Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we'd like to introduce you to Dr. Reena Dhanda-Patil. She's new to Northwestern Medicine and is a Professor of Otolaryngology Head and Neck Surgery at Northwestern Medicine. Dr. Dhanda-Patil, thank you so much for joining us today and welcome. So, what inspired you to pursue a career in otolaryngology? What aspects of this incredibly unique specialty are you most passionate about?

Dr. Reena Dhanda-Patil: Thanks, Melanie, for having me on the podcast, first of all. I would like to just talk about how we go back to our interests all the way back in medical school and how that shapes where we end up with our careers. And so, you know, I entered medical school with no preconceptions of what I wanted to practice. I was attracted to many specialties, but I really loved the head and neck anatomy. And this was very striking when we were in the Gross Anatomy Lab in our first year.

And then, when I actually rotated through Otolaryngology, I was a medical student at UIC, I found that it was a perfect combination of fulfilling that intellectual curiosity, understanding the intricate nature of those nerves and how they worked and actually seeing them in action in surgery, and our ability as physicians to directly affect patients' quality of life with a variety of procedures. And I was first interested in ENT because of that ability to restore sensory abilities. For example, cochlear implantation. And when I was training, in otolaryngology at Washington University in St. Louis, I had the chance to experience the wide breadth of our specialty. And I loved how so many aspects of what we did impacted the overall health and well-being of our patients.

Melanie Cole, MS: Thank you so much for sharing that. Now, can you share some insights into the specific areas of ENT that you specialize in? What conditions are you most commonly going to be treating?

Dr. Reena Dhanda-Patil: So, as I mentioned, I do treat all areas of ENT. And, you know, I'm considered a general ENT or now what we call a comprehensive otolaryngologist. But for this specific position here at NM, I was recruited to build the program for surgery, for sleep disordered breathing, most typically obstructive sleep apnea.

And so, this is a really important area. I think that anybody who's listening to this podcast or just lives in our country would say that the attention to sleep quality, sleep apnea, snoring, and a whole host of other sleep disorders, things like insomnia, restless leg disorders. The attention and interest has really exploded over the past decade or two. And this was really honestly a pretty dormant area when I was a resident. It wasn't anything that people really were interested in specializing in or investigating. And that has changed drastically.

I think that there has been so much attention by everyone in our healthcare community, especially with regard to undiagnosed obstructive sleep apnea. And then, those worries about sleep, our sleep quality, our well-being has just been amplified so much, you know, in no small part by social media certainly and, in general, our media just showing concerns for people's sleep. And so, at the same time that this has happened in the sort of general population, our academic community has also become very vibrant.

So, I am very involved with the International Surgical Sleep Society, as well as a member of the American Academy of Sleep Medicine. And there's just so much new technology out there and updates of older surgical techniques that are constantly changing and improving and developing and working with our international community really gives us a wide understanding of all the things that are out there that we may not do as much in the United States, but are certainly beneficial for patients.

Melanie Cole, MS: Wow. That's so true and so well said, because it is. We're learning more and more about sleep and its relation to a whole host of diseases. Now, I'd like you to speak a little bit, Dr. Dhanda-Patil, about your philosophy of care. What would you like patients and your colleagues to know about how you approach disease, wellness, and care for the whole person? As we think of head and neck issues and some things like cancer can really have devastating effects on appearance and function of the patients, can be some of the most disabling, socially isolating defects. And you're working with some of the most intricate and unique areas of the body. So, tell us, what's your philosophy of care?

Dr. Reena Dhanda-Patil: My philosophy of care was really truly informed by my previous work. I spent over two decades working as a VA site director in my previous position at University of Cincinnati. And in that job, I was treating veterans who were an incredibly complex group of patients. And they had so much stuff going on with them with regard to their medical health and their mental health.

And so, I have always approached these patients from a holistic perspective. I don't believe that any one-size-fits-all approach is ever valid because everybody is different. And so, I have really learned from my patients, you know, my patients teach me this all the time. I've learned from spending time with them to really put together a multifaceted treatment plan. And this involves, of course, not just myself, but using a multidisciplinary team approach. And so, as an example, yesterday, I saw a really complicated patient with obstructive sleep apnea. She also has insomnia, she has bipolar depression, she has morbid obesity. And these are just to name a few of the things that are going on, and we can't just throw a surgery at her and expect her to suddenly be better with her sleep. There's so many facets of her care that we have to address.

So, that is really my approach. I love to spend time with patients. I really try to talk to them and really understand what's going on in their whole life, not just with regard to this one aspect of their care. And I think this is the approach that is going on throughout the community, healthcare community, right? We all want to treat our patients with an individualized approach. And there's this concept out there called precision medicine, which is just gaining so much traction.

And so, as an example, in my field, I would utilize a drug-induced sleep endoscopy, which is a quick procedure we do in the operating room where we induce a sleep state. We see how patients are collapsing. And then, we can counsel them really in a thorough fashion about whether, what kind of surgery might be able to help them. Let's say a newer variation of an old surgery like a uvulopalatopharyngoplasty with more reconstructive techniques or let's say something like a patient-activated technology, something that many are familiar with called hypoglossal nerve stimulation, historically Inspire, now FDA approved in this country with Nixoa, which is another new device. And so, I'm always working with these companies and with my colleagues throughout the world, honestly, to try to figure out what are the best techniques and the newest things that we can offer for patients.

Melanie Cole, MS: It's really an exciting time in your field. And Dr. Dhanda-Patil, one of my favorite questions, I love to ask new physicians joining Northwestern, what do you do for fun? Tell us a little bit about your family and life outside of work, and what are some things that your new colleagues may not know about you?

Dr. Reena Dhanda-Patil: Well, I'm definitely in the mid-career to late career stage. So, I have a lot of life experiences already behind me. My husband and I moved here together. He's actually a head and neck cancer surgeon, also in the Otolaryngology Department, with a vast experience in reconstructive techniques after cancer resection.

And so, we came as a pair into the department and we've been welcomed so much by all the people that I've met. It's just been fantastic, and we were lucky to be able to do this and make such a change in our lives when these positions came up because our children are in college, we have two boys who are sophomores and seniors in college right now. And so, for fun, ,you know, I love Chicago, I think it's a fantastic city, i'm so enjoying the vibrant arts and food scene. And I love walking on the lake with my little dog, Remy, and playing tennis, yoga and crossword puzzles, and piano too. I play the piano. So, a lot of fun things in spare time.

Melanie Cole, MS: Oh wow. That's lovely. Thank you so much for sharing that. Now, as we look at your field, and you mentioned Inspire, what advances in otolaryngology excite you the most and how are you planning to incorporate these new technologies and techniques into your practice?

Dr. Reena Dhanda-Patil: As I mentioned earlier, there's just an explosion in sleep medicine and sleep surgery. So many advances. They're so exciting and very varied honestly this time. And what I think is most exciting is how we can incorporate these treatments together, this combination therapy approach.

So for example, let's say we have a patient who has collapse at the palatal level, but they also have collapse at the base of tongue level. And maybe we combine uvulopalatopharyngoplasty with an oral appliance. That's something that we can trial with a lot of patients when they don't necessarily want additional procedures on their base of tongue.

What if we have a patient who wants to get hypoglossal nerve stimulation or Inspire? But they don't sleep well, they have insomnia. And so then, the device can't work when they're not sleeping. So, we can incorporate cognitive behavioral therapy for insomnia to get them ready for the therapy and to get them to be able to optimize their sleep time.

There are GLP-1 agonists that are up there that are really-- like, for example, Zepbound, which was relatively recently approved for obstructive sleep apnea by the FDA, and that can help bring their patient's weight into a goal that allows them to actually be candidates for surgery. Sometimes patients come for nasal surgery so that they can better tolerate their CPAP, and there are even more things on the horizon.

There are new drugs, apnea medicine trials to improve pharyngeal tone, treat obstructive sleep apnea. There's myofunctional therapy. I could go on and on, but there's just so much going on. And I love the idea of being able to combine treatments to best address each patient's individual situation.

Melanie Cole, MS (Host): It's great to speak with you, Dr. Dhanda-Patil. And I'm so glad you could join us on this episode. As we wrap up and as a new member of the Northwestern Medicine team, what are your goals for contributing to the ENT Department and the community that we all are a part of?

Dr. Reena Dhanda-Patil: Thanks so much, because I am really passionate about contributing to sleep surgery in Chicago. I would first off like to establish a presence for Northwestern Medicine within our city's vibrant academic community of sleep surgery based on the latest in evidence and technology, and help train next generation of students, residents, and fellows, and collaborate with my colleagues at other universities so we can best teach our future providers in Sleep Medicine and Sleep Surgery.

But when it comes to patients, which is really my passion, I really want to be able to offer hope for these patients. So many of them are so frustrated by their sleep quality, their inability to use CPAP and solve the problem with sleep surgery. And they're very worried that their untreated OSA will hurt their health in the long run. So, I really want to be able to offer them other therapies or options that will give them some hope. And lastly, that will help improve their quality of life because without good sleep, it's really hard to function on a day-to-day basis and experience the joys of life.

Melanie Cole, MS: It certainly is. And thank you so much for joining us today and sharing a little bit about yourself for your new colleagues at Northwestern Medicine. And to refer your patient and for more information, please visit our website at breakthroughsforphysicians.nm.org/ent to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.