Latest / Voices of Otolaryngology / From Wildfire Smoke to Microplastics: Otolaryngology Has a Place

Transcript

From Wildfire Smoke to Microplastics: Otolaryngology Has a Place · Voices of Otolaryngology

0:01
Welcome to the Voices of Otolaryngology podcast series, where we spotlight
0:05
diverse perspectives and insights within the field of otolaryngology.
0:08
I'm your host, Rahul Shah.
0:10
Let's jump into it.
0:12
Welcome to the Voices of Otolaryngology.
0:14
I am really excited to have Doctor Kara Meister with us.
0:19
A friend. Colleague.
0:20
She has some great artwork back there, but she's going to tell us about herself.
0:24
Doctor Meister, please introduce yourself to our audience
0:28
of Voices of Otolaryngology.
0:30
Good morning.
0:31
Thank you for having me.
0:32
I'm Kara Meister, I'm a pediatric otolaryngologist
0:36
at Stanford Children's, and I'm really excited
0:39
to be here today to talk some about, the impact of the environment
0:45
on health, on otolaryngology and on kids.
0:48
Some of my favorite things.
0:50
So thank you for having me.
0:52
Awesome, awesome, I love it.
0:53
Tell us a little bit about where you trained,
0:56
maybe where you grew up, if you played any sports, anything fun.
0:59
But we like to relate to our audience, to our members.
1:04
Kara- So I am from South Carolina.
1:07
I grew up on the outside, right outside, about two and a half miles from,
1:12
a DuPont manufacturing plant.
1:15
And I and my dad worked in a, plastics manufacturing plant.
1:19
And so, a little bit of this is my my Erin Brockovich moment.
1:23
I went to medical school, in South Carolina at Medical University of South
1:27
Carolina, and, and it just really had great, otolaryngology mentorship there.
1:33
Trained in Pittsburgh, for my residency
1:36
and t 32 and then have been at Stanford ever since.
1:39
So I did, pediatric fellowship there and have been there,
1:43
just shy of ten years, which is wild.
1:46
Awesome.
1:47
And I don't know if I missed it because I was still thinking
1:49
about growing up 2.5 miles from a plastics plant,
1:51
which is going to be an awesome discussion.
1:54
Where'd you do your undergrad?
1:56
Clemson. Oh. So fun. Go, Tigers!
1:58
Yeah. Yeah.
1:59
And then you love the East Coast so much, you went as far away as possible.
2:03
That's right, that's right.
2:05
Don't know what drove you to the other coast.
2:08
Oh, you know, it was, time for a change.
2:11
Which, you know, I thought would be a short lived change, right?
2:15
If we're being totally honest, my husband was in California, so.
2:18
Yeah, he's a Pittsburgh guy.
2:19
And, had a great opportunity in California.
2:23
And it was a win win because it was a great place for my career to start.
2:26
And of course, it's it's been a wonderful place for for me to grow as well.
2:30
For someone from Pittsburgh, seeing the ocean there, never leaving.
2:34
Like he's there.
2:35
Yeah. Yeah.
2:37
We've got to answer this because it's going to distract me the whole time.
2:40
Beautiful piece of artwork behind you. What is that?
2:43
Yeah.
2:43
So, Yeah, embarrassingly, it was me with DAL-E.
2:47
So it was made with generative AI,
2:51
and it's supposed to be capturing the academic ladder.
2:55
So one of the hats that I wear, within our department, is faculty mentorship.
3:00
And so I work with a PhD colleague Theresa Nicholson
3:03
to help faculty get to the next level, whatever that means for them.
3:08
And so when we looked at our program, we were putting together,
3:12
it was just at the beginning of, using generative AI.
3:15
And, this is one of the, the themes that it came up
3:19
with as an illustration for that program.
3:21
So that is incredible.
3:23
So just for the audience, I thought you meant Salvador Dali,
3:26
but you mean DAL-E as in, can you can you describe it for the group?
3:29
DAL-E is?
3:31
DAL-E is a generative AI platform that makes visual
3:35
representations based on prompts, and uses quite a bit of energy.
3:40
Wow, that's like be like, that could be like me.
3:44
Is it
3:44
awkward to have you go a tad off screen and you can show us what it looks like?
3:48
It's really amazing.
3:49
I can see someone reaching for the ladder.
3:51
Okay.
3:52
What does that stand for?
3:54
I think it must stand for surgeon.
3:56
Yes yes yes yes. Okay.
3:58
And then there's a little surgeon down below and a bigger one as well.
4:02
Yeah. What, what do you think that represents?
4:03
Mentorship. Mentorship.
4:05
Yeah. Yeah.
4:06
Yeah. Awesome. Well, I. Sponsorship. Allyship.
4:09
All the all the ships that we need to, to get us through this, career.
4:14
Yeah.
4:15
So one of the joys of my career
4:18
is serving as your EVP, CEO, and getting to know the story
4:22
behind people I've known you, your, pediatric otolaryngology career.
4:27
Because we're contemporaries.
4:28
And I attended a session, which you were part
4:31
of the panel, at the Academy.
4:34
It was, I forget what day was, but it was phenomenal.
4:37
And as soon as you were done, I accosted you.
4:39
And begged you to join, the Voices of Otolaryngology.
4:42
Because I think our members need to learn about it.
4:44
Can you talk a little bit about that panel and why?
4:47
We started off in jest, but in sincerely
4:50
talking about growing up near a plastics plant.
4:53
Sure.
4:53
So, this panel, “Little Patients/Big Impact: climate, health and sustainability
4:58
in pediatric otolaryngology.” I was fortunate to present alongside
5:03
Patrick Kiessling, who's
5:04
one of our, star residents who's very invested in this work, both,
5:08
in the basic science lab as well as community outreach and clinical research.
5:12
Laurie Lalakea, who's a professor
5:16
at at Stanford, she, was our chief at, the Valley Medical Center,
5:21
where she did really amazing supply chain work, and has taken
5:26
some of those findings and use them as a platform
5:29
to get the eyes and ears of all types of stakeholders, within otolaryngology,
5:34
from the C-suite to patients,
5:36
to industry, as well as Duncan Meiklejohn, who's a Stanford alum,
5:40
he is now the program director at University of New Mexico.
5:44
And he's done a lot of, work as well about what can we do as surgeons
5:48
in the hospital, to think about how we can impact
5:52
supply chain, and what choices we make in our daily lives.
5:56
Duncan and I also work together looking at microplastics,
5:59
which is adjacent to, to climate change,
6:03
in the fact that those microplastics are, made out of fossil fuels,
6:08
but not exactly what were the topic of that presentation was.
6:12
And so that's how it comes full circle.
6:14
But we were really excited to present that panel.
6:17
Thank you for the to the Academy, for hosting it.
6:20
And I think that this is a growing topic of interest, for all of us.
6:25
And so hopefully we can use today to share a little bit
6:28
about the highlights and where we see this going next.
6:31
Yeah.
6:32
Thank you for that succinct summary of an awesome panel.
6:35
I will start with this is not about politics.
6:38
It's about our patients.
6:40
And I like to throw in fun little nuggets in these Voices of Otolaryngology.
6:45
And I would say our members, this is just from me
6:49
meeting thousands of them, are the whole spectrum of politics.
6:54
And I'm sure you don't judge.
6:56
I don't judge.
6:56
We’re half and half, whatever party you are.
6:59
It's just really the whole spectrum.
7:01
So Doctor Meister and I are not here talking about politics.
7:05
We're just talking about how the environment impacts patients.
7:08
What are some big takeaways from there?
7:10
I had like 15 takeaways.
7:11
It just blew me away.
7:13
What what should otolaryngologist across the world kind of be thinking about.
7:18
Try to some and I'll help I'll help you get along.
7:20
You don't have to give it all to us in one minute.
7:22
But what are some of those big takeaways kind of the “a-ha!” moment like,
7:26
oh my gosh this really impacts patients!
7:29
Sure.
7:29
So you know thinking about the the political charge
7:33
I think, you know, this has become politically charged.
7:36
But at it's fundamental.
7:38
It's really about health right.
7:39
It's about planetary health.
7:40
And what's good for the planet is good for people.
7:43
Usually.
7:44
Sometimes it's not the easiest choice.
7:47
It's not the quickest choice.
7:48
But that's kind of the ethos of my mentor, Steve Luby.
7:52
That's how I approach this work.
7:53
And so, a question that we're often asked and we actually had a slide in the panel
7:58
is, are we in our lane?
7:59
Is this our lane?
8:00
Right.
8:01
Like, who are we as otolaryngologists to talk about
8:04
and to talk about climate change and health?
8:07
And really especially as otolaryngologists,
8:10
climate change affects otolaryngology health, we have the best data
8:14
around allergic rhinitis, otitis media
8:17
and airway respiratory diseases.
8:20
There's emerging data about sleep disorder breathing.
8:22
We can go into some of that.
8:24
But but first takeaway is this is definitely our lane,
8:27
because our charge is to take care of people. Right.
8:29
And to advocate for, things that impact health and specifically
8:35
ENT health.
8:36
The second big takeaway that I would, that I would leave with the audience
8:41
is that, health care is, is a is a pretty big culprit.
8:46
There's many different statistics that you'll hear, but
8:48
some of the more remarkable ones are that, you know, if U.S.
8:52
health care was its own country, we would rank 13th in
8:56
the rankings of total greenhouse gas emissions.
9:00
That's more than the UK as an entire country.
9:04
Which is is quite impressive.
9:06
And health care, when you look at the global,
9:09
carbon emission footprint, health care is just under 30% of the contribution.
9:15
We often think about things like, cars and, and industry.
9:20
But actually health care is a pretty big sector.
9:22
Now, most of that emission is coming from, energy
9:26
now generating enough energy to run our health care sector.
9:29
And, it really spans the whole gamut of health care.
9:34
So we're not just thinking about,
9:36
you know, the operating room, we're thinking about pharmaceuticals,
9:38
we're thinking about
9:41
patients commuting to clinic.
9:43
And so anywhere along that care continuum around the pipeline
9:46
is an opportunity to to enact change or to educate ourselves about,
9:51
about just really the impact of health care on our climate.
9:57
Yeah. Thank you for that.
9:58
I think for today, both of those could be awesome podcasts.
10:02
And maybe we'll do the health care one later.
10:03
I'd love to focus in on those diagnoses.
10:06
What was your “a-ha!” moment?
10:08
Usually it starts with the patient story.
10:10
Might have been your own children.
10:12
I think you mentioned kiddos somewhere, but where did you realize the impact?
10:16
I admittedly might be late to the game.
10:18
I realized it learning from you
10:20
and from your colleagues in New York, who've done work on this as well.
10:24
But what was your “a-ha!’ moment?
10:26
There were there were two and they were, pretty contemporary in, in timing.
10:30
So, we had, several wildfires
10:34
here in 2020,
10:37
there was a campfire and, one of our residents, Patrick Kiessling,
10:41
who was on this panel, he was on call and he noticed “Wow,
10:46
we seemed to be getting a lot of just what we call mommy calls, people
10:49
coming in and.
10:50
Is that the Palisades Fire, Kara?
10:53
These are the Northern California fires.
10:55
So little.
10:55
So, yeah, previous to the Palisades fires, but, a similar in, in impact.
11:00
Yeah. We love those mommy calls.
11:02
So what were the mommy calls?
11:04
The mommy calls.
11:05
What do we do? Can my kid go to their soccer game?
11:07
Do we need to stay indoors?
11:09
What we had, we had school districts calling our pulmonary clinics.
11:12
What do we do about P.E. class?
11:15
And we had our residents triaging in the ED and there
11:18
they were seeing more kids coming in with respiratory problems.
11:23
And so, Patrick Kiessling, one of our residents, actually,
11:27
did an amazing study, that was,
11:30
serendipitous in the sense that he was able to look at, air quality,
11:35
during the weeks of those fires, backtrack, as a control a previous year.
11:40
And luckily, we were able to show that there was low,
11:44
air quality, no problems with air quality during those weeks,
11:47
and then looked at presentations and he saw, most importantly,
11:52
most markedly and a real uptick in croup.
11:55
And as we think about the pediatric airway, we think about, you know,
12:00
there's old laws from our medical school where you think about resistance by,
12:04
diameter and the child's airways very vulnerable.
12:07
And when it gets swollen, say, from, wildfire smoke or PM 2.5,
12:12
we we do see that inflammation and our patients are coming in with croup.
12:17
So that was definitely one “a-ha!” moment.
12:20
The second one, which I
12:21
mentioned in the panel is, I've had three kids.
12:24
Anyone that knows me knows that,
12:26
I have three kids because I talk about them a lot.
12:28
How old are they, Dr. Meister?
12:30
They are, one, almost two, three and four.
12:35
Oh my word.
12:37
Yeah, I don't know whether to say sorry or congrats.
12:40
It'll get better, I can tell you that.
12:42
So they, we were we were
12:44
we moved for six months, to a rental house.
12:48
And in that house, there was a lot of carpet.
12:50
It was an older house.
12:52
It was meant for,
12:55
you know, a faculty temporary thing for Stanford employees while we,
12:59
did some work to our house, and, there was gas in the kitchen.
13:05
Basically anything that you could look on a poster
13:08
for poor indoor air quality, it was in this house.
13:10
And my middle child could not sleep in this house.
13:14
She was she would could not go to sleep.
13:16
She was stuffy. She was snotty.
13:18
She had sleep disordered breathing.
13:20
And it's like, “oh here we go.
13:21
Who's going to take her tonsils out?” It's always the middle child.
13:24
I wouldn't blame the environment.
13:25
I blame being the middle child.
13:28
There might be some truth to that.
13:30
She is more feral than the rest of them.
13:32
Or spirited as we say.
13:35
And as soon as we moved back into our, other environment, she was much better.
13:41
How much later? Like, after 1 or 2 weeks?
13:43
When did you?
13:44
After 1 or 2 weeks, she was 80% better.
13:45
Were you just, like, shocked? I was shocked.
13:48
Did you make the causality or you're like, whatever, she's better.
13:50
I'm happy.
13:51
I was like, whatever, she's better, right?
13:53
Because, you know, I wasn't thinking too much about it.
13:56
But right around that time, a group at a Brigham and Women's,
14:00
produced a paper looking at low income families.
14:04
They monitored air quality.
14:06
They found that nearly 30% of them had, air quality levels
14:10
that were, incongruent with, what is recommended by the W.H.O..
14:15
And there was a significant, correlation with the
14:19
the poor indoor air quality and sleep disorder breathing.
14:22
And so this is it just came out a few months ago,
14:25
and it's one of the first studies where I think we're really going to see
14:29
the impact of poor indoor air quality and how it affects the pediatric airway.
14:34
And then, you know, consequential to that sleep disorder,
14:39
breathing in all of our other respiratory and, arrow allergen types of disorders.
14:43
So when did that was a.
14:44
When did the connection for your daughter
14:47
once you were in the different place after two weeks,
14:50
when did it click to you like, oh my gosh, it must have been the environment.
14:55
It was
14:56
really is that, Patrick and I were preparing for another talk, and
14:59
I came across this paper and I thought, hey, this is what I see since then.
15:04
That was about 6 to 9 months ago.
15:06
Since then, I've been advocating to a lot of parents.
15:09
Hey, make sure you have an air filter in your house.
15:12
Right? Great. If you have a PM 2.5 filter.
15:15
So they want to know what can we do, doctor?
15:17
Besides, just taking out their adenoids.
15:19
What can you do besides tonsillectomy? What do you mean?
15:21
Do I put that for my Hvac, or do I go buy something?
15:25
So there are many different strategies.
15:26
I think the most important thing to consider is we're really looking
15:30
to get to that level. 2.5.
15:32
So particulate matter 2.5 microns, is where the data is showing that.
15:37
So I have no idea what you're talking about.
15:39
I know the size of a golf ball and a baseball.
15:41
What is particulate matter 2.5? You're rattling it off.
15:44
Can you explain that for our audience? Sure.
15:46
So particulate matter 2.5 is is just a it's a size measurement right.
15:50
So 2.5 microns as a as a size.
15:54
And usually these are things like dust, polyester,
15:59
chemicals, things that can be burned.
16:01
So we see a lot of it in, in wildfire smoke, a PM
16:04
2.5 filter is meant to get to that level.
16:08
Why are you using the word 2.5?
16:10
is that a certain
16:11
micron size that affects the airways, or is that an industry standard?
16:16
It's an industry standard, and it's where the data for airway Health comes from.
16:20
Please talk about that, do you mind, a little bit for our audience?
16:24
So we think about, 2.5 as really,
16:28
if you want to put in perspective, it's
16:29
about 30 times smaller than a piece of human hair.
16:32
So we think that that can get deep into your body, right?
16:36
So you breathe it in
16:37
most likely we can talk about ingestion, probably at a later date.
16:42
But our thought is that when you get that small,
16:44
you can create systemic and local inflammation.
16:47
So we're thinking about things like gets into your lungs,
16:51
it gets into your bloodstream.
16:52
And that can affect, how your body is reacting to your environment.
16:57
We can have 2.5 got really sexy during, wildfire
17:00
because it is a huge component of wildfire smoke.
17:03
It's also, in other things like cigarette smoke and indoor air pollution.
17:08
So things like your gas stove, dust mites, laundry, these types of things.
17:14
So that's where the 2.5 came to us especially is otolaryngologist like.
17:18
Really?
17:18
We should understand that because we are airway experts from nose to bronchi.
17:23
So 2.5 let's take a little commercial and talk a little bit about it.
17:27
So when you talk about air filters so do you recommend that?
17:32
You said you would have had an air filter.
17:33
Talk to our our members about this.
17:36
Should they counsel patients? Where do they send the patients?
17:38
How do they manage a patient when they start thinking
17:41
about environmental impact and getting an air filter?
17:43
Sure.
17:44
So there are a lot of commercial air filters.
17:47
Dyson has one, right?
17:49
That's kind of,
17:50
you know, a it's something that you can buy as an everyday consumer.
17:54
And what you want to do is you want to say,
17:55
look at that 2.5 and make sure that you're going down.
17:58
Some will only go to ten microns or say five microns.
18:01
But we really want you to, if
18:04
the patient has the resources, get to 2.5.
18:06
So there are commercial ones where I counsel my patients is
18:09
if you can have it in the bedroom, that's probably going to help.
18:14
The other thing that I will counsel patients, is it bedroom isn't an option.
18:19
The laundry room may be a next best step
18:21
because we bring in a lot of allergens, a lot of pollution on our clothes.
18:25
And we also actually create a lot of, particulate when we wash
18:29
and dry our clothes, especially things like polyester and nylon.
18:34
Many homes in the Bay area, the, the laundry is actually outside.
18:38
And so that's less
18:40
less applicable. But,
18:43
if there's laundry in the home that that's an option.
18:45
Many washers and dryers are actually putting these types
18:49
of filters, in inside and that's actually
18:52
the standard in the European Union, is to have these types of filters
18:55
within the washers and dryers that are, that, that you're using, residentially.
19:01
We at, at yeah, I was going to say at Stanford, we also have created
19:06
some patient handouts and we'd be happy to share those
19:09
with any of the listeners of how to Make your own air filter.
19:12
It's not going to go down to the level of 2.5.
19:14
But, you know, if we are in a setting where there's wildfire smoke, it may
19:18
well get us to that ten micron level, which is probably better than nothing.
19:22
And these are very user friendly, like make your own air filter at home
19:26
types of handouts.
19:27
So I'm going to, I don't mean to put you on the spot
19:30
if you're not, but I presume your board certified your board certified?
19:34
Good. So we are both.
19:35
Yeah. Otolaryngology and Pediatric Otolaryngology.
19:37
Okay.
19:37
Yes, we are both board certified and we're fellowship trained and
19:43
let's talk about your daughter.
19:45
So came to my office six months of rhino and nasal congestion
19:48
and obstructed breathing.
19:50
I would probably do a nasal steroid depending on her age for 2 to 3 months,
19:55
see efficacy, come back and probably then would think about adenoidectomy.
20:00
You don't have to agree with me, but that's kind of your algorithm.
20:03
Maybe before, but now, have you changed your algorithm?
20:07
Do you?
20:07
I honestly, before attending your panel, wouldn't ask about too much environmental.
20:13
All right.
20:13
I'm not as good as a doc as you are.
20:15
So now do you ask that?
20:16
Do you screen it?
20:17
Where do you start thinking about it and how does it impact?
20:20
Let's take your daughter's vignette. There.
20:22
Sure. So I do think about it.
20:26
It it fits into my algorithm, but I'm not sure that it's changed it.
20:29
So my typical approach is my first meeting with the family.
20:32
I want to know, did the child have eczema as an infant?
20:36
Do they have asthma reacted airway disease?
20:38
And, do you have a strong family history of environmental allergies
20:42
or food allergies?
20:42
And what I'm trying to get out of there is: how atopic are they, right?
20:46
It seems to be.
20:47
There's no data to support this, but it seems to be that our children
20:51
who are more atopic oriented tend to react
20:54
more, to these environmental exposures.
20:57
Right.
20:57
As I explain it to parents, we have great allergy panels,
21:01
but they're not comprehensive.
21:02
Of the 80,000 exposures that we come across every single day.
21:06
Right.
21:06
And so I think it's, I ask that as part of my history in those families
21:12
where they're either very motivated to try nonsurgical management.
21:16
I also do nasal corticosteroids.
21:18
I like, since it is the best politics and furoate, and nasal saline.
21:23
I also counsel them
21:25
on putting an air purifier in the bedroom if that's a resource that they can do,
21:29
as well as just thinking a little bit about their exposures for example,
21:33
if I have a soccer player who's playing outside on rye grass all day
21:37
and he seems to be more atopic, I'll say, hey, take that jersey off,
21:40
don't put it, don't, don't, don't jump on your bed like change your clothes, right.
21:44
Jump in the shower, rinse all this stuff off, like as much as you can.
21:48
Control your environment.
21:49
And I would say probably 10% of my patients, anecdotally
21:53
they come back and they're like, doc, better
21:55
like and they can come off their steroid and life is good.
21:59
So I use it as an, as an adjunct.
22:02
And I do think it makes an impact, in certain patients.
22:07
Has it ever avoided surgery?
22:08
Maybe for, maybe for a handful.
22:11
I don't I don't know that I see those patients back to really,
22:14
have a, have that full data set.
22:17
But I can tell you
22:18
it made a huge difference in my daughter when we changed her environment.
22:22
Yeah.
22:22
I hate extrapolating from an N of one, but these (inaudible) are amazing.
22:26
You are such a thorough, great doctor.
22:29
We should kind of set up a referral.
22:31
Like, you see them medically and send them to me for all the surgeries.
22:34
I mean, those are awesome, awesome questions.
22:36
I'm thinking of my son's baseball team, right?
22:39
When all 20 of them come into our basement in their uniforms.
22:43
And I know it's gross, right?
22:45
And like, I never thought about that.
22:47
They've been outside
22:48
for eight hours in there and they're just sitting on the carpet.
22:52
Then what happens?
22:53
You know, so interesting. Very interesting.
22:56
And it literally took you one minute to explain that to a patient.
22:59
It's not like a 30 minute soliloquy.
23:03
Yeah.
23:03
And so, you know, we we know that, our environment, influences
23:08
our long term health. Right?
23:09
Just look at things like,
23:12
peanut. Right.
23:13
We took peanut out of our environment because we were afraid of anaphylaxis,
23:16
and we ended up with more peanut allergies. Right.
23:18
Kids who grow up with a dog in the home,
23:22
tend to have less allergies because they are exposed to dirt.
23:25
So you need some of this, right?
23:27
You need that exposure.
23:28
It's just when it's in excess, or when it's,
23:31
when it doesn't jibe with your body.
23:33
I think that that is is the difference.
23:35
So, I don't think that everyone needs to live in a bubble.
23:38
And, certainly we don't want 20 baseball players.
23:42
Like, throwing all their muddy clothes all over your your basement.
23:46
But, you know, if there's a child on that team has a really bad
23:49
grass allergy, like you know, something to think about for them.
23:52
Yeah. Really interesting. You talked about three kiddos.
23:55
You mentioned a spouse.
23:56
Any pets in the Meister home?
23:59
Oh, totally.
24:00
I knew it was one of those happy, self-inflicted wound.
24:04
Pediatric otolaryngologist with three children.
24:06
What what pets do we have?
24:08
Yeah, she's a half Australian shepherd.
24:10
Half poodle.
24:12
She's our toughest child.
24:14
She's so spoiled.
24:15
Yeah, I can imagine. God, God bless you.
24:17
There's four little ones in there.
24:19
So you you mentioned, allergic
24:23
rhinitis, otitus media, airway and potentially sleep
24:27
help is
24:29
guide our listeners who are usually split half private practice half academicians.
24:34
You mentioned a great - I don't want to use the word algorithm,
24:37
but how you weave in the discussion in your intake,
24:40
how your medical assistant can do that - What else are you seeing?
24:44
You mentioned the Brigham study, the other studies. I love that.
24:46
What should our otolaryngologist be thinking?
24:48
So you've already changed my mind.
24:50
Now I'm in the office, two Fridays from now on the 23rd.
24:54
So I'm going to start asking about.
24:57
I like how you said it's more the ATP.
24:59
It's not just like jumping on, you know, specific stuff.
25:03
How else should we weave it into our practice
25:05
and kind of other specific diagnoses you've seen or thought about?
25:11
When, right after the, we
25:13
had some flying in Northern California a few years ago on a mazing rainy season.
25:18
It was beautiful, but it made a ton of pollen. Right.
25:21
And then we, we were seeing in, in our clinics more and more,
25:26
kids and adolescents, and even the parents of those children
25:30
coming in and saying, I've never had allergies and I have all this stuff!
25:34
I now have rhinitus, my nose is draining, etc..
25:37
And so the, the one thing I would say is kind of a clinical pearl is,
25:41
we often think of things like allergic rhinitis as being binary.
25:45
You either have it or you don't.
25:46
And I think it's more on a spectrum.
25:48
I think if you get someone around enough, exposure
25:52
to something, you can irritate their nose.
25:54
Right.
25:55
And so, I, I tend to think about it that way.
25:59
And, I tell patients, you know,
26:02
if, if you're out all day and you're hiking and it's a, it's
26:06
been a bad pollen season, you know, think about nasal saline.
26:10
Think about just rinsing your nose.
26:11
You rinse your hair, rinse soil out of your hair.
26:14
You know, just get that stuff moving through your system.
26:16
And they'll say, but, doc, I don't have allergies.
26:18
And, you know, then we have the discussion of, even if you don't have
26:22
allergies, your body's going to react to something that it sees.
26:25
The data around allergic rhinitis is fascinating.
26:29
It is exponentially increasing, to a level that is,
26:36
it's more likely to be,
26:38
a true incidence increase than a diagnosis bias.
26:42
Right.
26:43
And so what we think is that,
26:45
because of climate change and because of changes in air quality,
26:49
there's some data that those actual air allergens are picking up.
26:53
Our, our air, our chemicals in the air,
26:57
and they look different to our immune system
26:59
and they are heavier, so they're harder to get out of your body.
27:02
Which I think is fascinating.
27:04
They're they're more pro-inflammatory.
27:06
And also, with climate change,
27:09
we are getting, increased pollen counts.
27:12
And so people who kind of flew under the radar,
27:15
are now at a threshold that's, pathologic for them.
27:18
And so, I think just thinking about the, what you see in your local environment
27:23
and how that might be affecting just the community at whole is also
27:27
it's been a really fascinating part of, of part of medicine because,
27:31
you know, we all complain
27:32
about another nasal congestion in a four year old.
27:35
But this just adds a lot of depth to, what I see.
27:39
Yeah.
27:39
I just take out the adenoids.
27:41
No, I'm just kidding.
27:42
I promise you know, my reputation care. I'm just kidding.
27:45
I'm very conservative, but I really like that nasal saline idea,
27:49
so I really hadn't thought about that.
27:54
Very cool.
27:54
Otitis media.
27:55
You mentioned a little bit if you want to rattle off you.
27:58
And I see that probably every other patient.
28:00
But how?
28:02
I'm trying to think this through.
28:03
Yeah.
28:04
Talk to me through the environmental impact on otitis media and you're.
28:09
Yeah. So you mentioned Pittsburgh.
28:10
So you're continuing
28:11
the fine legacy of otitis media coming out of Pittsburgh, right?
28:14
Yes, yes.
28:15
So the otitis media, literature is a little bit softer.
28:18
It's not as robust as allergic rhinitis.
28:21
But one study that I think is as truly
28:25
interesting, is was looking at, prenatal exposure.
28:29
Right.
28:30
And so, this is in utero exposure to PM 2.5 and nitrous oxide,
28:35
in a large cohort study of about 9000.
28:40
On who gets close to nitrous oxide, it seems like anesthesiologist
28:44
and surgeons.
28:45
That's right, that's right, that's right.
28:47
Who gets nitrous?
28:48
We get nitrous in the environment.
28:50
We get nitrous in the environment.
28:51
Seriously? I'm not. It's a greenhouse gas.
28:53
Yeah, yeah, I'm not making fun of you, but where are certain areas that you would.
28:57
Where would a mom be exposed to nitrous?
28:59
Just, in, in in any urban environment, you're going to have some nitrous oxide.
29:05
Really?
29:05
So in, in Alexandria, if I look outside, the concentration
29:09
of nitrous oxide is higher than in the California mountains.
29:12
Oh, my gosh, I have no idea.
29:14
But, you know, I would I would guess, given,
29:17
you know, that it's more of an industrial byproduct.
29:19
Thank you, thank you. Yeah. Great.
29:20
So the study, 9000 patients exposed to PM 2.5 and nitrous oxide.
29:25
In utero. Right.
29:27
So these are prenatal exposures, right.
29:30
And certain, in utero exposure to PM 2.5,
29:34
especially in the mid gestation window as well as Pm10,
29:39
were associated with a higher incidence of childhood otitis media.
29:43
Now, that is not causal, right.
29:46
It could be that prenatal exposure meant that they were born
29:50
into an area of higher postnatal exposure.
29:53
It could be that, there's some epigenetic modification.
29:56
It could be that, you know, their immune education is just different.
30:01
But it's it's a pretty big group of 9000 kids.
30:06
And they are seeing this prenatal exposure.
30:09
And we think that, you know, that early immune education,
30:13
when you have a new, when the mom has immune tolerance to the fetus,
30:16
probably does have lifelong, immune impact on the child.
30:20
And so this
30:21
I think this is
30:22
an interesting study in the sense that it's really the tip of the iceberg.
30:25
It's a completely undiscovered field, of what our in utero exposures
30:30
doing to our health, and how our immune system functions.
30:35
Yeah. Thank you.
30:35
I told you, I'm a little bit off kilter at times.
30:38
This is an Academy Oto Journal pen, so I encourage anybody who's a scientist
30:44
or writer or clinician or member publish all your stuff in our journal.
30:47
So you mentioned, PM 10.
30:49
So you I got PM 2.5.
30:52
What are Pm10 and what are the implications of that.
30:55
If you could just educate us a little bit.
30:58
Sure.
30:58
So PM 10 is going to be just a it's a heavier micron size.
31:02
So instead of 2.5 microns, we're talking about ten microns.
31:05
Also a marker of air pollution.
31:10
When we
31:10
think about PM 10 it's that's pretty big as far as particulate size goes.
31:16
Likely not going to get intracellular.
31:18
So you're thinking more macro disruption.
31:21
So it's not a golf ball. It's smaller than a golf ball?
31:23
Smaller than a golf ball.
31:24
So PM 10 microns can I see it.
31:27
You can see it. Yeah.
31:28
You should be able to see that on a filter. Yeah.
31:31
But like with your your own eyes you can see that.
31:34
You know how sometimes if you, shake out your shirt
31:36
and you look in the sun and you can see it through the, through the sunbeam.
31:40
You said something interesting about the wildfires,
31:44
so let's,
31:45
let's I'm going to tell you a little vignette
31:46
and then you'll make it clinically relevant.
31:48
So out here in DC we had the impact from the Canadian wildfires.
31:52
No reason for you to know that.
31:54
But it came down and my son's baseball practice was canceled.
31:58
And I was so angry I thought everybody was weak and losers,
32:03
and they couldn't be out there until I attended your panel.
32:06
And I was super embarrassed because sometimes the coaches,
32:09
you know, might be the only doctor on the team.
32:11
So, like, what do you think, doc?
32:12
And like, yeah, you should be out there playing.
32:14
I was really embarrassed because there was like a, a smoke warning in the area.
32:19
And so I got, I got nervous.
32:21
Yeah.
32:23
Shame on me.
32:24
But your, your panel opened up my eyes about how to think
32:31
about
32:32
how we guide our patients with those environmental factors.
32:35
Can you talk a little bit about that?
32:37
Sure.
32:37
So I think that, for many patients, for many children, you're absolutely right.
32:42
It's fine to be out there.
32:44
But for those children who, have any reactive airway disease
32:49
who may have a smaller trachea or more prone to croup, I would say for kids under
32:54
five years old, they're more vulnerable, to the effects of,
33:00
wildfire smoke or air quality.
33:03
Right. So.
33:04
Oh, and it was not a normal day, Kara.
33:06
It was like a red alert.
33:07
They shut all county activities, and then I said, oh, the fields are open.
33:11
Oh, no, it was not a normal day.
33:13
So yeah.
33:14
Keep going. What do you say stay indoors.
33:16
Yeah. Right.
33:17
But that's a hard thing to understand. So.
33:19
But you're.
33:20
Yeah. Keep going.
33:20
You're doing great.
33:21
So stay indoors because.
33:24
Yeah.
33:24
Just because children are more vulnerable. Right.
33:26
So, they are their airway is smaller to start with.
33:31
They tend to have more, reactive physiology.
33:34
And you know, it's always about risk versus benefit.
33:37
Right.
33:38
So there is the risk of, of being out there and,
33:41
worsening someone's asthma or precipitating some type of event.
33:46
Is it worth, a week or so, a baseball practice?
33:49
I don't know, I guess it depends on,
33:52
you know,
33:53
the, the ethos of your team, but, Exactly.
33:57
Kara. That's what I told them.
33:58
Like, we're not going to have a winning record if you keep missing practice.
34:01
I love it.
34:02
So you just said that too, Doc.
34:04
You said, you know.
34:06
Yeah.
34:07
So, why did. You say a week again?
34:09
It's phenomenal. You look at life so differently.
34:12
I was so angry.
34:13
They missed an hour of practice that once,
34:16
I don't know, a little bit later I sent them outside.
34:18
So it really it impacts the kids for quite a while.
34:22
Yeah. It impacts the kids for quite a while.
34:24
Yeah.
34:25
And so and and we don't know like what is your clearance of that of,
34:30
of those substances. Right.
34:31
So that's where they, we don't know.
34:33
Talk a little bit about that. Yeah. Talk about okay.
34:35
You go into a PM 2.5 chamber. Right.
34:38
And you breathe this stuff in for how long is it going to be either one.
34:42
So within you on the macro scale or to it's effects of you
34:46
know, subsequent I think one of the things about that prenatal exposure,
34:50
literature is there seems to be some, some actual true modification now created
34:55
that was prolonged exposure in a, in a period of, time wherein,
35:00
you know, the your immune system is, is different
35:02
than it is in a, during a normal physiology.
35:06
But I think that there may be more long lasting side effects than we know about.
35:10
And we just don't know how long this stays in the body.
35:13
So So just a couple more questions, because I could monopolize your insight.
35:18
And I'm starting to realize I'm not such a good doctor.
35:20
I've completely missed this part.
35:23
You insinuated a little bit.
35:26
Airway and sleep.
35:28
You don't have to quote me stuff, but talk to me a little bit about it,
35:31
and we don't have to even talk about your daughter.
35:33
But you mentioned she was having sleep disturbances.
35:35
But are you seeing studies or abstracts or posters out there in other countries
35:41
or here on a macro level that there's an impact to that?
35:45
We we really only have the
35:47
the first big paper is the, this 2.5,
35:53
indoor air quality from the
35:55
the group was around 300 children outside of the Boston area.
35:59
But I do anticipate that we're going to see more more data coming out around this.
36:03
And, you know, physiologically, it makes sense, right?
36:05
You know, if you are more of an atopic person,
36:08
you're a 2 to 3 year old who's adenoids are already a little enlarged
36:13
because that's their job.
36:14
You know, kids are exposed to viruses.
36:16
They live near the floor. They're picking up dirt.
36:19
They don't have great hand hygiene.
36:20
It's normal that their tonsils and adenoids are a little bit thick.
36:23
Right.
36:24
But then you throw on top of that their environment and they're, they're
36:29
totally plummeted, pummeled, pummeled,
36:33
by insult from their own environment.
36:36
And, you know, now you have a mismatch between the size of their little body
36:40
and the size of that immune tissue.
36:42
And so I think that to me, that more hypertrophy
36:46
and mucosal inflammation, they have very little wiggle room to start with.
36:50
You put this on top of it and boom, there you go.
36:53
Now you've got sleep disorder breathing from a obstructive standpoint. So.
36:58
What are you working on these days?
37:00
Not just you, but your colleagues.
37:02
You mentioned your trainee,
37:03
Doctor Patrick, you mentioned other collaborators.
37:06
You can talk about yourself or the field in general.
37:09
Where are we looking at,
37:13
or where are you looking at now?
37:15
Sure.
37:15
So I think there are, three kind of areas
37:18
that that we are focusing on.
37:21
The collective we.
37:22
So within my lab, Patrick Kiessling and our clinical research coordinator,
37:27
Andrea Miranda, who's been with me for, gosh, almost six years now.
37:31
She's an amazing, resource.
37:34
They are doing a good bit of, community advocacy work.
37:37
So we know another wildfire is coming.
37:40
We know that cycles of poor air quality is coming.
37:43
How do we proactively get this information out?
37:45
Right, to the communities that need it,
37:48
in the format that that is accessible, to them.
37:52
And so, they've been working with some of our local Hispanic health groups
37:56
and doing boots on the ground advocacy, as well as having those resources
38:00
that it and ready to go, within our electronic medical record
38:04
for when this does happen.
38:05
So community outreach and engagement is - Kara, are you going to use my favorite
38:09
two words? AI and innovation.
38:13
I mean, it seems like you all could create tools.
38:16
You could have alerts go out there that we see on our phones.
38:19
I love that you're doing boots on the ground.
38:21
That's awesome.
38:22
Yeah.
38:22
So we'll we'll use AI, and and integration.
38:26
I think that's, a different, area where we can maximize the use.
38:32
And what I mean by that is we have so much data.
38:36
Right.
38:36
We have all of these learning health systems that are coming online.
38:41
We have epic cosmos.
38:42
We are getting better and better, community level data.
38:46
And so, you know, as a surgeon/scientist, we've always thought
38:49
about discovery as you start in the lab, you have this question.
38:53
You do it in this very controlled model, and then you go out and you take that drug
38:58
that you've created in the lab, and you test it in people.
39:00
And most of the time it fails.
39:02
And then you go back to the lab and you iterate, right?
39:04
I think that with AI and with the amount of sheer data that we have
39:10
that is changing, we can ask these big questions
39:13
with messy data, because we have so much data and the tools to mine them,
39:17
we can find the answer and then we can prove it in the lab.
39:20
And so kind of that backwards flow, I think, is where AI is really going
39:24
to help us
39:25
to answer these, these huge questions that are just impossible
39:28
to control for in the lab setting.
39:31
And I didn’t mean to sidetrack you?
39:33
Yeah.
39:33
I didn't mean to sidetrack you with my my personal, philosophies, but.
39:37
So community is.
39:39
The third thing.
39:39
So I say community outreach. Yeah.
39:41
And then I say what we're working on in the lab is really focused
39:45
on microplastics.
39:46
And so, we, we use human tonsils.
39:50
From patients, to both grow model systems
39:53
as well as to study the microplastics in, in those, tissues.
39:57
And spoiler alert, 100% of the of pediatric tonsils
40:01
we've studied have microplastics in them,
40:04
whether they are causing harm, we don’t know.
40:06
You just gave me a crazy, crazy nugget.
40:10
Yeah. Unpublished data.
40:12
We'll be looking for a home soon. Once the,
40:15
stuff is there, Get it submitted to Doctor Schamlbauch, the
40:19
editor.
40:20
I don't know how much you can tell us. That's insane.
40:22
Like in medicine, it's never 0 or 100%. And.
40:25
But I know what you're saying makes a lot of sense. But.
40:28
So why again, excuse the ignorance, but I can ask it.
40:31
Why do I care?
40:32
Why do I care that 100% of tonsils have microplastics?
40:35
What does that mean?
40:36
We don't know what it means, right?
40:37
It may just be that they are innocent bystanders.
40:39
They're not affecting us at all.
40:41
The question that we're really trying to answer in the lab now is, without going
40:45
too far into the weeds, is
40:47
and whether or not our antigen presenting cells actually present plastic.
40:51
Right.
40:51
And what the mechanism is, because if that's actually happening,
40:54
then we may have, a mechanism to think about them
40:59
influencing our immune system and how our immune system functions.
41:03
So that's kind of the second thing.
41:05
And then the third thing is.
41:06
Hold on just a second.
41:07
You're so wicked smart.
41:10
I had no idea what you said, but my head is getting it.
41:12
That is super cool.
41:14
How does your lab do this?
41:16
How are they looking? What the APC is putting out there?
41:19
That's so cool. What?
41:20
What are the methodologies.
41:22
That we use? Organoids.
41:24
We grow tonsils from patients.
41:27
So, the advantage that it they have some genetic diversity to them.
41:30
And then we study both, the outputs of those tonsils after exposure to plastics.
41:36
So looking at things like, TH2 responses, MH what you can infer about
41:42
the MHC complexes, we're going way back now to a basic immunology,
41:46
as well as, some, pretty slick imaging tools that we have on campus.
41:51
So, that’s what we’re working on.
41:53
That's crazy.
41:54
Kara, could you grow me a new brain when you're done with the tonsils?
41:57
That is super, super cool.
41:59
And I interrupted you.
42:00
You you were talking about something else in your lab,
42:02
and I interrupted you because I got excited about.
42:04
No, no, no, I, I would just say.
42:05
And then number number three is, is really just,
42:09
challenging ourselves to think about, data and science in a different way
42:13
because we have a whole new set of tools, right?
42:15
To answer some of these population based longitudinal exposure
42:20
and questions, which is exactly what planetary health is.
42:24
And we're really thinking about how do we use AI and to, to mine, collect
42:30
and understand these data in a way that we've never been able to do before.
42:33
And so I think it's really flipping the, the scientific method on its head
42:38
a little bit.
42:38
And I'm excited to see what we can learn.
42:42
Yeah, I want to acknowledge all your collaborators because you said,
42:45
I don't want to do a podcast myself because I represent all these great people
42:50
you mentioned.
42:50
Patrick, I believe Andrea from your lab. Andrea.
42:53
Yeah, if that's right.
42:54
So you mentioned all those collaborators.
42:56
So I want to be clear.
42:58
That was Doctor Meister's ask, and I said no, but
43:01
anybody that I've forgotten you to shout out, by all means.
43:03
Yeah, I would say my mentors
43:05
and collaborators in this space, Laurie Lalakea and Duncan Meiklejohn.
43:10
So if anyone's actually looking for a true, patient facing expert.
43:14
There you go.
43:14
Two people there.
43:15
And so, very happy that,
43:18
they'll be putting in a sustainability module for our core curriculum.
43:21
Both those individuals are doing a lot with, their respective schools of medicine
43:25
and for educating our medical students, which it's
43:28
now a part of the curriculum, at Stanford,
43:31
and for our otolaryngology residents through the,
43:34
through the OCC, as well as
43:39
educational content for our
43:40
general membership through the sustainability task force.
43:45
Thank you for shouting out the otolaryngology core curriculum
43:47
as we keep it contemporary.
43:48
That was not none of this was rehearsed.
43:50
Everybody knows I just make it up as we go.
43:53
When did you, finish fellowship, if I may ask?
43:56
I finished in 2018.
44:00
Kara, we're not contemporaries.
44:02
One of us is a titch older than the other.
44:04
I finished in 2006.
44:06
So 2018, and we're now at 2026, right.
44:12
All right.
44:12
So that's a phenomenal career progression in eight years.
44:16
And this is not rehearsed. I'm just super impressed.
44:18
How did that happen.
44:19
How do you have time to be a surgeon/scientist and operate?
44:24
What advice would you give to those that are finishing fellowship
44:27
early in their career?
44:28
That's a phenomenal, eight year rise.
44:30
Congratulations on that.
44:32
Thank you.
44:32
I would I would say that, your your family is incredibly important.
44:37
I mean, that, both my personal family.
44:40
And I have an incredibly supportive husband that gets some sleep,
44:44
which is helpful.
44:45
But also, my work family is amazing.
44:47
So. And our, our department is is very supportive.
44:50
It gives people the opportunity and resources to do.
44:53
And then I have a great mentor in Allen Chang, he is our division chief.
44:57
He's been my mentor since I was a fellow at Stanford.
45:00
And partners that are willing to.
45:03
Hey, I need to do this panel.
45:04
Can you cover my call? Hey, you know,
45:07
we help each
45:08
other out, and it's a really professional, professionally safe area.
45:12
So I'm so thankful to be a part of our, our division.
45:15
That kind of gives us all the opportunity to to do whatever it is.
45:18
And so I think just, choose choose your family as much as you can,
45:22
your work family, in your home, family,
45:24
and then find something that's exciting, right?
45:25
Find something that's really fun and then it's not work anymore.
45:29
So I, I still can't believe I get to operate.
45:31
I love my tubes and tonsils days as much as my big head neck days.
45:35
And I love being in the lab.
45:36
Those are definitely my intellectually challenging days.
45:39
Is to be in the lab.
45:40
And, I really think one of the things about,
45:44
being an otolaryngologist is our day to day is, is so varied, right?
45:48
Whether that's clinic versus O.R.
45:50
or whether I'm filling a role with some of my Academy and leadership
45:54
work, or working in the lab is just an amazing career
45:58
where you get to do something different every day.
46:01
And that's really fun.
46:02
I think it keeps us all excited and engaged.
46:05
Yeah, I love that.
46:06
I get to know people like you.
46:07
You can count me in your your family there because having a student
46:12
like you so easy, we just sit back and you just shine.
46:15
You make our specialty look better.
46:17
So I'm sure your mentors, love having a great student.
46:19
Two more questions.
46:20
I promise this could go on forever, because I think you're really educating us
46:24
on things that we didn't learn.
46:25
And since I know that you and I are almost a generation apart,
46:28
we we didn't we just didn't learn some of this.
46:31
So, I'm learning as we go.
46:33
Two more questions, I promise.
46:35
You grew up two and a half miles from a plastics plant.
46:38
When were you like, that's interesting.
46:41
And maybe it's now, I don't know, I'm just curious.
46:44
Yeah,
46:44
I think it's now I remember, And it might be fine.
46:47
I don't know, I'm just. Just like.
46:49
When did you ask yourself?
46:51
Yeah, I think that, I have distinct memory of,
46:55
you know, when I was, young, my parents shared a, you know, a queen bed.
46:59
And if you looked on my where my mom slept or shook or my dad slept, it was black.
47:04
When she get home, I would take a shower.
47:06
What did your father do? You.
47:08
He was a mechanic in that plastics plant.
47:11
Wow. And your mother? Yeah.
47:13
My mother was a special education teacher.
47:16
Okay, so.
47:16
So you noticed. You noticed?
47:18
I guess that's PM 10s.
47:20
Probably PM
47:21
10, some type of - and polymers and all other types of industrial waste.
47:25
But, it was kind of ingrained in him, so.
47:29
So then I remember that as a very distinct memory.
47:32
Yeah. But then when did you say “hmmm?”
47:35
This is interesting?
47:36
I think it was honestly living in California.
47:38
So my patients asked the questions, what about all these plastics?
47:42
What does this wildfire smoke doing to us?
47:44
And you started connecting - Seems to be a super bloom of pollen.
47:47
And then I started thinking, you know, I have a real interest
47:50
in in our environment and what it's doing to our health.
47:53
Do they still live there?
47:56
Both my parents passed from cancer when I was younger.
47:58
Yeah. I'm sorry to hear that. Yeah. Thank you.
48:00
It's certainly where our passion comes from.
48:02
So proud of what you're doing. It's incredible. Kara.
48:05
All right, what can we do?
48:06
So this is one of our coolest podcasts.
48:08
It might be one of our longest because you're that good.
48:10
What can I do?
48:12
I am an otolaryngologist.
48:14
In a private practice setting.
48:15
You've already educated me on thinking about ATP, environmental factors.
48:20
I just love your honesty.
48:22
I don't need to slip in an allergic eval
48:25
in my algorithm for adenoidectomy, but you're just raising awareness.
48:29
Give me some pearls. Any? Give me a couple, though.
48:31
Don't overwhelm me because I'm learning.
48:33
So give me a couple things I should do tomorrow.
48:36
That I should think about as an otolaryngologist.
48:37
We'll have a separate one on health care because this was super fun.
48:40
But vis a vis diagnoses and patients.
48:44
Yeah.
48:44
So I would say, just ask if they are more
48:49
atopically oriented.
48:51
That's that's number one.
48:52
Probably even even before that.
48:54
Maybe that's getting ahead of ourselves.
48:56
It's just, find something that that's of interest and give it a read.
49:01
Really just, take it, take half an hour.
49:04
Find a couple of find a paper to two.
49:06
Bonus points if it comes from the White Journal.
49:09
But just to do a little bit of, of investigating and
49:12
see if this is something that that's sparked your curiosity.
49:16
I think if it does, it's easier to talk to patients about it.
49:19
Right.
49:19
And then just pay attention, keep our eyes open because right now
49:23
we're talking about, you know, air quality and climate change,
49:27
but we don't know what's next, right?
49:29
We don't know, all of the things that are influencing our health.
49:32
And, you know,
49:33
this is something I'm passionate about, but I, really encourage our trainees to,
49:37
approach their, their clinical care with new eyes and fresh questions.
49:42
Right. So I think that's number one is just staying curious.
49:45
Number two is, is asking about environmental exposure.
49:48
Hey, do you have an air purifier at home?
49:50
Would you be willing to try that that type of thing.
49:52
And it can be very, very beneficial.
49:56
And then number three is, if you're interested in
49:59
any of this work at all, and how we as health care
50:02
providers are contributing and can not contribute,
50:07
to greenhouse gas emissions, feel free to, to reach out.
50:11
There's also, a good bit of material on the Academy website.
50:14
Amazing!
50:16
A little plug when it was your session at the annual meeting,
50:20
because if you attend the annual meeting, you get a webcast.
50:23
And so people can hear the whole presentation from the panel,
50:26
which sparked my interest.
50:27
I love your point about go read something.
50:30
What day was it in Indianapolis?
50:32
Do you remember? It was the last day, the last panel.
50:34
Cheers. That's why I was there Tuesday. Yeah.
50:37
And remember I promised you that they're all recorded
50:40
so people can go back and listen to it, because I thought it was phenomenal.
50:43
And what was the title of that panel again?
50:46
It was “Little People, Big Impact: environment, health
50:51
and sustainability in pediatric otolaryngology.” All right. Yep.
50:54
You guys got that.
50:55
And then Doctor Meister, you can search for her name and find that webcast.
50:59
But it was of course a panel.
51:00
There were several of you on.
51:02
This was absolutely amazing.
51:03
I'm going to give you a final word.
51:04
Anything you want to shout out.
51:06
Thanks for having me.
51:07
I really appreciate it. Amazing.
51:09
Thank you so much.
51:10
We hope today's episode sparked some fresh ideas.
51:13
If it resonated with you, please subscribe and share it with friends.
51:17
Have thoughts or suggestions?
51:18
Use the feedback form in the show notes.
51:20
We'd love to hear from you.
51:21
And don't forget to follow us
51:23
on social media for highlights, behind the scenes content and updates.
51:27
Thanks for listening. See you next time.