Speaker 1: Imagine the place where you can escape for a day,
Speaker 1: get immersed in a world of rooms, inspiration, and expertise,
Speaker 1: where you can lay luxury, accommodation and kids cam fees
Speaker 1: from ninety five sets. Tickets are free to everyone and
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Speaker 1: at the kia Ikia the Wonderful every Day.
Speaker 2: Oh hello, hey, Hi, it's your little newborn niece who
Speaker 2: looks like an old Greek sailor. Ali Ward here with
Speaker 2: another episode of Ologies. So in this episode we're going
Speaker 2: to talk to a person who is passionate, so passionate
Speaker 2: about those lumpy snoots we've all got sniffing around right
Speaker 2: in the bullseye center of our faces. And this ologist
Speaker 2: really knowses stuff. So much information on allergies and smells
Speaker 2: and history and street drugs. But before we get to it,
Speaker 2: per usual, thanks to everyone making the podcast possible by
Speaker 2: buying into the Patreon membership starts to twenty five cents
Speaker 2: an episode. My heart is cheap, so you guys, let
Speaker 2: me pay an editor and buy Mike cables and memory cards,
Speaker 2: and you ask great questions which I pass on to theologists. Also,
Speaker 2: merch is available at ologiesmirch dot com and on Mondays.
Speaker 2: I post photos on theologies Instagram of you sexy biscuits
Speaker 2: wearing your Ology shirts and hats and pins. You can
Speaker 2: tag it Ologies merch and let me see your faces
Speaker 2: the babies. Also, for no money and very little effort,
Speaker 2: you can be a friend of Ologies just by telling
Speaker 2: your carpet cleaner or aunt in law or account executive
Speaker 2: that you like it and that they might also, And
Speaker 2: as a quiet, thirsty thank you, I read all your
Speaker 2: reviews on iTunes each week, and then to prove it,
Speaker 2: I read you one. This week's review is titled on Creepiness.
Speaker 2: It's from Jjpyo. Hello, Allie. I would like for you
Speaker 2: to stop calling yourself creepy. Although you do often admit
Speaker 2: to some creepy things, Reading all your reviews is not creepy.
Speaker 2: So if you're creepy, that makes me creepy. And I
Speaker 2: think it's rude that you're calling me creepy all the time.
Speaker 2: I digress. The podcast it is very good five stars. Okay,
Speaker 2: Onto Rhinology. Why not a gy? So you likely have
Speaker 2: a firm but soft and a beautiful but gross wedge
Speaker 2: of flesh holding cord on your face. But how well
Speaker 2: do you know it? I mean, it's a mystery in there, man,
Speaker 2: It's a moist catacomb that leads to your brain. Is
Speaker 2: that how it works? We're going to find out. So,
Speaker 2: first off, rhinology comes from the Greek for snout. I
Speaker 2: came to know this rhinologist through a Twitter lead. Someone
Speaker 2: was like, heypes, I got a rhinologist for you, and
Speaker 2: I was like, let me add him. So I happened
Speaker 2: to have been in Detroit last week shooting, and I
Speaker 2: made some time to take a lift over in a
Speaker 2: torrential Michigan summer downpour to find the entrance at the
Speaker 2: Henry Ford Medical Center in the downtown d No relation
Speaker 2: to the museum I also do work with. It's just
Speaker 2: in Detroit. Literally everything is named after Ford. Gcuting a
Speaker 2: restaurant where I Tater Tots the same day. Now, this ologist,
Speaker 2: who by the bye has an entire YouTube channel brimming
Speaker 2: with sinus surgeries, took me to an office and we
Speaker 2: gabbed about noses for oh almost an hour. Over an hour.
Speaker 2: Side note, Okay, I can deal with a lot of
Speaker 2: gross shit. I've held spiders as big as my palm.
Speaker 2: I've eaten scorpions. I've even dated musicians, but I cannot
Speaker 2: deal with the word or the concept of this, and
Speaker 2: I'm gonna whisper one time. Okay, mucus. I did not
Speaker 2: want this episode to be a sonic minefield for my
Speaker 2: gag reflex. From now on, when you hear the that's
Speaker 2: just me bleeping the moist M word, I'm gonna say
Speaker 2: the F word freely, but I'm censoring the word that
Speaker 2: rhymes with fucus because I can and I will. So
Speaker 2: to make it fun, feel free to take a sip
Speaker 2: of your beverage at the ding or do a tiny,
Speaker 2: imperceptible butt dance when you hear that noise in celebration
Speaker 2: of not hearing the word that it's replacing. I will
Speaker 2: do that on my end with my end. Now, if
Speaker 2: you love that word, feel free to lock yourself in
Speaker 2: asana and sing a song about it on a banjo.
Speaker 2: I don't give a fuck. I just can't deal. So
Speaker 2: it's dings from here on out. It's Dad's podcasts. She'll
Speaker 2: do it the way she wants, Okay, all right, oh man.
Speaker 2: In this episode, we talk about hey fever and nose
Speaker 2: jobs and septims and piercings and snoring and snorting and smelling,
Speaker 2: and I had nose idea of the mysteries deep deep
Speaker 2: in my skull holes. So open your ears, throat, and yes,
Speaker 2: your nose for the life altering wisdom of rhinologists, Doctor
Speaker 2: John Craig, so works. Yeah, get up in it. Thank you,
Speaker 2: by the way for doing this.
Speaker 3: Are we on?
Speaker 2: We were on, We're already rolling. But thank you so
Speaker 2: much for letting me come to this hospital on a
Speaker 2: very very rainy sunday in Detroit.
Speaker 3: We are in the depth of the d.
Speaker 2: We'll start with the basics. How long have you been
Speaker 2: a rhinologist? And that is a word, correct.
Speaker 3: It is a word. Yes, So I've been in practice
Speaker 3: for three years now. That's after doing a five year
Speaker 3: residency in E and T surgery and then a one
Speaker 3: year fellowship in dedicated rhinology.
Speaker 2: When you were a kid, did you have a fascination
Speaker 2: with certain body parts or certain types of medicine? Or
Speaker 2: I mean, I want to ask how you picked noses,
Speaker 2: but that's not it. I feel like how you've selected
Speaker 2: noses would be a better way of phrasing that, but it.
Speaker 3: Could call No, there wasn't any particular my father was
Speaker 3: an emergency room position.
Speaker 2: Oh he was, so you grew up around I grew
Speaker 2: up around.
Speaker 3: Yeah, my mother was a X ray tech as well,
Speaker 3: so a lot of medical conversation. I was just always
Speaker 3: fascinated by not so much anatomy because we didn't talk
Speaker 3: about anatomy that much, but just the thought processes behind
Speaker 3: medical decision making. And for some reason that that was
Speaker 3: interesting to me, and like, you know, the high school
Speaker 3: era really yeah. So and then I went to college
Speaker 3: and studied psychology and then it took on like a
Speaker 3: whole other level of understanding the doctor patient interaction, and
Speaker 3: that combined with my kind of interest in science, just
Speaker 3: made sense.
Speaker 2: Do you find that when when rhinologists get together, it's
Speaker 2: just like a chat? Are all cha boxes?
Speaker 3: Big doork session?
Speaker 1: Oh?
Speaker 3: Yeah, it's pretty common. Actually, it's probably one reason I
Speaker 3: liked it too. Everybody's very passionate about the nose and
Speaker 3: the sciences. So I definitely had a lot of sinus
Speaker 3: slash nasal issues growing up. And I don't think it
Speaker 3: drove me to choose to do this, but it is interesting.
Speaker 3: There must be some subconscious process or maybe conscious that
Speaker 3: drove me.
Speaker 2: There's got to be a doctor heel self situation, like
Speaker 2: you know, I'm also a client, Like there's got to
Speaker 2: be something there. Now, I'm sure you get this a lot.
Speaker 2: E and T's why are ears, noses, and throats all
Speaker 2: lumped together? Were you studying and you're like, I'm leondering
Speaker 2: about this throat and these ears, but I really care
Speaker 2: about the noses. Was there any part of you where
Speaker 2: you're like, let's just get to the noses. Do you
Speaker 2: prefer the nose over the ears in the throat is
Speaker 2: what I'm asking?
Speaker 3: Oh, yes, okay, very much so. Yeah, No, I've always
Speaker 3: been since about midway through residency. I was more fascinated
Speaker 3: by the inner workings of the sinuses and the nasal cavity.
Speaker 3: So all those areas for me were just more interesting
Speaker 3: than the throat in the ears.
Speaker 2: Poor throat in ears. The ears seem like a whole
Speaker 2: other situation, to be honest, because I get that the
Speaker 2: nose in the throat are connected. Anyone who's ever gotten
Speaker 2: soda up a nose or out a nose. I threw
Speaker 2: up jello shots on my twenty first birthday out of
Speaker 2: my nose, So we get that they're connected. But the ears,
Speaker 2: that's hearing. Did you have to learn everything about ears
Speaker 2: as well, and then you could say, okay, noses, I'm
Speaker 2: on to you.
Speaker 3: I think that's a very insightful comment you just made.
Speaker 3: A lot of us do feel that the ears are
Speaker 3: their own world. But yes, I think the people treating
Speaker 3: the nose definitely view the ear as a separate entity.
Speaker 3: A lot of times the hearing apparatus is definitely a
Speaker 3: separate entity.
Speaker 2: I do also feel like ears are like, we have
Speaker 2: the smallest bone in the body, and everyone knows that
Speaker 2: fact about us. Yes, that's okay, ears, we get it
Speaker 2: so quick. Aside, this was going to be an insert
Speaker 2: to just talk shit on the smallest bone in the
Speaker 2: body and the ear for being like, yes, I do
Speaker 2: contain this smallest bone in the body. But I looked
Speaker 2: up this little thing. It's called the stapes. It means
Speaker 2: stirrup because it's shaped just like a metal stirrup that
Speaker 2: you slide your boot in while hoofing around on a horse.
Speaker 2: It also looks like a tiny, tiny wishbone glued to
Speaker 2: a plate. And I wanted to be like whatever, ears,
Speaker 2: who cares? But I gotta be straight with you. I
Speaker 2: gotta come clean and say it's a really cute fucking bone. Like,
Speaker 2: it is so tiny, it's smaller than your pinky nail,
Speaker 2: this cute little thing, and it's held aloft in your
Speaker 2: inner ear by tendons, and it makes the femur look
Speaker 2: like Godzilla. And it's so cute that you have two
Speaker 2: of these, probably gently rattling around in your skull like micromachines. Ooh. Anyway,
Speaker 2: Doctor Craig cares about nose medicine in particular because, as
Speaker 2: we mentioned in his upbringing, having shitty nose function can
Speaker 2: be a real buzzkill. Sinus issues suck.
Speaker 3: But they can cause significant quality of life issues for patients.
Speaker 3: If you have trouble breeding through your nose, a lot
Speaker 3: of a lot of pain bleeding. These things affect your
Speaker 3: daily life. It's hard to conduct normal work day if
Speaker 3: you always have blood or fluid pouring from your nose.
Speaker 2: It's true, it is very like a first day with
Speaker 2: a bloody nose. Yeah, not happening.
Speaker 3: Not good.
Speaker 2: Do people ever shove tampons up their nose when they
Speaker 2: have bloody noses? Sorry, I'm still asked some.
Speaker 3: Version of that. Yes, some type of packing material can be.
Speaker 2: Placed perfect for it to be honest.
Speaker 3: I've actually definitely seen a patient show up to my
Speaker 3: office with a tampon on their nose, so it's possible.
Speaker 2: Was it a lady or a man?
Speaker 3: Man?
Speaker 2: Yeah, I have a feeling he borrowed.
Speaker 3: It from somewhere I think he did. Yes, were you
Speaker 3: like well done, sir? I definitely applauded his efforts. He
Speaker 3: got the job done.
Speaker 2: So when you talk about pathologies, run me down some
Speaker 2: of the big eiaes. I mean, what would you say,
Speaker 2: or maybe run me down what your most common issue is.
Speaker 2: Is it like I can't sleep because my nose is
Speaker 2: messed up? Or is it allergies?
Speaker 3: That's a great question. So the full gambit, I would say,
Speaker 3: from inflammation to tumors, So inflammation would be things like
Speaker 3: allergies sinusitis. Sinusitis can actually be either inflammation driven or
Speaker 3: infection driven, so it doesn't always mean an infection heads up.
Speaker 2: Itis just means inflamed or swollen, red, painful, So siny
Speaker 2: sitis just means inflamed nosal area. Now, if you've ever
Speaker 2: had senioritis your last semester of school, you have maybe
Speaker 2: been inflamed and hot and swollen, which honestly sounds a
Speaker 2: lot more like a freshman problem. But I'm not a doctor,
Speaker 2: so I don't know. Okay, onto nose problems.
Speaker 3: The nasal obstruction is a huge one. What do I
Speaker 3: mean they're just trouble breathing through your nose?
Speaker 2: I thought you meant someone shoving something up there.
Speaker 3: No, no, we'll talk about that. But so with nasal obstruction,
Speaker 3: it can be an anatomic cause. People talk about a
Speaker 3: deviated septum. So those would be the more common things,
Speaker 3: but then you have the rare things such as tumors,
Speaker 3: and then this area that I also work on. It
Speaker 3: was called the skull base, which is the bony separation
Speaker 3: between the sinus cavity and the brain cavity.
Speaker 2: Oh, there's a bony separation there.
Speaker 3: Yes, okay, they're very close to each other.
Speaker 2: I didn't realize that we had a bony separation because
Speaker 2: I feel like you always learned about like in Egyptian
Speaker 2: mummies would use a hook to gather the brains through
Speaker 2: the nose. I figured it was a straight shot.
Speaker 3: In it's kind of a straight shot. But yes, you
Speaker 3: would have to go through the skull base to do that.
Speaker 2: Oh, you'd have to poke through. You'd have to preforate it.
Speaker 2: How thin is it?
Speaker 3: It's a good question. Pretty thin overall, some areas or
Speaker 3: a couple of millimeters.
Speaker 2: Some areas are less than a MILLIMETERSO is anyone else
Speaker 2: having an existential meltdown? Thinking about like a millimeters thin
Speaker 2: plate of bone separating your brain from the entire world, including,
Speaker 2: but not limited to the air of a porta potty,
Speaker 2: or the door handle of a mall, Like we have
Speaker 2: thin bone plates in our skeleton heads with the fuck
Speaker 2: So you had to do a lot of dissecting, of
Speaker 2: course in.
Speaker 3: Your life, right, many many, And I also have a
Speaker 3: weird interest in cadaver dissections, so I've actually published a
Speaker 3: number of papers on that.
Speaker 2: So it's wait, okay, you have a weird interest in
Speaker 2: cadaver dissection. Yes, explain to me what a normal interest
Speaker 2: in cadaver times section would because I feel.
Speaker 3: Like that's it might be true.
Speaker 2: What do you mean by that?
Speaker 3: Because that just means that in training you're always expected
Speaker 3: to do some degree of cadaver dissection as part of
Speaker 3: your learning. But I just realized that it's harder to
Speaker 3: read it in books than it is to just get
Speaker 3: in there. And so in both residency and fellowship, and
Speaker 3: even now, whenever we have cadavers available, I stressed to
Speaker 3: the residents that I teach that it's really important to
Speaker 3: get in there and really explore the anatomy, so.
Speaker 2: Everyone, because I have a friend who's a doctor who
Speaker 2: said that once you crack someone open, there's so much
Speaker 2: more variation than you would imagine. Oh yeah, you think
Speaker 2: like this is when the limit goes. But just as
Speaker 2: people's faces look different, like their livers look different, and
Speaker 2: their pancrases look different, like you really got to see
Speaker 2: a lot of them. Yep, was that scary the first
Speaker 2: time you cut open a cadaver? I'm sorry, I gotta ask.
Speaker 3: I wouldn't use the word scary, but different for sure.
Speaker 2: I feel like different is what you would call something
Speaker 2: like like pineapp couscous or jazz fusion. Cutting open a
Speaker 2: husk of a person seems like a bit of an
Speaker 2: understatement for that word. But once again, all Ward here
Speaker 2: is not a doctor. I have never filayed a dead
Speaker 2: volunteer in order to fix living.
Speaker 3: People gives you a different perspective on life.
Speaker 2: Did you do you find that, having been around cadavers
Speaker 2: that you embrace your living life more. You're more aware
Speaker 2: of mortality or no, No.
Speaker 3: It doesn't affect me that way.
Speaker 2: I guess I feel like I would be man, I'd
Speaker 2: be like, that's gonna be amazing. Would you ever donate
Speaker 2: your body to science?
Speaker 1: Uh?
Speaker 3: Yes, I haven't officially done that yet, but.
Speaker 2: Well I know you're alive, but you've considered it.
Speaker 3: Yes.
Speaker 2: The one thing that's weird about the nose is it's
Speaker 2: something that's in our in our face. But you look
Speaker 2: at a skull and you're like, there's just an empty cavity.
Speaker 2: Noses are just cartilage, which is kind of crazy to me.
Speaker 2: So this, but can you give me the breakdown of
Speaker 2: the anatomy of a nose? What is a nose made out?
Speaker 3: All? Right? So, if you think the nose is an
Speaker 3: external component, kind of the floppy part that you actually see,
Speaker 3: there are cartilages that form kind of the external architecture,
Speaker 3: but they're in places that you wouldn't really predict, and
Speaker 3: so it's not like one solid sheet of cartilage. There's
Speaker 3: two sets of cartilage that do some weird curvature things.
Speaker 3: But that's how the tip of your nose is formed.
Speaker 3: And then we call them the side walls kind of
Speaker 3: the floppy nostril parts. They provide support there, and then
Speaker 3: the inner lining of the nose is made up of
Speaker 3: what we call mucosa. Mucosa is like the inside skin.
Speaker 3: Of course, you got the nostrils that lead into each
Speaker 3: respective nasal cavity. And then how deep do we want
Speaker 3: to go inside the nose here? How deep do we
Speaker 3: want to go inside the those here?
Speaker 2: By the way, I had a boyfriend whose Polish grandmother
Speaker 2: called nostrils n assholes. Oh, she didn't realize that wasn't
Speaker 2: the word for them, And I've ever since then, I've
Speaker 2: always loved the term soles.
Speaker 3: That's pretty good. Yeah, well, remember.
Speaker 2: That, what are the sinuses?
Speaker 3: So you've got cheek sinuses we call them the maxillary
Speaker 3: sinuses in each cheek, and then the forehead or frontal
Speaker 3: sinuses up in the forehead, and then you have these
Speaker 3: other weird sinuses that go kind of further back in
Speaker 3: the nose between the eyes, called the ethmoid sinuses. And
Speaker 3: then way back, about seven or eight centimeters back in
Speaker 3: the nasal cavities, you have the sphenoid sinuses.
Speaker 2: So to recap, you are just lousy with sinuses, just
Speaker 2: tiny hidden rooms in your face. And your skull. But wait,
Speaker 2: how many and what exactly are they where? What are
Speaker 2: they doing there?
Speaker 3: In total? We say there are eight sinuses, four on
Speaker 3: each side, and then what are they They're basically just
Speaker 3: air filled spaces within the bones of the face. But
Speaker 3: they're lined by that mucosa that we spoke of. All right,
Speaker 3: So the mucosa that's what gets swollen when we talk
Speaker 3: about allergies and sinusitus. So you can imagine if you
Speaker 3: have these sinus chambers draining into the nasal cavities. They
Speaker 3: drain through small holes.
Speaker 2: Gross, but stay with me.
Speaker 3: So if circumferentially around that opening the tissue that mucosa
Speaker 3: swells up too much, that's when we have problems with straining.
Speaker 3: And if you have that swelling curry inside the nose
Speaker 3: too much, you could have trouble breathing through your nose.
Speaker 2: So a lot of the stuff that comes out of
Speaker 2: your nose originates in these in these caves in your face. Yes,
Speaker 2: what happens when you have let's say, allergies or you
Speaker 2: have an infection. Why does your why does this tissue
Speaker 2: insist on swelling? What does the inflammation help? What's the point?
Speaker 2: Why do why is it like, oh, there's pollen in
Speaker 2: the air well for you, I'm going to swell up
Speaker 2: so you can't breathe.
Speaker 3: Yeah, well, it's definitely not an adaptive measure. It's not
Speaker 3: normal for people to have this swelling, right, the average
Speaker 3: human being. So you get fluids ceping into the tissue
Speaker 3: that causes swelling, and that's when you get a lot
Speaker 3: of the symptoms. Now, patients with allergies and they have
Speaker 3: a significant histamine response, all right, So they have certain
Speaker 3: cells on their tissue that release histamine and that sets
Speaker 3: off a whole cascade of different symptoms.
Speaker 2: Now, histamines, before you float them to the top of
Speaker 2: your shit list, can have your back when things are good.
Speaker 2: They keep you awake and they help flush out bacteria
Speaker 2: that might want to kill you. But with allergies like
Speaker 2: to pollen or dust or pets, the immune system senses
Speaker 2: it freaks the fuck out, like this pollen is trying
Speaker 2: to kill us. All hands on deck and sends a
Speaker 2: group text essentially to your body being like if you
Speaker 2: see this pollen around eighty six, this mofo, we hate it.
Speaker 2: Pollen's like, hey, I'm just airborne plants, ferm. I don't
Speaker 2: even want to be in your nose holes. You inhaled
Speaker 2: me calm down. But histamines tell your blood vessels to
Speaker 2: get leaky, y'all, and your eyes and nose water to
Speaker 2: flush it out of your body. Now, why do some
Speaker 2: people have shitty allergies and others are like, I've got
Speaker 2: nine nine problems, but ragweed season is not one. It's
Speaker 2: mostly genetics, so thanks to your mom and dad. But
Speaker 2: there's also something called the hygiene hypothesis. So if you
Speaker 2: weren't raised around enough like low key grime like animal
Speaker 2: dander and fungus spores, your body freaks out when it
Speaker 2: encounters it. I myself grew up digging for worms in fields.
Speaker 2: I have no allergies. Thank you mom and dad for
Speaker 2: letting me go dig for worms. Speaking of which, you
Speaker 2: can also eat worms to help your allergies. I mean, yes,
Speaker 2: there are anahistamines and steroids which block your body from
Speaker 2: launching that inflammatory attack. But also also you can eat hookworms.
Speaker 2: So these little parasites attached to your gut walls, and
Speaker 2: some studies show that they may release compounds that tell
Speaker 2: your immune system to just take it down and notch sun.
Speaker 2: Not a lot of hookworms in the developed world, but
Speaker 2: it's hookworm Palooza in other parts of the globe where
Speaker 2: they have fewer allergies. You can also try local honey,
Speaker 2: as discussed in the B episode melotology, which may help
Speaker 2: your body warm up to neighborhood planches, or immune therapy
Speaker 2: where you're slowly introduced to allergens so your immune system
Speaker 2: calms down and stops being let's be honest, kind of
Speaker 2: a bigot. But if you don't want to get shots
Speaker 2: or take drugs that make you sleepy, or get intestinal
Speaker 2: parasites on purpose, doctor Craig has some other saltier advice.
Speaker 2: But what do you tell people who have allergies? Is
Speaker 2: there anything they can do on the front end that's
Speaker 2: not just tamping down the histamine response.
Speaker 3: Yeah, so I'm going to throw out a disclaimer first off. Okay, well,
Speaker 3: I am a rhinologist. I lean on my allergy colleagues
Speaker 3: here significantly, so I can tell you what I do,
Speaker 3: and then when things get too complex, I definitely employ analogists.
Speaker 3: But in general, if you have kind of run of
Speaker 3: the mill allergies, I think the simplest, safest thing you
Speaker 3: can do actually is topical saline to your nose. It's
Speaker 3: actually been shown that we don't know why precisely, but
Speaker 3: if you can flush the allergens that might be in
Speaker 3: the nose out of the nose, than you in general
Speaker 3: have a better baseline of symptoms.
Speaker 2: Oh like a netty pot.
Speaker 3: Yeah, much like a netti pot.
Speaker 2: I've never used a netty pot.
Speaker 3: Oh, you got to try it.
Speaker 2: I imaginely have is it really?
Speaker 3: Oh?
Speaker 2: Yeah, Okay, there's part of me that knows I'm not
Speaker 2: going to flood my brain with saline. But I'm like,
Speaker 2: what if I'm the one person that has just a
Speaker 2: gaping hole in my skull based bone and I just
Speaker 2: flood my brain?
Speaker 3: Well, we could put one thing to rest. If you
Speaker 3: don't have clear fluid pouring out of your nose at
Speaker 3: the baseline, you probably don't have a spinal fluid leak,
Speaker 3: which means you probably don't have a hole in your
Speaker 3: skull base. But but no, I mean, the one in
Speaker 3: a trillion type situation of that happening, I wouldn't worry
Speaker 3: about that.
Speaker 2: What does it feel like, I've never done it?
Speaker 3: If you do it properly, you know, head over a sink.
Speaker 3: I use a squeeze bottle. Personally, but some people do.
Speaker 3: The netty pot fluid will go inside one nasal cavity,
Speaker 3: it comes out behind your nose back out the other
Speaker 3: nasal cab So you score it on the right, it's
Speaker 3: going to come out the left.
Speaker 2: Where is it going in the meantime.
Speaker 3: That's a good question if you have not had sinus
Speaker 3: surgery before. Most of it just goes through the nasal
Speaker 3: cavities and in some of these nooks and crannies called
Speaker 3: the me eight I within nose. But if you haven't
Speaker 3: had sinus surgery, they don't usually get into the sinuses themselves, okay,
Speaker 3: so they just go in and out. So basically you're
Speaker 3: flushing out any crust debris, maybe thinning out the layer
Speaker 3: that's in your nose.
Speaker 2: But it does seem to help, so squeeze bottle daddy
Speaker 2: pot so. Doctor Craig says that well, the salty nose
Speaker 2: enema is a great starting measure. Most patients might need
Speaker 2: an over the counter topical steroid like a flownaise which
Speaker 2: will drop the inflammatory response in the nose, or like
Speaker 2: an oral antihistamine. Those are tablets, but remember histamine also
Speaker 2: keeps you awake, so don't take antihistamines before like a
Speaker 2: four hour annual sale symposium, or when you're about to
Speaker 2: walk into a Catholic wedding ceremony, because that's just asking
Speaker 2: to drool on yourself, which I have recently done. Now
Speaker 2: in Japan, I just looked this up. Nodding off in public.
Speaker 2: They have a word for it. It's called in emory,
Speaker 2: and it means to sleep well present, and it happens
Speaker 2: on trains and in the office all the time. The
Speaker 2: Japanese are like, good on you, dude, you must be
Speaker 2: working hard. Also, it's nice that you didn't just leave.
Speaker 2: You just stayed at this dinner party and napped upright.
Speaker 2: So enemory isn't a bad thing. However, it's frowned upon
Speaker 2: in like assembly lines and such, so your benajeryl may
Speaker 2: have those side effects, including an emuri, which I've got
Speaker 2: to be honest, is my new favorite Japanese thing, like
Speaker 2: since their game shows. Did you know some of their
Speaker 2: game shows involved discovering if everyday objects like tables and
Speaker 2: chairs are actually made of candy by biting them and
Speaker 2: climbing slippery stairs covered in soap and getting a butt
Speaker 2: in your face if you answer trivia wrong, a naked butt.
Speaker 2: I love you Japan anyway. Have you ever been super
Speaker 2: just flummixed or just stumped by a case both?
Speaker 3: The interesting part and the problem in my field is
Speaker 3: that there's a lot of rare pathology. Some tough ones
Speaker 3: that come to mind would be nasal polyps. So nasal
Speaker 3: polyps if you've ever heard of them. They're basically extreme
Speaker 3: swelling of tissue inside the sinus and nasal cavities. They
Speaker 3: turn into basically like swollen grapes hanging down on your nose,
Speaker 3: and so they can cause the whole spectrum of sinucide
Speaker 3: of symptoms, trouble breathing through the nose, lack of smell
Speaker 3: would be the classic ones.
Speaker 2: Ooh, nose grapes.
Speaker 3: Yeah, no, no, not a good fruit to have.
Speaker 2: Do you this stupid question? But can you spot a
Speaker 2: nose job a mile away? Usually yes you can?
Speaker 3: How so it takes Actually, rhinoplasty is separate from my feel.
Speaker 3: I collaborate with rhinoplasty surgeons when I need the external
Speaker 3: portion of the nose addressed. And so do you mean
Speaker 3: the classic esthetic rhinoplasty? How you tell? Yeah? Usually there's
Speaker 3: a narrower look to the nose, perhaps the nasal tip
Speaker 3: is a little more upturned than average and just in
Speaker 3: general smaller.
Speaker 2: And have you seen any trends with that or you know,
Speaker 2: I mean, if you look at hair trends over the
Speaker 2: last thirty years, there have been some good ones and
Speaker 2: some bad ones. Do you see that happening in and
Speaker 2: I know that you don't focus on rhinoplasty, but do
Speaker 2: you see that happening in like cosmetic surgeries at all?
Speaker 2: Like is this nose very in from these this year
Speaker 2: to this year?
Speaker 3: Definitely in the eighties nineties there was a characteristic nose
Speaker 3: that people were going for. Definitely the narrower look. There
Speaker 3: are definitely trends.
Speaker 2: Like with fashion, it's probably just look up at Kardashian's
Speaker 2: Instagram or something.
Speaker 3: No, I won't comment on that.
Speaker 2: Yeah, but I wonder if people are like, I want
Speaker 2: to Jane nose.
Speaker 3: Oh, I'm sure that.
Speaker 2: So I look this up and this is indeed the case.
Speaker 2: So a bunch of plastic surgeons are saying that the tiny,
Speaker 2: eurocentric look is falling out of fashion. People don't want
Speaker 2: perfectly straight or symmetrical noses either. They're like, change it
Speaker 2: up a little bit. I still want to look like me,
Speaker 2: don't make it too boring. Also, now some people are
Speaker 2: getting non surgical nose jobs, where instead of shaving down
Speaker 2: your cartilage fins, essentially a doctor will pump some filler
Speaker 2: into the bridge of the nose just to fill out
Speaker 2: a line. And other folks are getting kind of a
Speaker 2: reverse nose job with implants added to restore what their
Speaker 2: nose look like pre surgery. They're like, you know what,
Speaker 2: I just want to look like me speaking of putting
Speaker 2: things into noses. Weirdest thing you've seen shoved up on nose?
Speaker 3: Uh? An undone paper clip?
Speaker 1: Why?
Speaker 3: Uh so it was actually a child?
Speaker 2: Oh? Man, ouch, poor kid place.
Speaker 3: It up their respective grandparents knows while sleeping.
Speaker 2: Oh never mind, that child is ruthless. Okay they what
Speaker 2: did they do?
Speaker 3: Well? We had to go to surgery and it was interesting,
Speaker 3: to say the least.
Speaker 2: Once again, interesting is good for pineapple couscoose. This is
Speaker 2: intense and brutal ps. It wasn't a paper clip.
Speaker 3: And actually was multiple paper clips. So yeah. Luckily they're malleable,
Speaker 3: so you can kind of bend them with instruments and
Speaker 3: get them out of the nooks and crannies of the sinuses.
Speaker 2: But multiple when you say multiple, are you saying two
Speaker 2: or are you saying there are three? That's too many? Yeah,
Speaker 2: once you get over one, it's too many paper clips.
Speaker 3: One would argue one is a lot, but I.
Speaker 2: Think that's I think that's more than enough. How was
Speaker 2: the patient's morale?
Speaker 3: So it's funny. So this case that always comes to
Speaker 3: mind was when I was in training and I didn't
Speaker 3: follow the patient pre impostoperatively, So I don't totally know,
Speaker 3: but one would imagine there may be some familial tension
Speaker 3: after that.
Speaker 2: Yeah, you think, I wonder what the kids next birthday
Speaker 2: was like. It's like, uh, Grandpa's on a cruise on
Speaker 2: purpose and is never going to make it to your birthday. Man, Yeah,
Speaker 2: that's rough. Did you ever see that Simpsons episode where
Speaker 2: Homer puts a crayon off his nose? No?
Speaker 3: I didn't, mister Simpson.
Speaker 2: I'm afraid you have a crayon lodged in your brain.
Speaker 2: They find that he has a blue crane up his
Speaker 2: nose and that is my Homer's Homer. They take it
Speaker 2: out and Homer is very like realizes how dysfunctional society
Speaker 2: is and how.
Speaker 3: Wow was it in his brain? He was in his
Speaker 3: brain interesting.
Speaker 2: And I think at the end he puts the crayon
Speaker 2: back in because he's just like, you.
Speaker 3: Know, all right, tell me when I hit this week,
Speaker 3: but deeper, you Pilsner pusher. Maybe he had a spinal
Speaker 3: fluid leak.
Speaker 2: Afterward, let's debunk some flint flam. What do you think
Speaker 2: is the biggest myth about noses and sinuses that you're like,
Speaker 2: that is not correct?
Speaker 3: I love this question. One thing is that facial pain
Speaker 3: is most commonly not from SIGNI sitis. What is it
Speaker 3: from most commonly, and this has been studied some form
Speaker 3: of neurogenic pain, so whether that's migraine would be a
Speaker 3: very common one. Actually migraine. Everybody thinks of the classic migraines,
Speaker 3: but there are atypical forms of it where you can
Speaker 3: just have isolated facial pain and a running nose and
Speaker 3: nasal destruction. Really because it affects nerves, nerves supply the
Speaker 3: tissue within the nose as well as the tissue of
Speaker 3: the skin, so you can get the running nose factor,
Speaker 3: the congestion feeling a lot of times they'll feel like
Speaker 3: just things are full, yeah, and then of course the
Speaker 3: severe stabbing pain like over their cheeks or forehead, And unfortunately,
Speaker 3: this information is not disseminated to all physicians as well.
Speaker 3: So it's a tough one because if if you're not
Speaker 3: seeing noses all the time and putting scopes inside your
Speaker 3: nose to see where the sinuses drain, I think the
Speaker 3: tendency is to hear that somebody has a running nose,
Speaker 3: trouble breathing, facial pain that matches all the symptoms of
Speaker 3: signy SIDIS. But if you do sign a surgery for
Speaker 3: all these people, you're gonna find that the pain does
Speaker 3: not reliably go away.
Speaker 2: Oh no, so and it might just be an unlucky migraine. Yes,
Speaker 2: oh god, that's got to be frustrating.
Speaker 3: Yeah, it can be very frustrating. And so whenever I
Speaker 3: see patients with those conditions, I just get them checked
Speaker 3: out by a facial pain person. And it almost every time,
Speaker 3: like seriously, almost every time, they find something that they
Speaker 3: can treat medically and then we avoid sign a surgery.
Speaker 2: How often would you say that it's that case where
Speaker 2: it's like it's just an unlucky migraine.
Speaker 3: So we're talking isolated facial pain nearly. I mean, it's
Speaker 3: over ninety percent of the time.
Speaker 2: Really, that's so interesting. I didn't know that it's crazy.
Speaker 3: I mean, I probably see out of twenty patients, twenty
Speaker 3: thirty patients a day, I see at least three per
Speaker 3: day with isolated migraines.
Speaker 2: So if you have a face ache instead of a headache,
Speaker 2: it might be a migraine. How crazy is that? Now?
Speaker 2: Why does our nose run? Why do we get stuffy
Speaker 2: when we cry?
Speaker 3: So if you cry too much, you could get some
Speaker 3: tears literally coming out of your nose, and then there's
Speaker 3: probably some emotional nerve response that again signals those same
Speaker 3: nerves that somebody's get signaled with migraines and can cause
Speaker 3: a runniness and that the congestion though, does that happen
Speaker 3: when you cry a lot? I guess I don't cry
Speaker 3: very often, so.
Speaker 2: I feel like you get congested when you cry. So
Speaker 2: evidently when your nose cries, like literally tears come out
Speaker 2: of your nose, your tissues get coated with liquid sadness
Speaker 2: and things just jam up a bit. In there also,
Speaker 2: your tissues swell, causing you to need tissues.
Speaker 3: I'm going to blame the same nerve reflex.
Speaker 2: I'm sure it is. It's got to be a nerve
Speaker 2: reflex your brains is like, are we sad, let's jack
Speaker 2: some things up to distract you.
Speaker 3: Yeah.
Speaker 2: Perhaps, And now, how much of your work involves smell
Speaker 2: in disorders with.
Speaker 3: Smell percentage wise? Isolated smell loss is not a major
Speaker 3: part of my practice. I mean, I definitely see those patients.
Speaker 3: It's a very difficult condition. You kind of break it
Speaker 3: down into how long it's been there, and you try
Speaker 3: to figure out why it occurred. Sometimes you don't come
Speaker 3: up with a true reason. People just develop spontaneous smell loss.
Speaker 2: Oh, my friend Micah had a fever as a baby.
Speaker 2: He has no sense of smell. So you just don't
Speaker 2: have to shower when you go out to brunch as
Speaker 2: much as you want. It's great.
Speaker 3: Not for him though, yeah other people.
Speaker 2: Yeah, but what is happening when you're smelling something? It's
Speaker 2: going through your tissues? Does the air? Does the air
Speaker 2: hit your sinuses and then your sinuses pick it up
Speaker 2: and tell your brain what smell it is?
Speaker 3: Like, what sort of But it's more about the location
Speaker 3: of those smell fibers. So air brings in odor molecules.
Speaker 3: Those molecules hit the surface the nasal surf. It's more
Speaker 3: than nasal cavity than the sinuses. So airflow normally doesn't
Speaker 3: go into the sinuses. It actually just goes through that
Speaker 3: central kind of inner chamber that we spoke of. And
Speaker 3: so the olfactory receptors on specific nerves are located high
Speaker 3: up in the nose, and then there are certain structures
Speaker 3: in the nose where there are higher concentrations of the
Speaker 3: olfactory cells, and then then that triggers a whole cascade
Speaker 3: of chemical and neurogenic reflexes that go to the brain,
Speaker 3: and then that's how we interpret smell.
Speaker 2: So there are certain areas of the inside of your
Speaker 2: nose at smell, and certain areas are like, that's not
Speaker 2: my job.
Speaker 3: Most of it definitely occurs. Yeah, just to the nasal cavity.
Speaker 2: Do people give you a lot of nose gifts like
Speaker 2: coffee mugs in the shape of noses?
Speaker 3: I wish, but no, there's not a lot of.
Speaker 2: Like Etsy items for rhinologists.
Speaker 3: There actually are. I mean, I've got like a Picasso
Speaker 3: painting that has a big nose. Whenever I do see
Speaker 3: weird nose art or anything, I definitely pick it up.
Speaker 2: Side note, I popped over to Etsy to see what
Speaker 2: kind of nose gifts the craft of Sphere had to offer.
Speaker 2: And first off, there are a lot of delicate nose
Speaker 2: rings out there, and also crocheted nosewarmers which look kind
Speaker 2: of like a macrome bikini top and a surgical mask
Speaker 2: bread tiny children. There was also an item advertised as
Speaker 2: a bronze's nose refrigerator magnet, which seems like at eighteen bucks,
Speaker 2: a steel for solid bronze, but it turns out it's
Speaker 2: a painted plaster object according to the seller quote, an
Speaker 2: exact replication of my own nose. I popped on over
Speaker 2: to Amazon and I found a tank top bearing simply
Speaker 2: hashtag rhinologist and a bike bell stating that its user
Speaker 2: was the world's best rhinologist. So there's some gifts there.
Speaker 2: In the end, I primed doctor Craig a plastic snawse
Speaker 2: that was also a pencil sharpener. I'm sure you can
Speaker 2: imagine how that worked. It cost five dollars, but I
Speaker 2: sprung for the four dollars gift wrap to include a
Speaker 2: note of thanks for his appearance on ologies and that
Speaker 2: I couldn't have picked a sharper expert who knows his material.
Speaker 2: This is why I call myself your dad. Do you
Speaker 2: dream about noses?
Speaker 3: Oh? Yeah, you do?
Speaker 2: Oh yeah, what's your latest nose dream?
Speaker 3: It's usually more perioperative stress, you know, like you just
Speaker 3: did a case and you think about the end. I
Speaker 3: see people sinuses in my mind all the time.
Speaker 2: You do.
Speaker 3: Oh yeah, I remember people sinuses. It's weird.
Speaker 2: But yeah, like how you would remember a dog or
Speaker 2: a face.
Speaker 3: I'm probably better. I'm probably better with that than I
Speaker 3: am with like remembering names.
Speaker 2: What do they look like?
Speaker 3: Well, you just remember their surgical anatomy and some of
Speaker 3: the challenges during the case and specific surgical maneuvers and
Speaker 3: things like that.
Speaker 2: So what was your first surgery, like on a live
Speaker 2: human being, Because you're good at cadavers, Like the first
Speaker 2: time you were like, they're like, all right, Doc Europe.
Speaker 3: Yeah, it's creepy. Yeah, it's a nerve wracking. Plus you
Speaker 3: have people watching you and critiquing you, so it's always
Speaker 3: it's a unique experience, to say the least.
Speaker 2: Cutting into a person is unique, like a good pineapple
Speaker 2: couscous You.
Speaker 3: Know, in training, you start like not so much in
Speaker 3: the operating room, but maybe in the er and you're
Speaker 3: closing up lacerations in the face, and that's always a
Speaker 3: unique experience as a young resident training.
Speaker 2: So people's bleeding faces.
Speaker 3: Yeah, yeah, they can be pretty extensive lacerations or dog
Speaker 3: bites or things like that.
Speaker 2: So ooh and so surgically, they kind of train you
Speaker 2: and you go up and up until you get deeper
Speaker 2: into the face perhaps sort of.
Speaker 3: Yeah, you definitely start with more run of the mill
Speaker 3: surgeries up front, things like tonsils and adenoids, and then
Speaker 3: more in the middle of your training. You developed the
Speaker 3: endoscopic skills for for sinus surgery.
Speaker 2: So you've had to do tons of ectomies. Oh yeah,
Speaker 2: I got one of those.
Speaker 3: Oh at what age?
Speaker 2: Oh twenty six, dude.
Speaker 3: Not pleasant.
Speaker 2: It was not It was not okay, But I it
Speaker 2: was the only time I've ever been put under, and
Speaker 2: I remember waking up being like that wasn't so bad.
Speaker 2: And then I looked in the mirror and I just
Speaker 2: saw a little smear of blood under my chin that
Speaker 2: they had not wiped, they had missed, And I was like,
Speaker 2: what happened here? Like if this is just a smear
Speaker 2: that they missed, Like there's just must have been blood
Speaker 2: all over my face, right, Like, is that what happens.
Speaker 3: Who knows. I meant the anesthesiologist pulled the tube out, you.
Speaker 2: Know, Okay. I was just like, never the surgeon's fault. No, no,
Speaker 2: But I was like, what kind of game of throne
Speaker 2: shit was going down when I was asleep?
Speaker 3: Like, well, that's a whole other world. Yes, it's the
Speaker 3: operating room environment, but I mean, you guys.
Speaker 2: This always this always surprises me that like as surgeons,
Speaker 2: you guys talk and play music and like it's it's
Speaker 2: not I've pictured just deally silence and like you could
Speaker 2: hear someone breathing. What is the actual environment, Like what's
Speaker 2: the what's the mood, what's the atmosphere.
Speaker 3: Yeah, I mean it definitely varies by you know, surgeon personality.
Speaker 3: So they're definitely some people that prefer very quiet or
Speaker 3: I don't prefer it that way. I like music. I
Speaker 3: like people talking because I do a lot of teaching,
Speaker 3: so I expect people to be asking me questions throughout
Speaker 3: the whole case, and I also fire questions back at them.
Speaker 3: So it's a very interactive or environment with me.
Speaker 2: That's cool though if I'm pretty much half deaf on
Speaker 2: the operating table, so there's no reason for everyone else
Speaker 2: to have stony silence. Right, what do you listen to?
Speaker 3: Oh? So I am a hip hop fan. Okay, so,
Speaker 3: and I'm in Detroit and I've almost been an Eminem fan,
Speaker 3: so I do listen to Eminem. I also listen to
Speaker 3: a lot of nineties hip hop. I'm from the West Coast,
Speaker 3: so I'm a big Tupac fan. And then I often
Speaker 3: will listen to Hits stations, you know, And I don't
Speaker 3: want to offend anybody, So if anybody's offended by rap,
Speaker 3: then I definitely will just go to the Hits.
Speaker 2: The patient can't object, and that'd be great if they
Speaker 2: came out of it and suddenly they were like, you know,
Speaker 2: let's put on some Tupac on the way home.
Speaker 3: Yeah, a little subconscious recollection would be cool.
Speaker 2: So what kind of situation would get you on the
Speaker 2: rhinologists table as a professional? As a rhinologist, what should
Speaker 2: people be on the lookout for when it comes to
Speaker 2: their nose health? Because we don't think about our noses
Speaker 2: unless we're contouring them or there's fluid pouring out of them.
Speaker 2: What should we be aware of?
Speaker 3: Yeah, there are some more red flag symptoms that sometimes
Speaker 3: get overlooked and we might as well just highlight them.
Speaker 3: So I always think of anytime you have one sided symptoms.
Speaker 3: So if for like the last month or two, the
Speaker 3: left side of your nose is completely blocked and not
Speaker 3: the right, or you only have left sided nosebleeds, it's
Speaker 3: probably time to get checked out. You know, it could
Speaker 3: be as something as simple as a deviated septum, but
Speaker 3: you don't want to miss the bad things. And so
Speaker 3: when I see one sided nasal obstruction, the first thing
Speaker 3: that goes through my head is I need to make
Speaker 3: sure there's no tumor. So tumors tend to grow and
Speaker 3: affect one side and by the time, and they usually
Speaker 3: sit in the sinuss for a while before they grow
Speaker 3: out into that inner chamber.
Speaker 2: And now you will put a camera up a n
Speaker 2: asshole and poke around. Has that been like revolutionary?
Speaker 3: Yes, game changing, I mean totally change the field.
Speaker 2: You mean you must have to use less radiology as well, right.
Speaker 3: It's that great comment. Yes, I actually am very principled
Speaker 3: against unnecessary radio or radiographic imagine because I can see
Speaker 3: the important areas where the scinus is drain, and so
Speaker 3: we don't need to be getting cat scans and things
Speaker 3: to radiate people all.
Speaker 2: The time, and so what anything else that anyone should
Speaker 2: look for.
Speaker 3: Yeah, another one that has been popping up in the
Speaker 3: media too, or is the spinal fluid leak?
Speaker 2: So god? Uh okay, So yeah, this is brain fluid,
Speaker 2: so stuff from the comfy, watery sack surrounding your brain
Speaker 2: kind of like when you buy a pickle and a
Speaker 2: pouch at seven eleven. But it's brain fluid out of
Speaker 2: your face. So doctor Craig says that if you ever
Speaker 2: have clear fluid leaking from your nose, especially if it's
Speaker 2: one sided, definitely get it checked out because normally clear
Speaker 2: nasal drainage should be both sides. So one quick question, fuck,
Speaker 2: walk me through. A spinal fluid leak is when the
Speaker 2: shit around your brain is dripping out of your nose.
Speaker 3: Correct?
Speaker 2: That should be like fire alarm emergency, Like that's not
Speaker 2: something you want to happen.
Speaker 3: No, you don't. But the problem is it's not common
Speaker 3: enough to where even a whole lot of physicians are
Speaker 3: thinking about it all the time. So if patients present
Speaker 3: and they have a runny nose, they might just get
Speaker 3: put on some sprays and then follow up in three months.
Speaker 2: Oh my god, how mad would you be if your
Speaker 2: brain fluid was leaking out your nose and someone's like,
Speaker 2: take some clareton.
Speaker 3: I know it happens. It's not that uncommon for that
Speaker 3: to happen.
Speaker 2: I feel like it's too bad that brain fluid isn't
Speaker 2: tinted a certain color like a transmission fluid or something.
Speaker 2: Oh it's blue. Like this is a real issue, and
Speaker 2: what would cause that?
Speaker 3: So two main causes. One would be trauma. Okay, So
Speaker 3: if you have a high velocity head injury, you can
Speaker 3: crack that skull based bone and the leak may occur then,
Speaker 3: or it could occur like months later, just from a
Speaker 3: delayed wound healing process. Or there's another type called spontaneous
Speaker 3: spinal fluid leaks. The thought is you get chronic pressure
Speaker 3: changes at that skull base. It's already thin, eventually it
Speaker 3: thins to a point where it's gone, and then one
Speaker 3: way or another there's a tear in the lining of
Speaker 3: the brain that then allows fluid to drip.
Speaker 2: Oh so it's like a burst dam kind of yeah.
Speaker 2: Oh yeah, man, So watch out for those things. What's
Speaker 2: happening when people put cocaine up their nose, when people
Speaker 2: are crushing things and snorting them. I'm sure that you
Speaker 2: have a cautionary tail or two.
Speaker 3: Uh you know what's fun I haven't seen that many
Speaker 3: people yet. I mean I've seen a few. So what's
Speaker 3: happening is cocaine basically acts to constrict blood vessels, so
Speaker 3: it's extreme. We call it vasoconstriction. And so there's obviously
Speaker 3: mechanical trauma from the actual shards of cocaine and that
Speaker 3: can cut the nose and then it gets deposited in
Speaker 3: the tissue that will cause a really extreme construction of
Speaker 3: the blood vessel, so that over time can basically cause
Speaker 3: death to the tissue. And so the nasal septum is
Speaker 3: a very highly susceptible area because it's right there in
Speaker 3: the front of the nose, and so if you hit
Speaker 3: it with cocaine for a long period of time, the
Speaker 3: mucosa on either side of the septum can die and
Speaker 3: then the cartilage in between doesn't have a blood supply,
Speaker 3: so it's gone. So that's how people get holes in
Speaker 3: their septum from cocaine.
Speaker 2: Use. God, why do people snort some drugs instead of
Speaker 2: just putting them in their body through other mucosal areas.
Speaker 3: I couldn't give you perfect answers, but I mean, for one,
Speaker 3: it gets absorbed fairly quickly. I think that gives the
Speaker 3: like initial high quicker. But I don't know if there's
Speaker 3: ingestible form of cocaine. To be honest, it.
Speaker 2: Didn't strike me until later. But yes, if you've ever
Speaker 2: read up on altitude sickness in Machu Pichu, you may
Speaker 2: have heard that a lot of hikers keep a soggy
Speaker 2: lump of chewed up cocoa in the cheek, or you
Speaker 2: can drink cocoa tea. Also booty bumping. What's booty bumping? Oh,
Speaker 2: it's the same as key stirring or plugging or butt chugging,
Speaker 2: which is when you mix drugs with water and then
Speaker 2: stream them up your dark canals of your posterior, thereby
Speaker 2: bypassing the pesky delay that digestion might afford. Now this
Speaker 2: all according to a blog post entitled Everything You Need
Speaker 2: to Know about butt Chugging, written by a retired police
Speaker 2: sergeant named Keith Graves. I wish I went to his
Speaker 2: retirement party. I bet that was so fun. But wait,
Speaker 2: ingestable cocaine? Hmmm, Hello soft drinks, Lest we forget that
Speaker 2: Coca Cola got that coca from somewhere now in the
Speaker 2: late eighteen eighties. It was invented by doctor J. Pemberton,
Speaker 2: who was a Confederate soldier who was addicted to morphine
Speaker 2: and he wanted to make a health tonic. He was like, man,
Speaker 2: this cocaine juice. We'll fix your fucking life. And he
Speaker 2: began selling it in drug stores and then he died
Speaker 2: suddenly two years later. But his family was like, yeah, man, yeah,
Speaker 2: you know what, let's make this a business. Like one
Speaker 2: day it'll be the biggest business in the world and
Speaker 2: people wake up and drink it and we'll sponsor the Olympics.
Speaker 2: Holy shit, man, yeah, let's do it. Because they were
Speaker 2: on cocaine. Now. Originally Coca Cola had about nine milligrams
Speaker 2: of cocaine per glass, which is about a fifth of
Speaker 2: what you would see like when a chubby line is
Speaker 2: snorted in movies about nineteen eighty Stockbrokers or like on Entourage.
Speaker 2: I don't know, by the way, what are those actors
Speaker 2: really snorting. Well, it turns out it's usually lactose powder
Speaker 2: or the prop master coats the inside of the rolled
Speaker 2: up one hundred dollar bill with vasoline so that the
Speaker 2: lactose sticks to the inside. But either way, doing pricey
Speaker 2: street drugs that wrote your septum and turn you into
Speaker 2: a maniac d bag probably not the best life choice
Speaker 2: if you could avoid it. Just just picture like an
Speaker 2: image of a rainbow star streaking across the cosmos and
Speaker 2: a the more you know graphic. But it's a bad idea.
Speaker 2: It also seems very expensive.
Speaker 3: That probably is also true.
Speaker 2: Yes, if anyone really needs an upper I drank yerbamate
Speaker 2: for a number of years, and boy, oh boy, that
Speaker 2: thing that have you ever had it?
Speaker 3: What's that?
Speaker 2: It's a type of South American tea. Oh seriously, though,
Speaker 2: your bmate, man, I don't know how it's legal, because
Speaker 2: like a month's supply is four dollars and I would
Speaker 2: scrub my bathroom grout at midnight for fun. I had
Speaker 2: to finally quit because I drank too much and I
Speaker 2: turned into the human equivalent of a scared chihuahua. Yeah.
Speaker 2: I had some friends that are like, are you on drugs?
Speaker 2: And I was like, no, I discovered a tea at
Speaker 2: Trader Joe's. It's very care oftenative. It was, It's intense
Speaker 2: a lot. I'm sure a lot cheaper than street drug.
Speaker 2: How do you feel about septum piercings when you see it?
Speaker 2: Are you like no? Are you like go for it?
Speaker 3: Hmm? There is of course the potential when you take
Speaker 3: it out that you would have a hole in your septum.
Speaker 3: So to me it would seem like unnecessary risk. But
Speaker 3: if it's you know, a strong personal preference, I don't know.
Speaker 3: I haven't seen too many problems from them holes in
Speaker 3: the septum.
Speaker 2: That's good. So you don't see a lot of people
Speaker 2: coming in just like dragging themselves into the er with
Speaker 2: an infect.
Speaker 3: Effectually, I haven't, but I mean, it's of course a
Speaker 3: possibility if.
Speaker 2: You're let's say you had a child that's like, Dad,
Speaker 2: I'd like a septum piercing. Would you be like, okay,
Speaker 2: but I'm doing it.
Speaker 3: I would probably just be with them at the piercing
Speaker 3: studio and hyper analyze exactly what they're doing.
Speaker 2: But I feel like it's an easy one to fake though,
Speaker 2: you know what I mean. I feel like there's some
Speaker 2: good clip on septum rings.
Speaker 3: It could be true, right, kind of makes sense. I mean,
Speaker 3: it might be a market you should explore.
Speaker 2: I try to find out what percentage of septum piercings
Speaker 2: you see in the wild are actually piercings and what
Speaker 2: percentage are just clip on? But like a bow tie,
Speaker 2: you'd have to tug on it or ask or launch
Speaker 2: a multifaceted study on it. Now, I did learn that
Speaker 2: they don't actually pierce your cartilage. They find what's called
Speaker 2: your sweet spot, scientifically known as the columella, which is
Speaker 2: a little bit of flesh at the tip of your
Speaker 2: nose past your actual septum, which makes the whole shebang
Speaker 2: less drilly and really more gentle pokey. But can I
Speaker 2: just say that, hot dang, If you're afraid of blood
Speaker 2: or commitment and you want to clip on septum piercing,
Speaker 2: Etsy is coming through for you. But what about putting
Speaker 2: things on the outside of your whiffer? Oh? I did
Speaker 2: forget to ask. Do strips that you stick to your
Speaker 2: nose that open your nose up to prevent snoring? Do
Speaker 2: they work? And how? So?
Speaker 3: They work, But it's not so much for the snoring.
Speaker 3: What it works on is what we call nasal valve collapse.
Speaker 2: Ooh, get in bed with nasal valve collapse.
Speaker 3: So the floppy part of the nose, the nostrils, we
Speaker 3: call them the nasal valve region. So it's actually pretty
Speaker 3: common to have some degree of narrowing or collapse there.
Speaker 3: So what the breathe right strip is help or you know,
Speaker 3: generic strips whatever are helping with They'll just lift the
Speaker 3: floppy nostril outward, kind of like flaring the nose. So
Speaker 3: if that is your area of obstruction, which isn't necessarily
Speaker 3: the case, but if it is, then it should improve airflow.
Speaker 3: And in those situations, if that's your only cause for storing,
Speaker 3: it'll help with storm. But it's not. I mean, snoring
Speaker 3: is multifactorial. You can have obstruction at any level of
Speaker 3: the throat that won't help with a breathe right strip.
Speaker 2: Does snoring sound different if it's a nose snore versus
Speaker 2: a throat snore? Like, could you if someone played you
Speaker 2: an audio clip, could you be like, that's a flopping asshole?
Speaker 3: Good question. I don't. I don't. I'm not aware of
Speaker 3: any literature on it, and I don't watch enough snores.
Speaker 2: So if you try it and you are told that
Speaker 2: you're still snoring, you might it might be in the throat,
Speaker 2: it might be something else.
Speaker 3: Yeah, snoring actually is not a prominent primary complaint.
Speaker 2: I would think that would be the first. You just
Speaker 2: have a line of snores that are in there with
Speaker 2: like maybe a tired cranky spouses being like good at fixed.
Speaker 3: Well. In some people's clinics, yes, but in my rhinology clinic,
Speaker 3: it's not the primary. But it's definitely I mean a
Speaker 3: huge you know area of healthcare right now right obstructive SLEAPABNA.
Speaker 3: So yeah, a lot of people see that.
Speaker 2: So I looked at one website appropriately called stopth umble
Speaker 2: dot com that tried to describe the sounds of snores
Speaker 2: based on the cause, but it had a lot of
Speaker 2: weird pop up ads. So I don't know if it's
Speaker 2: even trustworthy. Now, as soon as I have a some
Speaker 2: knowledgist on this is going to be a top order
Speaker 2: of business, trust me. Okay, So onward and upward. Nose
Speaker 2: hair trimming. Should we do it? Should we not do it?
Speaker 3: Hmmm? Probably overall the recommendation should be you don't do it.
Speaker 2: Okay.
Speaker 3: There is some function to the nose hairs. They catch debris,
Speaker 3: but you can trim it up and it's fine. I mean, listen,
Speaker 3: if you are having nose hair growing out of the
Speaker 3: nostril and it bothers you. It's safe to clip them.
Speaker 3: You're not going to costume me problems. But if you
Speaker 3: do trim the tissue and cause a nose blade, then
Speaker 3: you could have a problem.
Speaker 2: Why does it? Do you know why it hurts so
Speaker 2: much if you pluck a nose hair. We've all done it.
Speaker 2: It's horrible.
Speaker 3: Yeah, it is quite it's the worst. Yeah, just the
Speaker 3: nerve innervation. It's those nerves again, they have to.
Speaker 2: Be very very sensitive.
Speaker 3: Mm hm, oh god, I know.
Speaker 2: Yeah, it's a it's a what a form of torture.
Speaker 2: I mean, as a person who's had a lot of
Speaker 2: things waxed, there's nothing I would rather wax my entire
Speaker 2: body twice than one nose hair.
Speaker 3: It is. Yeah, it's crazy how painful it is.
Speaker 2: Do you want to do a lightning round? Sure? Okay,
Speaker 2: these are questions from listeners. Okay about noses to you. Okay,
Speaker 2: But before we take questions from you, our beloved listeners,
Speaker 2: we're going to take a quick break for sponsors of
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Speaker 1: Imagine the place where you can escape for a day,
Speaker 1: get immersed in a world of rooms, inspiration and expertise
Speaker 1: where you can lay in luxury accommodation. Thank kids, cam
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Speaker 2: Okay, your questions, Krista Avanpado asks, My eye doctor once
Speaker 2: gave me exercises to strengthen my eyes and they worked. Wonders,
Speaker 2: is there anything we can do to strengthen our sense
Speaker 2: of smell?
Speaker 3: Hmmm, So there's some some good evidence when you have
Speaker 3: smell loss that something called olfactory training helps. I'm not aware.
Speaker 3: If you already have good smell, then I don't know
Speaker 3: if it'll strengthen it. But if you've lost your smell,
Speaker 3: then some studies have shown that if you get like
Speaker 3: some of those extract oils like citrus, rose, geranium, things
Speaker 3: like that, if you smell those thirty seconds each four cents, okay,
Speaker 3: around three times a day, that may stimulate more smell function.
Speaker 3: Really yeah, and actually I've seen it work, so it's
Speaker 3: got good evidence behind it at least.
Speaker 2: So oh that's amazing. I had I thought you were
Speaker 2: just just shit out of luck. There, you're just plumb
Speaker 2: out of luck.
Speaker 3: Sometimes sometimes you are, but sometimes you can fix it.
Speaker 2: So so huff some essential oil. See what happens?
Speaker 1: Yeah?
Speaker 2: Great? Late night Pie wants to know. I frequently get allergies.
Speaker 2: What can help me breathe better? Any nose exercises or
Speaker 2: herbal remedies that you suggest? Anything herbal?
Speaker 3: So I'm not aware of any herbal remedies. I'm sure
Speaker 3: there are some that would work, but just from you know,
Speaker 3: evidence based medicine per se, I would say, you know,
Speaker 3: a topical steroid is very safe for long periods of time,
Speaker 3: and the saline rents that I mentioned before are just
Speaker 3: good simple nasal treatments. And then if you have a
Speaker 3: lot of the itchiness it you knows that you eyes
Speaker 3: or some other you know, body hives or you know,
Speaker 3: antihistamines would be great.
Speaker 2: Okay, I got a couple of questions about sneezing. Tyler
Speaker 2: Q wants to know what's the deal with bright lights
Speaker 2: making people sneeze? What's the correlation there? And I have
Speaker 2: that where if I'm gonna sneeze and I'm about to
Speaker 2: lose it, if I look at light, I think your
Speaker 2: pupils constrict, and there's some like photo sneeze reflex.
Speaker 3: I need to read more. Apparently, Yeah, it's interesting. I
Speaker 3: wanted to blame it on migraines, but I guess maybe
Speaker 3: there's actually if.
Speaker 2: I am about to sneeze, you know when you lose
Speaker 2: a sneeze and it's just like devastating. Yeah, you're like
Speaker 2: where did that go? If I look at a bright light,
Speaker 2: then my pupils get small and then that's what triggers
Speaker 2: the sneeze. But my DNA profile said I'm likely to
Speaker 2: have a photo sneeze reflex, and I was like, damn straight,
Speaker 2: I do interesting? So yes, This is called photic sneeze
Speaker 2: reflex and it happens to about twenty to thirty percent
Speaker 2: of people and it is inheritable. So next time you're
Speaker 2: about to disseminate your nose contents away from your body
Speaker 2: in one hundred miles an hour, which is what a
Speaker 2: sneeze is, but it might go away, look at light
Speaker 2: and see if that does the old trick. Also, this
Speaker 2: whole thing is called ready for this autosomal compelling helio
Speaker 2: ophthalmolic outburst, which sounds like a real mouthful, but guess
Speaker 2: what it stands for? A chew? Yes, someone backronymed that
Speaker 2: shit so hardcore, and I have to say that that
Speaker 2: achievement is nothing to sneeze at. Sorry, you love it,
Speaker 2: you love all of it.
Speaker 3: I love these questions.
Speaker 2: I know, here's Carrie or here's carl wants to know?
Speaker 2: Does muco faigi mute coffage boost your immune system? That
Speaker 2: sounds like eating and I'm gonna bar right now onto
Speaker 2: my computer. Does it help your immune system?
Speaker 3: I don't think so, okay, and we all swallow our
Speaker 3: own about one. Did do court today?
Speaker 2: So when did you courts?
Speaker 3: Yeah? Four to eight cups if you want to do
Speaker 3: the measurements. So you're all, we're all swallowing it. Only
Speaker 3: a certain percentage of people actually notice it and get
Speaker 3: bothered by it.
Speaker 2: Oh my god, how do we make that much fluids?
Speaker 3: Well, it's part of the mucosa. It's it's a secreting powerhouse.
Speaker 2: Just keeps going, Oh my god, that's a lot. Julie
Speaker 2: Rose asks that. She says that her nose runs every
Speaker 2: time she eats, even if it's not anything spicy, every
Speaker 2: time she eats. Now, why do spicy things make our
Speaker 2: nose run? And why does her nose run every time
Speaker 2: she eats? She says, it happens. It's been happening as
Speaker 2: long as she can remember.
Speaker 3: Yeah, so definitely read up on vaso motor rhinitis vaso
Speaker 3: m oto r rhinitis.
Speaker 2: Now, if this happens to you, it might be an
Speaker 2: overactive nerve response or something is wonky at the junction
Speaker 2: between a nerve and a gland. But doctor Craig says
Speaker 2: there are other triggers, like temperature change or wine. Now
Speaker 2: with Rose on a patio season upon us, what do
Speaker 2: you do?
Speaker 3: And there's actually a nasal spray that works usually very
Speaker 3: well for it it's called atravant okay, and it basically
Speaker 3: binds a receptor on the gland. It just blocks it
Speaker 3: from secreting. Oh so, and there's actually there's a new
Speaker 3: treatment out that I do offer. I think I'm one
Speaker 3: of the few people in Michigan right now. It's an
Speaker 3: nasal cryotherapy that freezing yeah. Yeah, and it's there's a
Speaker 3: publication from Stanford last year very encouraging. This is a
Speaker 3: very difficult problem to treat, and so when patients either
Speaker 3: aren't responding adequately or just don't love using ACCURVT nasal
Speaker 3: spray whenever they have a running nose, it's an option,
Speaker 3: and it's a non surgical option. You usually do it
Speaker 3: in the office with them awake.
Speaker 2: So so anyway, you just freeze off an area, Yeah.
Speaker 3: Just one area in the back of the nose where
Speaker 3: most of the nerve fibers applying glands are and then
Speaker 3: if that fails, there's a surgical option that most people
Speaker 3: don't need. But every once in a while you'll have
Speaker 3: to consider cutting a nerve further back, a little trickier procedure.
Speaker 2: But but think of the money you're going to save
Speaker 2: on cleenex.
Speaker 3: There you go, see is there a.
Speaker 2: Kleenex types that you're like, don't use a kind of
Speaker 2: lotion in it, use a kind of lotion in it?
Speaker 3: So large for organic, I think I would just go
Speaker 3: with whatever feels smooth and less annoying to the tip
Speaker 3: of the nose. But nothing sticks out as superior.
Speaker 2: It's try the paper, okay to use on your nose.
Speaker 3: Not the rough stuff.
Speaker 2: Okay, just checking, yeah, okay. Charles Anderson wants to know
Speaker 2: what is the best technique for blowing your nose when
Speaker 2: you're super stuffed up? What do you do when it's
Speaker 2: just a traffic jam up there?
Speaker 3: Oh? Yes, So usually the problem is not blowing. The
Speaker 3: problem is too swollen in there, so it feels like
Speaker 3: something's like blocking and you can clear it. But a
Speaker 3: lot of times there's something in your nose called your
Speaker 3: turbinot's turbo t U r b I nat ees. Okay,
Speaker 3: they're tissues that swell up periodically. It's like their job.
Speaker 3: But they're kind of puffy, bulbous structures on the inside
Speaker 3: of the nose on the side walls, and they're made
Speaker 3: of bone on the inside and then puffy tissue on
Speaker 3: the outside. And so those are classically get crazy swollen
Speaker 3: during allergies, and so even a normal person without any
Speaker 3: disease at all may notice sometimes that one side's blocked
Speaker 3: and then a few hours later the other side's blocked,
Speaker 3: and then it switches back and forth. So what can
Speaker 3: happen when you have a cold or bad out allergies?
Speaker 3: Those tissues can both on both sides get crazy swollen,
Speaker 3: and then it's tough to breathe in, but it's also
Speaker 3: hard to blow out. Yeah, So if you're in that situation,
Speaker 3: I would say start by using a topical therapy. Flush
Speaker 3: your nose with salience. See if it's getting through at
Speaker 3: least try the floon aise or some kind of Now,
Speaker 3: you gotta be careful with the decongestins. All right, everybody
Speaker 3: hears the myths about they're not myths, they're real.
Speaker 2: But affron spray, yes, can you get addicted?
Speaker 3: Yes? So it's it causes something called taca phal axis,
Speaker 3: which is just an immediate kind of Your body immediately
Speaker 3: needs more of it pretty much, So then you have
Speaker 3: to keep using it, keep using it, and when it
Speaker 3: wears off, the tissue gets even more swollen. So that's
Speaker 3: a condition that we call rhinitis. Medica mintosa. And it's
Speaker 3: it's not a great scenario because it's hard to get
Speaker 3: rid of because patients don't want to stop using their
Speaker 3: affron chasing the dragon right exactly. So we do have
Speaker 3: ways to try to temper that. But obviously, if it's
Speaker 3: not getting better, if this is not a temporary congestion
Speaker 3: and issue blowing your nose, you really should get checked out. Okay,
Speaker 3: Usually it'll be a fleeting thing. You just have to
Speaker 3: deal with it for you know, hours to a day
Speaker 3: or something.
Speaker 2: But that's really interesting to know that you can get addicted.
Speaker 3: Yeah.
Speaker 2: I had a friend in high school named Jeff who
Speaker 2: was addicted to afron, and we're like, well, if a
Speaker 2: kid's going to get addicted to something, I guess right,
Speaker 2: the affron. But still you.
Speaker 3: Don't have like withdrawal from it. If anybody's wondering, it's
Speaker 3: just annoying to try to get off it.
Speaker 2: How long is the how long would it take to
Speaker 2: kick afron?
Speaker 3: So I actually it's funny. When I was in college,
Speaker 3: I had no idea about this, and I had a
Speaker 3: horribly deviated septum, couldn't breathe through my nose, and so
Speaker 3: I used afron because somebody told me to try affron,
Speaker 3: and I just use it for a few weeks and
Speaker 3: then I tried stopping it and I was like, oh
Speaker 3: my gosh, I can't breathe it all through my nose.
Speaker 3: So it took me, as I recall, two weeks before
Speaker 3: I felt like I don't need it anymore. But I
Speaker 3: kicked it. I just said, just so.
Speaker 2: Doctor Craig says you can kick affron addiction with a
Speaker 2: little topical steroid spray, which affron is not. It's kind
Speaker 2: of like weaning you off and then assess what caused
Speaker 2: you to need the affron So flownase is it's kind
Speaker 2: of like the methodone in this situation. I think I
Speaker 2: don't know. Okay, now this next question is quick and gross,
Speaker 2: but we're going to get through it together. Michael Kris
Speaker 2: has a question about if boogers serve any real purpose
Speaker 2: other than being annoying and embarrassing.
Speaker 3: No, not really, it's just dried up. It's annoying.
Speaker 2: Okay, good to know. I was hoping we weren't have
Speaker 2: to go down a real there's I could. I could
Speaker 2: talk about drain clogs, and I have in this podcast,
Speaker 2: but for some reason, boogers is one of the things
Speaker 2: that I'm like, like, my gag reflex chokes up, and
Speaker 2: that's very rare for me. I've let spiders crawl on
Speaker 2: my body, Like, I'm not grossed out by a lot,
Speaker 2: but that's one thing that I'm like, book, Yeah, you're
Speaker 2: a good man, dude.
Speaker 3: I pick a lot of them every day.
Speaker 2: Oh God, you're that's good karma. Okay. A last question
Speaker 2: for the lightning round. Jamie Gibbs wants to know why
Speaker 2: is smell such a big trigger for memories. But I
Speaker 2: think that's more a neurological thing.
Speaker 3: No, there's a specific section of your brain responsible for
Speaker 3: smell related memory, so it's strong too. I mean, it's
Speaker 3: a very strong neural connection.
Speaker 2: So side note, blame this heavy whiff of nostalgia on
Speaker 2: the old factory bulb having direct connections to the amygdala
Speaker 2: and the hippocampus. These are parts of the brain that
Speaker 2: deal with memory and emotion. So your smell center essentially
Speaker 2: cuts the line and is like, Hi, I'm here for
Speaker 2: the emotions right through the back door. It is nuts.
Speaker 2: You can smell a perfume from you know, high school
Speaker 2: and be like, oh.
Speaker 3: Ah, the memories, So true.
Speaker 2: Prom So what we just talked a little bit about
Speaker 2: having to pick buggers, But what's the worst part about
Speaker 2: your job? The thing that you're like, uh, is it spreadsheets?
Speaker 2: Is it anything disgusting? Is it?
Speaker 3: Well? I suppose as a physician, definitely the there's issues
Speaker 3: with the administrative side separate from the clinical side. So
Speaker 3: I mean the administrative things we just as doctors. It's
Speaker 3: just part of the job. Now you have a lot
Speaker 3: of paperwork, and now it's ework, but you spend you know,
Speaker 3: a good couple hours every day after a long day
Speaker 3: doing documentation, So that's it. It comes with the territory.
Speaker 3: It's just it's probably the less gratifying part of the job.
Speaker 3: I mean as far as clinically, honestly, for what I do,
Speaker 3: there aren't too many downside.
Speaker 2: Once again, this brave hero would rather literally pick strangers'
Speaker 2: noses than fill out forms. And honestly, I get it.
Speaker 2: What do you love about your job the most? What's
Speaker 2: the most gratifying or what moment has been like made
Speaker 2: you want to cry about it in a good way.
Speaker 3: I mean, there's just something gratifying about going to work
Speaker 3: every day, working hard to fix people's problems. You know,
Speaker 3: I don't think there's one thing that makes my job
Speaker 3: most gratifying, but there's definitely something fascinating behind deeply understanding
Speaker 3: an area that is very rare in terms of the
Speaker 3: diseases that affect the nose. The longer you do this,
Speaker 3: the more patent sinuses you see very gratifying because usually
Speaker 3: patent nice, widely open sinuses result in better outcomes. So
Speaker 3: I always joke with patients and say that pretty much,
Speaker 3: if not the probably the second purpose in my life
Speaker 3: is to keep sinuss open. Literally, so my deit deteriorates
Speaker 3: the more sinuses I see in the office that are
Speaker 3: starting to close down, because then I have to find
Speaker 3: ways to keep them open.
Speaker 2: It's like whack the mole with sinuses, just keeping them open,
Speaker 2: keeping them open. Yep, everyone, sinuses, keep them open. May
Speaker 2: your nose tears be joyous and your sinuses be as
Speaker 2: open as your heart. Have you considered getting a satin
Speaker 2: jacket with the words doctor knows best embroidered on the back.
Speaker 3: I would not be against that. I have made a
Speaker 3: sweatshirt already what it just says Henry Ford rhinology with
Speaker 3: my name on.
Speaker 2: It, and you got it made.
Speaker 3: But I make them for the residents toos. But no
Speaker 3: satin is a good spin on that. I might have
Speaker 3: to consider that next time.
Speaker 2: Just saying, just some fancy embroidery, perhaps a couple of
Speaker 2: more nose puns in your life. I think there was
Speaker 2: a room for it, to be honest, very I learned
Speaker 2: so much now I can't stop thinking about my skull
Speaker 2: plate base.
Speaker 3: Ah yes, yes, the skull base.
Speaker 2: No spinal fluid dripping out of it.
Speaker 3: Well, thank you so much for having me.
Speaker 2: Oh my god, I loved it so To hear more
Speaker 2: about doctor Craig's rhinology work, you can head to his
Speaker 2: YouTube channel, which I'll link in the show notes, or
Speaker 2: you can just search Henry Ford Rhinology on YouTube, or
Speaker 2: you can look for the Facebook page for the Henry
Speaker 2: Ford e NT group. Now. I'll also post more links
Speaker 2: on my website at alibard dot com slash ologies. You
Speaker 2: can follow ologies on Instagram at ologies also on Twitter
Speaker 2: at ologies. I'm on both as Ali ward with one l. Now.
Speaker 2: To cover your human body with ologies merch like pins
Speaker 2: and baby onesies and shirts, head to ologies meerch dot com.
Speaker 2: Sales support the production of the show, and thank you
Speaker 2: Bonnie Dutch and Shannon Feltis for that. Also, if you're
Speaker 2: looking for some good karma, maybe you need a boost
Speaker 2: and you want to help one of my favorite kids,
Speaker 2: Shannon Feltus's son Aidan, you can help him make it
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Speaker 2: that gets you access to video messages and you can
Speaker 2: submit questions to Ologists before I record the episodes. And
Speaker 2: those funds help me pay my cherished editor Steven Ray Morris,
Speaker 2: who edited this episode well in a metal tube over
Speaker 2: the Atlantic instead of watching a bunch of quality rom
Speaker 2: coms and action flicks on his flight to and from London.
Speaker 2: Thank you for that. You should be sleeping. The theme
Speaker 2: music was written and performed by Nick Thorburn, who I
Speaker 2: just saw driving around my neighborhood recently. I got very
Speaker 2: excited and I waved. Now, if you stick around until
Speaker 2: the very very end of each episode, you know I
Speaker 2: tell you a secret just for saying thanks for sticking
Speaker 2: it through the credits, and I'm going to give you
Speaker 2: one follow up secret. Rubbing hemorrhoid cream on a blemish
Speaker 2: did not help at all. If anyone needs a tube
Speaker 2: of barely used hemorrhoid cream, please contact me reach out
Speaker 2: on Twitter. I will mail it to you. You can
Speaker 2: put it anywhere you want. That's none of my business.
Speaker 2: And the other secret I'm gonna tell you, let's make
Speaker 2: it nose related and blemish related. Once I had a
Speaker 2: blemish on my nose after my senior year of high school.
Speaker 2: It was there for six weeks. It left a tiny scar,
Speaker 2: and boyfriends had asked me, oh, what's this from? And
Speaker 2: I told a couple of them that it was from
Speaker 2: chicken pox. I'm sorry I lied to you. Now everyone knows.
Speaker 2: If you zoom in, you can see it on pictures.
Speaker 2: It's very small. It looks like a chicken pox scar.
Speaker 2: But really, that was a hard summer, you gots. I
Speaker 2: remember when it finally went away. My mom was like,
Speaker 2: I'm so happy for you. I was like, thanks, mom. Anyway,
Speaker 2: there's my secret herby hacodermatology, hobbiology or doo zoology, lithology,
Speaker 2: new technology, meteorology, people, bettology, ethology, seriology, eldology. You know
Speaker 2: when you lose a knees and it's just like bo