Ologies with Alie Ward - Rhinology (NOSES) with John Craig

Episode Date: June 12, 2018

Allergies. Nose jobs. Smell nostalgia. Street drugs. Septum piercings. Snoring. Hang on to your faces because Dr. John Craig goes deep and shares why he's so passionate about rhinology. You'll have a whole new relationship with your whiffer, appreciating what happens behind your nas-holes and coming away with some strategies to combat hay fever, Afrin addiction plus: a very legal substitute for illegal party drugs. Also: why you may want to shove a crayon into your nose.Dr. John Craig's YouTube ChannelHelp send Aidan to camp via this t-shirt fundraiserMore episode sources & linksBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisTheme song by Nick Thorburn

Oh, hello. Hey. Hi. It's your little newborn niece who looks like an old Greek sailor, Alli Ward, here with another episode of Allergies. So in this episode, we're going to talk to a person who is passionate, so passionate about those lumpy snoots we've all got sniffing around right in the bullseye center of our faces. And this Allergist really knows his stuff, so much information on allergies and smells and history and street drugs. But before we get to it, per usual, thanks to everyone making the podcast possible by buying into the Patreon membership. Starts a 25 cents an episode, my heart is cheap. So you guys let me pay an editor and buy mic cables and memory cards and you ask great questions, which I

pass on to the Allergists. Also, merch is available at AllergiesMerch.com. And on Mondays, I post photos on the Allergies Instagram of you sexy biscuits wearing your allergy shirts and hats and pins. You can tag at AllergiesMerch and let me see your faces, the babies. Also, for no money and very little effort, you can be a friend of Allergies just by telling your carpet cleaner or Anton law or account executive that you like it and that they might also and is a quiet, thirsty thank you. I read all your reviews on iTunes each week and then to prove it, I read you one. This week's review is titled on creepiness. It's from JJPYO. Hello, Allie. I would like for you to stop calling yourself creepy, although you do often

admit to some creepy things. Reading all your reviews is not creepy. So if you're creepy, that makes me creepy. And I think it's rude that you're calling me creepy all the time. I digress. The podcast. It is very good. Five stars. Okay, on to Rhinology. Why not a G? So you likely have a firm, but soft and a beautiful, but gross wedge of flesh holding court on your face. But how well do you know it? I mean, it's a mystery in there, man. It's a moist catacomb that leads to your brain. Is that how it works? We're gonna find out. So first off, Rhinology comes from the Greek for snout. I came to know this Rhinologist through a Twitter lead. Someone was like, Hey, I got a Rhinologist for you. And I was

like, let me at him. So I happened to have been in Detroit last week shooting and I made some time to take a lift over in a torrential Michigan summer downpour to find the entrance at the Henry Ford Medical Center in the downtown D. No relation to the museum. I also do work with. It's just in Detroit, literally everything is named after Ford, including a restaurant where I ate tater tots the same day. Now, this alleges to by the by has an entire YouTube channel brimming with sinus surgeries took me to an office and we gabbed about noses for almost an hour over an hour. Side note. Okay, I can deal with a lot of gross shit. I've held spiders as big as my palm. I've eaten scorpions. I've even dated musicians,

but I cannot deal with the word or the concept of this. And I'm going to whisper one time. Okay, mucus. I did not want this episode to be a sonic minefield for my gag reflex from now on when you hear the, that's just me bleeping the moist M word. I'm going to say the F word freely, but I'm censoring the word that rhymes with Fuchus because I can and I will. So to make it fun, feel free to take a sip of your beverage at the ding or do a tiny imperceptible butt dance when you hear that noise in celebration of not hearing the word that it's replacing. I will do that on my end with my end. Now, if you love that word, feel free to lock yourself in a sauna and sing a song about it on a banjo. I don't give a fuck. I just can't deal. So it's

dings from here on out. It's dad's podcast. She'll do it the way she wants. Okay. All right. Oh man, in this episode, we talk about hay fever and nose jobs and septums and piercings and snoring and snorting and smelling. And I had no idea of the mysteries deep, deep in my skull holes. So open your ears, throat and yes, your nose for the life altering wisdom of rhinologist, Dr. John Craig. So, you know how microphone works? Yeah, get up in it. Thank you, by the way, for doing this. Are we on? We're on. Okay. We're already rolling. But thank you so much for letting me come to this hospital on a very, very rainy Sunday in Detroit. We are in the depths of the D. We'll start with the basics. How long have you been a rhinologist? And that is a word, correct?

It is a word. Yes. So I've been in practice for three years now. That's after doing a five-year residency in ENT surgery and then a one-year fellowship in dedicated rhinology. When you were a kid, did you have a fascination with certain body parts or certain types of medicine? Or, I mean, I want to ask how you picked noses, but that's not it. I feel like how you've selected noses would be a better way of phrasing that. Right. It could call. No, there wasn't any particular, my father was an emergency room physician. Oh, he was. So you grew up around? I grew up around, yeah, my mother was an x-ray tech as well. So a lot of medical conversation. I was just always fascinated by not so much anatomy, because we didn't talk about anatomy that much, but just the

thought processes behind medical decision-making. And for some reason, that was interesting to me in the high school era. Really? Yeah. So, and then I went to college and studied psychology. And then it took on a whole other level of understanding the doctor-patient interaction, and that combined with my interest in science just made sense. Do you find that when rhinologists get together, it's just like a chatter, are you all chatterboxes? Oh, big dork session. Really? Oh, yeah. It's pretty common, actually. It's probably one reason I liked it too. Everybody's very passionate about the nose and the sinuses. So I definitely had a lot of sinus slash nasal

issues growing up. And I don't think it drove me to choose to do this, but it is interesting. It must be some subconscious process or maybe conscious that drove me. There's got to be a doctor heal-thyself situation. I'm also a client. There's got to be something there. Now, I'm sure you get this a lot. ENTs. Why are ears, noses, and throats all lumped together? Were you studying and you're like, I'm learning about this throat and these ears, but I really care about the noses? Was there any part of you where you're like, let's just get to the noses? Do you prefer the nose over the ears and the throat is what I'm asking? Oh, yes. Very much so. I've always been, since about midway through residency,

I was more fascinated by the inner workings of the sinuses and the nasal cavity. So all those areas for me were just more interesting than the throat and the ears. Poor throat and ears. The ears seem like a whole other situation, to be honest, because I get that the nose and the throat are connected. Anyone who's ever gotten soda up a nose or out a nose, I threw up Jell-O shots on my 21st birthday out of my nose. So we get that they're connected. But the ears, that's hearing. Did you have to learn everything about ears as well? And then you could say, okay, noses, I'm on to you? I think that's a very insightful comment you just made. A lot of us do feel that the ears are their own world. But yes, I think the people treating

the nose definitely view the ear as a separate entity. A lot of times, the hearing apparatus is definitely a separate entity. I do also feel like ears are like, we have the smallest bone in the body and everyone knows that fact about us. Yes, that's true too. Okay, ears, we get it. So quick aside, this was going to be an insert to just talk shit on the smallest bone in the body and the ear for being like, yes, I do contain the smallest bone in the body. But I looked up this little thing. It's called the stapes. It means stirrup because it's shaped just like a metal stirrup that you'd slide your boot in while hoofing around on a horse. It also looks like a tiny, tiny wishbone glued to a plate. And I wanted to be like, whatever, ears, who cares? But I gotta be

straight with you. I gotta come clean and say it's a really cute fucking bone. Like it is so tiny. It's smaller than your pinky nail, this cute little thing, and it's held aloft in your inner ear by tendons. And it makes the femur look like Godzilla. And it's so cute that you have two of these probably gently rattling around in your skull like micro machines. Anyway, Dr. Craig cares about nose medicine in particular, because as we mentioned in his upbringing, having shitty nose function can be a real buzzkill. Sinus issues suck. But they can cause significant quality of life issues for patients. If you have trouble breathing through your nose, a lot of pain, bleeding, these things affect your daily life. It's hard to conduct normal work day if you

always have blood or fluid pouring from your nose. It's true. It is very like a first date with a bloody nose. Yeah. Not happening. Not good. Do people ever shove tampons up their nose when they have bloody noses? Sorry, I'm just gonna ask. Some version of that, yes. Some type of packing material can be placed. It seems perfect for it, to be honest. I've actually definitely seen a patient show up to my office with a tampon on their nose, so it's possible. Was it a lady or a man? Man. Yeah. I have a feeling he borrowed it from someone. I think he did, yes. Were you like, well done, sir. I definitely applauded his efforts. He got the job done, so. When you talk about pathologies, run me down some of the biggies. What would you say or maybe run me down what

your most common issue is? Is it like, I can't sleep because my nose is messed up or is it allergies? That's a great question. The full gambit, I would say, from inflammation to tumors. Inflammation would be things like allergies, sinusitis. Sinusitis can actually be either inflammation-driven or infection-driven, so it doesn't always mean an infection. Just a heads up. Itis just means inflamed or swollen, red, painful. Sinusitis just means inflamed nozzle area. Now, if you've ever had senioritis your last semester of school, you have maybe been inflamed and hot and swollen, which honestly sounds a lot more like a freshman problem, but I'm not a doctor, so I don't know. Okay, onto nose problems.

Nasal obstruction is a huge one. What do I mean there? Just trouble breathing through your nose. I thought you meant someone shoving something up there. No, no, no. We'll talk about that. With nasal obstruction, it can be an anatomic cause. People talk about a deviated septum. Those would be the more common things, but then you have the rare things such as tumors. Then this area that I also work on is called the skull base, which is the bony separation between the sinus cavity and the brain cavity. There's a bony separation there? Yes. They're very close to each other. I didn't realize that we had a bony separation because I feel like you always learn about like,

in Egyptian mummies would use a hook to gather the brains through the nose. I figured it was a straight shot. It's kind of a straight shot, but yes, you would have to go through this skull base to do that. You'd have to poke through. You'd have to preferrate it. How thin is it? It's a good question. Pretty thin overall. Some areas are a couple millimeters. Some areas are less than a millimeter. Is anyone else having an existential meltdown thinking about like a millimeters thin plate of bone separating your brain from the entire world, including, but not limited to the air of a porta potty or the door handle of a mall? We have thin bone plates in our skeleton heads. You had to do a lot of dissecting of corpses in your life, right?

Many, many. I also have a weird interest in cadaver dissection, so I've actually published a number of papers on that. Wait, okay. You have a weird interest in cadaver dissection. Explain to me what a normal interest in cadaver dissection would be because I feel like that's like... That might be true. What do you mean by that? That just means that in training, you're always expected to do some degree of cadaver dissection as part of your learning. But I just realized that it's harder to read it in books than it is to just get in there. So in both residency and fellowship and even now, whenever we have cadavers available, stress to the residents that I teach that it's really important to get in there

and really explore the anatomy. Everyone, because I have a friend who's a doctor who said that once you crack someone open, there's so much more variation than you would imagine. You think like this is when the liver goes, but just as people's faces look different, like their livers look different and their pancreases look different, you really got to see a lot of them. Was it scary the first time you cut open a cadaver? I'm sorry, I gotta ask. I wouldn't use the word scary, but different for sure. I feel like different is what you would call something like pineapple couscous or jazz fusion. Cutting open a husk of a person seems like a bit of an understatement for that word,

but once again, all word here is not a doctor. I have never filleted a dead volunteer in order to fix living people. Gives you a different perspective on life. Did you find that having been around cadavers, that you embrace your living life more, you're more aware of mortality or no? No, it doesn't affect me that way, I guess. Yeah, I feel like I would be, man. I'd be like, that's gonna be me soon. Would you ever donate your body to science?

Uh, yes. I haven't officially done that yet, but I've considered it. Well, you're alive, but you've considered it. Yes. The one thing that's weird about the nose is it's something that's in our, it's in our face, but you look at a skull and you're like, there's just an empty cavity, noses are just cartilage, which is kind of crazy to me. So this, but can you give me the breakdown of the anatomy of a nose? What is a nose made out of?

All right, so if you think of the nose as an external component, kind of floppy part that you actually see, there are cartilages that form kind of the external architecture, but they're in places that you wouldn't really predict. And so it's not like one solid sheet of cartilage, there's two sets of cartilage that do some weird curvature things, but that's how the tip of your nose is formed. And then we call them the sidewalls, kind of the floppy nostril parts. They provide support there. And then the inner lining of the nose is made up of what we call mucosa.

Mucosa is like the inside skin. Of course, you got the nostrils that lead into each respective nasal cavity. And then how deep do we want to go inside the nose here? And then how deep do we want to go inside the nose here? By the way, I had a boyfriend who's a Polish grandmother called Nostrils Nassholes. She didn't realize that wasn't the word for them. And I've ever since then, I've always loved the Nassholes. That's pretty good.

Yeah, we'll remember that. What are the sinuses? Okay, so you've got cheek sinuses. We call them the maxillary sinuses in each cheek. And then the forehead or frontal sinuses up in the forehead. And then you have these other weird sinuses that go kind of further back in the nose, between the eyes, called the ethmoid sinuses. And then way back, about seven or eight centimeters back in the nasal cavities,

you have the sphenoid sinuses. So to recap, you are just lousy with sinuses, just tiny hidden rooms in your face and your skull. But wait, how many? And what exactly are they? What are they doing there? In total, we say there are eight sinuses, four on each side. And then what are they?

They're basically just air-filled spaces within the bones of the face. But they're lined by that mucosa that we spoke of. All right, so the mucosa, that's what gets swollen when we talk about allergies and sinusitis. So you can imagine, if you have these sinus chambers draining into the nasal cavities, they drain through small holes. Gross, but stay with me. So if circumferentially around that opening, the tissue, that mucosa, swells up too much, that's when we have problems with straining.

And if you have that swelling occurring inside the nose too much, you could have trouble breathing through your nose. So a lot of the stuff that comes out of your nose originates in these caves in your face. What happens when you have, let's say, allergies or you have an infection? Why does this tissue insist on swelling? What does the inflammation help? What's the point?

Why is it like, oh, there's pollen in the air? Well, for you, I'm going to swell up so you can't breathe. Yeah, well, it's definitely not an adaptive measure. It's not normal for people to have this swelling, right? The average human being. So you get fluid seeping into the tissue that causes swelling. And that's when you get a lot of the symptoms. Now, patients with allergies, they have a significant histamine response.

All right, so they have certain cells in their tissue that release histamine, and that sets off a whole cascade of different symptoms. Now, histamines, before you float them to the top of your shit list, can have your back. When things are good, they keep you awake. And they help flush out bacteria that might want to kill you. But with allergies, like to pollen or dust or pets, the immune system senses it. Freaks the fuck out. Like this pollen is trying to kill us all hands on deck.

And sends a group text essentially to your body, being like, if you see this pollen around 86, this mofo, we hate it. Pollen's like, hey, I'm just airborne plant sperm. I don't even want to be in your nose holes. You inhaled me. Calm down. But histamines tell your blood vessels to get leaky, y'all. And your eyes and nose water to flush it out of your body.

Now, why do some people have shitty allergies? And others are like, I've got 99 problems, but ragweed season is not one. It's mostly genetics. So thanks to your mom and dad. But there's also something called the hygiene hypothesis. So if you weren't raised around enough like low key grime, like animal dander and fungus spores, your body freaks out when it encounters it. I myself grew up digging for worms in fields.

I have no allergies. Thank you, mom and dad, for letting me go dig for worms. Speaking of which, you can also eat worms to help your allergies. I mean, yes, there are antihistamines and steroids which block your body from launching that inflammatory attack. But also, also, you can eat hookworms. So these little parasites attach to your gut walls. And some studies show that they may release compounds that tell your immune system to just

take it down a notch, son. Not a lot of hookworms in the developed world. But it's hookworm pelusa in other parts of the globe where they have fewer allergies. You can also try local honey, as discussed in the bee episode, melatology, which may help your body warm up to neighborhood plantages. Or immunotherapy, where you're slowly introduced to allergens. So your immune system calms down and stops being, let's be honest, kind of a bigot. But if you don't want to get shots or take drugs that make you sleepy,

or get intestinal parasites on purpose, Dr. Craig has some other saltier advice. But what do you tell people who have allergies? Is there anything they can do on the front end that's not just tamping down the histamine response? Yeah, so I'm going to throw out a disclaimer first off. Well, I am a rhinologist. I lean on my allergy colleagues here significantly. I can tell you what I do.

And then when things get too complex, I definitely employ an allergist. But in general, if you have kind of run-of-the-mill allergies, I think the simplest, safest thing you can do actually is topical saline to your nose. It's actually been shown that we don't know why precisely, but if you can flush the allergens that might be in the nose, get them out of the nose, then you in general have a better baseline of symptoms. Oh, like a neti pot? Yeah, much like a neti pot.

I've never used a neti pot. Oh, you got to try it. I imagine you have. Is it really? Oh, yeah. Okay, there's part of me that knows I'm not going to flood my brain with saline, but I'm like, what if I'm the one person that has just a gaping hole in my skull base bone and I just flood my brain?

Well, we could put one thing to rest. If you don't have clear fluid pouring out of your nose at baseline, you probably don't have a spinal fluid leak, which means you probably don't have a hole in your skull base. But no, I mean, the one in a trillion type situation of that happening. I wouldn't worry about that. What does it feel like? I've never done it.

If you do it properly, head over a sink. I use a squeeze bottle personally, but some people do the neti pot. Fluid will go inside one nasal cavity. It comes out behind your nose, back out the other nasal cavity. So you score it on the right. It's going to come out the left. Where is it going in the meantime? That's a good question.

If you have not had sinus surgery before, most of it just goes through the nasal cavities and then some of these nooks and crannies called the mea tie within the nose. But if you haven't had sinus surgery, they don't usually get into the sinuses themselves. So they just go in and out. So basically you're flushing out any crust debris, maybe thinning out the layer that's in your nose,

but it does seem to help. So squeeze bottle neti pot. So Dr. Craig says that while the salty nose enema is a great starting measure, most patients might need an over the counter topical steroid, like a flonase, which will drop the inflammatory response in the nose, or like an oral antihistamine. Those are tablets. But remember, histamine also keeps you awake.

So don't take antihistamines before like a four hour annual sales symposium or when you're about to walk into a Catholic wedding ceremony, because that's just asking to drool on yourself, which I have recently done. Now in Japan, I just looked this up, nodding off in public. They have a word for it. It's called enemory.

And it means to sleep well present. And it happens on trains and in the office all the time. The Japanese are like, good on you, dude. You must be working hard. Also, it's nice that you didn't just leave. You just stayed at this dinner party and napped upright. So enemory isn't a bad thing. However, it's frowned upon in like assembly lines and such.

So your Benadryl may have those side effects, including an enemory, which I've got to be honest is my new favorite Japanese thing, like since their game shows. Did you know some of their game shows involve discovering if everyday objects like tables and chairs are actually made of candy by biting them and climbing slippery stairs covered in soap and getting a butt in your face if you answered trivia wrong? A naked butt.

I love you, Japan. Anyway, have you ever been super just flummoxed or just stumped by a case? Both the interesting part and the problem I feel is that there's a lot of rare pathology. Some tough ones that come to mind would be nasal polyps. So nasal polyps, if you've ever heard of them, they're basically extreme swelling of tissue inside the sinus and nasal cavities. They turn into basically like swollen grapes hanging down in your nose. And so they can cause the whole spectrum of sinusitis symptoms,

trouble breathing through the nose, lack of smell, would be the classic ones. Oh, nose grapes. Yeah, nose grapes. Want some. No, not a good fruit to have. Do you, this is a stupid question, but can you spot a nose job a mile away? Usually, yes. You can?

How? So it takes actually, rhinoplasty is separate from my field. I collaborate with rhinoplasty surgeons when I need the external portion of the nose address. And so, do you mean the classic aesthetic rhinoplasty, how you tell? Yeah. Usually, there's a narrower look to the nose. Perhaps the nasal tip is a little more upturned than average and just in general smaller. Have you seen any trends with that?

Or, you know, I mean, if you look at hair trends over the last 30 years, there have been some good ones and some bad ones. Do you see that happening in, and I know that you don't focus on rhinoplasty, but do you see that happening in like cosmetic surgeries at all? Like is this nose very in from this year to this year? Right. Definitely in the 80s, 90s, there was a characteristic nose that people were going for.

Definitely the narrower look. There are definitely trends like with fashion. It's probably just look up to Kardashian's Instagram or something. Oh, what comment on that? But I wonder if people are like, I want a Jane Fonda nose. Oh, I'm sure that happens. It changes. So, I look this up and this is indeed the case.

So, a bunch of plastic surgeons are saying that the tiny Eurocentric look is falling out of fashion. People don't want perfectly straight or symmetrical noses either. They're like, change it up a little bit. I still want to look like me. Don't make it too boring. Also, now some people are getting non-surgical nose jobs where instead of shaving down your cartilage fins,

essentially a doctor will pump some filler into the bridge of the nose just to fill out a line. And other folks are getting kind of a reverse nose job with implants added to restore what their nose look like pre-surgery. They're like, you know what? I just want to look like me. Speaking of putting things into noses. Weirdest thing you've seen shoved up a nose?

An undone paperclip. Why? Yeah. So, it was actually a child. Oh man, ouch, poor kid. It placed it up their respective grandparents nose while sleeping. Oh, never mind that child is ruthless. Okay, what did they do?

Well, we had to go to surgery and it was interesting to say the least. Once again, interesting is good for pineapple couscous. This is intense and brutal. P.S., it wasn't a paperclip. In actual, it was multiple paperclips. So, yeah, luckily they're malleable. So, you can kind of bend them with instruments and get them out of the nooks and crannies of the sinuses, but...

Multiple? When you say multiple, are you saying two or are you saying eight? I believe there were three. That's too many. Once you get over one, it's too many paperclips. One would argue one is a lot. I think that's more than enough. How was the patient's morale?

So, it's funny. So, this case that always comes to mind was when I was in training and I didn't follow the patient pre and post-operatively, so I don't totally know. But one would imagine there may be some familial tension after that. Yeah, you think? I wonder what the kid's next birthday was like. Grandpa's on a cruise on purpose

and is never going to make a two-birthday again. Man, that's rough. Did you ever see that Simpsons episode where Homer puts a crayon off his nose? No, I didn't. Mr. Simpson, I'm afraid you have a crayon lodged in your brain. They find that he has a blue crayon off his nose and that is why Homer is Homer.

They take it out and Homer is very, like, realizes how dysfunctional society is and how sad. Oh, wow. Was it in his brain? It was in his brain. Oh, interesting. And I think at the end, he puts the crayon back in because he's just like, you know...

All right, tell me when I hit the sweet spot. Deeper, you pucillanimous pilsner pusher? Maybe he had a spinal fluid leak afterward. Let's debunk some flim flam. What do you think is the biggest myth about noses and sinuses that you're like, that is not correct? Love this question. One thing is that facial pain is most commonly not from sinusitis.

What is it from? Most commonly, and this has been studied, some form of neurogenic pain. So whether that's migraine would be a very common one, actually. Migraine, everybody thinks of the classic migraines, but there are atypical forms of it, where you can just have isolated facial pain and a runny nose and nasal obstruction.

Really? Yeah. Because it affects nerves. Nerves supply the tissue within the nose, as well as the tissue of the skin. So you can get the runny nose factor, the congestion feeling. A lot of times, they'll feel like just things are full. And then, of course, the severe stabbing pain,

like over there, cheeks or forehead. And unfortunately, this information is not disseminated to all physicians as well. So it's a tough one. Because if you're not seeing noses all the time and putting scopes inside your nose to see where the sinuses drain, I think the tendency is to hear that somebody has a runny nose,

trouble breathing, facial pain. That matches all the symptoms of sinusitis. Yeah. But if you do sinus surgery for all these people, you're going to find that the pain does not reliably go away. Oh, no. And it might just be an unlucky migraine. Yes.

Oh, God, that's got to be frustrating. Yeah. It can be very frustrating. And so whenever I see patients with those conditions, I just get them checked out by a facial pain person. Almost every time, seriously, almost every time, they find something that they can treat medically, and then we avoid sinus surgery.

How often would you say that it's that case where it's just an unlucky migraine? So we're talking isolated facial pain? Nearly. I mean, it's over 90% of the time. Really? That's so interesting. I didn't know that.

It's crazy. I mean, I probably see out of 20 patients, 20, 30 patients a day, I see at least three per day with isolated migraines. So if you have a face ache instead of a headache, it might be a migraine. How crazy is that? Now, why does our nose run? Why do we get stuffy when we cry?

So if you cry too much, you could get some tears literally coming out of your nose. And then there's probably some emotional nerve response that, again, signals those same nerves that sometimes get signal with migraines and can cause a runniness. And the congestion, though, does that happen when you cry a lot? I guess I don't cry very often.

I feel like you get congested when you cry. So evidently, when your nose cries, like literally tears come out of your nose, your tissues get coated with liquid sadness and things just jam up a bit in there. Also, your tissues swell, causing you to need tissues. I'm going to blame the same nerve reflex. I'm sure it is.

It's got to be a nerve reflex. Your brain's just like, are we sad? Let's jack some things up to distract you. Perhaps. And now, how much of your work involves smell and disorders with smell? Percentage-wise, isolated smell loss is not a major part of my practice.

I mean, I definitely see those patients. It's a very difficult condition. You kind of break it down into how long it's been there. And you try to figure out why it occurred. Sometimes you don't come up with a true reason. People just develop spontaneous smell loss. My friend Micah had a fever as a baby. He has no sense of smell.

So you don't have to shower when you go out to brunch far as much as you want. It's great. Not for him, though. Other people. Yeah. But what is happening when you're smelling something? It's going through your tissues.

Does the air hit your sinuses and then your sinuses pick it up and tell your brain what smell it is? Like what? Sort of. But it's more about the location of those smell fibers. So air brings in odor molecules. Those molecules hit the surface, the nasal surface.

It's more the nasal cavity than the sinuses. So airflow normally doesn't go into the sinuses. It actually just goes through that central kind of inner chamber that we spoke of. And so the olfactory receptors on specific nerves are located high up in the nose. And then there are certain structures in the nose where there are higher concentrations

of these olfactory cells. And then that triggers a whole cascade of chemical and neurogenic reflexes that go to the brain. And then that's how we interpret smell. So there are certain areas of the inside of your nose that smell and certain areas that are like, that's not my job. Most of it definitely occurs just through the nasal cavity. Do people give you a lot of nose gifts,

like coffee mugs in the shape of noses? I wish, but no. There's not a lot of Etsy items for rhinologists? There actually are. I mean, I've got like a Picasso painting that has a big nose on it. Whenever I do see weird nose art or anything, I definitely pick it up. Side note, I popped over to Etsy to see what kind of nose gifts

the craft of Sphere had to offer. And first off, there are a lot of delicate nose rings out there and also crocheted nose warmers, which look kind of like a macrame bikini top and a surgical mask bred tiny children. There was also an item advertised as a bronze nose refrigerator magnet, which seems like at 18 bucks a steel for solid bronze, but it turns out it's a painted plaster object.

According to the seller, quote, an exact replication of my own nose. I popped on over to Amazon and I found a tank top bearing simply hashtag rhinologist and a bike bell stating that its user was the world's best rhinologist. So there's some gifts there. In the end, I primed Dr. Craig a plastic schnauz that was also a pencil sharpener.

I'm sure you can imagine how that worked. It cost $5, but I sprung for the $4 gift wrap to include a note of thanks for his appearance onologies and that I couldn't have picked a sharper expert who knows his material. This is why I call myself your dad. Do you dream about noses? Oh, yeah. You do?

Oh, yeah. What's your latest nose dream? It's usually more perioperative stress, like you just did a case and you think about the inside. I see people's sinuses in my mind all the time. You do? Oh, yeah. I remember people's sinuses.

It's weird, but yeah. Like how you would remember a dog or a face? I'm probably better. I'm probably better with that than I am with remembering names. What do they look like? Well, you just remember their surgical anatomy and some of the challenges during the case and specific surgical maneuvers and things like that.

What was your first surgery like on a live human being? Because you're good at cadavers. Like the first time you were like, they're like, all right, doc, you're up. Yeah, it's creepy. Yeah. It's nerve-wracking. Plus, you have people watching you and critiquing you.

So it's always a unique experience to say the least. Cutting into a person is unique, like a good pineapple couscous. You know, in training, you start not so much in the operating room, but maybe in the ER and you're closing up lacerations in the face. And that's always a unique experience as a young resident in training. To stitch up people's bleeding faces. Yeah, yeah. And they can be pretty extensive lacerations or dog bites

or things like that. And so surgically, they kind of train you and you go up and up until you get deeper into the face, perhaps? Sort of, yeah. You definitely start with more run-of-the-mill surgeries up front, things like tonsils and adenoids. And then more in the middle of your training, you develop the endoscopic skills for sinus surgery.

So you've had to do tonsillectomies. Oh, yeah. I got one of those. At what age? Oh, 26, dude. Not pleasant. It was not okay. But it was the only time I've ever been put under.

And I remember waking up being like, that wasn't so bad. And then I looked in the mirror and I just saw a little smear of blood under my chin that they had not wiped. They had missed. And I was like, what happened here? Like, if this is just a smear that they missed, there's just supposed to have been blood all over my face, right? Like, is that what happens?

Who knows? It could have come out when the anesthesiologist pulled the tube out, you know. Okay. I was just like, ah. Never the surgeon's fault. No, no. But I was like, what kind of game of throne shit was going down when I was asleep? Like.

Well, that's a whole other world, yes. And it's the operating room environment. I mean, you guys, this always surprises me that like, surgeons, you guys talk and play music. And like, it's not. I picture just steely silence and like, you could hear someone breathing. What is the actual environment like? What's the mood?

What's the atmosphere? Yeah. I mean, it definitely varies by, you know, surgeon personality. So they're definitely some people that prefer a very quiet OR. Um, I don't prefer it that way. I like music. I like people talking because I do a lot of teaching. So I expect people to be asking me questions throughout the whole case.

And I also fire questions back at them. So it's a very interactive or environment with me. That's cool though. If I'm pretty much half dead on the operating table. So there's no reason for everyone else to have stony silence, right? What do you listen to? Oh, uh, so I am a hip hop fan. Okay.

So, uh, and I'm in Detroit and I've always been an Eminem fan. So I do listen Eminem. I also listen to a lot of nineties hip hop from the West Coast. So I'm a big Tupac fan. And then I often will listen to hits, stations, um, you know, and I don't want to offend anybody. So if anybody's offended by rap, then I definitely will just go to the hits. And the patient can't object. That'd be great if they came out of it and suddenly they were like,

you know, let's put on some Tupac on the way home. Yeah, a little subconscious recollection would be cool. So what kind of situation would get you on the rhinologist table? As a professional, as a rhinologist, what should people be on the lookout for when it comes to their nose health? Because we don't think about our noses unless we're contouring them or there's fluid pouring out of them. What should we be aware of?

Yeah, there are some more red flag symptoms that sometimes get overlooked and we might as well just highlight them. So I always think of any time you have one-sided symptoms. So if for like the last month or two, the left side of your nose is completely blocked and not the right, or you only have left-sided nosebleeds, it's probably time to get checked out. Okay. You know, it could be as something as simple as a deviated septum,

but you don't want to miss the bad things. And so when I see one-sided nasal obstruction, the first thing that goes through my head is I need to make sure there's no tumor. So tumors tend to grow and affect one side. And by the time, and they usually sit in the sinuses for a while before they grow out into that inner chamber. And now you will put a camera up a nass hole and poke around. Has that been like revolutionary?

Yes, game changing. It's totally changed the field. You must have to use less radiology as well, right? Is that a great comment? Yes, I actually am very principled against unnecessary radiographic imaging because I can see the important areas where the sinuses drain, and so we don't need to be getting CAT scans and things to radiate people all the time. And so, anything else that anyone should look for?

Yeah, another one that has been popping up in the media too is the spinal fluid leak. Oh, God. Okay. So yeah, this is brain fluid. So stuff from the comfy, watery sac surrounding your brain, kind of like when you buy a pickle in a pouch. It's 7-Eleven, but it's brain fluid out of your face. So Dr. Craig says that if you ever have clear fluid leaking from your nose,

especially if it's one sided, definitely get it checked out because normally clear nasal drainage should be both sides. So one quick question. What the fuck? Walk me through. A spinal fluid leak is when the shit around your brain is dripping out of your nose. Correct. That should be like fire alarm, emergency, like that's not something you want to happen.

No, you don't. But the problem is it's not common enough to where even a whole lot of physicians are thinking about it all the time. So if patients present and they have a runny nose, they might just get put on some sprays and then fall up in three months. Oh my God, how mad would you be if your brain fluid was leaking out your nose and someone's like, take some Claritin? I know it happens.

It's not that uncommon for that to happen. I feel like it's too bad that brain fluid isn't tinted a certain color, like a transmission fluid or something. Oh, it's blue. Like this is a real issue. And what would cause that? So two main causes. One would be trauma.

So if you have a high velocity head injury, you can crack that skull base bone. And the leak may occur then or it could occur like months later, just from a delayed wound healing process. Or there's another type called spontaneous spinal fluid leaks. The thought is you get chronic pressure changes at that skull base. It's already thin. Eventually it thins to a point where it's gone. And then one way or another, there's a tear in the lining of the brain

and that then allows fluid to drip. Oh, so it's like a burst dam kind of? Yeah. Oh, man. So watch out for those things. Yes. What's happening when people put cocaine up their nose? When people are crushing things and snorting them,

I'm sure that you have a cautionary tale or two. You know, it's fun. I haven't seen that many people yet. I mean, I've seen a few. So what's happening is cocaine basically acts to constrict blood vessels. So it's extreme. We call it vasoconstriction. And so there's obviously mechanical trauma from the actual shards of cocaine

and that can cut the nose. And then it gets deposited in the tissue. That'll cause a really extreme constriction of the blood vessels. So that over time can basically cause death to the tissue. And so the nasal septum is a very highly susceptible area because it's right there in the front of the nose. And so if you hit it with cocaine for a long period of time, the mucosa on either side of the septum can die.

And then the cartilage in between doesn't have a blood supply. So it's gone. So that's how people get holes in their septum from cocaine use. God, why do people snort some drugs instead of just putting them in their body through other mucosal areas? I couldn't give you perfect answers. But I mean, for one, it gets absorbed fairly quickly. I think that gives the like initial high quicker.

But I don't know if there's ingestible form of cocaine, to be honest. It didn't strike me until later. Yes, if you've ever read up on altitude sickness in Machu Picchu, you may have heard that a lot of hikers keep a soggy lump of chewed up cocoa leaf in the cheek. Or you can drink cocoa tea. Also, booty bumping. What's booty bumping? Oh, it's the same as keystering or plugging or butt chugging,

which is when you mix drugs with water and then stream them up your dark canals of your posterior. Thereby bypassing the pesky delay that digestion might afford. Now this, all according to a blog post entitled, everything you need to know about butt chugging, written by a retired police sergeant named Keith Graves. I wish I went to his retirement party. I bet that was so fun. But wait, ingestible cocaine.

Hello, soft drinks. Lest we forget that Coca-Cola got that coca from somewhere. Now in the late 1880s, it was invented by Dr. J. Pemberton, who was a Confederate soldier who was addicted to morphine and he wanted to make a health tonic. He was like, man, this cocaine juice will fix your fucking life. And he began selling it in drugstores. And then he died suddenly two years later.

But his family was like, yeah, man, yeah, you know what? Let's make this a business. Like one day it'll be the biggest business in the world and people will wake up and drink it and will sponsor the Olympics. Holy shit, man. Yeah, let's do it. Because they were on cocaine. Now, originally, Coca-Cola had about nine milligrams of cocaine per glass,

which is about a fifth of what you would see like when a chubby line is snorted in movies about 1980s stockbrokers or like on entourage. I don't know. By the way, what are those actors really snorting? Well, it turns out it's usually lactose powder or the prop master coats the inside of the rolled up $100 bill with Vaseline so that the lactose sticks to the inside.

But either way, doing pricey street drugs that rot your septum and turn you into a maniac D bag, probably not the best life choice if you can avoid it. Just picture like an image of a rainbow star streaking across the cosmos. And the more you know, graphic. But it's a bad idea. Dude, it also seems very expensive. That probably is also true. Yes.

If anyone really needs an upper, I drink yerba mate for a number of years. And boy, oh boy, that thing that have you ever had it? What's that? It's a type of South American tea. Seriously, though, yerba mate, man. I don't know how it's legal because like a month's supply is $4. And I would scrub my bathroom grout at midnight for fun. I had to finally quit because I drank too much

and I turned into the human equivalent of a scared Chihuahua. A Chihuahua. Yeah. I had some friends that were like, are you on drugs? And I was like, no, I discovered a tea at Trader Joe's. It's very caffeinated. It was it's intense. A lot.

I'm sure a lot cheaper than street drugs. How do you feel about septum piercings? When you see it, are you like, no, or you let go for it? There is, of course, the potential when you take it out that you would have a hole in your septum. So to me, it would seem like unnecessary risk. But if it's a strong personal preference, I don't know. I haven't seen too many problems from them in terms of holes in the septum.

That's good. So you don't see a lot of people coming in just dragging themselves into the ER with an infected? Infected. I haven't. But I mean, it's, of course, a possibility. If you're, let's say you had a child that's like, dad, I'd like a septum piercing. Would you be like, OK, but I'm doing it?

I would probably just be with them at the piercing studio and hyperanalyze exactly what they're doing. But I feel like it's an easy one to fake, though. You know what I mean? I feel like there's some good clip on septum rings. It could be true. Right? Kind of makes sense.

I mean. That might be a market you should explore. I tried to find out what percentage of septum piercings you see in the wild. Actually piercings and what percentage are just clip on. But like a bow tie, you'd have to tug on it or ask or launch a multifaceted study on it. Now, I did learn that they don't actually pierce your cartilage. They find what's called your sweet spot, scientifically known as the columnella, which is a little bit of flesh at the tip of your nose past your actual septum,

which makes the whole shebang less drilling and really more gentle pokey. But can I just say that hot dang, if you're afraid of blood or commitment and you want to clip on septum piercing, etsy is coming through for you. But what about putting things on the outside of your wiffer? Oh, I did forget to ask. Do strips that you stick to your nose that open your nose up to prevent snoring? Do they work and how? So they work, but it's not so much for the snoring.

What it works on is what we call nasal valve collapse. Ooh, get in bed with nasal valve collapse. So the floppy part of the nose, the nostrils, we call them the nasal valve region. So it's actually pretty common to have some degree of narrowing or collapse there. So what the breathy right strip is held or generic strips, whatever are helping with, they'll just lift the floppy nostril outward, kind of like flaring the nose. So if that is your area of obstruction, which isn't necessarily the case, but if it is, then it should improve airflow.

And in those situations, if that's your only cause for snoring, it'll help with snoring. But snoring is multifactorial. You can have obstruction at any level of the throat that won't help with a breathy right strip. Does snoring sound different if it's a nose snore versus a throat snore? If someone played you an audio clip, could you be like, that's a floppy asshole? That's a good question. I'm not aware of any literature on it, and I don't watch enough snores.

So if you try it and you are told that you're still snoring, it might be in the throat, it might be something else. Yeah, snoring actually is not a prominent primary complaint. I would think that would be the first, you just have a line of snores that are in there with maybe tired, cranky spouses being like, get it fixed. Well, in some people's clinics, yes. But in my rhinology clinic, it's not the primary. But it's definitely a huge area of healthcare right now, right?

Obstructive sleep apnea. So a lot of people see that. So I looked at one website appropriately called StopTheRumble.com that tried to describe the sounds of snores based on the cause. But it had a lot of weird pop-up ads. So I don't know if it's even trustworthy. Now, as soon as I have some knowledge on, this is going to be a top order of business, trust me.

Okay, so onward and upward. Nose hair trimming, should we do it? Should we not do it? Probably overall, the recommendation should be you don't do it. There is some function to the nose hairs. They catch debris. But you can trim it up and it's fine. I mean, listen, if you are having nose hair growing out of the nostril

and it bothers you, it's safe to clip them. You're not going to cause any problems. But if you do trim the tissue and cause a nose bleed, then you could have a problem. Why does it... Do you know why it hurts so much if you pluck a nose hair? We've all done it. It's horrible.

Yeah, it is quite unbearable. It's the worst. Yeah, just the nerve innervation. It's those nerves again. They have to be very, very sensitive. Oh, God. I know. Yeah, it's a whole...

It's a... What a form of torture. I mean, as a person who's had a lot of things waxed, there's nothing. I would rather wax my entire body twice than one nose hair. It is. Yeah, it's crazy how painful that is. Do you want to do a lightning round? Sure.

Okay. These are questions from listeners about noses to you specifically. Okay. But before we take questions from you, our beloved listeners, we're going to take a quick break for sponsors of the show. Sponsors, why sponsors? You know what they do? They help us give money to different charities every week.

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So thanks for listening and thanks sponsors. Okay. Your questions. Krista of Empado asks, my eye doctor once gave me exercises to strengthen my eyes and they worked wonders. Is there anything we can do to strengthen our sense of smell? So there's some good evidence when you have smell loss

that something called olfactory training helps. I'm not aware if you already have good smell, then I don't know if it'll strengthen it. But if you've lost your smell, then some studies have shown that if you get like some of those extract oils like citrus, rose geranium, things like that, if you smell those 30 seconds each, four cents, around three times a day,

that may stimulate more smell function. Really? Yeah. And actually I've seen it work. So it's got good evidence behind it at least. Oh, that's amazing. I had, I thought you were just, just out of luck there. You're just plum out of luck.

Sometimes, sometimes you are, but sometimes you can fix it. So, so huff some essential oils, see what happens. Yeah. Great. Late night pie wants to know, I frequently get allergies. What can help me breathe better? Any nose exercises or herbal remedies that you suggest?

Anything herbal? So I'm not aware of any herbal remedies. I'm sure there are some that would work. But just from, you know, evidence-based medicine per se, I would say, you know, a topical steroid is very safe for long periods of time. And the saline rents that I mentioned before are just good, simple nasal treatments.

And then if you have a lot of the itchiness, itchy nose, itchy eyes, or some other, you know, body hives or, you know, antihistamines would be great. Okay. Got a couple questions about sneezing. Tyler Q wants to know, what's the deal with bright lights making people sneeze? What's the correlation there?

And I have, I have that where if I'm going to sneeze and I'm about to lose it, if I look at light, I think your pupils constrict and there's some like photo sneeze reflex. I need to read more, apparently. Yeah, that's interesting. I wanted to blame it on migraines, but I guess maybe there's actually-

If I am about to sneeze, you know, when you lose a sneeze and it's just like devastating? Yeah, yeah, yeah. You're like, where did I go? If I look at a bright light, then my pupils get small and then that's what triggers a sneeze. But my DNA profile said I'm likely to have a photo sneeze reflex. And I was like, damn straight I do.

Interesting. So yes, this is called Photic Sneeze Reflex. And it happens to about 20 to 30% of people and it is inheritable. So next time you're about to disseminate your nose contents away from your body at 100 miles an hour, which is what a sneeze is, but it might go away.

Look at light and see if that does the old trick. Also, this whole thing is called- Ready for this? Autosomal Compelling Helioophthalmolic Outburst, which sounds like a real mouthful, but guess what? It stands for Achoo. Yes. Someone background him that shit so hardcore

and I have to say that that achievement is nothing to sneeze at. Sorry. You love it. You love all of it. I love these questions. I know. Here's Carrie or here's Carl wants to know, does muco-phagy, mucophagy boost your immune system?

That sounds like eating- So I'm going to barf right now onto my computer. Does it help your immune system? I don't think so. Okay. I mean, we all swallow our own. About one to two quarts a day. One to two quarts?

Yeah, four to eight cups if you want to do the measurements. So we're all swallowing it. Only a certain percentage of people actually notice it and get bothered by it. Oh my God. How do we make that much fluids? Well, it's part of the mucosa. It's a secreting powerhouse.

It just keeps going. Oh my God. That's a lot. Julie Rose asks that she says that her nose runs every time she eats, even if it's not anything spicy. Every time she eats. Now, why do spicy things make our nose run? And why does her nose run every time she eats?

She says it happens. It's been happening as long as she can remember. Yeah. So definitely read up on vasomotorinitis, V-A-S-O-M-O-T-O-R, rhinitis. Now, if this happens to you, it might be an overactive nerve response or something is wonky at the junction

between a nerve and a gland. But Dr. Craig says there are other triggers, like temperature change or wine. Now, with rosé on a patio season upon us, what do you do? And there's actually a nasal spray that works usually very well for it. It's called Atravent. Okay.

And it basically binds the receptor on the gland and just blocks it from secreting. Oh. So, and there's actually, there's a new treatment out that I do offer. I think I'm one of the few people in Michigan right now. It's an intranasal cryotherapy that... Freezing?

Yeah. Yeah. And it's, there's a publication from Stanford last year. Very encouraging. This is a very difficult problem to treat. And so when patients either aren't responding adequately or just don't love using Atravent nasal spray whenever they have a runny nose, it's an option.

And it's a non-surgical option. You usually do it in the office with them awake. So, so anyways... So you just freeze off an area? Yeah. Just one area in the back of the nose where most of the nerve fibers applying glands are. And then if that fails, there's a surgical option

that most people don't need. But every once in a while, you'll have to consider cutting a nerve further back. A little trickier procedure, but... But think of the money you're going to save on Kleenex. There you go. See? Is there a Kleenex type that you're like,

don't use the kind of lotion in it, use the kind of lotion in it, splurge for organic? I think I would just go with whatever feels smooth and less annoying to the tip of the nose, but nothing sticks out as superior. Is toilet paper okay to use on your nose? Not the rough stuff.

Okay, just checking. Yeah. Okay, Charles Anderson wants to know, what is the best technique for blowing your nose when you're super stuffed up? What do you do when it's just a traffic jam up there? Oh, yeah. So usually the problem is not blowing,

the problem is just too swollen in there. So it feels like something's like blocking and you can clear it, but a lot of times there's something in your nose called your turbinates. Turbinates? So T-U-R-B-I-N-A-T-E-S. Okay.

They're tissues that swell up periodically. It's like their job, but they're kind of puffy bulbous structures on the inside of the nose, on the side walls, and they're made of bone on the inside and then puffy tissue on the outside. And so those are what classically get crazy swollen during allergies.

And so even a normal person without any disease at all may notice sometimes that one side's blocked and then a few hours later the other side's blocked and then it switches back and forth. So what can happen when you have a cold or bad allergies, those tissues can both on both sides get crazy swollen and then it's tough to breathe in, but it's also hard to blow out.

Yeah. So if you're in that situation, I would say start by using a topical therapy, flush your nose with saline, see if it's getting through at least, try the flow nays or some kind of, now you got to be careful with the decongestants. All right, everybody, here's the myths about,

they're not myths, they're real, but affrin spray. Yes. Can you get addicted? Yes. So it causes something called tachyphylaxis, which is just an immediate kind of, your body immediately needs more of it pretty much. So then you have to keep using it, keep using it.

And when it wears off, the tissue gets even more swollen. So that's a condition that we call rhinitis, medica mentosa. And it's not a great scenario because it's hard to get rid of because patients don't want to stop using their affrin. Right, you're chasing the dragon.

All right, exactly. So we do have ways to try to temperize that, but well, obviously if it's not getting better, if this is not a temporary congestion and issue blowing your nose, you really should get checked out. Okay. But usually it'll be a fleeting thing,

you just have to deal with it for hours to a day or something. But that's really interesting to know that you can get addicted. Yeah. I had a friend in high school named Jeff who was addicted to affrin. And we're like, well, if a kid's going to get addicted to something,

I guess let it be affrin, but still. You don't have like withdrawal from it, if anybody's wondering. It's just annoying to try to get off it. How long would it take to kick affrin? So I actually, it's funny, when I was in college, I had no idea about this.

And I had a horribly deviated septum, couldn't breathe through my nose. Oh no! And so I used affrin, because somebody told me to try affrin, and I just used it for a few weeks. And then I tried stopping it, and I was like, oh my gosh,

I can't breathe at all through my nose. So it took me, as I recall, two weeks before I felt like I don't need it anymore. But I kicked it. I just said, just cold turkey. So Dr. Craig says you can kick affrin addiction with a little topical steroid spray, which affrin is not.

It's kind of like weaning you off. And then assess what caused you to need the affrin. So flonase is, it's kind of like the methadone in this situation, I think, I don't know. Okay, now this next question is quick and gross, but we're going to get through it together. Michael Kiers has a question about

if boogers serve any real purpose, other than being annoying and embarrassing. No, not really. It's just dried up. It's annoying. Okay, good to know. I was hoping we wouldn't have to go down a real, I could talk about drain clogs,

and I have in this podcast, but for some reason, boogers is one of the things that I'm like, like my gag reflex chokes up. And that's very rare for me. I've let spiders crawl on my body. Like I'm not grossed out by a lot, but that's one thing that I'm like.

Boogers. Yeah. That you're a good man. I pick a lot of them out every day. Oh God, you're in them. That's good karma. Okay, last question for lightning round. Jamie Gibbs wants to know why

it smells such a big trigger for memories, but I think that's more a neurological thing. No, there's a specific section of your brain responsible for smell-related memory. So it's strong too. I mean, it's a very strong neural connection. So side note, blame this heavy whiff of nostalgia on the olfactory bulb

having direct connections to the amygdala and the hippocampus. These are parts of the brain that deal with memory and emotion. So your smell center essentially cuts the line and is like, hi, I'm here for the emotions right through the back door. It is nuts.

You can smell a perfume from high school and be like, oh, the memories. So true. Prom. So what, we just talked a little bit about having to pick boogers, but what's the worst part about your job? The thing that you're like, is it spreadsheets?

Is it anything disgusting? Is it? Well, I suppose as a physician, definitely there's issues with the administrative side, separate from the clinical side. So I mean, the administrative thing is we just, as doctors, it's just part of the job now. You have a lot of paperwork and now it's e-work,

but you spend, you know, a good couple hours every day after a long day doing documentation. So that's, it comes with the territory. It's just, it's probably the less gratifying part of the job. Um, I mean, as far as clinically, honestly, for what I do, there aren't too many downsides. Once again, this brave hero would rather literally pick strangers' noses than fill out forms.

And honestly, I get it. What do you love about your job the most? What's the most gratifying or what moment has been like, made you want to cry about it? In a good way. I mean, there's just something gratifying about going to work every day, working hard to fix people's problems. You know, I don't think there's one thing

that makes my job the most gratifying, but there's definitely something fascinating behind deeply understanding an area that is very rare, in terms of the diseases that affect the nose. The longer you do this, the more patent sinuses you see, very gratifying, because usually, patent nice, widely open sinuses result in better outcomes. So I always joke with patients and say that pretty much,

if not the, probably the second purpose in my life is to keep sinuses open, literally. So my, my day deteriorates. The more sinuses I see in the office that are starting to close down, because then I have to find ways to keep them open. It's like whack-a-mole with sinuses. Just keeping them open, keeping them open.

Yep. Everyone, sinuses, keep them open. May your nose tears be joyous, and your sinuses be as open as your heart. Have you considered getting a satin jacket with the words, Dr. Nose Best, embroidered on the back? I would not be against that. I have made a sweatshirt already.

What does it say? It just says Henry Ford Rhinology with my name on it, but. And you got it made? But I make them for the residents, too. But no, satin is a good spin on that. I might have to consider that next time. Just saying. Just some fancy embroidery.

Perhaps a couple of more nose puns in your life. I think there's room for it, to be honest. Very. I learned so much. Now I can't stop thinking about my skull plate base. Ah, yes. Yes, the skull base. No spinal fluid dripping out of it.

Yes. Well, thank you so much for having me. Oh my God, I loved it. So to hear more about Dr. Craig's Rhinology work, you can head to his YouTube channel, which I'll link in the show notes, or you can just search Henry Ford Rhinology on YouTube, or you can look for the Facebook page,

for the Henry Ford ENT group. Now I'll also post more links on my website at alleyboard.com slash oligies. You can follow oligies on Instagram at oligies, also on Twitter at oligies. I'm on both as alleyboard with 1L. Now to cover your human body with oligies merch, like pins and baby onesies and shirts,

head to oligiesmerch.com. Sales support the production of the show, and thank you Bonnie Dutch and Shannon Feltis for that. Also, if you're looking for some good karma, maybe you need a boost, and you want to help one of my favorite kids, Shannon Feltis' son Aiden, you can help him make it to camp for special needs kids.

You can get a very cool shirt designed by Bonnie Dutch, the proceeds send Aiden off to camp. That's at inktothepeople.com slash Aiden style, and I'm going to put a link in the show notes. In case you want to buy a shirt and send a very cool kid to camp, I'm just throwing that out there because I think it's a really great cause. Now to join the Facebook group,

where oligies listeners share photos of bee swarms and pictures of dogs and links to cool science news, you can find oligies podcast on Facebook, and one of the wonderful admins, Aaron Talbert or Hannah Lippo will approve you. Thank you guys for doing that. And you can join the behind the scenes club at patreon.com slash oligies.

That gets you access to video messages, and you can submit questions to oligists before I record the episodes. And those funds help me pay my cherished editor, Stephen Ray Morris, who edited this episode while in a metal tube over the Atlantic. Instead of watching a bunch of quality rom-coms and action flicks on his flight to and from London,

thank you for that. You should be sleeping. The theme music was written and performed by Nick Thorburn, who I just saw driving around my neighborhood recently. I got very excited and I waved. Now if you stick around until the very, very end of each episode, you know I tell you a secret. Just for saying thanks for sticking it through the credits.

And I'm going to give you one follow-up secret. Rubbing hemorrhoid cream on a blemish did not help at all. If anyone needs a tube of barely used hemorrhoid cream, please contact me, reach out on Twitter. I will mail it to you. You can put it anywhere you want. That's none of my business. In the other secret, I'm going to tell you,

let's make it nose-related and blemish-related. Once I had a blemish on my nose, after my senior year of high school, it was there for six weeks. It left a tiny scar and boyfriends had asked me, oh, what's this from? And I told a couple of them that it was from chickenpox. I'm sorry I lied to you.

Now everyone knows. If you zoom in, you can see it on pictures. It's very small. It looks like a chickenpox scar. But really, that was a hard summer, you guys. I remember when it finally went away, my mom was like, I'm so happy for you. I was like, thanks, well.

Anyway, there's my secret. Bye-bye. You know when you lose this knees, and it's just like devastating?