Darrell Rebouche (Host): Breathing, hearing, speaking, things we rely on every day, usually without a second thought until something goes wrong. That's where today's guest comes in. Welcome to Health on Point, presented by Willis Knighton Health. We're talking with an otolaryngologist or an ENT doctor who works at the intersection or the point where medicine, surgery and life intersect. J. Patrick Lavo, thank you for joining us for Health On Point.

John Patrick Lavo, MD: I'm so glad to be here.

Host: All right, an ENT. We hear a lot about that. I think a lot of people know, most people realize that stands for ear, nose, and throat. But I don't know if a lot of people understand the breadth of what ENTs do. Can you lay that out for us?

John Patrick Lavo, MD: So, ENT is a really big field strictly because it sounds kind of small when you think ENT. But the other name for it is head and neck surgery. So, some people say otolaryngology, head and neck surgery, and that's because we really deal with anything that starts at your collarbone moving north. And honestly, sometimes with some procedures, we cheat a little bit south, and we deal a little bit in the chest as well.

But as a result, you're dealing with a lot of different organ systems. So, you think about all the things that are in your neck. So, you've got vasculature, you've got nerves, you've got endocrine glands in the form of your thyroid. You've got breathing, you've got swallowing, all within one very tight little space in your body. You move further north. You've got things like your tongue, you've got your tonsils, you've got salivary glands, you've got swallowing function, you've got sinuses, you've got allergies, you've got all sorts of things. And even when you get to your ears, you start looking at different problems. You've got ear infections, you've got regular hearing loss, you've got congenital hearing loss. There's just a million different things because instead of focusing on a single area or a single organ system, we're focusing on a region of the body, and then all of the different organ systems that fall within that region.

Host: And then, there's one little carve out, because you don't do eyes, right?

John Patrick Lavo, MD: Oh my gosh. No, I leave those alone. Never. I think they used to do eyes. Someone told me the history of that was back in the day it was EENT for Eyes, Ears, Nose, and Throat. But then, they developed better lens technology, and the Eyes broke off, because they had enough stuff to do on their own. I have no idea if that's canonical or if that's a complete made up story.

Host: But that's your story, and you're sticking to it.

John Patrick Lavo, MD: I'm sticking to it. But I don't touch the eyes, no.

Host: All right. So, you know, you mentioned you're a surgeon. And I just wonder what the most common surgery you perform is.

John Patrick Lavo, MD: The most common surgery I perform is going to be a lot of pediatric stuff. So a lot of ear, nose, and throat—at least in the private world—ends up being in the like tonsils, tubes, ear infections, sore throats, difficulty breathing for children sort of realm of things. And that's just because kids get a lot of ear infections. And one of the best things we can do for ear infections is antibiotics. However, antibiotics and so many treatments can become problematic in their own right. And so, we put in ear tubes to prevent that from being a problem.

Host: Ear tubes are tried and true. I know my kids who are in their 30s had ear tubes way back in the day. So, explain to people exactly what those are and what they accomplish.

John Patrick Lavo, MD: So, ear tubes are—and the reason they still work is because ear tubes are physics. There's no medicine here when you think about it. This is a physicist's problem. Your ears are a contained space, so you've got your external ears, which is where you get swimmer's ear, which is where you stick your earplugs and your AirPods. And then, you get to your eardrum, which everybody knows about.

Behind your eardrum is an airspace, and that space is meant to be full of air, and that's where a couple other important structures live. When you're a child, that space can fill up with water, fluid. Normally, that fluid drains out the back of your nose, and that's great. That's through the anatomical structure known as the eustachian tube. Anyone who's watching this is familiar with a eustachian tube, because anytime you yawn on an airplane or plug your nose and blow and try to pop that ear to relieve that pressure that you experience, you're just forcibly opening your eustachian tube to allow that pressure to equalize.

In kids, they can't do that. And so, they'll get this fluid buildup in that middle ear space and they can't get that fluid to clear over time. Bacteria will find their way in there and you'll get an infection. So, an ear tube—the long way of saying it—an ear tube puts a little hole in your eardrum, which allows air to move into that airspace, and then drain down the back of your nose. It's the equivalent of if you've ever taken a two-liter bottle and turned it upside down to try to empty it out, it kind of—glug glug glug—moves very slowly. But if you just pop a hole on the top of it, it'll run out quite quickly. It's the exact same principle in action with ear tubes.

Host: So, do you leave the tubes in or what happens?

John Patrick Lavo, MD: Absolutely. So, the tubes get left in. They're a temporary product. They get left in as long as your body wants them most of the time—I'll say that with the big asterisk. They have a flange built into them and your eardrum is made of skin. And so, what happens is your skin, all over your body sloughs off all day long. Skin on your eardrum is no exception to that. You'll have sloughing of the skin on your eardrum from time to time, and it will catch that tube eventually, and the tube will fall out with the sloughed skin. Most of the time—most of the time, if everything goes according to plan—the hole will heal. And provided you have outgrown this problem, you'll stop getting ear infections. Hooray! We don't have to do anything else. Every so often the tubes will get stuck and they'll stay in too long and we'll have to go fish them out or they'll fall out and the hole won't heal, and then we end up having to correct that tube. But, you know, 99 times out of a hundred, the tube will fall out on its own. The hole will heal and we'll move on with life.

Host: Well, you mentioned that you treat a lot of pediatric patients.

John Patrick Lavo, MD: Absolutely.

Host: And boy, when it comes to kids and ENT, you think about tonsils. People talk about tonsils, but I don't think they really know what the tonsils are, what they do in your body, and why do we take them out sometimes—or a lot of the times—and why is it okay to take them out.

John Patrick Lavo, MD: Absolutely. So, your tonsils are a part of your lymphatic system, which is the system in your body that is in charge of immune function. It's part of your immune system. And your lymphatics are where different immunologic cells will gather and will share information and your body will ramp up basically immune responses to different invaders and pathogens, and your tonsils are just that in the back of your throat. They're great. They're supposed to be there. They're in charge of finding out what you're inhaling and swallowing, and then as a result, gearing up your immune system to deal with it.

Problem gets to be you can get some weird infections from them. So, two problems with your tonsils. You can start getting—not weird infections—but you can get a strep throat infection, just a strep bacteria, but you can get some unusual complications from that over time. You can actually get what's called rheumatic heart disease. You can have heart problems as a result of a strep infection. You can get something called post-streptococcal glomerulonephritis, which is where you get kidney problems after. It's not usually a permanent problem, but you have kidney issues just from the immune complex, bacterial depositions that happen inside your kidneys.

So once you start getting too many of those infections, we start running the risk of having these complications. And we say, "All right, it's time for those tonsils to come out so that we stop getting these bacteria overloads in those tonsils." And so, we take them to the operating room and take them out.

Host: And you just not need them. Are they more trouble than they're worth or are they some kind of e evolutionary anomaly? What's going on?

John Patrick Lavo, MD: No, they're great. You should keep them. If you don't have to get them out, don't get them out. That's true of almost all your body parts. Like you were born with them for a reason. If you've got it, keep it. So, the only reason we take them out is when you've had a preponderance of infections. You know, we'll do it if you've had seven infections in a year or five a year for two years, you know there's a criteria for that. So, you have to have a lot of infections, for me, to justify taking out your tonsils. Because yeah, I'd rather you keep them. They are part of your immune system. They're part of your lymphatics. If they're not working for the bad guys, then you might as well keep them around. So if you get a couple rounds of strep, I'm sorry, I'd still keep your tonsils.

But when you get them out, they have not really been shown to cause any significant problems. There was a study that demonstrated people who get their tonsils out may have a higher rate of anxiety later in life. I don't know if that's correlative or causative. Nobody knows. But that is the only negative I've ever seen for tonsillectomy, is the potential for anxiety. And again, that was a study I saw relatively recently. And I don't know that anyone has a causative mechanism there.

Host: It's almost always kids, but you certainly will do it as adults too. And so, are there different kinds of complications and considerations when you're doing tonsillectomies on adults?

John Patrick Lavo, MD: Yeah. So, a lot of times we do it for adults who get sore throats just consistently. They're constantly having swollen tonsils, they're missing a lot of work. We'll do it for tonsil stones. So, your tonsils are kind of gross little things, and they get these crypts and cavities in them. And what'll happen is bacteria and saliva will sit there and it will compound, and you'll get these hard rocks that we call tonsil stones, and they smell terrible. So, they make people's breath really bad and they can make their throat sore. And so, people will have stories about, like, "I get them out with a water pick every night before I go to bed." And it's just nasty. And so, we take them out for that because if you remove those tonsils, then you remove those little pockets where things can form and develop and you end up saving people a lot of hassle with bad breath and problems like that. But for the most part, the adults are the same.

Now for kids, we'll take out tonsils for sleep apnea. So, adults with sleep apnea, very rarely will removing your tonsils solve the problem. But there are some cases, I'm not going to say never, but I'm going to say it would be a special case that tonsillectomy would cure sleep apnea in an adult. But in children, children with large tonsils and sleep apnea, it's the recommended first step is getting your tonsils and adenoids out, provided they have obstructive sleep apnea, obviously. But the recommended first step is tonsillectomy, 95% cure.

Host: We've talked about throat, we've talked about ears, and you bring up sleep apnea. And for me, when I think about apnea, I immediately go to snoring, which seems like a nose issue. Is that a nose issue? And what about treating apnea? I mean, how involved are ENTs in dealing with apnea and, you know, in everything that causes it.

John Patrick Lavo, MD: A good question. So, sleep apnea or snoring. Let's start with snoring. So, snoring is sort of a nose thing, but it's also not sort of a nose thing, right? So, what is snoring? Snoring is just the back of your throat. It's your pharynx vibrating. So, it's the tongue, it's the soft palate, it's the walls of your throat hitting against each other as you try to move air past them. It's the equivalent of, you know, when you've ever blown up like a long, skinny balloon. And the first blow you make makes that funny noise because the balloon is vibrating against itself. Well, that's exactly what's happening in the back of your throat as you're breathing in. It can be impacted by your nose because if your nose is really congested or if you have a really deviated septum, then your lungs have to pull more oxygen, or they create a bigger vacuum in an effort to get that air to move through your nose. And that just creates a more violent reaction in the back of your throat, which creates a louder snore. So, we can sometimes decrease the volume of snoring or even eliminate snoring by straightening out a septum, working with your nasal congestion. But I'm not going to say it's a cure all, and people who come to me for snoring problems, who just want their septum fixed to cure it, I am very cautious to encourage them for it, because truth is you may or may not have resolution of your snoring. A lot of people, I think statistically, we can say that there's a reduction in the volume of snoring from fixing your nose. But a complete elimination is hard to promise.

As far as sleep apnea is concerned, ENTs are very involved in childhood sleep apnea because, like I said, the number one recommended therapy for a child with large tonsils and sleep apnea is tonsillectomy, get them out. Even if their tonsils aren't particularly large, most of the time the recommendation is still, if they have their tonsils, take out their tonsils and adenoids prior to any other interventions. Because in adults the number one intervention for sleep apnea is a CPAP. Everybody knows a CPAP. They've got the mask, they've got the pressure. And because all that does—a CPAP is great—it is the gold standard therapy for adult sleep apnea other than weight loss because sleep apnea is associated with neck circumference. So, the skinnier you are, the less neck circumference you have, the less likely you are to have sleep apnea.

But that's not always the case. Some people, even if they get down to a very normal BMI, will still have sleep apnea. So, a CPAP works by forcing air into the back of your throat, stenting those airway parts away from each other so that you don't end up having that vibration. Because the further apart they are, they don't vibrate anymore and it keeps your airway from closing off. So, you don't snore. You don't have apneic moments.

There is a new advance—I say new, it's been around for like five or six years now—called the Inspire device, which is a hypoglossal nerve stimulator. And that is a new thing that's come out that ENTs are pretty involved with, because we're usually the surgeons that place that device. So, we've become more involved with adult sleep apnea. But over the years, it's primarily been the role of neurologists and primary care physicians. But more recently, ENTs have been coming in trying to find out if there's any good surgical solutions.

Host: This is Health on Point presented by Willis Knighton Health. I'm Darrell Rebouche. Our guest is J. Patrick Lavo, an ENT, ear, nose and throat doctor—fancily known as an otolaryngologist. Earlier you mentioned thyroid, and so I'm curious where you begin to intervene with thyroid problems and where is the line that you will see for thyroid patients and where is the line that you will refer out?

John Patrick Lavo, MD: So, It really just depends. It's a good question. Your thyroid is an endocrine organ that lives in your neck and they always say it's a butterfly shape. I like to think it looks like a field goal because, you know, I enjoy football. But it's the same thing, it's just a gland that has a branch on either side of your trachea, which is your wind pipe, and then it has a tiny little interconnecting branch in the middle. And it is in charge of all sorts of processes in your body. It's incredibly important. And it tends to develop a few problems that require surgical intervention.

So for most thyroid problems, you're either going to see your primary care doctor or you're going to see an endocrinologist because they're going to deal with those problems medically, whether that be some sort of autoimmune problem that causes your thyroid to function too much. So, that would be like you're losing weight, you're hot all the time, and your hair falls out. Or your thyroid's functioning too little, and that would mean you're gaining weight and you're cold all the time and your hair falls out. A bummer is your hair falls out either way. It's just whether or not you're gaining or losing weight that distinguishes between those two.

But those are going to be managed mostly by an endocrinologist who deals with the endocrine system, or again, a lot of primary care providers will be willing to manage your thyroid for you, because it's something that can be done, provided you don't have any real complex pathology, it can be done relatively simply.

ENTs get involved when you start developing thyroid nodules or thyroid growths. So, that gland starts out pretty small. You know, we think about, it's probably four centimeters, five centimeters in height on each side as an average. And what can happen is you can develop a goiter where it just becomes massive and you can see it across the room like something's going on in that guy's neck.

And it's because your thyroid will explode and blow up in size. And then, that has to get removed, and that's when you can call. Any number of different surgeons take it out. But ENTs are amongst the group that take out thyroid. So, we'll go in and we'll make an incision in your neck and we'll go in and we'll carefully remove that gland. But there's a lot of very important structures in the area.

The other thing that we are in charge of following a lot of times is thyroid nodules. So, thyroid nodules, again, you've got that little gland shaped like a butterfly or a field goalpost. And inside it, you can start developing these little marbles of growth. So, the thyroid itself is growing these little cysts, if you want to think about it that way. They're not truly cysts, but it's a reasonable enough way to think about it. And they can or cannot be cancer. It just sort of depends. So, we are in charge of it, that's aggressive. We are part of the team that is responsible for following those and determining whether or not those need a biopsy or if they just need to be continued to follow them, or if we need to take them out. So, we're a part of that crew. But again, when it comes to surgical excision, ENTs are on the table. General surgeons do it. ENTs do it. I know some of the oral surgeons here do it as well. So, there's plenty of people who take out thyroids, but ENTs definitely fall into the category.

Host: I may have taken a wrong turn when I tried to get us to nose land by bringing up apnea, but I feel pretty confident I can course correct by getting you to sinus surgery and sinus problems. I figure that has something to do with the nose. So, I suspect you see a lot of sinus problems.

John Patrick Lavo, MD: That's right. A hundred percent. Oh my gosh. And this time of year especially, I mean, when your car turns yellow, when you park it outside for more than 20 minutes, you know that it's a busy time for ENTs. Yes, your sinuses, big air pockets that live in your head. You've got two in your cheeks, you've got some in your forehead. Sometimes those are kind of variable. You got a bunch that live in between your eyes, and then you got them and live in back of your head. And they can develop all sorts of problems. People chronically think about sinus infections, which can be viral, it can be bacterial. You can get fungus that grows in your sinuses, which can be kind of exciting. You can get cancer in your sinuses. You can do transphenoidal brain surgery. We're actually going to be doing some of that here this week where we go in through the nose with a neurosurgeon team as well. And we go remove tumors in the pituitary gland, which is part of your brain that sits in the very back of your sinuses. So, we're in there all the time.

Host: So, you said it's like collarbone up. So, the base of the skull, even however you access it is clearly part of what you do. So, you do you and your brethren and ENTs kind of do the whole head, the whole bit. I think about you being involved with the skull is a little bit surprising to me. Can you elaborate on that some?

John Patrick Lavo, MD: So, most of the things that we're going to be doing with skull, so we do facial trauma, so we'll do skull fractures. But I'm going to give that with a big caveat. I know some neurosurgeons who would look at me if I told them that. We do facial fractures, we do fractures that involve different parts of the skull. Typically, when you get into fractures of like, what you're thinking about is under your scalp, that's going to fall into like the neurosurgeon category of things. Because if there's any brain involved, we're going to have a neurosurgeon around. People don't think about it, but the inside of your nose, the roof of your nose is the base of your brain. So, we end up working along your skull base with the neurosurgeon somewhat routinely. If you have a brain fluid leak, a CSF leak that comes out your nose, it's going to be a combo team of an ENT and a neurosurgeon. We're working together to fix your skull base and make sure that that brain fluid stops leaking out. I was part of a case where we biopsied a brainstem lesion together, because we went through the nose again to access the base of the skull, drilled through the bone that was the base of the skull, and took a little biopsy of a brainstem lesion. Because again, we're just sort of working in the same area. Facial bone fractures are all sort of in that same vein. You know, anything that breaks in the middle, ENTs fall into the category of people that take care of that too.

Host: Very impressive versatility. You mentioned earlier when we were talking about apnea, correcting a septum. You've mentioned some facial fractures and that kind of thing. So, where is the line between what you do and cosmetic surgery?

John Patrick Lavo, MD: ENT has a branch of cosmetic surgery. So usually, once you complete a five-year ENT residency, you can actually go do another one to two-year fellowship and facial plastics if you want. So, that involves everything from cosmetic rhinoplasty to facelifts, to brow lifts, to blepharoplasty. So, part of our training is in those areas. Usually, if you're going to do that heavily in your practice, you've gone on and completed additional training just because people are very particular about their cosmetics. So, you want to make sure that you've had extra training in that.

So, part of what we do, we do some very basic cosmetic stuff. We'll do skin cancers that require adjacent tissue transfers, which is the fancy term for we have to make other cuts to make your scars look pretty. And we need to make all your tissue lay back flat when it's done. We'll do some basic broken noses, fixing noses back to where they were. We train for blepharoplasties, eyelid lifts. We train for nose jobs. We train for facelifts now.

In real-world, do I do a lot of that? No, not myself particularly. Because mostly that's going to be ENTs who've gone on. But, you know, locally, there's multiple facial plastics people in town who are all ENTs that I trained with who just went and did a little additional training, and then set out a shingle as a facial plastics person.

Host: So, it seems to me that you have an opportunity to cooperate with a lot of other specialists, and that goes back to your versatility. So, do you feel a lot of pressure or do you just feel a great deal of confidence in having such a wide range of things you can do for patients?

John Patrick Lavo, MD: You know, it can be a little bit intimidating, and all of the things we deal with are very minutia-heavy. So, the ear is such a different organ than the nose is such a different organ than the neck, or even head and neck cancer. Like, they're just such different realms and everything gets so deep in those realms. It can be a little bit intimidating.

Actually, I think it's a lot of fun. Because I'm very quick to say, "Yeah, this is in my field, but not in my wheelhouse. But I've got a guy that I love who's great at this." And I think one of the best parts of my job is being able to find the right physician for the patient to make sure that they're getting taken care of the best they can. So, I'm quick to say, "Yeah, I'm excellent at this. I'm great at this. Let me be your surgeon for this." And I'm quick to say, "Nope, I'm not the guy who does a lot of these cases. This is pretty complex. So, I think we need to send you over to see this doctor. And I think maintaining good relationships with other physicians in the network and even out of the network has been a real pleasure, and one of the things I really enjoy about it.

Host: What kind of questions do you encourage your patients to ask? Because I can imagine they would be very confused about, "Do I need to see a facial plastic surgeon? Do I need to see an oncologist? Do I need to see a dermatologist? Do I need to see an endocrinologist?" So, what is your narrative when your patients come in and there's so much to decide?

John Patrick Lavo, MD: That's an excellent question. It depends on a lot of things. So, it depends on the complexity of the case for sure. A lot of basic things. For example, let's talk skin cancer. Do you need to see a dermatologist or not? If you have a small localized skin cancer, you're just, you know, an average Joe Blow, you spend a little too much time in the sun when you're a kid and you've got a little skin cancer on your forehead, and that's it. I'm absolutely delighted to be the guy who cuts that off for you and takes it off. You don't need to go to tumor boards, you know, based on this.

Now, if you show up and you've got a skin cancer that has taken up half of your cheek, then I'm going to say, "You know what? We're going to need to go see a head and neck surgeon, and we're going to need to see a facial plastic surgeon for reconstruction. And we probably ought to get to meet a dermatologist. And also, you might need a radiation therapist." So then, that's my job is to move it out. So, a lot of it has to do with complexity.

You know, let's think about thyroids. A lot of thyroid stuff I can take care of on my own. If you come into me and you're hypothyroid, let's say you're a 35-year old female, your thyroid has started not working as well for you, and we need to put you on Synthroid. You know what? I'm your guy. I'm delighted to take care of that. But let's say you're a 35-year old female who walks in and you've got a little bit of decreased thyroid function. But it also looks like your thyroid has maybe some autoimmune conditions going on, and you have some other questionable endocrine problems, then you're going to need to meet that nice endocrinologist across the hall.

So, patients, let's say, what does a patient need to ask? Maybe a patient just needs to ask themself like, "How complex is this? Is this a simple problem? Or is this a complicated problem?" And then, find a physician who's going to be honest with you. I think that you don't want to walk into a physician's office who's going to blow smoke and tell you that they can do something that maybe they're not confident in. So, just make sure that you trust the physician that you're seeing to be radically honest with you. Is this something you're good at? And if not, we live in a big city with a great network. I mean, I'll give kudos to Willis Knighton where it's due. We have a great network of physicians who can take care of almost any problem imaginable. So if the guy that you're seeing isn't the one that can take care of it, I bet they have the phone number of the one who can. So as long as you find a good physician in the network, you should be able to get the appropriate care that you need.

Host: Okay. Let's go back down to the neck. Now, you know you have a spectacular speaking voice. My voice has been important to me in my life and career. Sometimes people have problems with their vocal chords, their vocal folds, larynx, pharynx. I mean, do you deal with voices in your practice?

John Patrick Lavo, MD: Absolutely. All the time. Chronic cough, chronic hoarseness, acute hoarseness, vocal cord masses, or a lesion. So, your vocal cords are a place that are very active. You think about the muscles you use most throughout the day, it's probably the muscles of your larynx because they're constantly working and tightening and lengthening and shortening and doing all sorts of things they need to do to produce that lovely sound that you see when you talk to other people.

It's an area that is also prime for abuse then. Anything you use a lot, you're going to end up seeing problems with. So, we see a lot of professional voice users. We see a lot of teachers who have vocal cord nodules because they just use their voice all day, and frankly, they abuse it to some degree. There are tips and tricks on how to use your voice well, and most people aren't aware of it unless they are professional voice users. And our job is frequently to diagnose that, to look down into their throat, to evaluate their larynx and make sure that we don't see a cancer. Anybody who shows up with hoarseness, we need to make sure—throat cancer is a real thing, laryngeal cancer is a real thing. So, our job is to, A, evaluate and rule out something frightening or malignant. And then, the nice thing about voice is a lot of times the answer is you need physical therapy, also called speech therapy. So when you're getting physical therapy for your voice, we send you off to a speech therapist and you can make incredible improvement in recovery with just appropriate exercises and understanding of how to support your voice better.

Host: Are there behaviors, habits, other external forces that have a deleterious effect on your voice?

John Patrick Lavo, MD: Oh yeah. Stop smoking. I'll have people come to me and they'll be like, "I have this cough, and I'm hoarse." And it's like, "Great. How much do you smoke?" "Oh, about a pack a day." And the answer is that's the best thing you could do—stay hydrated, don't smoke. So, Those are the two best pieces of advice I could give just a generic person. You know, there's all sorts of lifestyle things about support your voice with your lungs, breathe from your stomach. You know, there's all sorts of fun, different tips or tricks. But reality says the best things are generically, if you're a healthy individual who drinks plenty of water and doesn't smoke, you're doing the best things you can for your voice.

Host: While a lot of your activity is somewhat benign, I mean, if you're working with someone, something's gone wrong. But if it's something simple like tonsils and tubes, okay, we know we're just going to move on with our lives. But some of the stuff you do is really complex. It can often be disfiguring, life-impacting.

So, the families really need to support people. So, what advice do you give families and friends and loved ones for supporting the patients you see who have had these kind of life-impacting surgeries?

John Patrick Lavo, MD: So, probably most of those are going to end up being cancer patients. And that's just because head and neck cancer is very debilitating. As far as cancer goes, head and neck cancer is a bad one. Not skin cancer so much, not thyroid cancer so much. But if we're just talking about like, you know, thinking about lip cancer for patients who dipped or smoked or thinking about throat cancer, for people who smoked or even didn't smoke but had an HPV-positive cancer tongue cancer, these are things that end up being very life-altering. And that is a hard one because they need support. So, you know, you think about thyroid cancer, mostly if you take your thyroid out and you get on thyroid hormone replacements, you're doing fine. You don't even think about it five years down the road. People who are dealing with head and neck cancer, like throat cancer or tongue cancer, that's something that's going to be life-changing because it may impact the swallow for the rest of your life. It may impact your voice for the rest of your life. You may not have a voice for the rest of your life. So, it is super important for families to come around them. And like I said, we have a good team that does that. We have plenty a group of oncologists, a group of radiation therapists, a group of speech therapists. We have a good group that is here to support. But without a strong support net at home, we see people do very poorly. And that's because it does require 24/7 support and people who don't have a support net you just know are at-risk for having bad outcomes.

Host: You provide a very reassuring balance of having enough experience where we have full confidence in you, but being young enough to realize that you're probably still very forward thinking. So, what excites you about the future of your branch of medicine?

John Patrick Lavo, MD: There are some exciting things coming out. So as technology improves. We get some really cool, you know, surgical advances just because there's new things that make bleeding less likely. There's new things that make surgical intervention much easier. You know, the advent of good cameras and good optics make sinus surgery so much different than it was even 20 years ago.

You know, I'll have people come and tell me all the time, do y'all still do it this horrible way? And it's like, no, we don't. We've changed because we've had some really impressive technology. There's some really amazing medications that are coming out that are cancer medications. You know, there's some monoclonal antibodies that are involved in cancer therapy that are really promising, and they're not truly curative yet, but they've shown real promise in delaying disease progression and providing additional quality of life.

There's some really impressive biologic medications that are coming out for nasal problems and allergies. There's some really cool technology. You know, we talked about sleep apnea. I think the Inspire device is not perfect, and I would never claim that it is, and I tell all my patients, "This is not perfect. This is not being touched by an angel and miraculously cured." But it is a lot better than the other technological advances that have been attempted for sleep apnea. And that's come out in the last five or six years, and it has, like, let's say I believe it has an 80% success rate, 80%. That doesn't sound that great. Gosh, 80%. But can I tell you that before that, the surgical interventions had about a 15% success rate? So, that's massive, that's a paradigm-shifting change in the success rate of a surgical procedure for something like sleep apnea. Is it perfect? Heavens no. Is it so much better than what we had? Yeah, it is. This is exciting. And as that technology matures and gets better, we're going to see better and better things like that. And we'll just see people's quality of life improving across the board from an ENT perspective.

Host: J. Patrick Lavo, an ENT based in Bossier City, Louisiana, on the East Bank of the Red River across from Shreveport. Thank you for your time, thank you for your expertise, and thank you for your enthusiasm.

John Patrick Lavo, MD: Well, thank you very much. I was glad to be here.

Host: This is Health on Point presented by Willis Knighton Health.