Breath: The New Science of a Lost Art

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Published on
June 3, 2020
Updated on
June 11, 2020

This week on ADVENTing Dr. Kandula and Dr. Handler discuss ADVENT's conference room names, Muhammad Ali, Steve Jobs, and others, and the new book Breath: The New Science of a Lost Art by James Nestor.

- Hey, it's Dr. Madan Kandula from ADVENT, founder of ADVENT and host of our ADVENTing show all things about ENT, the world in general. ADVENT in specific, and I am joined by Dr. Ethan Handler. How you doing?

- I'm doing well happy to be here and as always, and enjoying this warm weather, you know?

- Yeah, it's very warm, it's super duper warm right now. But yeah, summer's here. And we are. Well, big news at ADVENT couple big news, one piece of big news is we have moved our admin space, which, you know, I don't know if the rest of the world cares about but for us, it is a big deal, yeah.

- No, I was gonna say that, you know when I joined the practice, you know, four years ago, we were kind of a certain size and you forget when you're kind of, you know, when you're in the midst of your clinical work, kind of how the company might grow kind of around you as we get bigger. And so kind of seen the first step for admin and then seeing this next admin space, you know, you realize that we're expanding and growing, and it's fun and reaching a lot of people. So I think it's pretty cool.

- Yeah, now, it's the first time for us we've had administrative space that's been separate from clinical space. So it's gonna take some getting used to it for us. And but yeah, it'll be good thing. It really is, I mean, we've moved that space to kind of prepare us for continued growth. And part of that growth as we get bigger and bigger part of it is sort of, kind of making sure we're kind of all staying on the same page. So I think you were talking earlier about the conference rooms at our new admin space, which have specific names for specific individuals. And those individuals sort of embody our core values which is kind of the mindset that came along with those things so yeah. Any names on the list, I don't know if we have to run through all the names. I guess we could, but any names on that list that are of note?

- I think the Britney Spears room is pretty cool.

- Yes, that's our late 90s themed room which is--

- Yeah, Christina Aguilera, and Maroon Five, you know, they're kind of all hit the major spots for us. Certainly, the Steve Jobs room is pretty cool. You know, he's is such a fascinating character and an interesting story. So I loved his biography that was written. You know, and then hitting, you know, Churchill, I mean, the big dawg, you know, that's our big conference room. And any that have a special place in your heart in particular? No, they all I mean, I kind of was at the center of putting that list together. So they're kind of, they all have different angles on things. So, but yeah, I mean, Churchill is our main kind of war room, over the new space, our biggest conference room and that's where those big decisions, you know, tend to happen. But yeah, Disney, Muhammad Ali, I mean, there's sort of, you know, these names mean something. But I'd say for us at ADVENT, they all kind of embody some aspect of our values. Actually, like Ali specific, I can go on and on each one some I can spend all the time going over each conference for each person, but Ali in particular. Let me go this way, I'd say I think of Muhammad Ali, for his sense of humor, and wit, and confidence and those are all things that I think are really worthy. But I think the weird warped thing with him is, he was a badass boxer would beat your butt kind of a thing, but I don't know that many people think of him that way. He was, you know, he's the heavyweight champion of the world and yet nowadays, when we think of Muhammad Ali, at least I do, I think of him in non-boxing terms, which is a kind of an interesting dynamic. So I think that's where, he embodies our core value of sustainability and specifically, you know, kind of having a sense of humor versus many other values he could have, you know, sort of championed. So anyway, I think it's interesting, I would say, we put a lot of thought into everything, including some of those things. And as we continue to get bigger for us, as a company, it's gonna be important, like I was saying is for us to kind of maintain the same playbook and make sure we're playing with the same values and those sort of things. The other big news at ADVENT is on June 1, we are opening our latest clinic, which is in Appleton, Wisconsin, so that's a big deal. And big deal near and dear to me, my wife, Gwen, who's a co-founder here at ADVENT, she born and raised up in the Fox Valley. So it's something that's been on our short to-do list to get a clinic up there and we're actually making it happen, which is good so.

- Yeah.

- You have no Appleton fondness whatsoever. You've never been to Appleton, right?

- That is not true, so, quick little anecdote here a little story. So before, so I went to medical school here at the Medical College of Wisconsin, which is my first foray into living in this area. And so I only knew of the Medical College at Wisconsin cause my dad happened to be living in Fond du Lac, so he was a radiologist at St. Agnes hospital there. And so he'd buy all his cars from Appleton from a Volvo dealership there at Bergstrom which apparently owns pretty much the majority of car dealerships kind of in the state. And so we would go to Appleton and there was a restaurant that we'd have like a lunch buffet at every time that we go there, so if I was in town it was always a trip to Appleton. It was an Indian restaurant that had a great lunch buffet so that's how we know Appleton.

- Cool Indians dots not feathers.

- Red Dot, yeah. I haven't been to other restaurants restaurant but you know, you may know some that I don't. You will actually you'll be working up in Appleton for a bit correct?

- I will be yeah, as we kind of you know, get finish our position search and obviously get somebody trained and on boarded and station there long term I will be helping to cover that gap.

- Excellent, and you'll be partaking in the Indian buffets up there probably on a weekly basis so.

- Yeah, for sure.

- That's good, that's good. Yeah, today, I think there's many things we could cover. There was an article in Wall Street Journal this weekend, I think was the Saturday journal that was talking about breathing and I guess it's an article that's a skinny down version of a book that I think is just come out, which talks about breathing. Which is near and dear to our hearts here at ADVENT, cause that's actually all that we do, you know. I think, you know, and I think the article is poignant for a couple different angles. But I think we're starting out at the very beginning of that concept when people think of breathing or hear the word breathing, I think people, everybody just sort of jumps to the lungs, which might be rightfully so. And a lot of this article does talk about the lungs and the importance of that part of the breathing. But obviously, in order to get air to your lungs, in order for your lungs to work, the air has to get there to begin with. And the only way it's gonna be able to get there is through your nose, ideally, or your mouth less ideally. And so those are the areas that we deal with exclusively, we deal with the nose and throat. And so the intake of your airway system is coming through our wheelhouse and many, many, many, many people are built with equipment that doesn't work with noses that don't work, with throats that don't work, and it impacts them greatly. And so, you know, I think one of the first kind of fundamental takes on this article is importance of breathing, and really looking at the fact that for those folks that have the best chance for a long life, you can look at multiple factors. You can look at genetics diet and lifestyle and this and that. But the thing that really, really has the most direct correlation to living a long and healthy life is really your breathing capacity, your lung capacity. So any thoughts? Or was that surprising information to you?

- No, I mean, I felt like that was well, I guess, when it looked at some of the studies that kind of just confirm that. It seems such a simple concept, although it's lost on pretty much everyone, you know, at least who's kind of walking around taking breathings for granted, right. And I think the first paragraph of that article touched on that, that people just kind of assume it's something that you do, as a byproduct of living, as opposed to being the major player and having a long life. So it's refocusing people on the importance of breathing and what that means for us, versus just something that we do and get by with.

- Right, which I mean, it goes both ways because I think if you're struggling to breathe, then that's the only time you think of that breathing. And if you're not struggling to breathe, you don't generally think about it. But then the flip side is most of us don't breathe properly. Because you're not putting conscious thought into it. And so there's a big, big wave of thought coming into play these days, really surrounding meditation and mindfulness and those sorts of things. And every single, every meditative practice I've ever seen or heard of, focuses your attention on your breathing, and focuses on various aspects of that generally longer deep breathing, which is actually what this article is talking about. Is sort of long, deep breaths are good and short, shallow breaths are bad. And the way to train yourself to breathe, you know those long deep breaths is it actually takes training. It's not something that comes natural generally. I mean, breathing comes natural, cause it's the foundation of life. But I'd say most of us breathe, you know much more shallowly than we should, and much more quickly than we should. And there's a feedback loop there. And so if you're breathing properly, there's a calming part of that. I didn't design you know, as I didn't design equipment, I just sort of know, my personal equipment is this. I'm under stress or anxious, then I'm breathing shallow and quick and that's not a healthy way to do that. And so if I wanna break that cycle, but wanna break a mental cycle of anxiety, what I can do is I can concentrate on my breathing and you focus on the physical to train your mental to get there and you focus to yourself to say, "Oh, well, I'm breathing really shallow here, let me take a nice deep breath, slow breath, and I'm gonna repeat that." And then what you find is when you focus on the physical, the mental follows and then vice versa. And so this isn't meant to be kind of, you know, spiritual mumbo jumbo it's really meant to be real, you know, really as animals, if we're breathing properly, there's a mind and body feedback loop, which is good conceptually, but then from a proof of effect is if you're breathing properly, and you're doing it over time, then you live your longest and best life, right?

- Yeah, and I think it also touched on I mean, it touched on so many different elements of this and that short article that obviously you know, reading the book is gonna be pretty interesting, I just came out I think yesterday or whatever it is, but you know, it talks about okay, and the current situation with COVID and there's a lot of people anxiety and mental health that spiked and just other issues is that the importance of breathing when one is anxious and right now we're in a perfect climate to you know, deploy that tactic. And then also you know, the history there that for thousands of years you know, people have understood and written about the importance of breathing through your nose versus mouth breathing, you know, and it was considered bad breathing when you breathe through your mouth. And then just also touching on kind of the changes to the face in like humans, it said, we're the only kind of creatures where our teeth as originally designed don't sit in our mouth anymore. You know, our mouths have kind of gotten smaller, our nasal passages have gotten smaller. And anyway, lot of topics to dive into but.

- Right well, I think that was the other kind of part of, I mean the article it was good. And again, it's just an excerpt from the greater book which I'm assuming will be good as well. But part of what that the author talks about in the article is the concept and I think he went through an experiment on his own, which is he had an ENT plug his nose up, plugged it up. I think it was for like 10 days or so. Which yeah, if you wanna make somebody miserable, I've said this all the time. And this is the proof positive this author did what I say to do, if you wanna make somebody miserable is you plug their nose and you'll take if somebody's nose was working and you plug their nose, you're going to make that person miserable. And they don't even know how miserable they're gonna be. Because you know 30 seconds of that is annoying, a minute a little bit more, you go days and days, I can't imagine it would be, it's unbearable. And literally they were tracking some biological data on the author and you know, he went from not having sleep apnea to having sleep apnea went from normal blood pressure to high blood pressure.

- Going like crazy.

- All those things that we talk about commonly, routinely, he experienced going from not having those things there to having those things there. And, you know, flip that around, and I'd say, you know, most of the patients that we see are walking around, and lifelong versions of that guy's experiment. They've had lifelong issues with nasal obstruction, and they don't even know, a lot of people don't know it. And I say this oftentimes, too, but it's true. Most of our patients don't know how bad they have it until we fix them. And we get in the way that they're supposed to be breathing and many times it's for the first time in forever. And so you know, this author did it for you know, was normal, miserable for 10 days, took the plugs out, you know, unwound from that, got back to his normal existence. And so he knew what was normal, he knew what was not normal when he was in it, and he was able to get back to normal. Our patients, many of them never know normal, don't understand the impact of the nose and how impactful it is. Both from a nose standpoint, as well as just a breathing standpoint, as well as a sleeping standpoint. And so this author gave himself sleep apnea by plugging his nose up. Our patients, many of our patients have given their bodies have given themselves or forced themselves into sleep apnea because their noses aren't working. And our first step if somebody nose isn't working, is to get their nose working. And so, you know, again, if you have sleep apnea, it's coming from your throat, and so when we fix your nose, we haven't fixed your throat and we can do that as a separate measure. But it's a fundamentally and I think what we do falls right in the cross hairs of what this author is talking about. Is that your airway starts with the nose, and either your nose is working properly or it's not if it's not working properly, let's get it working properly and atomically and then we'll start moving beyond that. And really, the reality is the rest of the world in the medical community doesn't start with that premise. And doesn't start with that fundamental step, and therefore, they're always sort of a step behind the game. And I'd say, you know, it's kind of your choice as a patient and it's our choice as a practitioner, you know. I'd rather have my patients be a step ahead versus step behind, and I'd rather approach their issues with that mindset and that's how we do it. And it does, you know, it's something that works, because we see it before our own eyes, but then you know, books like this, and then there are many articles talking about similar things. But they all come back to those fundamentals, which just never get old, it'll never get old. The emphasis on nasal breathing needs to be shouted from the rooftops and most people have never heard of it. So we haven't been shouting very well.

- Well, and, you know, at least some literature starting to come out obviously, we do a lot of, you know, just kind of branding around this because it's so important. Obviously, we need to connect with patients and help them understand the importance of nasal breathing. And, you know, I mean, the problem with patients like so in comparison to the author who plugged his nose to try and walk through that experiment of what that felt like, which, honestly even thinking about that gives me a little level of anxiety and wants me to breathe through my nose. Like, I can't imagine not breathing through my nose for a week. Like that seems horrific, but the majority of our patients, you know, they start here in life, and maybe it's okay, maybe it's not and then they end up way down here, but it's such usual small increments, that they don't see how far they've traveled and how poorly, their nose is functioning, and so they get kind of used to it over time, right? Like people have their own nose and they get used to breathing the way that they do. And they don't know what it's like to breathe well. And unfortunately, they haven't fast track that, like this author did. And so, you know, we talk to patients a lot here and we asked a lot of questions about nasal breathing, one they never had thought about asking or thinking about. And so, you know, we get them thinking about what it means to breathe through their noses, and paying attention to it. You know, and I think it's pretty eye opening for a lot of people. And then when they're on the back end, I mean, one of the best feelings is patients who are happy and feel like it's changed their lives, you know, and I've experienced it personally, you know, I've had these procedures done, you've had worked on, like, I know what it's like to breathe like crap. And I couldn't tolerate for more than like, a few months, and it was partially blocked. Like, it can be life changing.

- Yeah, and it is. And I think I'd say, I think if we potentially how do you say this? Because we're such big champions for the nose and nasal breathing, in a world where nobody else, not many other folks, not many folks in medicine champion the nose. Even folks in our own ENT community, I think don't do the job that we should do. Like nobody champions the nose as it ought to. We were trying to do that as a practice and we will do that because it's the right thing to do. You know, as we've talked about previously, there are many dentists around that have begun to understand the impact of this and they tend to be more champions for the nose and nasal breathing than ENTs and allergist, which is insane to me. Not that they shouldn't be, but it's just that it's sitting in our court and as a specialty, I think the thing that gets me I know it's hard to get me frustrated, but I'd say what will get me from frustrating and it happens all the time. Is if I'm seeing a patient who's been previously evaluated elsewhere by an ENT, and this patient is sitting in front of me and their nose obviously isn't working properly, and they've been dismissed elsewhere. And you know, it's sort of the double maybe it's a triple whammy. The whammy they have this issue that they've sought treatment for that has been dismissed. And then they feel kind of foolish for even looking into something that maybe this isn't even an issue. And then they come in and we find out lo and behold, but it is an issue and well, we can do something about that. And we can do something about that, that's super simple. We could do a five minute procedure in the office and take care of this issue. And the proof on whether this is an issue or not is well let's find out, it's an experiment, it's because it's a consistent, reliable result, which is you take this person that's been dismissed elsewhere you identify a problem, you fix that problem and then you ask that person how does that feel? And that's kind of what you were just talking about is the back end of procedure. And most folks like the large majority, almost all of our patients in the back end procedures, feel this overwhelming sense of relief and overwhelming sense of being fixed, you know, fixing what was broken. And, you know, for us, it's so simple, and we have the tools to do that in a simple manner. And then it just boggles my mind. And then it frustrates me and annoys me to no end that person that you know, was dismissed elsewhere shouldn't have been and with the right tools and the right mindset could have been fixed. And when you do do that thing, that again, sometimes it gets diminished as well. I'd say you know, part of, so we talked about the nose, about in relation to breathing and you cannot breathe properly if your nose doesn't work properly, period, and yet, sometimes you can sort of diminished what we do as like, you know, you guys just fix noses and I'd say, "Yeah, you're right, we fix noses, which is the start of your way." And that creates a domino effect, a massive domino effect towards health or unhealthy. And, you know, that's something that, you know, if it's my health and I've done this with my own nose, and you've done this with your own noses if it isn't working, then and you have the choice, anybody in the right mind will choose to fix that. And I did it and my life is dramatically better on the back end of getting my nose fixed versus what was pre that. And you know, yours is as well and so I think it is something that we should be, you know, we should shout it from the rooftops and we should be unafraid to have people hear it and want to seek out the care that they deserve. Because it's more than the nose because when you have that nose it's working for you as back to this article, it really sets you up for life that you are meant to have and it has a massive, massive impact that I think, the reason that we stand out from the crowd is the crowd is wrong here. The crowd is wrong, the crowd who sort of diminishes this as an issue is wrong. And, you know, again, my proof of that, how can you say that, you know that bluntly? I'd say that bluntly, because, again, you take a patient, you put them through our system, and you take that same patient, you put them through the alternative, and results matter. And when we get some of the results that they're looking for, that's the proof right there. Like that's the experiment that should be run so yeah.

- Well, it is validating this, you know, I mean, think about how many patients like you said they see even people in our own specialty and they're told that nothing's wrong or given medications but don't actually address what the patient knows internally something's going on here, right? Like something's wrong and they're seeking care in a specialty that isn't necessarily giving them the care that they deserve and need. And so there's a validation element here that's also important. I mean if I can, even today in clinic where a patient's like so, I'm feel, basically she was saying that, so I'm right that I feel this way. And I was like, "You're telling me you feel this way." Like you are having this experience, you know, and you're not breathing well and so yeah, you know, and so there's a validation kind of component here that I think is, you know, equally important for patients to be heard, I guess.

- Right, yeah and I think back to this article, and maybe just finishing up on that thought is, I think back to these fundamentals, which again, this whole concept of breathing, I mean, obviously, breathing is the most important thing and like you know, so again, how do I know this? Because you can, if you don't breathe, you die and if you are down on the side of the road, and you're you know the ambulance comes up, they're going to follow the ABCs, which is airway, breathing, circulation in that order. Always airway is first, the start of your airway the nose and your throat secondarily. And so airway always comes first you have to have an airway. If you don't have an airway, you're dead. If you have an airway, you don't breathe, you're dead. If you have an airway, and you're breathing, and you don't have circulation, you're dead. But all of those things come back to the first you know, it's that first domino, second domino, third domino, in that order kind of thing. And so everybody talks I mean, I think, you know, you need a heart that's beating and that's really important. Everybody knows about heart disease, knows about strokes don't want anything to do with those things. And yet, that's in my mind, in a way, a tertiary issue to the breathing part of things. Meaning it's airway, breathing, circulation, airway, breathing, circulation, and yet we again as a specialty, do a poor job of explaining it with clarity and explaining it with tact and explaining with understanding that those things interrelate with each other. And they all come together, so why is it the ABCs? Because if you have an airway that's functioning okay, that allows you to breathe and you're breathing, that's a good thing. Circulation with circulation is doing is taking blood and moving around your body, why? Because blood is what carries your oxygen. So you need the airway and the breathing to deliver oxygen into your bloodstream. And you need the heart to move that around. So the heart works for the nose at the end of the day. Nobody says that, but it's true your heart work, you can't, your heart doesn't matter if your lungs aren't working, and your airway isn't working. It doesn't matter and so in that-- So my wife specialty and I are even more interrelated, you know.

- Absolutely, and it's like, well, I'm not saying it's your heart's not important, it's not that. But I'd say I think in the grand scheme of things, it's easy to--

- That's a simple eloquent way of stating I don't mean, interrupt like I never thought about it in that sense, but I haven't heard you state it in that way or thought about it that way, but I see what it's doing.

- I don't know that I've ever said it that way because I don't know that it's , but it is that's exactly what it's doing. Like, you know what I mean? Like if your heart was pumping on oxygenated blood, well then you're dead. And so that's what happens if you need the Heimlich maneuver. Like you know, meaning if you're choking and you're not breathing, your heart is still pumping until you no longer have oxygen in your system and then your system shut down and you die. Now, did you die from a heart attack? No, you died from this fixation from you know what I mean, it all starts back to the airway. Now people die from heart attacks, unrelated airway issues certainly. But their death is because the lack of oxygen throughout their body you know what I mean. It all comes back, like you have to breathe to live.

- And that article said that the nose you know, when you breathe through your nose, you deliver a higher percentage and content of oxygen to your lungs, right? So the whole idea of the lung is to move oxygen that your airway gets into your bloodstream. And that's the whole complex nature of lungs. And so, yeah, I mean, the heart does work for the nose, I like it.

- So we, I mean, again, part of this is a little, there's like 10% in jest and 90% in like, this is real. This is like not joking about it, you know, kind of a thing, you know, because it's so easy. Like I said, noses are easy to dismiss and diminish, and you've got an alternative to nose because you got your mouth and you got your throat and might say, okay, well, you could do your nose or your mouth, or both. Then the mouth that's been proven, the book talks about that reality the nose is the preferable route to breathe, and that's why you do have a nose. So there's ways to breathe but those three holes, your two nostrils in the back of your throat, that's all you got. And so if those aren't working, you're not living you just it's not happening unless you have some alternative method to make that happen. And so fundamentally, I'd say it does start there, the airway starts, you know, airway starts with us, meaning, you know, nose and throat. And we are not afraid to own that reality we're not afraid to state the reality too which is most people who have issues in these areas have anatomic issues in their nose and throat, I mean those areas aren't working. And so you could do all the things you want, you could use a CPAP machine, you could you know, take your high blood pressure medication, you could, you know, have your heart replaced, you could go to a cardiac transplant, and those things might be necessary. But if all or any of those things are coming after you, that many times, if you look all the way upstream and we're the most upstream in the airway as you get, you might find some issues there. And if you find those issues, then the nice thing is our issues are easy to correct. Like if you got an anatomy issue in your nose, it is so easy for us to correct that issue that it is almost I mean, nothing's too easy in life but I'd say it's really easy. It's not like, you know, a cardiac bypass or a heart transplant. Like we're talking simple office based, you know, minutes long procedures that have dramatic, lifetime and body wise impact. So there's no joke about that, like, that's real.

- Not to diminish it but it's easy for those who have, like, we have, you know, you talked about we have a lot of reps doing it, right. So, I mean, it's also people also make things look easy that might not be that way from just being good at them and taking time to learn a skill set too but yes. I mean, relatively speaking to, you know, big bypass surgery or something else like is a the same as big as that some you know, from a difficulty standpoint.

- Absolutely not, no. So, yeah, I mean, I think basically bottom line and I mean, I will read the book, it just came out. So I'll read it and sort of see if there's more nuances around sort of his breathing. But breathing, you know, I think that at least in last couple years, the nice thing is in the lay public, there's been a much, much deeper understanding of the importance of breathing, of sleep, of the things that we deal with are coming front and center to people's minds, which is really good. And it's really important, and it puts the spotlight on us as a practice and us as physicians to step up and own it and do the right thing, which is what we try to do. And so it's a nice mixture there. But it says, I mean, the reality is our services are needed in so many places, and that kinda closing the loop back to the front end, you know, talking about Appleton and talking about kind of us growing, is yeah, I mean, people need our services and because people need our services. We are figuring out ways to get where people are coming from to come to see us. As we've had people come down to Milwaukee from the Fox Valley for since we started the practice 16 years ago. And the nice thing is, we're coming closer to them and we're delivering the same services closer to home for those individuals because they deserve it. And, you know, it's sort of a shout out to the Fox Valley and Appleton specifically that's where our office, our initial office up in the Fox Valley is gonna be. And you know, for, again, for me personally, Gwen born and raised up in the Fox Valley, we were married up in the Fox Valley, so it's kind of a nice thing to kind of close the loop. So I'd say Appleton gets our shout out. We have it's been kind of a long time coming, but we're happy to be there and happy to kind of serve you in your home court, so any shout out or thoughts from your?

- No, I mean, I'm excited to spend some time there and get to know the people, the community and, you know, hopefully get that office up and going and be successful and reach a lot of people in Appleton so.

- Absolutely Fox Valley that's where it's at. So yeah, that's all we got. So, you know, thank you all for watching and listening, if you're watching us on YouTube, please subscribe to our channel. If you're listening to us on whatever medium, you've got to give us a rating, give us a like, give us a shout out, that'd be a nice thing. And always, if there's information that you guys are looking for from us, our website is, and that's where you can find us. So till next time, take care.

First published by ADVENT on
June 3, 2020
Table of contents
Breath: The New Science of a Lost Art