Why Can't I Breathe Through My Nose? (with Michelle Fisher, MD)

[: 00:00:00

[00:00:04] Jeremy Alland: Julie, I frequently can't breathe through my nose so much so that I committed to the podcast today and brought my own nasal strip to make sure that I could breathe perfectly well. So I now have a breathe right nasal strip on for the rest of this episode,

[: 00:00:19

[00:00:24] Jeremy Alland: but I, I'm just, I'm, I'm breathing so much better now.

[: 00:00:27

[00:00:28] Jeremy Alland: I f I have this problem. I can't breathe through my nose at all times. So,

[: 00:00:32

But what do you do when you've tried like the regular stuff, like your Breathe Right Strip to unclog your nose and it's not working?

[: 00:01:00

[00:01:03] Julie Bruene: Yeah, and to give some context, according to University of Michigan Medicine, nasal and sinus disease affects 31 million Americans and accounts for 16 million outpatient visits every year in the U. S. The obstruction of airflow can come from a variety of sources, and the common factor is usually inflammation and swelling of the mucosal, I feel like Jeremy, you've explained mucosal a lot to us, um, lining of the nasal and sinus passages.

Sometimes other things can physically obstruct the flow of air like polyps or like a deviated septum or sometimes, if you're my sister Becky, a myconike. That you've shoved up there and then given to your other sister to eat. So, so what should we do if we find ourselves mouth breathing? What if the neti pot is a neti knot and you're full of neti snot?

Should I just stop here?

[: 00:01:55

[00:01:58] Julie Bruene: So thankfully, meaningful research exists to provide helpful data on nasal and sinus disease and its treatment and its prevention. And we have our friend and a renowned expert in the field of otolaryngology to help us understand more.

Let's do it.

Welcome to your doctor Friends, the show that teaches you to sniff out the garbage and answers all the questions that you wish you could call or text your doctor friend. My name's Julie Bruny. And I'm Jeremy Allen. And we are two physicians who work at a nationally ranked practice and take care of some of the world's greatest athletes.

We know that you have questions and we want to help. We wanna be your doctor friends.

[: 00:02:37

She studied at Emory for undergrad. She went to Rush, uh, for medical school with me. Um, yes. And did her residency at the Medical College of Georgia. Um, she's authored several publications in the field of otolaryngology and head and neck surgery and she's lectured at conferences and national meetings.

She is also an all around badass and a lovely human being and I'm so happy, we're so happy to have you. Welcome,

[: 00:03:23

[00:03:28] Julie Bruene: Miki. Aw, awesome. Dr. Fisher, can you give us your origin story? Like how did you choose a career in otolaryngology?

[: 00:03:34

You know, you see people before and after kind of like a, a makeover, but with surgery, um, I liked that there were kids and adults and you got to make them feel better. And then you kind of just get into the conversation of which holes do you like the best?

[: 00:04:08

[00:04:14] Mickey Silverstein: And so you know, the ears, nose and throat just seemed much more approachable than the other ones to me personally. And so that's how I got into a career of, of nose picking to make a long story short.

[: 00:04:25

[00:04:26] Jeremy Alland: um, that's a different podcast. The, uh, Which Holes Do You Like The Best?

[: 00:04:30

[00:04:33] Julie Bruene: I love it. I love it. Miki, can you explain what otolaryngologists do? Like why do patients come see you? What usually spurs a patient to see an ENT?

[: 00:04:43

Then, you know, all the way up to the adults with sinus problems, allergy problems, thyroid problems. And, um, you know, um, nasal obstruction, as we're talking about, is probably one of the most... common things I do see patients for and then that kind of falls in the realm of allergy as well. So a lot of different things that just involve the ears, nose and throat, everything from the The dura to the plura, as we say, between the neck and the head.

I can be cheesy too. And,

[: 00:05:29

[00:05:30] Mickey Silverstein: uh, this is great.

[: 00:05:31

[00:05:34] Julie Bruene: Mm hmm. Do you

[: 00:05:35

[00:05:36] Julie Bruene: all, Jeremy?

[: 00:05:37

[00:05:42] Mickey Silverstein: No, it's super fun just watching your face right now with

[: 00:05:45

Because looking at myself right now, I can see why I, like, only wear these at night. I look like an idiot.

[: 00:05:56

[00:06:04] Jeremy Alland: Yeah, no.

[: 00:06:06

[00:06:08] Mickey Silverstein: see it, it makes me excited because I feel like there's a lot of stuff we can do to help you.

[: 00:06:12

[00:06:16] Mickey Silverstein: Yeah. I mean, if you take a little medical trip down to Florida, we can get y'all fixed up.

[: 00:06:20

[00:06:37] Mickey Silverstein: do people get stuffy? Well, there's kind of two different reasons. One is either they're, or I guess three different reasons. One, their nose is too small. So there's not enough physical room for air to get through. You know, whether that be a broken nose, a DVS, something, something physically. Two, that the mucosal shiny shit lining is inflamed and is taking up a lot of room in that limited space.

Or, which happens to people who wear a lot of the Breatharite strips, if they kind of have floppy cartilage, and so when they breathe in, it's kind of like sucking through a straw too quickly when it collapses, and then it just kind of gets nasal collapse, which can be a combination of kind of the, the space and the inflammation together, but those are probably the three main reasons why people can't breathe.

And then it breaks down to why are they inflamed, you know, is it allergy, infection, or, or what? So, a lot of subgroups, as you said.

[: 00:07:30

Stukas, um, and that the causes we discussed before are like indoor and outdoor allergens. Often try to do treatment with like nasal rinses, or nasal steroids, or oral antihistamines, and avoiding triggers. Anything else that you would add from the ENT perspective,

[: 00:08:05

So that's another kind of extra step you could take in addition to the avoidance and medication for the allergies.

[: 00:08:29

[00:08:45] Mickey Silverstein: Perfect. So, um, I'd say the allergic rhinitis would cause swelling and inflammation of the lining of your nose, which would fall into the kind of the, the actual swelling in the nose that's keeping the air flow from coming in.

[: 00:08:59

next one is chronic sinusitis, which I think, you know, Dr. Fisher, that, correct me if I'm wrong, that would still kind of fall in the swelling, but also maybe even a little bit of an obstructive,

[: 00:09:14

[00:09:40] Jeremy Alland: I feel like I'm kind of like thinking about that. I may be confused. I didn't realize sinusitis is an infection, right? You just said it's one of those three types. It's viral bacterial or fungal. Yes.

[: 00:09:51

It can be precipitated by something like allergies, so if you get inflamed, more crap can get stuck in there and then it can get more infected.

[: 00:10:22

[00:10:28] Mickey Silverstein: Yeah, that's, that's a good call. So how do you get a chronic infection? Um, the definition of chronic infection, I guess, would be something that lasts for more than about 12 weeks. So, you know, if you've taken antibiotics or, or not and just the stuffy nose, the pressure in your face, your teeth pain, all that just isn't going away for over 12 weeks, then in the ENT world, we put that on as a chronic infection.

So that's when it kind of changes from acute to chronic. Um, in your nose, there's only a limited amount of space. So sometimes if it doesn't get treated, things just get so inflamed. that everything backs up. And so once it gets backed up, kind of all the medicine in the world can't, can't get it out. So it gets stuck up there.

And that's when you hear about the stuff that doesn't get better with antibiotics keeps coming back over and over and need kind of more, more treatment than just your average neti pot for the neti snot or an antibiotic.

[: 00:11:23

[00:11:25] Mickey Silverstein: Yes, we do see crazy stuff like that.

[: 00:11:27

[00:11:36] Mickey Silverstein: Absolutely. I'd say, um, one people with allergic rhinitis or different allergies are just more prone because. They're have more inflammation in there to people with anatomic defects of their nose You know if it's real crooked if they got in a fight or if they have a deviated septum Which means that you know one side of the nose is smaller than the other and it's kind of blocking the average flow of the mucus in the air

um, so, anyone can get it though. It's also, you know, you can get it like any other bacteria, but some people are going to get affected more just by their anatomy and their underlying conditions.

[: 00:12:11

[00:12:25] Mickey Silverstein: Yeah.

[: 00:12:26

[00:12:29] Mickey Silverstein: There's not one size fits all workup for chronic sinusitis. I'd say, if someone comes in with symptoms, such as a stuffy nose, if they're wearing a Breathe Right strip and look super cool like you, or if, um, you know, they say that they have pressure in their... Face, teeth pain, headaches, sometimes they even say blurry vision if they're tired.

So, you know you start with the symptoms and if it seems like something that could be caused from the sinuses then we go on to a physical exam, you know, and you look in their nose then you see if there's any swelling of the lining of the mucosal lining, if there's any pus, if you see any polyps. Then we have, um, what's called like a nasal endoscopy, which a camera, um, basically there's two options.

There's a rigid one that's like a little metal stick or another one that's a long rubber thing. So it's like a rubber hose up your nose. We like to say, and, um, can go in each nostril, look around, look for inflammation, see if anything's blocked up there, if there's any pus or polyps, if it looks kind of discolored up there.

If, um, there's just no space to get through with a camera and people are completely clogged, those are some things to look for. Uh, we definitely do take swabs at times and see if there's a bacteria growing. I'd say, usually, you know, there's a first line treatments and you try that first, but if it doesn't work, then I've been known to swab a lot to kind of just figure out exactly what bacteria it is, because then it, you know, gives you a list.

It's this bacteria, these are what treats it and you give it and they can. Get better. Um, and then there's CT scans of the sinus, which we use all the time to see if it's just in the nose or if it goes farther. It's actually filling the sinus cavities in the head.

[: 00:14:11

[00:14:14] Mickey Silverstein: That is a very good question. Depends. So, um, let's say you come in with acute sinusitis, or you think it's acute sinusitis, so most of the time if it's only been for a few days, we kind of can assume that it's viral because that's the most common reason people come in. If it goes on for about a week or 10 days.

And it looks like there's pus in there or something like that. Then the first round is definitely an antibiotic. Um, you know, we do antibiotic and most of the time, some. nasal steroid, like a Flonase or something like that. Who knows? Um, we love neti pots. I think, you know, rinsing the nose out is the best.

You know, if you, dilution is the answer to everything, as they say, you know, just rinse it all out. If it's not up there, it can't be infected. And then, um,

[: 00:15:02

[00:15:05] Mickey Silverstein: did. I had to like hold it in. I was holding, I felt like I was being

[: 00:15:08

[00:15:09] Mickey Silverstein: a little bit. Yeah. So, well, you know, it's the solution to pollution.

But, um, and then if that doesn't do it, and if people turn into chronic sinusitis, where we can't really get with maximum medical therapy of steroids, rinses, treated all their allergies, see sinusitis on their CT scan, that's when we turn to more procedural or surgical options.

[: 00:15:35

[00:15:55] Mickey Silverstein: Yeah, so I'd say it's a common misconception that it's a whole procedure separate from everything else we do, say in the ENT armamentarium of things that we do, um, definitely the scope is part of our physical exam. So, you know, what do we have that you're. Average family medicine doctor, ER doctor, primary care can't do like they can look in your nose as well as I can, right?

But I have the tools to look a little bit farther and and see what's going on So that's how we do it with a nasal endoscopy So if you're coming in for stuffy nose to an ENT chances are you're gonna get something stuck up there. So be prepared So, what do we do?

[: 00:16:32

[00:16:33] Mickey Silverstein: I'm not gonna say it's like what you want to do on a Friday night, but it's it's not painful You're not gonna go home with any lasting side effects or anything like that.

We, uh, usually spray the nose first with a combination of Afrin, which kind of. Opens it up a little bit in your nose to give it more room and some lidocaine that, that numbs it. So most of the time people's biggest complaint is that the nasal spray tastes bad and it makes their throat a little numb. And then, you know, you get real nervous about the nasal endoscopy.

We look in the nose about, you know, seven to ten seconds each side most of the time and then everyone's like, that's it? I was expecting it to be something awful, but it's not. We do it all the time.

[: 00:17:12

[00:17:19] Mickey Silverstein: No, it's not that fun. No,

[: 00:17:21

[00:17:23] Mickey Silverstein: no, no pounds are lost. It's not a diet. We

just

[: 00:17:26

That would be a major problem.

[: 00:17:32

I

[: 00:17:36

Yeah, I just wanted to touch briefly on, um, like when is surgery indicated and, and like briefly how's it performed, you know, what's the general recovery time? You don't have to go into like crazy, you know, so how do we treat it? When is surgery indicated? And generally like how is the surgery done these days?

[: 00:17:54

And sometimes. We have to take matters into our own hands and take the things that are swollen and shrink them down. So, in that case, I'd say the most common thing that allergies cause, if you don't have chronic sinusitis and just have a stuffy nose, is called inflammation of the inferior turbinates. So your turbinates are these guys in your nose that kind of look like a grape on each side, and they get big and small and big and small and humidify air.

And everyone has them, they do a job, and they're important, but if they kind of get too big, then they can take up the limited... spot of your, your nose. So, um, if we can't treat that with medicine, the next step is called a turbinate reduction. And that's something we often can even do in the office where we take those grapes and a machine called the micro debrider, which is like a little liposuction to the grapes and turn them to little raisins, push them to the side.

So they can still get big and small and do their thing, but from a smaller starting point. So it's just kind of, kind of cheating.

[: 00:19:09

[00:19:13] Mickey Silverstein: it's awesome. So, you know, if you, and if you can't make things smaller, you got to make the room bigger. So you know, if there's, if you have tiny holes of your sinuses that drain all your sinus cavities, there's more stuff even in the office you can do, like a balloon sinuplasty. I don't know if you've heard of that, or under local inflammation, you go into the actual natural hole of the sinus with literally a balloon on the end of a stick, blow up the balloon, deflate it, take it out.

So the little hole, instead of being a few millimeters is more like a centimeter and everything can just. So it's either shrink stuff down or make stuff bigger.

[: 00:19:47

[00:20:03] Mickey Silverstein: well it definitely depends on the severity of your disease. Um, I'd say back in the day, meaning, I don't know, just more than 15 years ago when I've been doing this, there, there's these horror stories where people exactly have black eyes, they say their nose was stuffed with like a cotton that was 10 feet tall and they remember.

You know, back in the sixties going in and their dad had to get like a whole yarn ball pulled out of their nose. And it was the worst thing that ever happened to them. Um, I'd say it's not like that anymore. Even in the more severe cases where we go to the operating room and kind of rotor root or everything out, it's usually about an hour long surgery.

People go home, it's about a week, like you feel like you got punched in the nose, but you have no bruising or anything like that, take it easy. And then a week later you come back, look in the nose, suction stuff out. Cause you're going to have a bunch of bloody boogers. And then. You feel better. So it's not, not the worst surgery in the world.

[: 00:20:56

[00:21:05] Mickey Silverstein: What you have done. Tell us everything. I'm

[: 00:21:07

[00:21:07] Julie Bruene: had spine surgery too, Jeremy! Jeez, and the sinus was worse?

[: 00:21:12

[00:21:14] Jeremy Alland: I would do the spine surgery a thousand times before I would do the nasal surgery was the worst recovery I've ever had. And it didn't work either as I'm sitting here with a nasal strip. That's by the way, I, I, I didn't use one of my good nasal strips for this episode. I used one of my cheap off brand ones and it's already, it's already coming off.

So it gives you an idea of how much we suffer with these things. But, um, Yeah, I'm excited for the next category because my surgery was for that and I'll get into my surgery when we do the next categories.

[: 00:21:39

[00:21:43] Jeremy Alland: No, it's kind of like, uh, breathe right for the next, uh, like hour to an hour and a half until it comes off your nose strip.

[: 00:21:49

[00:21:52] Jeremy Alland: So we've established in this kind of like everything swollen and inflamed, um, world, we have allergies and we have kind of like chronic inflammation a lot of times due to infection. Is there anything else that fits into that category?

[: 00:22:06

[00:22:08] Julie Bruene: Alright, well, let's, let's, uh, meander away from, you know, chronic swelling. Problems and then talk more about obstructive issues. So the first one that came to my mind were nasal polyps So like what are they Mickey?

[: 00:22:24

That the lining basically can't handle all of it. So it pops out these little great balls and they kind of cause more inflammation and multiply on themselves and you get filled with polyps in your nose where it just blocks all the air flow and can go into your sinuses. And, you can't get rid of them unless you see me.

[: 00:23:02

[00:23:09] Mickey Silverstein: So it depends. I'd say, you know, most of the time, that's where the nasal endoscopy comes in. You know, you look in the nose and you can check and you see all the normal anatomy and then, if there's extra little balls of inflammation in there, then you can tell that it is. I've definitely had some patients who have severe polyps where I've seen them actually physically coming out of their nose before.

So, that is not the, the norm, but definitely sometimes you can even see them coming out of your nose

[: 00:23:36

[00:23:37] Jeremy Alland: But it sounds like the average person's not like looking up their wife's nose and being like, look, there's a polyp right there. Like that, that this is something diagnosed more by a doctor. Yeah. Okay. Why do people get polyps? Was I born with it?

[: 00:23:49

[00:23:52] Jeremy Alland: No, it's not.

[: 00:23:52

[00:23:53] Julie Bruene: Getting a free consult

[: 00:23:55

[00:24:01] Mickey Silverstein: So there's a few reasons. Um, some people have it due to untreated chronic sinusitis where the inflammation just gets So at a hand that it again kind of spirals out of control I'd say down here in the south where it's kind of warm and moist It's a Georgia Florida kind of that Bible Belt area a lot of times There's something called allergic fungal sinusitis where you know There's there's fungus out there and everyone breathes it in all day where you know Maybe me or you doesn't have a reaction.

Some people have a severe reaction to it And it causes polyps in their nose, causes it's like kind of thick, thick peanut butter, creamy, nasty drainage from their nose. And I can kind of, now this is the fun stuff, Julie. And that's, um, kind of a really common thing we see with people with severe polyps, especially in kind of the Southeast region.

And then there are a bunch of syndromes out there as well. One that comes to mind is something called Sampter's triad, where, um, basically it's just a combination where people have a sensitivity to. aspirin, have nasal polyps, and something else that I just forgot, so I have to look that up. It's a Sampter's biad for now.

[: 00:25:09

That was

[: 00:25:13

[00:25:16] Julie Bruene: Sometimes we forget shit and so we just change the

[: 00:25:20

[00:25:37] Jeremy Alland: So more importantly though, people, this isn't like a polyp, like a mass that I was born with or whatever. This is something that develops through exposures and whatnot.

[: 00:25:44

[00:26:06] Julie Bruene: Um, and for the record, Jeremy mentioned people that are listening to this in the car. And we were talking about whether or not you can see polyps, you know, just by looking at them. Don't, don't look in your rear view mirror to see if you have polyps right now. Or if you do, just pull over first. Yeah, don't, don't do that.

[: 00:26:25

you

[: 00:26:32

[00:26:36] Jeremy Alland: well,

[: 00:26:37

[00:26:39] Jeremy Alland: we're waiting for that, uh, that, that iPhone attachment where I can stick that, you know, like that endoscopy up my nose and you can tell me what, what you're seeing,

[: 00:26:48

[00:26:50] Julie Bruene: Oh, that'd be great. Um, How do you remove them or shrink them or lessen their effect? Can you do it without surgery?

[: 00:27:00

So picture this, it has a little thing that goes up your nose, like a normal nasal spray, and a little phalange that goes in your mouth. So, you know, you got to kind of have, tell patients before you just call it in for them, because if they pick it up, they're like, what is this thing? But so basically you blow into it.

And it makes a seal between your nose and your mouth so it kind of closes up that whole system. And they press it kind of like an inhaler. And then it goes up the nose and kind of spreads past the polyps and can kind of treat it better. Most people stay with conventional nasal steroids. They just spray it in their nose and it feels like it just comes right out.

Because it's all, this one actually creates a little tunnel for it to go right up

[: 00:28:01

[00:28:08] Mickey Silverstein: cool.

[: 00:28:08

[00:28:13] Mickey Silverstein: Yeah. It's

[: 00:28:14

[00:28:16] Jeremy Alland: I, it's not going to treat my problem. We haven't gotten there

[: 00:28:19

[00:28:19] Julie Bruene: Oh, got it. Sorry. Okay.

[: 00:28:20

Some implants that you could put in your nose that are drug eluding stents. What does that mean? Basically, it's a little device you put up someone's nose while they're awake. And over time, it slowly releases medication locally. So those are some ways to avoid surgery. And then, um, there's some new fancy kind of biologic and injections that were originally created for more like, um, eczema and asthma, but now are being used for nasal polyps as well.

So sometimes people can get away with a, you know, biweekly injection and. And stuff like that. So we're seeing all sorts of options before getting to surgery.

[: 00:29:13

[00:29:14] Mickey Silverstein: Yeah.

[: 00:29:15

[00:29:16] Jeremy Alland: I'm learning a ton. And to be honest, we haven't gotten to my, my Narrative here, but, but, but you, you, you have lessened the fear of ever going back to the ENT for me through this episode, because there's so many other options. Yes. It sounds.

[: 00:29:33

[00:29:35] Mickey Silverstein: We'll take good care of you. You get VIP treatment.

[: 00:29:38

[00:29:40] Mickey Silverstein: With a doctor who's an ENT friend now.

[: 00:29:42

[00:30:00] Mickey Silverstein: Yeah. All of the above. So sometimes, you know, people are not born completely symmetrical and one side can be different than the other. So it could just be. You too, you know, in theory is trauma from the birth canal itself. I hear it's kind of a, a small hole and, you know, get a lot of pushing in there and it can definitely push on the nose and it depends how, what angle you come out and, um, then a lot of times people say, you know, they don't remember getting their nose hit or the nose broken, but you know, maybe they played soccer growing up or just, you know, rough house to bunch and sometimes that causes it and then there's people like, I'm presuming Jeremy who got in the bar fight and. And then, you

know, just

[: 00:30:43

[00:30:47] Jeremy Alland: I also do not have the body type to ever go into a bar fight.

I,

[: 00:30:53

[00:30:54] Jeremy Alland: the odds are, the odds are against me.

[: 00:30:56

[00:31:02] Jeremy Alland: Yeah. If, if the, if the bar fight involved like running as fast as we could, I'd be in, I

[: 00:31:08

[00:31:09] Jeremy Alland: had a, I had a better chance.

[: 00:31:11

[00:31:20] Mickey Silverstein: Yeah, so, so the, the septum itself isn't going to move on its own.

[: 00:31:26

[00:31:27] Mickey Silverstein: You are, you have what you have with the septum. So I like to think of the nose as two different rooms, right? So it's split with a wall in the middle. So sometimes. They're 50 50, they're the same size room, sometimes one room is smaller than the other if you have a deviated septum into one side.

So it could be 70 30. So if you're like, I can't breathe through my left nostril, it's because that room is smaller than the other room. Without knocking down the wall, you can't change the size of the room. So you need surgery to fix it, but you can shrink down what's in that room, like the size of the furniture, and give you more space. So, you know, if you're really trying to avoid surgery, you know, you can address the other issues like we talked about, like inflammation. You know, if you have less allergies, less inflammation, then even though one's smaller than the other, it might be enough for you to breathe. That's when you can talk about some of those more less invasive procedures, like the turbinate reduction that we said, where, you know, you're, you're not moving the septum, but you're making what's filling each side of the nose smaller to help the nasal flow on, on both sides.

So, you can't move it with all the medicine in the world, but. You can kind of trick it into thinking it's okay by making everything around it less inflamed and smaller.

[: 00:32:42

[00:32:54] Mickey Silverstein: Yeah, so the septum is a combination of cartilage and bone, separating the left and the right nostril. And then it's covered by that mucosal lining on both sides. So the mucosal lining itself can get inflamed like anywhere else in the nose, but basically it's covering some cartilage that is Split in the nose in half and then as you go farther and farther back in your nose like where your finger can't reach it turns Into bone and gets a little harder and kind of incorporates with the rest of your your skull again Don't try to put your finger in your nose while you're driving to see how far back that is

[: 00:33:27

[00:33:31] Mickey Silverstein: Do it for a living. It's awesome

[: 00:33:33

[00:33:36] Jeremy Alland: well, this is, this is the surgery I had and, uh, um, I mean, it was, I mean, how many years ago now, which, so I was 12 years ago. Um, and so I have a bad deviated septum. Um,

[: 00:33:54

[00:33:55] Jeremy Alland: I have a great room and a closet

[: 00:34:00

[00:34:01] Jeremy Alland: and I, anytime that I would get any bit congested in any form or fashion, I basically wouldn't be able to breathe out of that nostril. Like it was even like the lightest amount. And so I tried all the noise, nasal steroids and whatever. And you know, like sometimes I was fine, but like, it just was happening so frequently that I consulted and, and at some point went through and decided to do the surgery and the surgery took.

Like two to three times longer than they quoted. I mean, I was in there for a long time. My wife was freaking out. And afterward, I just remember being in bed. I had that image that you've already described, Julie. Like my face was. Black and blue. I had the nasal, like, uh, dilators up in my nose. I was so uncomfortable.

And I just remember basically taking a pain pill, falling asleep, waking back up, taking a pain pill, falling asleep, just basically trying to sleep my way through the first few days. Um, and then the worst, uh, of that outcome of that is that it didn't get any better. It didn't work. Um, and so, you know, again, I, I have actually reconnected with a local ENT Something that happened to me recently, Julie, that I thought was an interesting anecdote was I, we wear whoops, whoop is a wonderful way to get information on your recovery and, and, um, you can get a free month by using your doctor friends link that we'll put in, we'll put in the show notes,

[: 00:35:23

[00:35:24] Jeremy Alland: but, but, uh, ultimately speaking, um, my wife started wearing one and she was getting like a hundred percent sleep efficiency scores and I like, Got like in the mid seventies.

And I was like, I feel like I do a decent, I don't understand. So all I did was one thing I put on a breathe right nasal strip. It was the first time I'd done it in years. And for the next five consecutive days, my sleep efficiency went up to 94%. It was a 20% increase. All I did was put on a nasal strip and I was like, it's, I can't breathe out of my nose at night. Um, and I wasn't,

[: 00:35:53

[00:35:58] Jeremy Alland: I don't, I don't actually snore that bad to be honest. Um, I get in certain positions and I can snore. Um, but if I get congested, it's just, it's a disaster, right? Cause like when I, when I give you that anecdote, I was not. Sick or congested in any way. That was my baseline. We've already talked about this on our other podcast with allergies.

I use Flonase on a daily basis, um, and have for years, um, for allergies. So anyways, one of the encouraging things to me about this podcast and also what was referred back to me is like endoscopy didn't really get used much back in those days. I'm sure some people were doing it. It just wasn't like a standard, like you just didn't go in and get it all the time.

And. The concept now is, and this is the way it was described to me. Cause I, I noticed that big improvement. I was like, I should probably go get this looked at again, but I will never go through that surgery ever again, unless somebody tells me it's like way different.

[: 00:36:47

[00:36:48] Jeremy Alland: Yeah, yeah, right, right.

Um, I, I, in, in, in fairness, like again, and I, I'm not, uh, the surgeon said it was one of the two or three worst he'd ever seen.

Um, and I don't know if that's something he just told me or not. It doesn't matter. But the, the point is, well, when he told me that he didn't know it wasn't going to work. So maybe he didn't just tell me that because it had lasted a long time in the surgery, but the concept of basically being able to do that endoscopy, look up in there and kind of see all the furniture.

Right. Cause there is a chance that the rest of the furniture isn't actually being optimized as well. And maybe I could do some things for that without doing surgery. So I think that you've done a really good job of painting a picture of there's options. And I'm excited to go back into the NT office now and maybe have that endoscopy and kind of get an idea of where everything's at.

Um, but this thing's it's miserable. I, I, I, I, anybody sitting and listening right now who has a deviated septum, you have a doctor friend who understands.

[: 00:37:39

[00:37:45] Jeremy Alland: I hope so. I hope nobody has my, my recovery on that. And again, I, I don't mean to scare anyone away from the surgery. And in fact, I think Mickey, you've done an amazing job so far of basically, I think I had my experience. I should be the one that has the most trauma of the, you know, like on this podcast of like thinking about this.

And I felt really comfortable through everything you were just saying about, like, I should go back in and hear what they have to say and, and do some stuff. So I think you've done a really nice job of opening the door back up for at least this one person.

[: 00:38:12

Thicken the sides, there's something that implants they can put to kind of keep your nose from from collapsing So there's a bunch of little things to do to fine tune you without having to Rebreak your nose and put you through all that trauma again So I think you're I think they already did the heavy lifting So even if you don't feel better all the the big walls were knocked down already And I just got to get a little interior designer to spruce it up a

[: 00:39:02

[00:39:05] Julie Bruene: we

[: 00:39:06

[00:39:07] Julie Bruene: I love this. Mickey, you are a wordsmith. I mean, if you, if you ever were sick of ear, nose, and throat stuff, you should definitely write. I would, uh, I would read anything that you put in front

[: 00:39:18

[00:39:22] Julie Bruene: Um, any other causes? I mean, unless we're, we have more to say about deviated septums, and you mentioned that nasal valve collapsed. Mickey, um, any other things that you see very frequently in the office when people say, oh my gosh, I can't breathe through my nose, help me, Dr. Fisher, that we didn't touch on?

[: 00:39:41

[00:40:01] Julie Bruene: Jeremy, do you have anything else you want to add before I get into some debunking of myths and misinformation, many of which we've already done, but I'll try to find the ones on my weird, dumb list that we haven't talked about.

[: 00:40:12

Are there some things that people can do? On their own at the start to just either help identify or even help their symptoms without necessarily running off to the doctor immediately

[: 00:40:42

That's kind of twofold. One, if there's boogers in there, just rinse them out, and you'll get more room. Two, let's say you have allergies, and you're allergic to dust. All that dust is going in through your nose and sitting there, and you're reacting to it. So if you rinse it out, then you don't react to it as much.

And kind of same with bacteria. So just rinsing it out is like a shower for your nose. No side effects, all natural, can't hurt you. Um, so that's, that's kind of step one. Then, um, I'm a big proponent of Flonase, so I like that over the counter. Just kind of can use it daily, as long as you don't have, you know, glaucoma or anything else that would keep you from needing to use it.

Um, and you can use that daily and then, you know, you can go to an ENT and get a whole allergy test, but kind of a Quick and dirty allergy test is take an allergy pill and see if it makes a difference, you know, if it does, then it's allergies, if it doesn't, then it's probably not, so, you know, over the counter Clareton, Zyrtec, Allegra, any of that stuff, mix with Flonase for maybe a few weeks and see if that makes a difference with your nasal rinses is probably a good place to start.

[: 00:42:09

[00:42:15] Mickey Silverstein: So boogers are, you know, I don't remember the actual chemical breakdown, but basically it is Your body's way of a first line of defense. So basically your nose is an open hole to the rest of your body. And there's a lot of really important things there. You know, your eyes, your brain, your throat, which goes into your lungs.

So kind of the nose is a passage way to your. body. Um, so if nothing was in it, if we didn't have any way of trapping stuff, then everything could just get through. So the boogers are there to basically trap stuff from coming through. And that's why when you have allergies or infection or something that's kind of posing a risk to your body, you're going to make more boogers and get more congested.

So kind of a vicious cycle. So everyone needs boogers. You just need just the right amount.

[: 00:43:00

And

[: 00:43:23

[00:43:24] Jeremy Alland: that just a genetic variant?

[: 00:43:25

So, even if you're making the same amount as someone else, you might seem like it's more because it's sitting there, it's like a puddle that's just getting dirty and gross. I'm coming out, so that's all I

[: 00:43:53

[00:44:03] Mickey Silverstein: Yeah, absolutely, burgers.

[: 00:44:05

[00:44:09] Mickey Silverstein: Yes. Don't eat them either. Because they literally trap all the bad stuff.

[: 00:44:13

[00:44:18] Jeremy Alland: I

mean,

[: 00:44:19

[00:44:21] Mickey Silverstein: I literally have a job where I say the word burger like 50 times a day. It's pretty

awesome.

[: 00:44:25

[00:44:25] Jeremy Alland: we haven't had an ENT on, so of course this is the booger episode.

[: 00:44:28

[00:44:33] Jeremy Alland: All right, we can debunk now that we're past boogers. Thank you.

[: 00:44:36

So I think you could just sometimes even just give me a true or a false if you know, but if you want to give some follow up, that'd be great too. So one, uh, all sinus infections need antibiotics.

[: 00:44:51

[00:45:16] Julie Bruene: Uh, yeah, follow up question. If your snot slash mucus slash boogers are green or yellow, it's definitely a bacterial sinus infection and needs antibiotics.

[: 00:45:26

[00:45:53] Julie Bruene: uh, all sinus infections are contagious.

[: 00:45:57

You know, make sure washing your hands and probably don't share drinks, but it's mostly localized in your sinuses. But again, if it's from a bacteria or a virus, that is something that can get passed on. But, unless someone's picking your nose or, or all up in there, then it should be avoidable to transmit.

[: 00:46:31

open it

[: 00:46:39

And then you kind of. Need more of it because the more you use it, the more it comes back with a vengeance. So it'll shrink it up real quick, but then it'll rebound and be worse than ever. So you actually do get addicted and get a physical dependence to it. It's not just, you know, people think, oh, I'm addicted to it because it feels good.

No, you're actually addicted to it because you are physically dependent on it. Cause when you don't use it, it's worse than if you never used it. So it actually is a real addiction.

[: 00:47:56

[00:48:06] Mickey Silverstein: yeah. Yeah. No, all the time. It's like. Do you use Afrin? I can do Q tips in the ears too. I'm like, do you happen to use Q tips? Like you can't hide anything through ear and teeth. We see everything. So

[: 00:48:16

[00:48:26] Mickey Silverstein: it can if you're using water with amoebas in it.

[: 00:48:31

[00:48:35] Mickey Silverstein: So, you know, I definitely, you know, it was more of, do you practice what you preach? Like I use a neti pot every day and I use the water for my shower. Right. But what do I tell patients, you know, definitely use, don't use well water. Don't use anything from, you know, a. county lake or a pond. Um, you know, if you're gonna, if you wouldn't drink it, don't put it up your nose.

Um, you know, so definitely I recommend something that's somewhat purified. But, you know, ultimately, if you're drinking it, your nose and your mouth are connected, so it's all So if you can drink it, you can put it up your nose, but to be safe, to avoid any extra bacteria getting in there, definitely something either distilled or you can just put it or boiled or filtered.

They're all, they're all good stuff. Ooh, but something with a neti pot. This is just a little, little thing that I learned the hard way. Never forget to put your salt packet in the neti pot. Don't try to do it without the salt. You think that it would burn less. It is like an ice cream headache on crack.

It's like the worst thing you'll ever experience in your life. So make sure you put your little powder solution into the neti pot before you you rinse. You

[: 00:49:43

[00:49:45] Mickey Silverstein: know, it's like putting vodka up your nose.

[: 00:49:48

[00:49:50] Mickey Silverstein: Not that I would know what that feels

[: 00:49:52

[00:49:54] Jeremy Alland: so you recommend against that too, then

[: 00:49:57

[00:50:05] Julie Bruene: Oh,

[: 00:50:06

[00:50:07] Julie Bruene: find it and

[: 00:50:08

[00:50:16] Julie Bruene: This is a disclaimer. Please don't do this. I love it. I love

[: 00:50:20

[00:50:21] Julie Bruene: Um, some of these we've answered already. All right. Uh, nasal steroid sprays are bad for you. Steroids are bad. They will make you gain weight.

[: 00:50:29

[00:50:34] Julie Bruene: Mm

[: 00:50:35

You know, get absorbed to the point where it's going to affect your whole system. So when you're putting in your nose, it is coating the area. The only real thing I tell people to avoid is sometimes people with glaucoma can get increased ocular pressure or eye pressure from, from using it. So that's the one thing because it's, even though it's local, your eyes are right there.

So if there's any little connection between the eyes and the nose and it can kind of affect that, but no studies have really shown that it causes weight gain. I know a lot of parents are worried that it's going to stunt their kids growth. I think a study came out maybe 15 years ago where it said it stunted the growth, but then when you read it, it says it was like 0.

001 centimeter difference. So I mean,

[: 00:51:29

[00:51:30] Mickey Silverstein: I think it's kind of, you know, there's, there's a risk benefit to everything, but in the world of medications, I think a topical nasal steroid is one of the safest things you could use.

[: 00:51:38

[00:51:53] Mickey Silverstein: Yeah. Yeah. Yeah. So I think flownase has been out a little bit longer, so I've kind of been out my whole time, but yeah, there's definitely some endohistamines up the nose that they can, you know, people have been treating their own inhalers over the counter and stuff like that. But yeah, I think it's definitely a game changer.

I think that if it's gone through all that testing, then they're normally pretty safe.

[: 00:52:14

[00:52:20] Mickey Silverstein: Yes. Unless you don't.

[: 00:52:23

[00:52:29] Jeremy Alland: Yeah I feel like that's a wellness. It's a wellness trend. I think people there, there's some, there's some. Like, uh, movement at this point that breathing out of our nose is better for us overall than breathing out of our mouth. And like, if you don't breathe out of your nose, you're missing out on a wellness benefit.

And so people are taping their mouths shut. And I think there's a lot of things to get into there, but not all on this podcast.

[: 00:52:50

[00:52:53] Mickey Silverstein: Yeah. And I I've heard this, especially from people septoplasty or their sinus is done and they come to the office and they say that they can breathe so much better through their nose. But then, you know, once they fall asleep, it's not really changing their snoring or anything, cause they're so used to being a mouth breather that they're still breathing through their mouth.

So I don't know how much of that is habit versus just their, their body. But, um, I would not recommend taping your mouth shut until you're a hundred percent sure you can breathe through your nose.

[: 00:53:21

[00:53:29] Jeremy Alland: No, put that on a bumper sticker.

[: 00:53:32

[00:53:46] Mickey Silverstein: So, there's many online, obviously not, not any of them, but you know, WebMD always has great stuff. The American Academy of Otolaryngology has some good references for, for patients that you can click on. Um, you know, if you go to Florida ENT and Allergy, there's a bunch of... Um, and and interviews that you could look at as well.

You know, there's also ways to email the doctors and, you know, I would be more than happy to answer anyone's questions if they emailed me as well. And yeah, just don't watch too much YouTube. Don't believe what you see, but there's definitely options out there. Not all the NTs are scary and not everything means that we're going to go in there and, and break your nose.

There's, there's a lot in between not breathing and having to go through a big surgery that can, can really change your life.

[: 00:54:35

[00:54:43] Jeremy Alland: Nope. I, uh, I got a lot of personal information here and I will be scheduling my nasal endoscopy. So mission

[: 00:54:51

[00:54:52] Mickey Silverstein: And keep me posted. I'm really excited to know what it looks in there.

[: 00:54:55

[00:54:58] Mickey Silverstein: You might be able to ask them to record it.

[: 00:55:01

[00:55:02] Mickey Silverstein: I would love to see it.

[: 00:55:04

[00:55:06] Mickey Silverstein: like that would be, we get closer quickly.

[: 00:55:07

[00:55:14] Mickey Silverstein: That was awesome.

[: 00:55:15

Alright, well, if you have greater than average amount of boogers, uh, maybe you should check out an ENT so they can go up your nose with a rubber hose. And listen to your doctor friends.

the amazing music is credited to Skill Cell with Bay Licensure The podcast is meant for educational and entertainment purposes only The contents of this podcast should not be taken as medical advice to treat any medical condition in either yourself or others Please consult a medical professional for any medical issues that you may be having The contents of this podcast are the opinions of the host only and do not reflect the opinions of their employers or affiliations This entire disclaimer also applies to any guess or contributors to the podcast Under no circumstances shall Dr Julie Bruny or Dr.

Jeremy Allen or any guest to the podcast be responsible for damages arising from use of the podcast