Dr. Kandula on the Uninvisible Podcast

Lauren Freedman:

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Lauren Freedman:

Welcome to Uninvisible. I'm your host, Lauren Freedman, and I'm here with my guests to bring you info, insights, and inspiration for coping with, diagnosing, and treating invisible illness. We're here oversharing so you don't have to struggle with invisibility anymore.

 

Lauren Freedman:

All right, guys. Thank you so much for joining us today. I'm here with Dr. Madan Kandula, who is the founder of Advent in Wisconsin and Chicago. He is an otolaryngologist and he specializes in sleep disorders like sleep apnea, which I have, as well as other disorders related to ear, nose, and throat. So Dr. Kandula, thank you so much for joining us today.

 

Dr. Madan Kandula:

Thanks for having me. Thanks for having me. Yeah. I'll be looking forward to talking more about sleep apnea and some of these other issues too.

 

Lauren Freedman:

Absolutely. Well, why don't we jump straight into it. Why don't you tell us about your area of work and your specialty?

 

Dr. Madan Kandula:

Yeah. So I'm an otolaryngologist, which is a fancy name for ear, nose, and throat physician, which is the specialty that obviously covers those areas that are in its name but it really covers head and neck issues other than the eyes and the brain specifically. And really, our practice, we started as a general ENT practice but we really are focused on what we call the breathing triangle, which is the nose and throat part of that. So if you take ear, nose, and throat and lop off the ears, then you have a nose and a throat.

 

Dr. Madan Kandula:

What I've come to learn and what my patients have taught me over the 15, 16 years I've been in practice is that folks who have issues in those areas often have issues in both of those areas and much of the time don't know that reality. So the nose and throat really are very, very much entwined. If they are challenged in those areas, people do their best when we remove the obstacles in both of those areas.

 

Dr. Madan Kandula:

So it's absolutely in our wheelhouse from a specialty standpoint, so sleep apnea, which you mentioned out of the gate, it's a throat issue. If you have obstructive sleep apnea, you have a throat issue 100% of the time, not 99, not 98. It's always that. But unfortunately most folks who have sleep apnea never see an ear, nose, and throat physician. There are other physicians that can certainly help out, and I don't think this is too much of a rocket science approach, but if you have a throat issue, I feel and our practice believes, that you should be seeing a throat specialist. And there are multiple options that come along with some of these issues. But that's the long and the short of it, is that we really treat basically sleep apnea, snoring, nasal blockage, sinus issues, allergies, so those issues. And there's so many people who suffer with those issues.

 

Lauren Freedman:

Yeah. I mean, these are also issues that can cause a host of other problems. So are you talking about surgical interventions as the main focus of the practice or are there other holistic approaches that you take as well with your patients?

 

Dr. Madan Kandula:

It depends. We are surgeons so we do do surgery. Let me walk you through the walk here though. Most people who have sleep apnea, so everybody who has sleep apnea has a throat issue. If you have sleep apnea, there's three options. There's a CPAP machine, which is the machine you can wear when you're sleeping at night either on your nose or your nose and your mouth. There's an oral appliance, which is like a retainer that you can wear when you're sleeping at night. It just sits in your mouth. And then there are surgical procedures that we do on the throat for the right candidates.

 

Dr. Madan Kandula:

When we see patients, the least likely thing we're going to offer somebody is surgery on the throat. There are certainly folks who are good candidates for that but most aren't. Alternatively, for folks who have sleep apnea or snoring issues, if you've got a nasal blockage, that is very common in those situations, then on that side of the fence, if you've got nasal issues, it's either anatomy or lining, so either things aren't open enough or the lining's irritated. In that situation, most folks actually could benefit from simple in-office options, procedures to get the nose more open because medications don't treat the anatomy.

 

Dr. Madan Kandula:

It depends on the area we're talking about but what we try to do is listen anda understand what our patients are telling us, listen and understand the place that they're coming from and try to match up our treatments to make sure things are fitting properly.

 

Lauren Freedman:

Absolutely. It sounds like, as you have mentioned, a lot of patients who have these kinds of issues aren't necessarily being referred to see an otolaryngologist or an ENT. So is part of the work you're doing about raising awareness of the need for overlap in these treatment areas?

 

Dr. Madan Kandula:

Yeah. Absolutely, absolutely. I mean, the first principle is people need to understand more about these issues. These issues, as you mentioned before, they don't affect just that one area. It really can ruin somebody's life, and we see this all the time. It's a massive domino effect and we are guarding the first domino. As that guard, as the person who's the gatekeeper there literally to somebody's airway, we, and when I say we, I mean my specialty and me specifically, needs to do a better job of getting the word out and letting people know that they don't need to suffer.

 

Dr. Madan Kandula:

And part of why I get on my soapbox sometimes is you see patient after patient that's mistreated, unfortunately. How do you say that? People are frustrated and rightfully so because the system that exists right now throughout this country is broken. For somebody who has sleep apnea, the system doesn't typically work for them. And so when you look at statistics, if you have sleep apnea, the likelihood that you're going to find success with treatment is about 30% with the typical pull it off the shelf one size fits all approach. It doesn't work.

 

Dr. Madan Kandula:

But the thing that gets me going is that if you just have a little bit more thought put into it, the success rates go massively up and so it's just trying to make sure people are aware of some of these facts, and then letting people live their own lives and do what they feel is right. I mean, to each their own. But I think if you're ignorant because the information's never been presented to you or options have never been presented to you, and I have maybe some information that might be helpful, then it's my job to get that information to you.

 

Lauren Freedman:

Absolutely. And what about within your practice, what are you finding to be the most recurrent illnesses and symptoms that you're seeing among the patients who come in?

 

Dr. Madan Kandula:

It really runs the gamut. Because I think theoretically, if you want to connect the dots back, so if somebody who has sleep apnea, they may come in ... The most likely reason for them to come in is because they're snoring and they're keeping their bed partner awake. That's very, very common. But in addition to that, they might just be dragging through their life and just not having the energy that they feel like they should have. The challenge is if you have sleep apnea, it's happening in your sleep and you're the last person to know that something's going on.

 

Dr. Madan Kandula:

I think it runs the gamut. Yes, we're an ENT practice. We have these specific areas of focus. I think we see folks coming in seeking help for conditions that you wouldn't sometimes necessarily relate with ENT issues. Even like the fatigue I just said. I don't know that people would say, "Oh, I'm tired. I should go see an ENT." You might think, "I'm tired. I don't know what you do." You might want to do a whole lot of other things. Maybe you're going to be on the right path, maybe not.

 

Dr. Madan Kandula:

And then from a nose standpoint, we see a lot of folks with chronic headache issues, sinus infections, those sorts of annoying ongoing quality of life devastators. Yeah.

 

Lauren Freedman:

Absolutely. It's interesting because it seems to me that allergies, nose issues, even fatigue, those are things that most of us would go to our GP first for care. Do you think it's a disconnect between the referral system as well that perhaps GPs aren't always aware that any of those symptoms should probably be referred to an ENT as well?

 

Dr. Madan Kandula:

Yeah, I think so. And I don't like to point fingers but I would say that system isn't working really well, meaning from a referral standpoint. I guess, I can only speak to my experience with definition. I'd say definitively for the patients that we see here and we treat, far, far too many of them have been given multiple band-aids to try to stop a massively hurtful wound and that's not right. So for me, there was a time where I held my tongue a little bit more and tried to be polite about it. At this point, I don't want to be rude about it and I don't want to be anything other than truthful and forthright and just letting it be known.

 

Dr. Madan Kandula:

Not all ills in the world are due to sleep apnea. That's not true. But I'd say there are more people in this world walking around in suffering needlessly than there ought to. And even one person who's suffering needlessly is one more than there should be. But we're talking millions of people whose lives are being impacted. And then when I get heavy on this is we typically think about this quality of life impact, which is significant, but if you have sleep apnea that's not getting treated properly, yeah, it's impacting your quality of life. It will likely end your life sooner than it was supposed to be.

 

Dr. Madan Kandula:

Now, the actual sleep apnea is not going to get you but the heart attack or the stroke or the diabetes or the depression. Those things will get you. So the challenge for me and the world around us is that if somebody dies from a heart attack and they had sleep apnea that was undiagnosed for 40 years, nobody typically connects it back to the sleep apnea. They say, "Oh, it's sad that Joe Smith died at 50 from a heart attack. Isn't that too bad?" If it's true that Joe Smith had sleep apnea that was untreated or undertreated and he died from a heart attack, what's true is in his untreated sleep apnea was that first domino that led to this devastating impact.

 

Dr. Madan Kandula:

And I think if that story was told, then everybody would be up in arms and say, "We need to do something. We need to do something about this." But that story's never told. Not to be too rude or puny, but that gets buried. It's buried away and it's a sad story but nobody learns a lesson from it. That's just not right in my opinion.

 

Lauren Freedman:

Absolutely. Well, what about the stigmas attached to illnesses like sleep apnea? We walk around the world like allergies are a normal thing, right? But with something like sleep apnea, it's very interesting because I had that experience personally as someone in their 30s getting diagnosed with sleep apnea and being like, "I thought only old people got sleep apnea." Right? How do we begin to break down those barriers of stigma and allow people to understand that this is something that affects a much larger portion of the population?

 

Dr. Madan Kandula:

Right. The person that may be pointing the finger at you and saying, "What's wrong with you?" They might have an issue as well, is the reality. It's such a common issue. I think that there is some awareness of sleep apnea these days. When I came out of training in 2003, and back when I came out of training, I'd say back 20 years ago, I don't know that most people would have heard of sleep apnea. Maybe a little bit. I think in 2020, I think most people have at least head that term, like, "Oh, okay, sleep apnea." Or CPAP. I think a lot of people-

 

Lauren Freedman:

But that's usually, it's like your grandpa has it. It's not like you do, right?

 

Dr. Madan Kandula:

Yeah, exactly. I mean, although it's absolutely a ... Sleep apnea, just to cut through some misperceptions potentially is it's not an old person's disease and it's not a young person's disease. It's a person's disease. The truth, and this is another truth that I don't think people are aware of, is that we as a species, this is where it gets a little weird, as a species our airways are becoming smaller, which is why you're seeing so many people who have this issue. So when somebody has sleep apnea, just so all your listeners understand what we're talking about here, if somebody has sleep apnea, what that means is that person's sleeping at night and their airway is shutting down. And when I say airway, I mean the back of their throat.

 

Dr. Madan Kandula:

So they're trying to breathe, their throat is shutting down, and therefore they can't breathe. They stop breathing and then the body does something to wake them up mentally or shift positions so that their airway opens up again. That's sleep apnea. So if your airway can take a punch, then okay, you don't have sleep apnea. But what's happened over time, and it's actually fascinating to me as a science geek, is that when you look at skulls, you look at us now in 2020 and you look at our ancestors not that long ago, pre-industrial age, early 1900s, our skulls don't look the same. Our airways are shrinking.

 

Dr. Madan Kandula:

How many people do you know who have had their wisdom teeth out and I'd say almost everybody. Who hasn't had their wisdom teeth out nowadays? Our great grandparents didn't get their wisdom teeth out. Not because they didn't have the medicine to do it, because their jaws were bigger. Their airways were bigger. Some of this stuff really-

 

Lauren Freedman:

Why do you think that is that that's happening? It seems like a fault in our biology, doesn't it?

 

Dr. Madan Kandula:

It seems strange. But similar and actually related, I think, to the allergy thing that you said, I mean, allergies are so common these days.

 

Lauren Freedman:

I mean, that's environmental for sure.

 

Dr. Madan Kandula:

It is environment. And so if you walk it back and you walk to the industrial revolution. Things have changed in our environment. There's different things in the air. Additionally, our environment at this point, it's going to sound weird, but it's a situation where it's so clean and so managed that our bodies aren't exposed to the things that our ancestors were. So back in the day, simple things like if you were living in a farming community, then you were breathing in stuff constantly from when you were born and your body adapts to it and says, "Hey, that's pollen. No big deal. We're going to move on."

 

Dr. Madan Kandula:

Now in our new environment, you're walking around in a city. You're walking around with your hands nicely washed, everything's clean and all of a sudden you see a little bit of pollen come through and what all allergies are, your body misidentifying something as an enemy. So your body's breathing a little pollen in and saying, "That's a poison and we need to shut that down. We're going to shut that down by swelling the lining of your nose up, making your eyes itch and water, your nose run. We're going to make you sneeze. It's taking something that's not a problem and making it a problem.

 

Dr. Madan Kandula:

But then that's the start of your airway. Your nose is the start of your airway so if your nose is a little bit stuffy and you're a child, then what ends up happening is that nose that's stuffy causes your mouth to drop open maybe just at night, maybe day and night. A mouth that's open creates a domino effect there too where your jaws do not form properly. You can make a nice story that way. Not everybody who has sleep apnea has that story, but a lot of folks do.

 

Dr. Madan Kandula:

Most folks who have sleep apnea, the issues actually started way back in the day a lot of times when they were kids and they might not have had sleep apnea then but they were destined or programmed because of their environment to have an airway that they weren't supposed to have. And then as you get older and your airway is compromised, most people I think ... When you hear the word sleep apnea, a lot of folks think about you have sleep apnea because you got too much weight on and sometimes that's true.

 

Dr. Madan Kandula:

But I'd say the flip opposite is actually more true. This is something I've recognized more recently unfortunately is that if you have a compromised airway, almost a guarantee is you're going to have more weight on your body than you're supposed to have because it's hard to be active and productive and make the right choices food-wise when you're not breathing and sleeping properly. I don't. If I don't get a good night's sleep, the next day I'm less likely to exercise and more likely to eat trash. And so if you eat trash and you're not mobile, then you're going to put some weight on. You put weight on and you've got a compromised airway, that's going to make your airway even tighter and there you go.

 

Lauren Freedman:

It's a vicious cycle.

 

Dr. Madan Kandula:

Absolutely. And so I'd say certainly there's folks who ... If you want sleep apnea, gain a lot of weight and you're going to have sleep apnea. Nobody chooses to do that. I'd say maybe somebody out there is in that camp but I'd say more folks are in the camp of compromised airways that they don't even know that starts the ball rolling.

 

Lauren Freedman:

Do you think it's something that perhaps more people should be getting tested for as a baseline? We go in for our annual checkup at our GP. Should we be having our airways checked as well?

 

Dr. Madan Kandula:

It's a slippery slope there. Yes. I think yes if the person who's looking and thinking, isn't just checking a box off. Because unfortunately in medicine, I think, as anybody who goes and interacts with the healthcare system these days, there's a lot of box checking and not a whole lot of listening and not a whole lot of common sense going on these days. But yes. I think if we had a system in place where somebody who has a question or, "Man, maybe I have this issue. I'm not sure." If those people could go in. The way we diagnose this is so simple these days. It's an at home sleep study. So you don't have to go to the sleep lab. You can sleep in your own bed. It's a simple device. You go to sleep with it one night. If you bring it back, we download the information. It tells us exactly what's happening.

 

Dr. Madan Kandula:

That's a big deal. That we've been able to do really well for the last 10 years or so. Prior to that, everybody had to go into the sleep lab. Sleep labs still have their place in the world today, but a small place. But anyway, I'd say awareness of these issues, diagnosis, and going from there. I mean, when you think about healthcare in general, and I actually try not to, I try to think about the person who's sitting in front of me and that's the most important person in the world to us. And when you do that, when you're intentional and in the moment, that's I think how you actually change the world. But if I allow myself to fly out into space and look down upon us, I'd say if you think about healthcare in this world and this country specifically is a massage change that could be created in a simple manner would be to diagnose all those folks out there who have sleep apnea and then to treat them properly.

 

Dr. Madan Kandula:

Because all the other things we've talked about, when you look at healthcare spend and you look at heart attacks and strokes and diabetes and depression. I could go on and on and on. If you could magically wave your wand and take those things out of people's lives, that's massive impact on lives but it's also massively decreased spend from just a global standpoint. So it's a win-win. But the challenge is people have a hard time connecting those dots, which, again, is why I like to talk about some of these things. Some of it gets a little complex but a lot of it I think is very, very-

 

Lauren Freedman:

It's deceptively simple, isn't it?

 

Dr. Madan Kandula:

It's very simple. It's literally in front of your face. That's where the answer is.

 

Lauren Freedman:

It's literally, that the place where it all happens, yeah.

 

Dr. Madan Kandula:

That's it, that's it. So there's not many things where it's like it's right in front of you, man, it's right there. Yeah.

 

Lauren Freedman:

It's very interesting because it seems to me that you're actually in your practicing taking a root cause approach, which is a more functional medicine ideal. But actually in my discussions with various practitioners who I've had on the show, it seems to me that the agreement tends to be among doctors and especially good ones, that we should be taking an integrative approach in all medicine, shouldn't we?

 

Dr. Madan Kandula:

Correct. We should. The challenge is that the system isn't built for that. So if you try to do that, you're bucking the system and it's hard to buck the system. Most people don't want to buck the system and sometimes when yo buck the system, the system bucks back.

 

Lauren Freedman:

I'd say that's more often than not. Yeah.

 

Dr. Madan Kandula:

So it's not for the faint of heart. Most people are faint of heart. Kind of what I was saying before about I was a good boy for a while and then what I began to understand is that being a good boy and playing by the rules of a system that's broken, morally I'm not okay with that. And not that we're doing anything ... We are as buttoned up as you can be. But all I'm saying is that if you believe there's a problem and you believe you have a solution, then it's your duty to bring that and bring that full force. And that's all we're trying to do.

 

Dr. Madan Kandula:

Yes. I would say the integration of some of these disparate areas in healthcare would be wonderful but the solution for that will never be a top down approach. It cannot happen because when you go top down, you crush what's on the bottom. It has to be a bottom up approach. When you're on the bottom, you're trying to raise awareness and bring things up. Again, you're fighting that entire system that's above you. Yes. We need more people who are willing to fight the good fight. Yeah, absolutely.

 

Lauren Freedman:

Yeah, absolutely. I couldn't agree with you more. I'm sure our listeners would agree as well. I'm wondering in terms of the people who come into your practice, are you finding that you're dealing with hypochondria at all in the practice? I mean, this is always my question particularly as it revolves around invisible illness, right?

 

Dr. Madan Kandula:

Sure.

Lauren Freedman:

Because the number of us who've been told that we were fine when we weren't. Obviously you talked about patients who are coming to you and are frustrated by the time they get there because they've dealt with not being believed. But are you seeing by the time they get to you, are you seeing any hypochondria in your practice and how do you handle it if you do see it?

 

Dr. Madan Kandula:

Honestly, I wouldn't necessarily say I see so much hypochondria. I mean, I'm trying to really think about the definition of hypochondria to me means somebody who doesn't have an illness and ...

 

Lauren Freedman:

Thinks they do.

 

Dr. Madan Kandula:

Thinks they do or wants to. I don't know, one of those two things. I do think there are some folks who come to see us because they do think there's something wrong with them and sometimes they just want us to assure them that things are looking okay. Now, the truth there though is many times, not all the time, many times those people who wonder, "Jeez, I think there's something not quite right. And we dive beneath the surface and we look. Many times we actually find that that's true. I feel like we see ... I don't honestly ... How do you say this?

 

Lauren Freedman:

You don't see a lot of hypochondriacs.

 

Dr. Madan Kandula:

We don't see a lot of them. And in fact, I see a lot of people who maybe have been pegged as something like that and actually they had an issue, which is almost like to me ... I'm thinking about this honestly. But to me, almost the greatest sin that we could do as clinicians is to dismiss somebody because of our own-

 

Lauren Freedman:

Not to believe our patients. Yeah.

 

Dr. Madan Kandula:

Because of our own ignorance or inadequacy.

 

Lauren Freedman:

Or ego maybe.

 

Dr. Madan Kandula:

It sounds harsh, but I think sometimes it's intentional, meaning intentional that you're taking a lot of time out of my schedule and I don't have the time for you today, buddy. You know?

 

Lauren Freedman:

Yeah.

 

Dr. Madan Kandula:

So that's intentional. But I think a lot of times it's lack of understanding. And even some of these airway things we were just talking about is that if you don't understand that concept, if you don't understand that a narrowed airway can lead to sleep apnea and sleep apnea can lead to depression, for instance ... Again, those are simple jumps to make. That's absolutely been proven. And you're seeing somebody for depression, if you don't open your mind to start trying to walk your way back to the root cause, then you're not doing that patient a disservice. And I think especially for mental illness specifically is there's all ... And I don't want to necessarily open up that door. But there's so little good science there, in my opinion, and so much chatter and disinformation that it's ... And I'm not-

 

Lauren Freedman:

It sounds like from your perspective a lot of mental health issues actually have a physical beginning.

 

Dr. Madan Kandula:

Yeah.

 

Lauren Freedman:

And it's not a brain issue necessarily but more to do with the rest of your anatomy not working properly.

 

Dr. Madan Kandula:

Potentially it may mean that. Certainly there are people who are depressed and have no airway issues whatsoever. And that's a shame and they ought to be treated. But again, my bias is a bigger a shame is somebody who ... Let's just use this as an example. Somebody who's got depression and actually has an airway issue and actually has sleep apnea that hasn't been treated, that's not a shame, that's a sin. And that person, it's not just like, "Oh, that's sad." Really, if you think about the balls there, good god, if we would have just had our eyes open, understood the situation, treated that medical, the physical issue, that might have prevented that whole other issue kind of a thing.

 

Dr. Madan Kandula:

And back to this awareness sort of a thing, that shouldn't happen. And if I have anything to do with it, under my watch, it won't happen. Now, it still does happen because I'm one person and there's only so much I can do. But I would say that I think if more people had awareness and the attitude to just check it out. I mean, again, on this one, if you or somebody you loved had this issue and you could simply figure out what's going on, why wouldn't you do that? You should do that. Anybody who says otherwise, I need to hear a counter argument to that because I don't think there is one.

 

Lauren Freedman:

To make sense of it.

 

Dr. Madan Kandula:

Yeah.

 

Lauren Freedman:

And I wonder also because you've touched on doctors who are strapped for time and how the system is rigged against not only doctors but patient =s in that way as well. I wonder, how have you found at your practice a way to work around it? Have you removed yourself from the larger system of health insurance entirely in order to deal with that?

 

Dr. Madan Kandula:

We haven't. We walk this fine line. I'm sure this is not the first time you've heard this, is that people have their healthcare insurance and they would like to use their healthcare insurance for their healthcare.

 

Lauren Freedman:

Because they still need it to be affordable.

 

Dr. Madan Kandula:

Exactly. And we understand that. And so for us, it's like, "Okay. How do we help our patients?" If we can play by the rules of the system but figure out a way-

 

Lauren Freedman:

Just enough.

 

Dr. Madan Kandula:

Well, but yeah, kind of. I think to me that's a truth as it is exists today. People who have health insurance want to use it for their healthcare. Okay, fine. Now, the rest of the system typically, like a typical medical practice, if you're going in to see an ENT practice, let me say specifically, if you're going to go see an ENT, you're going to go see the doctor at the first visit and every visit and that's a good thing, that's a fine thing. We don't do that here. That sounds weird but it's how we do it. How we approach our patients is we call it team based care. So we have PAs and nurse practitioners and MDs and we work together.

 

Dr. Madan Kandula:

So by doing that, it allows us, for instance, if somebody comes in to see us, their first visit's going to be with a physician assistant or nurse practitioner. Now some people might not like that, and those that don't like it don't like it because they don't understand why that's set up that way. And if somebody's willing to listen, I'd say, "Hey, I get it. I understand that you want the best care that you can have. The reality is, this is the best way to do that." Because when we do it that way, then that physician assistant at the first visit has plenty of time to sit down, look at you in the eyes, talk to you like a human being, and understand what's going on and then use the tools that they have to look at you.

 

Dr. Madan Kandula:

Again, let's say it's an airway issue, look at what's going on anatomically and have a, "Okay. I hear what's going on. I can see what I see here." And then if additional testing is necessary, so say a home sleep study is necessary or imaging is necessary to look at the nose and the sinuses, they're going to get those things set up and then the next time that you're going to come in, now your going to see the doctor who now has the information that they need and they have the time now. Now instead of wasting that doctor's time by information gathering on the front end, let's make sure that the doc has all the information that they need so when they sit down with you, we're not wasting your time or their time. And that's how we do it.

 

Dr. Madan Kandula:

So really, what we do is we protect and preserve our doctor's time by making sure that our docs are doing things that only doctors should be doing and we protect and preserve our PA's time that way. That's how we do it and that works okay within the system.

 

Lauren Freedman:

It sounds to me like it's more of a medical concierge system in that way. Because so many patients, so many of us struggle when we sit down with a new doctor to tell the story, right? There's so much that can get lost in translation. It sounds like your bridging that gap by bringing the PAs or the nurse practitioners in first to create the story in the doctor's language so that there is an understanding between doctor and patient and you can lead them through the process.

 

Dr. Madan Kandula:

Yeah, absolutely.

 

Lauren Freedman:

To me that's more sensible and it's a shame that more practitioners probably haven't figured that out yet, right?

 

Dr. Madan Kandula:

Right, right. And there's the counter argument to that which is ... I guess bottom line, as you said, and I'd repeat it is we don't have the perfect system and our system, we're always working to make it better, but our system is as good as we can make it to be in the day and the age that we live in and meeting all of our masters. We serve our patients but in order to serve our patients, we need to work with their insurance companies because that's what most people want. We've thought and talked about, "Well, could we just buck the whole the system?" We could, but then we would actually reach fewer people and fewer patients which that's not a great option for us, what we're trying to do.

 

Dr. Madan Kandula:

Yeah. It's trying to say, "Okay, these are the rules. With these rules, how can we continue or how can we deliver the best care that we can?" In this day and age, this is how we do it. It really does work. It works as a physician, I'm a better physician because I work in the system that I work in than I was back 10 years ago when I was seeing every patient every visit. There's so much time in a day. In addition, there's so much time in a day but there's also so much time that somebody can be truly present and engaged. And I think the frustration on both sides, from a physician and a patient standpoint is when a patient comes in and expects full engagement, full attention and doesn't get that.

 

Dr. Madan Kandula:

And then as doctor, if I were put in a situation where I was not able to be present and fully engaged, I would feel like I'm compromised. Most doctors in this country, they call it burnout, but they're getting crushed in this system as well because they aren't able to do what they got into this business to do because the system is so discombobulated that it ruins it for everybody. It ruins it for the patient, it ruins it for the physician. And then you have a bunch of ... Everybody's unhappy, which is a shame because doctors are generally in it for the right reasons and want to do the right thing and the system almost sometimes makes it impossible.

 

Lauren Freedman:

Works against them.

 

Dr. Madan Kandula:

Yeah.

 

Lauren Freedman:

Yeah.

 

Lauren Freedman:

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Lauren Freedman:

And I'm wondering, is there special training that the practitioners in your practice go through in order to address that patient feeling of frustration, that so many patients are coming to you after going through doctor after doctor after doctor getting no answers maybe or getting the wrong answers feeling very frustrated and like they've been shuttled from specialist to specialist? Does that mean that you're also making sure that the clinicians who work in your practice are practicing greater empathy toward patients as well, that their bedside manner is a really important part of the hiring process?

 

Dr. Madan Kandula:

Yeah, yeah. Anything short of excellence in that regard is a nonstarter. Part of it is just if you're in a culture where that's the expectation, then you raise your game if your game wasn't there to begin with. How do you say it? We don't actually sit and talk about this so much. We do and we model by doing and then that's the culture that we have. I mean, we've got a few core values. The first core value, we call it Advent's Golden Rule, which is not ... The Golden Rule is do unto others as you have others do unto you. Advent's Golden Rule, there are other words for it, other terms for this, is it's not just doing as you have others do unto you, doing the ideal thing for that person because sometimes, and especially in this culture and this day and age is I think a lot of people don't do or think enough for themselves. Meaning a lot of people expect or accept a compromise in life and a comprised situation. So if you just follow the Golden Rule, you actually aren't treating somebody the way that they ought to be treated in my opinion.

 

Dr. Madan Kandula:

So here, it's really more a matter of optimizing the care of that patient by caring for that patient. These are all words and words are cheap. So action is where it comes into being.

 

Lauren Freedman:

But it's making the patient number one, it sounds like.

 

Dr. Madan Kandula:

Absolutely, absolutely. Yeah.

 

Lauren Freedman:

Yeah, yeah. And doing good by them. We've talked a lot about the ways in which the healthcare system is rigged against doctor and patient. I'm wondering if there are ways in which you see it working in its current form?

 

Dr. Madan Kandula:

I think the potential ... So here's what I'd say. In this country in my opinion we have, when all cylinders are firing, we have the best healthcare in the world.

Lauren Freedman:

But?

 

Dr. Madan Kandula:

Period. But what I said before, the system's broken I'd say because there's so many barriers to entry toward getting to when it's firing on all cylinders that when it's firing, if you have ... There's many times where the system works better than anywhere else in the world and then it depends on how you define that. That's where you start losing it because we've got however many million people we have in this country, is it averaging the care for all those people across every individual [crosstalk 00:37:01].

 

Lauren Freedman:

I feel like at access we're not doing so great.

 

Dr. Madan Kandula:

Correct. But I guess that's the thing. I'm just stating the facts. I think if you have access and you have an issue and you get plugged into the right resource-

 

Lauren Freedman:

Then you can get great care. Yeah.

 

Dr. Madan Kandula:

You're going to get the best care around in the world. And I'd say, "What's my proof of that?" Because in my specialty, folks come from around the world to hear about what we can do here at that top level of care. I'm not saying it's all ... I'm just saying-

 

Lauren Freedman:

It's not all terrible.

 

Dr. Madan Kandula:

It's not all terrible. And in fact, there are great, great things happening in healthcare.

 

Lauren Freedman:

How do we increase that access though? I mean, if the patients who are getting care are getting very high level care, how do you as a clinician, how do I as an advocate, how do patients create better access so that our success rate can keep going up?

 

Dr. Madan Kandula:

Right. That's a tricky question.

 

Lauren Freedman:

That's the one we're trying to figure out. Yeah.

 

Dr. Madan Kandula:

Yeah. I guess, I'd say that would start with having an expectation. If you're a healthcare consumer having an expectation and also a will or a say in the game to begin with, and when you aren't receiving the kind of care that you feel like you expect, letting it be known. And I'd say letting it be known by letting them ... And this is where I start losing it, as you see.

 

Lauren Freedman:

No, no, no. You're doing great.

 

Dr. Madan Kandula:

Sputtering here.

 

Lauren Freedman:

You're doing great.

 

Dr. Madan Kandula:

But it's challenging. I think-

 

Lauren Freedman:

It's a philosophical discussion as much as it is a logistical one.

 

Dr. Madan Kandula:

It is, it is. But I would say if people who become patients are empowered in their care-

 

Lauren Freedman:

Well, we're all going to become patients too at some point.

 

Dr. Madan Kandula:

Yeah, exactly.

 

Lauren Freedman:

That's something to keep in mind, right? We're all going to need this system at some point.

 

Dr. Madan Kandula:

Absolutely. When you cross that door into a healthcare facility, you are in charge of your care. And if you have that mindset, then you're going to watch out for yourself and protect yourself and make sure you're getting what you need. Whereas, it's a different mindset. I mean, both my parents are physicians. I remember when I was a kid, there was much more of a paternalistic model. And that still exists. I think you have this overlap of a paternalistic model, which means you go into the doctor and the doctor is like your parent and you, "Yes, ma'am."

 

Lauren Freedman:

You do what doctor says.

 

Dr. Madan Kandula:

Correct. And so you have vestiges of that. There's a little bit of a nostalgic like ... There was a time and place where maybe that was, I wouldn't say bad, but that existed. In the current day and age, there's a memory of that but then a system that doesn't at all behave like that. And then we're also in an entirely new information age where literally every single person walking around in this world has access to as much information as their doctor does.

 

Lauren Freedman:

Well, and that's great because you're even participating in that information system, right? You're posting videos that have information about your practice and the kinds of patients that you're seeing and tests you're running. So being aware, looking for that kind of information from a patient perspective for sure.

 

Dr. Madan Kandula:

Yeah. It's good. And if somebody's motivated, you can find a lot of stuff. Sometimes it's too much stuff. Sometimes you read so much and-

 

Lauren Freedman:

How do you know what's real and what's not? Because we're in this post truth world.

 

Dr. Madan Kandula:

Absolutely, exactly. And that's the challenge. And then you really ... We move from a paternalistic model to your physician is really the arborator I think of maybe truth versus not truth to some extent and it's a different role that you're serving. When my parents went through medical school, you could only get this information by going through medical school and that's it. And if you didn't go through medical school, then you need to just listen to what we're saying. Nowadays, everybody's got access but then nobody knows what to do with all that information.

 

Lauren Freedman:

Right. So it's sort of the same problem. It's the other end of the same problem.

 

Dr. Madan Kandula:

Correct. And that's happened, at least in my lifetime. That's happened and it's happening. And then that's where you get the system where you get so much frustration, I think, is that you have some disconnects there.

 

Lauren Freedman:

Yeah. So when patients are coming to you, say they have a nebulous symptom situation, "Oh, I'm kind of tired. My nose is a little stuffed." What kinds of tests are you going to run on patients when they first come to your practice?

 

Dr. Madan Kandula:

Well, first is listening and really that's ... It's not a test but it's the first. We need to understand what are you noticing. Sometimes that's crucial. Well, it's crucial for us to hear you but then it's also crucial for us to maybe hear between the lines of what you're saying. And then based on that, then we actually look. Before we do any additional testing, it's looking at you. Fortunately, as a head and neck doc, this is easy access. We can look in your nose, we can look in your throat. We can see everything we need to see. You've got all the scopes. Correct, exactly. You don't even have to undress to see us, so it's nice. Between what you say and what we're seeing, we pretty much have a good sense as to how likely are you to have, let's say sleep apnea.

 

Dr. Madan Kandula:

The first time you come in, we should have a pretty good guesstimate. And we say, "Between what you're saying and what we see, this seems like you're likely to have this." Then absolutely, we'll do a home sleep study to see what's going on and go from there. It's taking the tools that we have and making sure we're using them in the right way and then going. Same thing for the nose and sinus people. Simple, a very, very common test that we would do would be do imaging of the nose and sinuses because one thing we can't see is we can't see into the sinuses when we look at you. We have to use x-rays to do that. We do that when necessary so we can see what's happening behind the scenes so we can know what's going on so we can treat you properly.

 

Lauren Freedman:

So would someone like me, like I've got a CPAP, right?

 

Dr. Madan Kandula:

Mm-hmm (affirmative).

 

Lauren Freedman:

Do you see that as a longterm solution to something like sleep apnea, or is it am imperfect ... Because I often think to myself, "Gee, it's a good thing my CPAP is more compact." They've gotten smaller over the years but it still feels like a bit an ancient way to be treating something that we haven't come up with something more convenient, if you will.

 

Dr. Madan Kandula:

Yeah. It could be a permanent solution. It is a bit of a ... How do you say this? It's a bit of a ...

 

Lauren Freedman:

Like a gray area?

 

Dr. Madan Kandula:

Well, I wouldn't say it's so gray. My bias is ... Let me dial back. If you have sleep apnea, you have the three options. You have CPAP, you have the oral appliance option, and you have surgery. Most people who do well with the CPAP machine would do just as well with an oral appliance. Most people who have sleep apnea have never heard about an oral appliance. To me, that's not right. And nobody's going to do very well if their nose isn't working. So if you have sleep apnea, like I said, you have a throat issue. There's about a 70, 80, 90% chance your nose isn't optimal either. And so if you're in a CPAP machine, the best way for the machine to work for you is your mouth shut, nose open, just in a nasal mask. If you're in an oral appliance, appliance in your mouth, nose open. That's working. If we do surgery on your throat, same thing. Your nose needs to be working.

 

Dr. Madan Kandula:

So to answer your question, I'd say it's a good solution. It's really the gold standard that we have right now. There are advancements on the surgical side of things. The tools we have there, I don't want to go into too much detail, but for instance, if somebody who has sleep apnea is using an oral appliance, what we're doing is putting something in their mouth that's just pulling the lower jaw forward. Your tongue is attached to your lower jaw. That opens up the back of your throat when you just move that a few millimeters. There are ways to actually change the configuration of your jaws through massive surgery. There's a standard surgery out there and you probably have not heard of this, but there is a big time surgery where they break your lower and lower jaws-

 

Lauren Freedman:

Oh, I've heard of this and I thought, "Oh, God, I hope I don't end up having to have my jaw broken.

 

Dr. Madan Kandula:

Exactly.

 

Lauren Freedman:

I like my jaw.

 

Dr. Madan Kandula:

So there's this big, bad surgery that actually works really well but nobody really wants to go down that road unless they have a good reason to go down the road. Now, if we had a more elegant approach to do a similar sort of thing, I think a lot of people would go down that road and there are those options. I don't want to get into a whole lot of detain, but if you could have a lower key procedure and change your airway by changing how those jaws are configured, a lot of people would move that way. But really right now in this day and age, I think most people are better served ... Actually, honestly, I think most people would be best served in an oral appliance. But you have to work with a dentist who knows what they're doing and wants to be able to work with you.

 

Dr. Madan Kandula:

Most people who come in with sleep apnea or questioning sleep apnea are pulled into a system that's rigged where basically the system assumes-

 

Lauren Freedman:

You're going to have to try the CPAP first.

 

Dr. Madan Kandula:

And even-

 

Lauren Freedman:

It's like a fail first situation.

 

Dr. Madan Kandula:

Or this is the only option and it's either this or the highway, buddy. I think a lot of people get that thing and there's never a discussion about any other option. But anyway, back to the machine, I'd say, yes, it's nice that the machines are smaller and quieter and better than they have been back in the day. It'd be nice if you had sleep apnea if you didn't have to have a machine to begin with.

 

Lauren Freedman:

At all. Yes. I often think that. I travel and I have to carry this extra briefcase around with me and I think, "God this would be so much easier if I didn't have to ..." I'd love to be low maintenance again.

 

Dr. Madan Kandula:

Yes. Absolutely, absolutely. I don't want to take this over, but have you heard of that oral appliance option or no?

 

Lauren Freedman:

I tried it actually.

 

Dr. Madan Kandula:

Yeah, okay.

 

Lauren Freedman:

I did the CPAP first and was only offered a mask that went over my nose and mouth. And no one told me about other masks. Then that didn't work because it kept me up all night because the cord hit me in the face every time I moved. So then I tried the oral appliance and went through months and months of dealing with ... I kept getting infections in the corner of my mouth. The appliance wasn't fitting right. We kept adjusting it and ultimately it just didn't seem to work. And then I went back to my ... I found a new sleep doctor and explained what had happened. He was like, "Oh. Why don't we just try a different mask." And he got me the nose pillows and it's been like night and day. But I still find it's not a perfect solution because it's not something that is fixed. It doesn't mean that your mouth won't open. It doesn't mean that you're not going to move and it might go off center a little.

 

Dr. Madan Kandula:

Sure, exactly.

 

Lauren Freedman:

So it's still not perfect and I do wonder if ... This is exactly why I went to my GP and said, "Hey, I think I might have some kind of underlying issue that might require a more elegant surgical option." Said, "Look, the CPAP's fine but I actually think what's happening is that I'm having a sinus issue and I need to get it checked out." There could be all of these underlying issues. I could have gone on with the CPAP for another 60 years but maybe there's an easier option.

 

Dr. Madan Kandula:

Correct. I would say, at least just how our system works, our system is built with the assumption that most people would rather not use the machine unless they have to use the machine. So our bias is that way versus the opposite. Now, we certainly prescribe a lot of CPAPs and there's a lot of our patients are in CPAPs but the system is built that way. The other part of our system is we start with the nose. It's a nose first approach because your airway starts with the nose.

 

Lauren Freedman:

See, no one's looked at my nose.

 

Dr. Madan Kandula:

Right. I'd say the reality is your sleep apnea is not coming from your nose, period. It's coming from your throat, but some of what you just said sort of ... And you're not alone here. It's a typical story. Your story is the every person's story, which is the system that's jumping to conclusions and jumping to treatments before we just say, "Okay, we can jump but let's walk logically in a forward direction." So our system, how we do things here is listen to you, look at you. If we think there's something going on in the nose sinus-wise, we're going to make a pit stop there before we go too far down the road.

 

Dr. Madan Kandula:

Now, if we look there and either we look and everything's good, we're going to let you know about that. Or we look at somethings not quite right here, we're going to talk through what's not right, what might we want to do about that kind of a thing before we even get you into any active treatments for sleep apnea. So we would overlap that step with we need to just do a sleep study. Do a sleep study but before we get to any active sleep apnea treatments, we are either going to give you the stamp of approval for your nose because your nose is good and your sinuses are good by themselves or we're going to do something to make them optimal or better or reliable before we even put you into a CPAP machine or oral appliance or anything else.

 

Dr. Madan Kandula:

What you said, and I don't know, but I would say ... Well, I do know. The number one reason ... The thing I do know, the number one reason for people to not succeed with a CPAP machine is because their nose is blocked up and they don't know about it. The number one reason for somebody to not succeed with an oral appliance is because their nose is blocked up and they don't know about it. For you, I don't know. Your nose might be just fine, but I'd say it makes me wonder. Folks whose noses are working properly and are in an oral appliance that's well fit for them, they tend to do really well. Not everybody. Certainly there are exceptions to that, but the rule is nose working, appropriate oral appliance, people do well.

 

Dr. Madan Kandula:

I'd actually say a similar thing with a CPAP machine. Somebody who we put in a CPAP machine, nose working, then we put them in a CPAP machine ideally with a nasal ... Again, the reason you got put in a full face mask is that is the laziness of the broken system, which says, "You have sleep apnea. We don't really care about you. We're going to shove something on you. We don't care the fact that most people cannot tolerate a full face mask because it's really claustrophobic."

 

Lauren Freedman:

Well, that was the other thing. I felt really claustrophobic.

 

Dr. Madan Kandula:

Absolutely.

 

Lauren Freedman:

And I've never experienced claustrophobia in my life.

 

Dr. Madan Kandula:

And it's frightening.

 

Lauren Freedman:

And I couldn't get to sleep because I was anxious. It makes you think, that was setting off my fight or flight, right?

 

Dr. Madan Kandula:

Absolutely, yeah.

 

Lauren Freedman:

I imagine that the apnea itself, the fact that I would stop breathing in my sleep and people who have sleep apnea, surely that's setting off your body's fight or flight response every time it happens and it could happen upwards of 15 or more times an hour.

 

Dr. Madan Kandula:

Absolutely.

 

Lauren Freedman:

So the fact that it can happen that often in your sleep and that your body's basically ... I mean, we talk about dealing with chronic stress in your waking life, imagine if you're having it in your sleeping life too, and this is exactly why sleep apnea is such a dangerous issue to deal with and why you need to get it treated if you have it.

 

Dr. Madan Kandula:

Yeah. To me, there's many definitions of insanity but this one, what you just said, if you follow the ball there is if you have sleep apnea, you have a throat issue. Again, you're likely to have a nose issue. So your throat is tight, your nose is tight. It's just a figurative person. Throat's tight, nose is tight. How can we truly ruin this person's life is we're going to put something over their tight nose and tight mouth and somehow think that they're going to go to sleep with that. That's the definition of ... It just doesn't make any sense at all, and yet that's the standard of care. It doesn't make sense. Absolutely, that fight or flight reflex.

 

Dr. Madan Kandula:

When somebody has sleep apnea, multiple times, sometimes more than 100 times every hour, their body's shutting down and so the body is just revved up and it's revved up and it knows your airway is not working right and it doesn't trust the airway and now all of a sudden, like I said, somebody's going to shove this thing on you. That's why the compliance rates are so poor with CPAP is that it's an insane process that's the standard of care. You're story is a story I hear all the time. Again, maybe that's just how it is and it would have been that way, but I'd say-

 

Lauren Freedman:

But also here we are three years later too.

 

Dr. Madan Kandula:

Right.

 

Lauren Freedman:

Let's get it together.

 

Dr. Madan Kandula:

A lot of folks jump off of that journey really early. A lot of folks go in, do a sleep study, get the CPAP machine, can't tolerate it. And not just can't tolerate it-

 

Lauren Freedman:

And that's it, they're done.

 

Dr. Madan Kandula:

I'd say there's one thing between "I can't tolerate this, I can't do this" versus "This thing, it feels like it's going to kill me." And then you go to tell your doctor that I tried this thing and I felt panicky, I felt like I had claustrophobia and your doctor, what they're going to say is, "Try it again." And you're going to say-

 

Lauren Freedman:

No.

 

Dr. Madan Kandula:

See you, buddy, I'm out of here. Because that's what you should say. You should say, "See you. I'm gone." That's crazy. And your mind is saying, "Don't do that."

 

Lauren Freedman:

And why hasn't health insurance companies then responded to the fact that there's such a low rate of response the first time around with a CPAP? They should be addressing other issues.

 

Dr. Madan Kandula:

Absolutely. Because they really don't get it. We've had many recent interactions where I'm talking to insurance companies. They have no clue, unfortunately. The insurance companies, I mean, it's easy to bash them. But I'd say the truth about all insurance companies is they absolutely are focused on their bottom line. And I'd say even there, if they actually listed to some of what we're talking about, if you're a bottom line guy or gal, this is bottom line. If we could treat these issues early on and prevent these downstream complications, if you're a top line, bottom line, or just sort of golden rule person, it hits it right there. It's good in all regards but they actually don't listen. In fact, I think how they're wired is they would rather not see that you're diagnosed with sleep apnea because that means you're going to get some treatment and they'd rather not you have a treatment. You know what I mean?

 

Lauren Freedman:

Yeah. They'd like to deny you anyway. Yeah.

 

Dr. Madan Kandula:

Correct. Which insanity. Even if they were looking out for their own selves, it's insane because if they were truly looking out for their own selves and they understood the dynamics, they would want you to get treated because it actually would end up saving them money in the long run. Yeah.

 

Lauren Freedman:

And I'm wondering, because we're talking about success and failure rates with something like CPAP. When you see a new patient and maybe you've found the solution for them. Maybe it's a CPAP, maybe it's an oral appliance, maybe it's someone who's going for the surgical option, how disciplined do patients need to be when it comes to these changes in their lifestyle? Does the diagnosis mean that they need to upend their lives and make it happen all the time? Just because I have a CPAP, does it mean i have to use it every night or I'm going to get a heart attack?

 

Dr. Madan Kandula:

No.

 

Lauren Freedman:

Right, okay.

 

Dr. Madan Kandula:

The short answer is no. Well, no, period. Then part of it depends on the severity of your sleep apnea to some extent. But one night away from a machine is not going to do you in. But multiple nights? Yeah, now you start ... It's the damage over time that gets you from sleep apnea. Though, most people who have sleep apnea and are being successfully treated don't want to go a night or two without their machine or appliance because ...

 

Lauren Freedman:

Because you're a basket case the next day.

 

Dr. Madan Kandula:

Exactly. That's where the world let's you know how bad the problem was. We see this all the time for a variety of things including sleep apnea. You get somebody treated properly and you get them back in the normal realm of existence and then one night away from your machine, all of a sudden sucks you back into the life that you used to have and it's no longer acceptable to you because now you have this new understanding, new life, new awareness. So I think that's usually ... If we were treating somebody successfully, then I really ... We don't usually have to do much arm twisting because if we're truly successful, then our patient is on board with the treatment and the treatment is working and they want to use it because it's working for them kind of a thing verus, "Hey, buddy. You've got to use this or you're going to die." That's not an approach that's-

 

Lauren Freedman:

Right.

 

Dr. Madan Kandula:

That's not really a convincing approach. Scare tactics don't generally have a place here. But care does.

 

Lauren Freedman:

Yeah. You're not Fear Factor. Care does, right. Yes, absolutely. Care over fear.

 

Dr. Madan Kandula:

Correct. Absolutely, absolutely.

 

Lauren Freedman:

So I like to wrap up my interviews with a top three list. For practitioners who I have on the show, I'm wondering for you, what would your top three tips be for someone who maybe suspects they have something off. Maybe they're about to become a patient of an otolaryngologist, an ENT, might be living with something invisible that's chronic. What would you recommend to these people who are on the precipice of diagnosis?

 

Dr. Madan Kandula:

Right. Yeah. That's a good question. I think first thing is establishing an awareness of what might be. To say, we focused a lot on sleep apnea in this discussion, which is fine, but if it's sleep apnea, do a little homework. You don't have to do a ton of homework. Get an understanding about what does sleep apnea look like. Might this be you? Might this not be you? Okay. If it is you or you think, "Okay, this is a possibility," then the next thing, your next bit of homework is finding the right resource for you, which is tricky. The tricky part is that I know what I do and I know what we do here but we are where we are. We're in Milwaukee and Chicago. We're not in California. Not that we're the be all, end all, but I'm just saying that it's finding the right resource from a medical standpoint that, "Okay, I think I have this issue. These folks seem like they know what they're talking about."

 

Lauren Freedman:

They know how to do it. Yeah.

 

Dr. Madan Kandula:

I think that's step one, step two. Step three is once you find the right resource or resources, say maybe it's a couple of things, once you actually engage is trust your gut and trust your head on is does this seem to be making sense to me. And a way for you to easily check that is when you're going into your clinical appointment with your MD, PA, whomever, is do you understand? Have confidence that they understand what's going on. Do you understand? Because if they understand what's going on, have they explained it properly to you so that you understand it. And then I'd say the final thing, do you have a specific game plan designed for you moving in a forward direction? Meaning when you go in, do they listen to you? Do they understand you? Did they evaluate you in your mind properly? You don't have to be a doctor to figure this out. But does it seem like they really heard you and looked at you and understood you?

 

Lauren Freedman:

And have given you a roadmap.

 

Dr. Madan Kandula:

Yeah. I mean, I don't visit doctors often and when I do, I'm-

 

Lauren Freedman:

That's interesting. A doctor who doesn't visit doctors often.

 

Dr. Madan Kandula:

Yeah. I try to stay away. But when I go, I always am shocked at the lack of all the things I just said, the lack of ... And I'm a doctor. You could speed through the process. Just cut to the chase. Tell me what you-

 

Lauren Freedman:

Yeah. They can use the language with you. You're going to understand the terminology.

 

Dr. Madan Kandula:

Use the lingo. Tell me what you think is going on. You don't even have to do the explanation part so much. But like, "Okay, I think it's X, Y, and Z. And we're going to do this and that and boom, done." It doesn't happen. When I go in or if I'm taking my kids in or I go in with wife's appointments, it's always like, "This is craziness because ..." Not that I impose my will on them because I'm not going to tell them that I practice medicine. But I always leave, unfortunately, shaking my head. I shake my head because I get a first hand experience of what the experience is for most people out there.

 

Lauren Freedman:

Everyone else.

 

Dr. Madan Kandula:

And it's not okay. So I'd say back to the one, two, three is educate yourself, make sure you feel confident in the resources that you're reaching out to, and then finally I'd say make sure you're getting results. And results are delivered by options. If you have an issue, make sure you are getting all the options that are there, including the options that this particular person can't deliver for you. They should understand the things that they can and can't do and then you, now it's back on you, man. Now it's on you to take that information, synthesize it, and then make the choice that's right for you. Then it's a bit of a-

 

Lauren Freedman:

But making an educated decision, it sounds like.

 

Dr. Madan Kandula:

Absolutely. Unfortunately, that's easier said that done.

 

Lauren Freedman:

Well, and it's become the patient's responsibility when the system's failing us.

 

Dr. Madan Kandula:

Yeah, correct.

 

Lauren Freedman:

Is there anything else you'd like add? Certainly, please tell listeners where they can find you and your practice.

 

Dr. Madan Kandula:

Well, yeah. I mean, I think we had a good conversation. I think we covered all the ground. I mean, our practice at adventnose.com, either way, Advent K-N-O-W-S or Advent N-O-S-E.com.

 

Lauren Freedman:

Oh, it's both?

 

Dr. Madan Kandula:

It's both.

 

Lauren Freedman:

That's so funny.

 

Dr. Madan Kandula:

It's intentionally ... I don't know. It's either hokey or memorable or one of those things.

 

Lauren Freedman:

Well, at least you've got a sense of humor about it all.

 

Dr. Madan Kandula:

Yes. Oh, absolutely. No. We do. But that's where you can find us. As you said, there's a lot of videos and information. Because we're out and about on the internet, we get folks calling in from all over the place. And sometimes it's a, "Do you know somebody in Sacramento?" Maybe I don't but maybe I do and if we do it's trying to hook you in. We do get folks coming in from far away for treatment, which is cool in a way but uncool in that-

 

Lauren Freedman:

In that they have to do.

 

Dr. Madan Kandula:

That they have to do that, exactly. Pat of our mission here is we have what we have and there is a need for what we're doing and we are trying to grow this as quickly as feasible because we have to maintain the quality that exists here. Ideally, eventually we would like to be out where you're at because it's hard. It's hard for folks to try to come in to see us. But anyway, it's easy to find us online and hopefully we can get you some more information if you visit us.

 

Lauren Freedman:

And well, when you end up in California, I'll be your first patient.

 

Dr. Madan Kandula:

Yeah. There you go. There you go, excellent.

 

Lauren Freedman:

Well, Dr. Kandula, thank you so much for joining us today. It was such a pleasure chatting with you.

 

Dr. Madan Kandula:

Thank you, thank you. This was fun.

 

Lauren Freedman:

Yeah, of course.

 

Lauren Freedman:

That's it, folks. Thanks for listening. As always, please check us out online at uninvisiblepod.com and all over the social media world and Uninvisible Pod. We love your feedback and suggestions so please drop us a line via the website if you have questions, ideas for topics to cover in future episodes or just want to say hello. We're all about relationships and collaboration here, so credit where credit is due. Music for this episode is by Sean Hart, who can be found at seanhart.com. Don't forget to subscribe, rate, and review wherever you listen to podcasts.

 

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