:07,960 because as soon as it's within a family, 203 00:13:07,960 --> 00:13:11,720 it's not unusual that it's like, you know, the mum goes, 204 00:13:11,720 --> 00:13:14,000 oh, that was me when I was a kid. 205 00:13:14,000 --> 00:13:17,480 And, or it's dad is snoring too. 206 00:13:17,480 --> 00:13:20,400 And so it's like, oh, yeah, dad's been getting a bit grumpy 207 00:13:20,400 --> 00:13:21,880 and yeah, he's on antidepressants 208 00:13:21,880 --> 00:13:24,120 and having some anxiety issues. 209 00:13:24,120 --> 00:13:24,960 And they go, oh. 210 00:13:24,960 --> 00:13:26,160 You really start unpacking everything. 211 00:13:26,160 --> 00:13:29,360 And then it's just like, well, it's also my, 212 00:13:29,360 --> 00:13:32,560 you know, I can see this in the cousins. 213 00:13:32,560 --> 00:13:34,600 And this is what happens is that, you know, 214 00:13:34,600 --> 00:13:37,800 I start with this sentinel case, you know, 215 00:13:37,800 --> 00:13:39,320 which is the first one. 216 00:13:39,320 --> 00:13:42,720 And then the mum or whatever, go, oh, 217 00:13:42,720 --> 00:13:44,700 I've noticed that my three year old is starting 218 00:13:44,700 --> 00:13:46,780 to show signs of this as well. 219 00:13:46,780 --> 00:13:47,800 Should I bring them in? 220 00:13:47,800 --> 00:13:50,440 I'm like, absolutely. 221 00:13:50,440 --> 00:13:54,280 And then they're like, oh, well, all their cousins 222 00:13:54,280 --> 00:13:56,120 like had their tonsils and had no idea. 223 00:13:56,120 --> 00:13:58,680 And you go, right, it's in the family. 224 00:13:58,680 --> 00:14:00,400 You've got the genetics. 225 00:14:00,400 --> 00:14:01,640 You've got the environment. 226 00:14:01,640 --> 00:14:05,560 This is confluence of factors that are coming together 227 00:14:05,560 --> 00:14:07,200 and the disease is manifesting. 228 00:14:08,120 --> 00:14:10,920 And then all of a sudden, you know, 229 00:14:10,920 --> 00:14:12,360 I've started with the one case 230 00:14:12,360 --> 00:14:15,480 and then I've got the family and the extended family. 231 00:14:15,480 --> 00:14:16,320 Cause they're all, you know, 232 00:14:16,320 --> 00:14:18,160 we start with the one kid that gets better 233 00:14:18,160 --> 00:14:21,160 and everyone goes, oh my God, this is a different child. 234 00:14:21,160 --> 00:14:22,960 And then everybody is lining up for the, 235 00:14:22,960 --> 00:14:25,480 please fix my child, whatever you did. 236 00:14:25,480 --> 00:14:26,320 Do, do it again. 237 00:14:26,320 --> 00:14:27,160 Do it again. 238 00:14:27,160 --> 00:14:28,000 This one. 239 00:14:28,000 --> 00:14:28,840 Yeah. 240 00:14:28,840 --> 00:14:31,040 So, so that's where this knock on effect, you know, 241 00:14:31,040 --> 00:14:33,520 compounds itself over time. 242 00:14:33,520 --> 00:14:35,080 But it happens slowly, but it's, you know, 243 00:14:35,080 --> 00:14:36,440 it's a trickle effect. 244 00:14:36,440 --> 00:14:37,920 So I don't think about, you know, you know, 245 00:14:37,920 --> 00:14:39,720 how, how do you get a valley? 246 00:14:39,720 --> 00:14:42,480 Well, you get a valley because initially there was a raindrop 247 00:14:42,480 --> 00:14:44,600 that went over a piece of rock. 248 00:14:44,600 --> 00:14:46,040 And then there was a second raindrop 249 00:14:46,040 --> 00:14:47,520 and then there was a trickle. 250 00:14:47,520 --> 00:14:50,160 And then that trickle just slowly over time built up. 251 00:14:50,160 --> 00:14:53,440 And, you know, water created that valley, 252 00:14:53,440 --> 00:14:58,440 just that natural effect of what we call erosion over time, 253 00:14:58,600 --> 00:15:00,440 took a long time to happen. 254 00:15:00,440 --> 00:15:01,280 Sure. 255 00:15:01,280 --> 00:15:02,120 It got there. 256 00:15:02,120 --> 00:15:05,000 So that's what's going to happen here too. 257 00:15:05,000 --> 00:15:06,480 It's not going to be a flood. 258 00:15:06,480 --> 00:15:08,320 It's just going to be a slow, 259 00:15:08,320 --> 00:15:11,320 slow chipping away and erosion of things. 260 00:15:11,320 --> 00:15:13,560 Do you think the parents are going to drive this 261 00:15:13,560 --> 00:15:14,560 with the advocacy? 262 00:15:14,560 --> 00:15:16,000 Is that what's going to drive? 263 00:15:16,000 --> 00:15:20,000 That's what, if you think about who knows about this 264 00:15:20,000 --> 00:15:23,400 more than anybody else, it's ironically the layperson, 265 00:15:23,400 --> 00:15:25,400 you know, in terms of their numbers. 266 00:15:25,400 --> 00:15:26,240 Why? 267 00:15:26,240 --> 00:15:28,880 Because well, there's one of me and this year 268 00:15:28,880 --> 00:15:32,080 I might fix 2000 kids. 269 00:15:32,080 --> 00:15:32,920 Okay. 270 00:15:32,920 --> 00:15:35,600 So if I fix 2000 kids, well, that's 2000 parents. 271 00:15:35,600 --> 00:15:38,360 There's still only one of me, but that's 2000 parents. 272 00:15:38,360 --> 00:15:39,200 That now know it. 273 00:15:39,200 --> 00:15:40,040 Okay. 274 00:15:40,040 --> 00:15:40,880 That now know. 275 00:15:40,880 --> 00:15:43,240 And even if they just, you know, collectively, 276 00:15:43,240 --> 00:15:46,800 if only 10% of those parents tell another parent, 277 00:15:46,800 --> 00:15:51,800 well, that's 200 extra parents as a byproduct of it. 278 00:15:52,800 --> 00:15:56,880 So just that word of mouth thing, you know, and so forth. 279 00:15:56,880 --> 00:15:59,400 So then we start getting a compounding effect 280 00:15:59,400 --> 00:16:02,200 because of those 200, well, say, if she was 10% again, 281 00:16:02,200 --> 00:16:03,520 well, there's another 20. 282 00:16:03,520 --> 00:16:05,640 And out of that 20, there's another two, you know, 283 00:16:05,640 --> 00:16:07,600 and then they say, well, that's where it peed is out. 284 00:16:07,600 --> 00:16:11,320 Well, we still ended up with more than the 2000 285 00:16:11,320 --> 00:16:12,640 that I brushed against. 286 00:16:12,640 --> 00:16:14,520 There's still only one of me. 287 00:16:14,520 --> 00:16:15,520 Okay. 288 00:16:15,520 --> 00:16:18,120 So, you know, we've got in Australia, 289 00:16:18,120 --> 00:16:21,000 we've got say 500 ENT surgeons in total. 290 00:16:21,000 --> 00:16:25,440 Well, if I fix 2000 kids, you know, and 2000 parents, 291 00:16:25,440 --> 00:16:29,520 well, like I said, numerically, there are more parents 292 00:16:29,520 --> 00:16:33,520 that then know about this than ENTs, just numerically, 293 00:16:33,520 --> 00:16:36,200 you know, but you know, you've got other ENTs doing this too. 294 00:16:36,200 --> 00:16:38,600 So, you know, you know, it's more than just my 2000. 295 00:16:38,600 --> 00:16:40,880 It's everyone else's as well. 296 00:16:40,880 --> 00:16:44,880 So, the majority of knowledge actually sits 297 00:16:44,880 --> 00:16:46,120 at a community level. 298 00:16:47,000 --> 00:16:51,280 What we need to do is have them be the advocates. 299 00:16:51,280 --> 00:16:53,080 And they often will be, you know, 300 00:16:53,080 --> 00:16:58,080 they're so astounded and delighted 301 00:16:58,120 --> 00:17:00,440 that they just have this different child 302 00:17:00,440 --> 00:17:04,560 that they have no reservations or hesitations about 303 00:17:04,560 --> 00:17:08,200 just basically putting their nose into other people's business 304 00:17:08,200 --> 00:17:09,760 or for the right reason. 305 00:17:09,760 --> 00:17:11,280 You know, they might be at a mum's group 306 00:17:11,280 --> 00:17:13,000 or they're at a, you know, they've just gone 307 00:17:13,000 --> 00:17:14,320 and done their yoga and Pilates 308 00:17:14,320 --> 00:17:18,400 and they're sitting around having their coffee or whatever 309 00:17:18,400 --> 00:17:19,520 and so forth. 310 00:17:19,520 --> 00:17:21,280 And, you know, one of the mums will say, 311 00:17:21,280 --> 00:17:23,880 oh, sorry, I haven't been here for the past two weeks. 312 00:17:23,880 --> 00:17:26,360 I've just been dealing with Sarah who, you know, 313 00:17:26,360 --> 00:17:28,560 my darling little three year old just went through 314 00:17:28,560 --> 00:17:32,040 this operation and just had her tonsils and adenoids out. 315 00:17:32,040 --> 00:17:34,360 And they'll go, oh, is she getting lots of tonsillitis? 316 00:17:34,360 --> 00:17:35,920 She'll go, no, no, no, no. 317 00:17:35,920 --> 00:17:38,880 No, she was snoring and mouth breathing and stuff. 318 00:17:38,880 --> 00:17:40,720 And she'll go, oh my gosh, you know, 319 00:17:40,720 --> 00:17:42,520 I had no idea that this was a problem 320 00:17:42,520 --> 00:17:44,440 because she wasn't getting tonsillitis 321 00:17:44,440 --> 00:17:49,440 but she was just really waking up tired and so forth. 322 00:17:49,480 --> 00:17:51,320 And, you know, we got her checked out 323 00:17:51,320 --> 00:17:53,400 and then eventually ended up with an ENT 324 00:17:53,400 --> 00:17:57,040 who took, noticed that they were too big and took them out. 325 00:17:57,040 --> 00:17:58,520 And she's just like this different child. 326 00:17:58,520 --> 00:18:01,920 And then one of the other mums will go, oh, 327 00:18:01,920 --> 00:18:03,640 well, that sounds like my child. 328 00:18:05,400 --> 00:18:06,640 Tell me more. 329 00:18:06,640 --> 00:18:10,040 And, you know, what should happen, you know, 330 00:18:10,040 --> 00:18:12,560 and this is the failure of the health system. 331 00:18:12,560 --> 00:18:14,560 And there's many failures. 332 00:18:14,560 --> 00:18:16,080 You know, we talk about, you know, 333 00:18:16,080 --> 00:18:18,160 the Swiss cheese model of healthcare, 334 00:18:18,160 --> 00:18:19,680 which is basically, you know, 335 00:18:19,680 --> 00:18:22,400 where are the holes that people fall through? 336 00:18:22,400 --> 00:18:25,240 Well, they fall through at the starting point. 337 00:18:25,240 --> 00:18:28,200 You know, as soon as a child is born, you know, 338 00:18:28,200 --> 00:18:31,320 we would make a massive healthcare benefit 339 00:18:31,320 --> 00:18:34,760 if we had this basically just a simple booklet, you know, 340 00:18:34,760 --> 00:18:35,840 and you got to make it simple. 341 00:18:35,840 --> 00:18:37,360 You just got to fit on a page. 342 00:18:37,360 --> 00:18:38,960 And anything that's longer than that 343 00:18:38,960 --> 00:18:40,640 is not going to get absorbed. 344 00:18:40,640 --> 00:18:42,800 Not every parent's going to be on board. 345 00:18:42,800 --> 00:18:44,560 But just, you know, simple thing that says, 346 00:18:44,560 --> 00:18:48,320 hey, look, here is a little indicator list, you know, 347 00:18:48,320 --> 00:18:50,360 so that if over the development of your child 348 00:18:50,360 --> 00:18:53,480 over the first few years, you notice these things 349 00:18:53,480 --> 00:18:56,120 and we should put snoring and mouth breathing on that list. 350 00:18:56,120 --> 00:18:58,360 You say, look, if your kid starts to snore, 351 00:18:58,360 --> 00:18:59,760 they start to mouth breathe. 352 00:18:59,760 --> 00:19:01,400 They're waking up tired. 353 00:19:01,400 --> 00:19:04,720 That's the little red light that's turning on 354 00:19:04,720 --> 00:19:06,880 that's go get things checked over. 355 00:19:08,240 --> 00:19:11,160 But it should also be at a health screening level. 356 00:19:11,160 --> 00:19:13,520 So that when these children, for example, 357 00:19:13,520 --> 00:19:16,360 are going through their community health clinics, 358 00:19:16,360 --> 00:19:18,920 it's not just, you know, we're not just checking, 359 00:19:18,920 --> 00:19:21,800 you know, how are they growing and, you know, 360 00:19:21,800 --> 00:19:24,000 what's their vision like, what's their hearing like? 361 00:19:24,000 --> 00:19:26,760 It's like, what's their sleep like? 362 00:19:26,760 --> 00:19:28,720 What's their breathing like? 363 00:19:28,720 --> 00:19:29,760 It's not on the list. 364 00:19:29,760 --> 00:19:30,960 What's their behavior like? 365 00:19:30,960 --> 00:19:33,280 What's their school performance like? 366 00:19:33,280 --> 00:19:36,000 Yeah, it's not on the list, you know, 367 00:19:36,000 --> 00:19:38,160 and then, you know, we have the school health checks, 368 00:19:38,160 --> 00:19:40,280 which, you know, I remember doing as a child, 369 00:19:40,280 --> 00:19:41,480 what did they do? 370 00:19:41,480 --> 00:19:44,960 They checked my vision and they checked my hearing, you know, 371 00:19:44,960 --> 00:19:46,880 they were the two things that they did. 372 00:19:47,880 --> 00:19:50,680 In the main, in the mainstay, if we look at why a child 373 00:19:50,680 --> 00:19:52,600 will have a learning problem, 374 00:19:52,600 --> 00:19:56,040 hearing is very rarely an issue. 375 00:19:56,040 --> 00:19:58,080 An issue. Very rarely. 376 00:19:58,080 --> 00:19:59,880 It's certainly on the list. 377 00:19:59,880 --> 00:20:01,560 Vision, very rarely. 378 00:20:01,560 --> 00:20:03,880 If you look at a group of children in the classroom, 379 00:20:03,880 --> 00:20:05,160 how many of them are wearing glasses 380 00:20:05,160 --> 00:20:06,640 because they can't see properly? 381 00:20:06,640 --> 00:20:08,960 Not most of them, okay? 382 00:20:08,960 --> 00:20:10,400 How many of those children have a breathing 383 00:20:10,400 --> 00:20:11,600 and a sleep problem? 384 00:20:11,600 --> 00:20:13,600 20 to 25% of them. 385 00:20:13,600 --> 00:20:14,440 Right. 386 00:20:14,440 --> 00:20:17,200 How many of those children were asked 387 00:20:17,200 --> 00:20:19,320 as part of their screening process? 388 00:20:19,320 --> 00:20:21,240 And, you know, none of them, you know, 389 00:20:21,240 --> 00:20:23,200 when you fill out a form, you know, 390 00:20:23,200 --> 00:20:25,600 the school wants to know about the background of a child 391 00:20:25,600 --> 00:20:27,640 as part of the admission process, you know, 392 00:20:27,640 --> 00:20:30,520 does your child have any physical issues? 393 00:20:30,520 --> 00:20:31,920 You know, do they have a vision problem? 394 00:20:31,920 --> 00:20:33,600 Do they have a hearing problem? 395 00:20:33,600 --> 00:20:35,960 Do they have diagnosed behavioral problems? 396 00:20:35,960 --> 00:20:38,000 You know, are they going to need education support 397 00:20:38,000 --> 00:20:38,840 because of that? 398 00:20:40,680 --> 00:20:43,480 No one asks, does your child wake up tired in the morning? 399 00:20:43,480 --> 00:20:45,480 Because if you're waking up tired, 400 00:20:45,480 --> 00:20:47,000 you're off to a bad start. 401 00:20:47,000 --> 00:20:47,920 Yeah, you didn't sleep. 402 00:20:47,920 --> 00:20:49,480 You know, something went wrong. 403 00:20:49,480 --> 00:20:52,480 Either sleep quality or sleep quantity 404 00:20:52,480 --> 00:20:55,200 or there's a major health issue underneath it all 405 00:20:56,360 --> 00:20:57,920 is in the background. 406 00:20:57,920 --> 00:21:01,440 But again, there's no little red indicator light 407 00:21:01,440 --> 00:21:02,840 and no guidance. 408 00:21:02,840 --> 00:21:06,080 You know, again, you know, it's on my screening thing. 409 00:21:06,080 --> 00:21:09,080 I say to the parent, do they wake up tired 410 00:21:09,080 --> 00:21:12,520 in the morning, they go, all the time. 411 00:21:12,520 --> 00:21:15,400 You know, as if, again, you know, 412 00:21:15,400 --> 00:21:19,240 and it's usually the mum just by circumstance, 413 00:21:19,240 --> 00:21:22,440 the mum is exhausted with this going on 414 00:21:22,440 --> 00:21:24,800 because they've got this child, you know, 415 00:21:24,800 --> 00:21:26,480 that they need to get up and get moving 416 00:21:26,480 --> 00:21:28,120 and get to school and get on time 417 00:21:28,120 --> 00:21:31,000 because mum, she's got stuff to do too. 418 00:21:31,000 --> 00:21:31,840 You know, she's... 419 00:21:31,840 --> 00:21:32,680 But it's normalized. 420 00:21:32,680 --> 00:21:33,840 They're kids, they're tired. 421 00:21:33,840 --> 00:21:34,920 They don't like to go to school. 422 00:21:34,920 --> 00:21:35,760 They don't want to get up. 423 00:21:35,760 --> 00:21:37,200 This is what teenagers do. 424 00:21:37,200 --> 00:21:39,280 I mean, we normalize. 425 00:21:39,280 --> 00:21:40,360 Exactly, this is the problem. 426 00:21:40,360 --> 00:21:43,040 We've normalized pathology, you know? 427 00:21:43,040 --> 00:21:45,680 And it's just that no recognition. 428 00:21:45,680 --> 00:21:50,160 It's just that, again, things just don't click into place. 429 00:21:50,160 --> 00:21:52,000 It's like, you know, the jigsaw puzzle, 430 00:21:52,000 --> 00:21:53,760 you've got all the pieces. 431 00:21:53,760 --> 00:21:55,880 You just don't know how they fit together. 432 00:21:55,880 --> 00:22:03,880 MUSIC 433 00:22:03,880 --> 00:22:06,400 You're listening to Airway First 434 00:22:06,400 --> 00:22:09,680 with today's guest, Dr. David McIntosh. 435 00:22:09,680 --> 00:22:13,280 You can find out more about the Children's Airway First Foundation 436 00:22:13,280 --> 00:22:15,960 and our mission to ensure that every child has access 437 00:22:15,960 --> 00:22:18,720 to screening, evaluation, and treatment 438 00:22:18,720 --> 00:22:20,400 of all children's airway disorders 439 00:22:20,400 --> 00:22:23,000 before the age of six on our website 440 00:22:23,000 --> 00:22:26,120 at childrensairwayfirst.org. 441 00:22:26,120 --> 00:22:29,080 You can also find a ton of great resources for parents 442 00:22:29,080 --> 00:22:33,480 on our website, including videos, blogs, recommended books, 443 00:22:33,480 --> 00:22:36,920 comprehensive medical research, and more. 444 00:22:36,920 --> 00:22:40,720 As a reminder, this podcast and the opinions expressed here 445 00:22:40,720 --> 00:22:42,880 are not a medical diagnosis. 446 00:22:42,880 --> 00:22:45,680 If you suspect your child might have an airway issue, 447 00:22:45,680 --> 00:22:49,520 contact your pediatric airway dentist or pediatrician. 448 00:22:49,520 --> 00:22:52,920 And now, back to my conversation with Dr. McIntosh 449 00:22:52,920 --> 00:22:54,760 and Dr. David McIntosh. 450 00:22:54,760 --> 00:23:05,760 MUSIC 451 00:23:05,760 --> 00:23:08,160 And then someone like me comes along and I go, 452 00:23:08,160 --> 00:23:10,320 well, that clicks into that and that clicks into that. 453 00:23:10,320 --> 00:23:12,200 And then all of a sudden it's just like, 454 00:23:12,200 --> 00:23:15,720 huh, that's how you solve it. 455 00:23:15,720 --> 00:23:19,160 So, you know, that's it in a nutshell. 456 00:23:19,160 --> 00:23:21,560 So what we need to have with this in the background 457 00:23:21,560 --> 00:23:23,280 is we need to have something that's useful 458 00:23:23,280 --> 00:23:25,080 and constructive for parents. 459 00:23:25,080 --> 00:23:27,720 And I can show off how clever I am 460 00:23:27,720 --> 00:23:29,840 with this enormous amount of knowledge, 461 00:23:29,840 --> 00:23:32,200 but that's useless if it doesn't translate into something 462 00:23:32,200 --> 00:23:35,720 that's packed up into something that's a nice little package. 463 00:23:35,720 --> 00:23:40,360 So what I sort of like in parents to have is a... 464 00:23:40,360 --> 00:23:44,560 Just a little simple toolkit is like, all right, first up, 465 00:23:44,560 --> 00:23:45,880 most of the time you actually don't know 466 00:23:45,880 --> 00:23:47,040 what your child is doing at night 467 00:23:47,040 --> 00:23:49,200 because you don't go look and listen. 468 00:23:49,200 --> 00:23:52,640 Right, after the age of about one, you don't check anymore. 469 00:23:52,640 --> 00:23:54,520 No, no, no, once they've gone down to bed, 470 00:23:54,520 --> 00:23:56,080 they're usually down the other end of the house 471 00:23:56,080 --> 00:23:58,480 because that's how we've constructed things these days. 472 00:23:58,480 --> 00:24:03,480 And so there is a complete element of... 473 00:24:03,480 --> 00:24:04,360 There's a disconnect. 474 00:24:04,360 --> 00:24:05,360 ...I'm not going to use to it all. 475 00:24:05,360 --> 00:24:07,600 It's not a criticism, it's a reality. 476 00:24:07,600 --> 00:24:10,080 So step one, you've got to go watch your child. 477 00:24:10,080 --> 00:24:12,000 Every night for a week, random times, 478 00:24:12,000 --> 00:24:15,680 five to 10 minutes, just make a small investment in time. 479 00:24:15,680 --> 00:24:16,280 OK. 480 00:24:16,280 --> 00:24:19,920 Are they snoring, are they mouth-breathing? 481 00:24:19,920 --> 00:24:22,480 Are they stopping breathing at night? 482 00:24:22,480 --> 00:24:24,560 If you got that, that's enough. 483 00:24:24,560 --> 00:24:25,200 That's enough. 484 00:24:25,200 --> 00:24:28,040 You got EMT right there. 485 00:24:28,040 --> 00:24:29,680 Just keep it really simple. 486 00:24:29,680 --> 00:24:31,880 Now, if you want to layer it up, then you go, look, 487 00:24:31,880 --> 00:24:33,680 are they sleeping with their head tipped back? 488 00:24:33,680 --> 00:24:36,320 So that's that position. 489 00:24:36,320 --> 00:24:39,360 That is what we do when we do first aid 490 00:24:39,360 --> 00:24:42,040 in terms of mouth-to-mouth resuscitation type things. 491 00:24:42,040 --> 00:24:43,360 Right, to open the airway. 492 00:24:43,360 --> 00:24:45,520 Unless it's an infant, we tip the head back. 493 00:24:45,520 --> 00:24:46,360 Why do we do that? 494 00:24:46,360 --> 00:24:47,960 Because it opens up the airway. 495 00:24:47,960 --> 00:24:50,920 So if the child is sleeping with their head tipped back, 496 00:24:50,920 --> 00:24:52,640 they're opening up their airway. 497 00:24:52,640 --> 00:24:55,000 They're doing first aid on themselves 498 00:24:55,000 --> 00:24:56,680 to try and breathe properly. 499 00:24:56,680 --> 00:24:58,520 That's clearly not a good thing. 500 00:24:58,520 --> 00:24:59,680 Right. 501 00:24:59,680 --> 00:25:01,480 Are they sweating at night? 502 00:25:01,480 --> 00:25:04,360 You know, they're going through those adrenaline surges. 503 00:25:04,360 --> 00:25:06,200 Because they're having disrupted sleep, 504 00:25:06,200 --> 00:25:08,320 are they tossing and turning a lot? 505 00:25:08,320 --> 00:25:09,800 So when you sort of get there in the morning, 506 00:25:09,800 --> 00:25:12,880 their bed is like a tornado went through. 507 00:25:12,880 --> 00:25:14,000 Right. 508 00:25:14,000 --> 00:25:16,760 Are they sleepwalking, sleep talking? 509 00:25:16,760 --> 00:25:19,800 Are they got night terrors or grinding their teeth at night? 510 00:25:19,800 --> 00:25:21,920 They're all aberrant sleep pathologies 511 00:25:21,920 --> 00:25:24,720 related to not being able to breathe properly at times. 512 00:25:24,720 --> 00:25:28,000 Are they waking up through the night and coming into your room? 513 00:25:28,000 --> 00:25:30,640 They have disrupted sleep. 514 00:25:30,640 --> 00:25:32,040 That's not normal. 515 00:25:32,040 --> 00:25:34,680 OK, coming into the room, that's not normal. 516 00:25:34,680 --> 00:25:37,880 It's been normalized, but it's normal. 517 00:25:37,880 --> 00:25:38,840 OK. 518 00:25:38,840 --> 00:25:41,840 Are they wetting the bed beyond a normal age? 519 00:25:41,840 --> 00:25:45,360 OK, so is it five or six or seven or eight year olds 520 00:25:45,360 --> 00:25:46,760 that they're supposed to stop? 521 00:25:46,760 --> 00:25:49,480 There's a variety there where we draw what we think 522 00:25:49,480 --> 00:25:50,880 is the line in the sand. 523 00:25:50,880 --> 00:25:53,960 But are they still wetting the bed? 524 00:25:53,960 --> 00:25:56,720 OK, so there's these sorts of things 525 00:25:56,720 --> 00:25:59,120 that you can sort of add layers to 526 00:25:59,120 --> 00:26:00,600 if you want to get more sophisticated. 527 00:26:00,600 --> 00:26:02,840 But do they stop? 528 00:26:02,840 --> 00:26:03,800 Just watch them. 529 00:26:03,800 --> 00:26:05,240 Do they mouth breathe? 530 00:26:05,240 --> 00:26:06,680 Are they stopping breathing at night? 531 00:26:06,680 --> 00:26:08,440 Yes, all right, ENT. 532 00:26:08,440 --> 00:26:11,280 The rest of it's window dressing. 533 00:26:11,280 --> 00:26:13,960 We need to keep the ENT can sort the rest out, 534 00:26:13,960 --> 00:26:15,520 but let's start with that. 535 00:26:15,520 --> 00:26:17,040 OK. 536 00:26:17,040 --> 00:26:19,000 So that's your simple parent screen 537 00:26:19,000 --> 00:26:22,400 in terms of their breathing and sleep in a nutshell. 538 00:26:22,400 --> 00:26:24,520 You know, and if they can just walk out the door 539 00:26:24,520 --> 00:26:28,640 with just that simple screen methodology, 540 00:26:28,640 --> 00:26:31,640 we're going to pick up 90 to 95% of these kids 541 00:26:31,640 --> 00:26:35,080 that need seeing and help right there. 542 00:26:35,080 --> 00:26:36,480 All right, but if we're tripping over them 543 00:26:36,480 --> 00:26:37,800 through their daytime problems, 544 00:26:37,800 --> 00:26:40,440 so they're having problems with their education, 545 00:26:40,440 --> 00:26:44,960 their emotional issues, their mental and mental issues, 546 00:26:44,960 --> 00:26:47,520 you know, and it can be just like exercise things. 547 00:26:47,520 --> 00:26:53,040 So for example, they go out onto the soccer pitch 548 00:26:53,040 --> 00:26:55,400 and they're running around with a group of kids 549 00:26:55,400 --> 00:27:00,240 and there's no real reason, but they just can't keep up. 550 00:27:00,240 --> 00:27:01,040 You know, they're struggling. 551 00:27:01,040 --> 00:27:03,240 It's what we call exercise tolerance, 552 00:27:03,240 --> 00:27:06,760 which is basically, you know, we do it like, you know, 553 00:27:06,760 --> 00:27:08,280 for example, with people with heart disease, 554 00:27:08,280 --> 00:27:10,760 we'll put them on a treadmill just to see, you know, 555 00:27:10,760 --> 00:27:13,000 what they're having, you know, cope with. 556 00:27:13,000 --> 00:27:15,560 You know, so that's what we call exercise tolerance. 557 00:27:15,560 --> 00:27:18,160 Well, throw a group of kids onto a sporting field 558 00:27:18,160 --> 00:27:19,800 and get them to running around, play with a ball, 559 00:27:19,800 --> 00:27:21,840 or for, you know, for example, 560 00:27:21,840 --> 00:27:26,280 well, what kids just go, go, go, and what kids looking at them, 561 00:27:26,280 --> 00:27:29,960 you go, gosh, they're not very fit, are they? 562 00:27:29,960 --> 00:27:32,840 Well, they've got cardiovascular problems 563 00:27:32,840 --> 00:27:36,200 and breathing problems with the sleep-assorted breathing. 564 00:27:36,200 --> 00:27:38,480 That might actually be what's going on, 565 00:27:38,480 --> 00:27:40,440 but it's all about the perception of it 566 00:27:40,440 --> 00:27:43,240 that then helps you understand the reality. 567 00:27:44,680 --> 00:27:46,240 So that's that part of it, 568 00:27:46,240 --> 00:27:48,160 but we also got to realize that, you know, 569 00:27:48,160 --> 00:27:51,880 this isn't always about ENT either, okay? 570 00:27:51,880 --> 00:27:55,160 Historically, it was about tonsils and adenoids, 571 00:27:55,160 --> 00:27:56,920 but there's a few other things 572 00:27:56,920 --> 00:27:59,400 that have crept into the conversation too. 573 00:27:59,400 --> 00:28:02,000 One of them is nasal allergies. 574 00:28:02,000 --> 00:28:04,000 So we call that hay fever, okay? 575 00:28:04,000 --> 00:28:08,040 So with hay fever, we get sort of the runny nose 576 00:28:08,040 --> 00:28:10,320 and the sneezing and the itchy eyes, 577 00:28:10,320 --> 00:28:13,600 and, you know, and again, we've normalized it. 578 00:28:13,600 --> 00:28:14,640 Why do we say that? 579 00:28:14,640 --> 00:28:16,200 Because we have this term. 580 00:28:16,200 --> 00:28:18,360 Oh, they've just got a bit of hay fever. 581 00:28:18,360 --> 00:28:20,400 It's just hay fever. 582 00:28:20,400 --> 00:28:22,240 They've just got allergies. 583 00:28:22,240 --> 00:28:23,080 Right. 584 00:28:23,080 --> 00:28:27,280 We've normalized a disease, you know? 585 00:28:27,280 --> 00:28:29,120 We wouldn't go, oh, they've just got cancer. 586 00:28:29,120 --> 00:28:31,080 It's just a bit of cancer, you know? 587 00:28:31,080 --> 00:28:31,920 Sure. 588 00:28:31,920 --> 00:28:34,680 You know, we've normalized a disease. 589 00:28:34,680 --> 00:28:37,520 Hay fever is a disease. 590 00:28:37,520 --> 00:28:39,360 We don't, we shouldn't, you know. 591 00:28:39,360 --> 00:28:40,800 Why did you constantly get allergy, 592 00:28:40,800 --> 00:28:42,040 or deal with allergies, 593 00:28:42,040 --> 00:28:44,680 or have annual sinus infections, or? 594 00:28:44,680 --> 00:28:45,520 Yeah. 595 00:28:45,520 --> 00:28:47,880 So we just normalized it. 596 00:28:47,880 --> 00:28:48,720 Normalized it. 597 00:28:48,720 --> 00:28:49,560 You know? 598 00:28:49,560 --> 00:28:50,560 We've normalized pathology, 599 00:28:50,560 --> 00:28:54,760 but why did a hay fever, nasal allergies 600 00:28:54,760 --> 00:28:56,040 trip into this conversation? 601 00:28:56,040 --> 00:28:57,920 Well, one of the things it does 602 00:28:57,920 --> 00:29:01,040 is it causes swelling within the nasal passages. 603 00:29:01,040 --> 00:29:02,480 And if that swelling is enough, 604 00:29:02,480 --> 00:29:06,000 it can block the ability to breathe through the nose 605 00:29:06,000 --> 00:29:08,360 to the point that you then mouth breathe. 606 00:29:08,360 --> 00:29:10,400 And here we are with mouth breathing again. 607 00:29:10,400 --> 00:29:11,400 Okay? 608 00:29:11,400 --> 00:29:13,760 So, and we look at allergies certainly in my country, 609 00:29:13,760 --> 00:29:15,600 and I think it's probably similar in yours, 610 00:29:15,600 --> 00:29:19,160 and there's not unusual across many other countries too. 611 00:29:19,160 --> 00:29:22,160 In childhood, it's about 15%. 612 00:29:22,160 --> 00:29:23,720 So that's one in seven children. 613 00:29:23,720 --> 00:29:25,720 Forget about tonsils and adenoids now, 614 00:29:25,720 --> 00:29:28,040 but then they never even exist. 615 00:29:28,040 --> 00:29:32,680 One in seven children, nasal allergies, nasal obstruction, 616 00:29:32,680 --> 00:29:37,080 breathing problems, sleep problems, from just allergies. 617 00:29:37,080 --> 00:29:38,840 And what do we know if we look at it 618 00:29:38,840 --> 00:29:41,360 just from an allergy point of view? 619 00:29:41,360 --> 00:29:43,200 They don't do as well at school, 620 00:29:43,200 --> 00:29:45,000 and they're more prone to anxiety. 621 00:29:45,000 --> 00:29:46,320 Here it is again. 622 00:29:46,320 --> 00:29:49,320 We're landing on the same doorstep. 623 00:29:49,320 --> 00:29:50,760 Okay? 624 00:29:50,760 --> 00:29:53,880 But without it necessarily being about tonsils and adenoids. 625 00:29:53,880 --> 00:29:54,960 And guess what? 626 00:29:54,960 --> 00:29:56,280 Some kids can have both, 627 00:29:56,280 --> 00:29:58,280 but it doesn't stop there. 628 00:29:58,280 --> 00:30:02,280 We talked about the adults that have the obesity. 629 00:30:02,280 --> 00:30:04,280 Well, guess what's happening? 630 00:30:04,280 --> 00:30:06,280 Our food is terrible. 631 00:30:06,280 --> 00:30:08,280 Our lifestyle is terrible. 632 00:30:08,280 --> 00:30:11,280 What used to be a disease of thin scrawny kids 633 00:30:11,280 --> 00:30:14,280 is now becoming a disease of the adult pattern 634 00:30:14,280 --> 00:30:16,280 with overweight and obesity too. 635 00:30:16,280 --> 00:30:18,280 And again, what are we doing? 636 00:30:18,280 --> 00:30:20,280 We're normalising it. 637 00:30:20,280 --> 00:30:23,280 You know, we've got to just take a moment in time 638 00:30:23,280 --> 00:30:25,280 where we've got to let political correctness 639 00:30:25,280 --> 00:30:27,280 go to the side and say, 640 00:30:27,280 --> 00:30:29,280 are we dealing with a health problem? 641 00:30:29,280 --> 00:30:33,280 Go back and look at photos from the 1970s. 642 00:30:34,280 --> 00:30:37,280 Try and find, you know, that crowd of people, 643 00:30:37,280 --> 00:30:40,280 try and find the person that's overweight. 644 00:30:40,280 --> 00:30:42,280 They're few and far between. 645 00:30:42,280 --> 00:30:48,280 As a society, we have gone down a wrong, bad pathway. 646 00:30:48,280 --> 00:30:51,280 But we have normalised it. 647 00:30:51,280 --> 00:30:53,280 And we are now feeling like 648 00:30:53,280 --> 00:30:55,280 it's an insensitive thing to do, 649 00:30:55,280 --> 00:30:59,280 to highlight it and bring it to people's attention. 650 00:30:59,280 --> 00:31:02,280 And in the process of doing that, by normalising it, 651 00:31:02,280 --> 00:31:07,280 we basically are allowing illness to be okay. 652 00:31:07,280 --> 00:31:09,280 Something that we could fix. 653 00:31:09,280 --> 00:31:11,280 And unwellness to be okay. 654 00:31:11,280 --> 00:31:13,280 Instead of going, you know what? 655 00:31:13,280 --> 00:31:16,280 This is not how we are supposed to be. 656 00:31:16,280 --> 00:31:19,280 This is not how we're supposed to look. 657 00:31:19,280 --> 00:31:24,280 This is not... We are a product of our environment. 658 00:31:24,280 --> 00:31:28,280 And in our environment, really, at the end of the day now, 659 00:31:28,280 --> 00:31:32,280 is all one that's surrounded by us by privilege. 660 00:31:32,280 --> 00:31:37,280 You know, we're not having to walk the 20 miles to the water well 661 00:31:37,280 --> 00:31:41,280 to carry back those 20 litres of water every day. 662 00:31:41,280 --> 00:31:42,280 Right. 663 00:31:42,280 --> 00:31:44,280 You know, we don't have to do that anymore. 664 00:31:44,280 --> 00:31:47,280 We just turn on a tap. It's there. 665 00:31:47,280 --> 00:31:50,280 You know, that food, well, it's all in your fridge and freezer. 666 00:31:50,280 --> 00:31:51,280 How did you get it? 667 00:31:51,280 --> 00:31:54,280 Well, I got in my car and I drove down to the shop. 668 00:31:54,280 --> 00:31:56,280 There's no physical effort in that. 669 00:31:56,280 --> 00:31:58,280 There's no hunting or gathering. 670 00:31:58,280 --> 00:32:01,280 And then working to the seasons and so forth. 671 00:32:01,280 --> 00:32:04,280 You know, we're just not, you know, 672 00:32:04,280 --> 00:32:08,280 engaging in something that we've done literally for thousands of years. 673 00:32:08,280 --> 00:32:11,280 You know, we've made life easier for ourselves. 674 00:32:11,280 --> 00:32:15,280 You know, majority of our transport is not by our own means. 675 00:32:15,280 --> 00:32:18,280 It's something that has wheels. 676 00:32:18,280 --> 00:32:22,280 You know, so, you know, there's all these things that our bodies are primed for, 677 00:32:22,280 --> 00:32:24,280 but we just don't use them. 678 00:32:24,280 --> 00:32:29,280 And, you know, we've engineered our way into problems here. 679 00:32:29,280 --> 00:32:33,280 And I think we just need to just take a reflective moment and be honest with ourselves. 680 00:32:33,280 --> 00:32:39,280 You know, stop making excuses for things that are not good for ourselves. 681 00:32:39,280 --> 00:32:42,280 You know, and that's confronting, but it's a reality. 682 00:32:42,280 --> 00:32:43,280 Right. 683 00:32:43,280 --> 00:32:48,280 And what we're seeing in children now too is they're getting the adult pattern of disease because of being overweight, 684 00:32:48,280 --> 00:32:50,280 because of being obese. 685 00:32:50,280 --> 00:32:55,280 And then we have this other thing where jaw developments are a problem because, as I said, you know, 686 00:32:55,280 --> 00:32:59,280 not all the adults necessarily are overweight or obese. 687 00:32:59,280 --> 00:33:06,280 In fact, they're sort of the unlucky ones with obstructive sleep apnea because we dismiss them because they don't fit the stereotype. 688 00:33:06,280 --> 00:33:09,280 They, they, they're just not on our radar. 689 00:33:09,280 --> 00:33:11,280 We just walk straight past them. 690 00:33:11,280 --> 00:33:17,280 And they have, you know, skeletal and developmental problems where their jaws haven't grown and developed properly. 691 00:33:17,280 --> 00:33:23,280 So basically the jaws form the framework for them, you know, what's inside the airway. 692 00:33:23,280 --> 00:33:27,280 And if their jaws are underdeveloped, well, their airway is smaller. 693 00:33:27,280 --> 00:33:28,280 Right. 694 00:33:28,280 --> 00:33:29,280 It's smaller. 695 00:33:29,280 --> 00:33:32,280 But how do you get that jaw development as an adult? 696 00:33:32,280 --> 00:33:35,280 Well, because of how it grows a child. 697 00:33:35,280 --> 00:33:36,280 As a child. 698 00:33:36,280 --> 00:33:37,280 Yeah. 699 00:33:37,280 --> 00:33:44,280 You know, so, so 80 to 90% of your jaw development is done and dusted by the age of 12. 700 00:33:44,280 --> 00:33:52,280 So whatever you've got it as an adult was basically the growth pattern up to the age of 12 in the main state. 701 00:33:52,280 --> 00:33:58,280 So when can we find aberrant jaw and development problems? 702 00:33:58,280 --> 00:34:03,280 Well, clearly in kids and who's going to find that predominantly the dentists. 703 00:34:03,280 --> 00:34:08,280 And if we have a tooth focus where we have a look at, you know, are they brushing their teeth? 704 00:34:08,280 --> 00:34:09,280 Are they flossing their teeth? 705 00:34:09,280 --> 00:34:11,280 Have they got any cavities? 706 00:34:11,280 --> 00:34:13,280 And that's all we're worried about. 707 00:34:13,280 --> 00:34:17,280 And in the meantime, these jaws, which is what the teeth are connected to and not developing properly. 708 00:34:17,280 --> 00:34:20,280 And they're, they're, they're just left to time. 709 00:34:20,280 --> 00:34:24,280 Well, then we have that going on. 710 00:34:24,280 --> 00:34:27,280 So instead of this airway, so industry. 711 00:34:27,280 --> 00:34:28,280 Yeah. 712 00:34:28,280 --> 00:34:32,280 Well, if you have underdeveloped jaws, then, you know, you again, you might have a resilience. 713 00:34:32,280 --> 00:34:33,280 You might get away with that. 714 00:34:33,280 --> 00:34:39,280 But if as an adult, you get allergies, well, there's your tipping point, or you may get overweight and obese. 715 00:34:39,280 --> 00:34:40,280 There's your tipping point. 716 00:34:40,280 --> 00:34:45,280 Or for some reason, if you're tonsils or adenoids player, there's your tipping point. 717 00:34:45,280 --> 00:34:54,280 You know, anything that then comes along that, that basically in that, you know, you're, you know, a center of vulnerability. 718 00:34:54,280 --> 00:34:58,280 And you just need something that's just the straw that breaks that camel's back. 719 00:34:58,280 --> 00:35:04,280 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. 720 00:35:04,280 --> 00:35:11,280 And we're back to something that could have been caught had we known or had we been looking for it back in childhood. 721 00:35:11,280 --> 00:35:12,280 Absolutely. 722 00:35:12,280 --> 00:35:19,280 And when we talk about obstructive sleep apnea as a society in the mainstay, our paradigm is in adults, you know, 723 00:35:19,280 --> 00:35:20,280 Oh, absolutely. 724 00:35:20,280 --> 00:35:21,280 It's a adult male. 725 00:35:21,280 --> 00:35:22,280 That's what we think of. 726 00:35:22,280 --> 00:35:23,280 Yeah. 727 00:35:23,280 --> 00:35:27,280 We really focus on it's, it's an adult thing. 728 00:35:27,280 --> 00:35:31,280 You know, that's, that's, that's where we dwell on it. 729 00:35:31,280 --> 00:35:39,280 You know, and the fact that it could be happening in kids or it's happening in adults because of what happened in childhood. 730 00:35:39,280 --> 00:35:47,280 What you are having to concede is that through the development of that adults life, the health system screwed up. 731 00:35:47,280 --> 00:35:56,280 And again, we can either acknowledge that and admit a mistake and use that as a learning opportunity. 732 00:35:56,280 --> 00:36:03,280 And an opportunity for growth and development, or we can put our head in the sand and say, Oh, no. 733 00:36:03,280 --> 00:36:10,280 No, no, I've got my university degree from this prestigious place and I've been doing this for 40 years. 734 00:36:10,280 --> 00:36:16,280 I know everything about everything because, you know, and then that's where the ego gets in the way. 735 00:36:16,280 --> 00:36:23,280 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. 736 00:36:23,280 --> 00:36:27,280 I go, I really wish I'd known that 20 years ago. 737 00:36:27,280 --> 00:36:30,280 Well, I'm grateful for the fact that at least I know it now. 738 00:36:30,280 --> 00:36:31,280 Right. 739 00:36:31,280 --> 00:36:34,280 And I, and I, and I utilize it and I implement it. 740 00:36:34,280 --> 00:36:46,280 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. 741 00:36:46,280 --> 00:36:47,280 I don't know. 742 00:36:47,280 --> 00:36:48,280 Tell about affecting change. 743 00:36:48,280 --> 00:36:50,280 How do we affect change? 744 00:36:50,280 --> 00:36:51,280 Yeah, absolutely. 745 00:36:51,280 --> 00:37:04,280 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. 746 00:37:04,280 --> 00:37:05,280 Right. 747 00:37:05,280 --> 00:37:07,280 You know, it can be about allergies. 748 00:37:07,280 --> 00:37:09,280 It can be about diet and lifestyle. 749 00:37:09,280 --> 00:37:11,280 It can be about jaw development. 750 00:37:11,280 --> 00:37:16,280 So, you know, if they're going to the dentist and the dentist is going, Oh, their jaws aren't developing properly. 751 00:37:16,280 --> 00:37:19,280 Well, that's got to be a red flag to saying, Well, okay. 752 00:37:19,280 --> 00:37:21,280 So what do we do about it? 753 00:37:21,280 --> 00:37:24,280 You know, you don't just find a problem and go, Oh, and then just walk past it. 754 00:37:24,280 --> 00:37:26,280 You go, Oh, hang on, rewind. 755 00:37:26,280 --> 00:37:27,280 All right. 756 00:37:27,280 --> 00:37:28,280 So, so what are we going to do? 757 00:37:28,280 --> 00:37:29,280 And go, Oh, don't worry. 758 00:37:29,280 --> 00:37:33,280 We'll just let them grow there and look, they'll probably get crowded teeth and don't worry. 759 00:37:33,280 --> 00:37:41,280 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. 760 00:37:41,280 --> 00:37:43,280 That doesn't fix the jaws. 761 00:37:43,280 --> 00:37:45,280 And that's back to that normalization again, right? 762 00:37:45,280 --> 00:37:46,280 The extra teeth. 763 00:37:46,280 --> 00:37:48,280 They're on her extra teeth. 764 00:37:48,280 --> 00:37:49,280 Yeah, 100%. 765 00:37:49,280 --> 00:37:58,280 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. 766 00:37:58,280 --> 00:38:03,280 We know that that, but we're all effectively born with the same number of teeth. 767 00:38:03,280 --> 00:38:06,280 Why are there extra teeth then? 768 00:38:06,280 --> 00:38:07,280 There aren't extra teeth. 769 00:38:07,280 --> 00:38:13,280 Now, there are sometimes where there are actually, there is actually genuinely are extra teeth, but you know, that's a pathology. 770 00:38:13,280 --> 00:38:17,280 But when we all have the same in the main state number of teeth, 771 00:38:17,280 --> 00:38:19,280 well, why is that extra teeth? 772 00:38:19,280 --> 00:38:21,280 Why is it extra in that child? 773 00:38:21,280 --> 00:38:23,280 The same child has the same number of teeth. 774 00:38:23,280 --> 00:38:24,280 It's the other child. 775 00:38:24,280 --> 00:38:26,280 Why are we calling them extra teeth? 776 00:38:26,280 --> 00:38:29,280 And it's like, well, the teeth are attached to the jaw. 777 00:38:29,280 --> 00:38:32,280 It's the jaw that's the problem, not the teeth. 778 00:38:32,280 --> 00:38:35,280 The teeth are just fighting for the space that they've got. 779 00:38:35,280 --> 00:38:40,280 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. 780 00:38:40,280 --> 00:38:41,280 Yeah. 781 00:38:41,280 --> 00:38:46,280 And so it's like, hang on, we're on a road to pathology here. 782 00:38:46,280 --> 00:38:48,280 We got to get off this ride. 783 00:38:48,280 --> 00:38:50,280 This ride doesn't end in a happy place. 784 00:38:50,280 --> 00:38:51,280 No. 785 00:38:51,280 --> 00:38:58,280 So that's where we need a multidisciplinary approach to the management too. 786 00:38:58,280 --> 00:39:00,280 I can't fix jaws and teeth. 787 00:39:00,280 --> 00:39:03,280 I get the allergy doctors to help me with the allergies. 788 00:39:03,280 --> 00:39:05,280 I go looking for the allergies. 789 00:39:05,280 --> 00:39:11,280 I can pick that up as an ENT, but I need the allergy doctors to help me then manage it in the long term. 790 00:39:11,280 --> 00:39:19,280 And these children have aberrant breathing patterns. I can clear the obstruction, but then they need rehabilitation and so forth. 791 00:39:19,280 --> 00:39:25,280 And they might have been chewing and swallowing properly either because having big tonsils or being mouth breather, 792 00:39:25,280 --> 00:39:29,280 they have to work different ways to chew and breathe and swallow. 793 00:39:29,280 --> 00:39:31,280 So we need male functional correction. 794 00:39:31,280 --> 00:39:34,280 So this is where the male functional therapy comes into it. 795 00:39:34,280 --> 00:39:45,280 There's this whole thing where basically you need a village of people that come in and go, all right, here's the plan. 796 00:39:45,280 --> 00:39:47,280 So here's the sequence. 797 00:39:47,280 --> 00:39:49,280 First up, you've got ENT problems. 798 00:39:49,280 --> 00:39:53,280 All right, the sequence is ENT always goes first. 799 00:39:53,280 --> 00:39:55,280 You've got ENT problems. 800 00:39:55,280 --> 00:39:57,280 ENT always goes first. 801 00:39:57,280 --> 00:39:58,280 Let's get that out of the way. 802 00:39:58,280 --> 00:40:00,280 That may not be our full fix. 803 00:40:00,280 --> 00:40:03,280 It may not be our permanent fix, but it's our quick fix. 804 00:40:03,280 --> 00:40:05,280 And it's very effective. 805 00:40:05,280 --> 00:40:08,280 And it's just going to pull us out of trouble. 806 00:40:08,280 --> 00:40:11,280 So it's kind of like if someone's drowning, it's like, what do you do first? 807 00:40:11,280 --> 00:40:15,280 Well, look, you want to pull them out of the water, but hey, look, at the moment we can't do that. 808 00:40:15,280 --> 00:40:17,280 Let's throw them a life preserver. 809 00:40:17,280 --> 00:40:19,280 Let's at least stop them from drowning. 810 00:40:19,280 --> 00:40:20,280 So there's that. 811 00:40:20,280 --> 00:40:21,280 They're still in the water. 812 00:40:21,280 --> 00:40:25,280 They're still cold and so forth, but they're not going to drown anymore. 813 00:40:25,280 --> 00:40:29,280 We've got them to a point and it's like, okay, what do we need to do now? 814 00:40:29,280 --> 00:40:32,280 Well, all right, now we need to get these jaws sorted. 815 00:40:32,280 --> 00:40:33,280 Okay. 816 00:40:33,280 --> 00:40:39,280 And we can start some my functional rehab and we can start getting their allergies and calming that down. 817 00:40:39,280 --> 00:40:53,280 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. 818 00:40:53,280 --> 00:41:01,280 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. 819 00:41:01,280 --> 00:41:02,280 Okay. 820 00:41:02,280 --> 00:41:07,280 But that took a coordinated effort of different things at different times. 821 00:41:07,280 --> 00:41:08,280 It wasn't an immediate fix. 822 00:41:08,280 --> 00:41:10,280 It wasn't just a one thing. 823 00:41:10,280 --> 00:41:14,280 It was all these things that had to happen for that. 824 00:41:14,280 --> 00:41:17,280 And work together and talk to each other. 825 00:41:17,280 --> 00:41:19,280 It's the same with these children. 826 00:41:19,280 --> 00:41:22,280 You know, if there are any problems, tonsils and adenoids, fine. 827 00:41:22,280 --> 00:41:24,280 That's their only fix. 828 00:41:24,280 --> 00:41:26,280 But if their only problem is allergies, fine. 829 00:41:26,280 --> 00:41:27,280 That's their only fix. 830 00:41:27,280 --> 00:41:31,280 But often these children don't have just one thing going on. 831 00:41:31,280 --> 00:41:32,280 Right. 832 00:41:32,280 --> 00:41:33,280 All right. 833 00:41:33,280 --> 00:41:34,280 They've got a multitude of things going on. 834 00:41:34,280 --> 00:41:39,280 And it can be, you know, the parents can be going, oh, you've got to fix all of this. 835 00:41:39,280 --> 00:41:48,280 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? 836 00:41:48,280 --> 00:41:51,280 Or do you go and fix all flat type of all four, four flats? 837 00:41:51,280 --> 00:41:52,280 You go, well, right. 838 00:41:52,280 --> 00:41:53,280 All right. 839 00:41:53,280 --> 00:41:54,280 We've got to fix all four flats. 840 00:41:54,280 --> 00:41:56,280 There's no point fixing three of them. 841 00:41:56,280 --> 00:41:59,280 Well, it made things better, but I still got a problem. 842 00:41:59,280 --> 00:42:01,280 Well, this is the same. 843 00:42:01,280 --> 00:42:03,280 You've got to fix all of this. 844 00:42:03,280 --> 00:42:04,280 Right. 845 00:42:04,280 --> 00:42:08,280 You know, and that can be a journey at times, you know, things can take a while. 846 00:42:08,280 --> 00:42:11,280 But the outcomes, the health outcomes. 847 00:42:11,280 --> 00:42:12,280 They're long term problems. 848 00:42:12,280 --> 00:42:19,280 And things that we ultimately will never see because we won't see that disease in the pathology in that person. 849 00:42:19,280 --> 00:42:21,280 That's a good thing. 850 00:42:21,280 --> 00:42:23,280 You know, that's a good thing. 851 00:42:23,280 --> 00:42:24,280 Absolutely. 852 00:42:24,280 --> 00:42:34,280 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. 853 00:42:34,280 --> 00:42:46,280 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. 854 00:42:46,280 --> 00:42:49,280 You know, I'm not a health care provider. 855 00:42:49,280 --> 00:43:03,280 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. 856 00:43:03,280 --> 00:43:04,280 Okay. 857 00:43:04,280 --> 00:43:09,280 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. 858 00:43:09,280 --> 00:43:13,280 I'm telling you, there is something wrong with my child. 859 00:43:13,280 --> 00:43:18,280 And I want to go and get it looked at and get it looked at. 860 00:43:18,280 --> 00:43:20,280 And get it fixed. 861 00:43:20,280 --> 00:43:30,280 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. 862 00:43:30,280 --> 00:43:32,280 And then they get fixed. 863 00:43:32,280 --> 00:43:34,280 And it's just like different child. 864 00:43:34,280 --> 00:43:38,280 They're like, right, this can't ever happen again. 865 00:43:38,280 --> 00:43:46,280 And obviously that's where you know this foundation is founded upon is the journey, the journey that one child went through. 866 00:43:46,280 --> 00:43:52,280 And that basically then had the parents that said, this can never happen again. 867 00:43:52,280 --> 00:43:53,280 Happen again. 868 00:43:53,280 --> 00:43:54,280 Correct. 869 00:43:54,280 --> 00:43:55,280 I tell you now, it already is. 870 00:43:55,280 --> 00:43:57,280 It happens time and time again. 871 00:43:57,280 --> 00:44:05,280 But it's going to happen one time less every moment that a parent hears this message. 872 00:44:05,280 --> 00:44:12,280 And then that one moment less is going to come one moment and just a little bit less because we got another advocate. 873 00:44:12,280 --> 00:44:16,280 We got another ambassador and then it just spirals upwards. 874 00:44:16,280 --> 00:44:30,280 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. 875 00:44:30,280 --> 00:44:37,280 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. 876 00:44:37,280 --> 00:44:39,280 It's all well and good for me to know this. 877 00:44:39,280 --> 00:44:43,280 There's a lot of health care providers and that includes ENTs, by the way. 878 00:44:43,280 --> 00:44:45,280 This isn't even on their radar. 879 00:44:45,280 --> 00:44:48,280 It wasn't part of their education and it's not part of their knowledge base. 880 00:44:48,280 --> 00:44:51,280 And look, it may not be part of their focus. 881 00:44:51,280 --> 00:44:56,280 I'm in the ENT, but I don't specialize in ear disease. 882 00:44:56,280 --> 00:44:58,280 You can have major ear disease. 883 00:44:58,280 --> 00:44:59,280 I don't do throat cancer. 884 00:44:59,280 --> 00:45:01,280 You can get throat cancer. 885 00:45:01,280 --> 00:45:04,280 They're both ENT conditions. 886 00:45:04,280 --> 00:45:12,280 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. 887 00:45:12,280 --> 00:45:16,280 I know that, but I don't deal with it. 888 00:45:16,280 --> 00:45:29,280 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. 889 00:45:29,280 --> 00:45:35,280 Just like if you had bowel cancer, well, you wouldn't go and see the breast cancer surgeon. 890 00:45:35,280 --> 00:45:40,280 If you had a shoulder problem, you wouldn't go and see the knee specialist. 891 00:45:40,280 --> 00:45:42,280 They're both orthopedic surgeons. 892 00:45:42,280 --> 00:45:45,280 Just like we're all ENT surgeons. 893 00:45:45,280 --> 00:45:52,280 So again, where circumstances prevailing means that you can go and see, if it's a child, the pediatric ENT. 894 00:45:52,280 --> 00:45:55,280 If it's an airway problem, the airway focused ENT. 895 00:45:55,280 --> 00:46:00,280 You'll get a different perspective and so forth there too. 896 00:46:00,280 --> 00:46:04,280 And that's where it obviously then needs to layer up within the healthcare profession too. 897 00:46:04,280 --> 00:46:08,280 It's all well and good to have these parents that know their child needs fixing. 898 00:46:08,280 --> 00:46:15,280 But if they hit these brick walls of ignorance within the healthcare profession, then we also have a problem there. 899 00:46:15,280 --> 00:46:19,280 So it needs to spiral up in more than one place. 900 00:46:19,280 --> 00:46:21,280 But let's just start with the parents. 901 00:46:21,280 --> 00:46:26,280 They're the ones that know that their child has a problem and it needs fixing. 902 00:46:26,280 --> 00:46:28,280 Advocacy. 903 00:46:28,280 --> 00:46:30,280 Absolutely. 904 00:46:30,280 --> 00:46:31,280 Awesome. 905 00:46:31,280 --> 00:46:38,280 Thank you so much for all this amazing information and putting it in just language that parents can understand 906 00:46:38,280 --> 00:46:46,280 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. 907 00:46:46,280 --> 00:46:52,280 Yeah, that's my absolute pleasure. 908 00:46:52,280 --> 00:47:03,280 Thanks again to today's cast, Dr. David McIntosh for sharing his medical insight and each of you for listening to today's episode. 909 00:47:03,280 --> 00:47:06,280 If you're new to our podcast, please don't forget to subscribe. 910 00:47:06,280 --> 00:47:12,280 And if you enjoyed today's episode, please remember to leave us a review or a comment about what you enjoyed most. 911 00:47:12,280 --> 00:47:20,280 You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, Twitter and LinkedIn. 912 00:47:20,280 --> 00:47:31,280 If you'd like to be a guest on 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. 913 00:47:31,280 --> 00:47:40,280 And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better. 914 00:47:40,280 --> 00:47:44,280 Take care, stay safe and happy breathing everyone. 915 00:48:10,280 --> 00:48:17,280 .