Linking Medicine and Dentistry: Dr. Jessica Lee on ENT Innovations

What happens when dentistry meets ear, nose, and throat medicine? In this fascinating episode of The Root of the Matter, Dr. Rachaele Carver sits down with Dr. Jessica Lee, a double board-certified ENT and lifestyle medicine physician, to explore how integrative, cross-disciplinary care is transforming patient outcomes.

From the connection between jaw development and airway health to the truth about tonsil stones, sinus surprises on dental CBCT scans, and how allergies really develop, Dr. Lee offers a rare blend of conventional expertise and holistic insight. Together, they uncover why medical–dental collaboration is crucial for tackling chronic issues, and how curiosity, open-mindedness, and personalized care can change the game.

In This Episode, You’ll Learn:

• Why dentists and ENTs should be collaborating more closely
• How airway health, jaw growth, and tonsils are connected in kids and adults
• The hidden causes (and surprising fixes) for swollen tonsils and tonsil stones
• What your dental CBCT scan might reveal about sinus health
• How reflux, allergies, and the microbiome influence ENT conditions
• Why personalized, integrative medicine can succeed where a single approach fails

Episode Highlights:

• The “two toolboxes” approach: blending conventional and holistic medicine
• Maxillary deficiency, tongue posture, and their effect on breathing
• ENT tips for preventing allergy flare-ups and nasal congestion
• Surprising stories of patient intuition and detective-style diagnosis
• The importance of being your own healthcare advocate

🔗 Resources & Links:

• Connect with Dr. Jessica Lee: Instagram @entchat | Website

🎧 Listen now to discover how bridging the gap between medicine and dentistry can open new possibilities for prevention, diagnosis, and treatment.

To contact Dr. Carver directly, email her at drcarver@carverfamilydentistry.com

Want to talk with someone at Dr. Carver's office?  
Call her practice: 413-663-7372

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Disclaimer: This podcast is for educational purposes only. Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. Before using any products mentioned or attempting methods discussed, please speak with a licensed healthcare provider. This podcast disclaims responsibility from any possible adverse reactions associated with products or methods discussed. Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests. We do not provide guarantees about the guests' qualifications or credibility. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Dr. Rachaele Carver: [00:00:00] Hello everybody. Welcome back to another episode of The Root of the Matter. I am your host, Dr. Rachaele Carver, and I'm very pleased to introduce to you guys Dr. Jessica Lee, who is a double board certified ENT or ear, nose and throat doctor. She's got a focus in integrative medicine too. So of course I latch right onto her and her reading her website and her bio really resonated with me because like me, she has that curious mind and always wants to learn more why is certain things happening?

Dr. Rachaele Carver: And I reached out to Dr. Lee because I see all sorts of things when I take my 3D cone beam X-rays and patients may have certain symptoms and I'm always curious what's going on. I've never been able to really find the answers. So I found the person who could provide us with those answers today. Dr.

Dr. Rachaele Carver: Lee, thanks so much for coming on. Maybe introduce yourself, tell us a little bit about how you got to on your path. 

Dr. Jessica Lee: Great. First, thanks for having me. I was honestly so tickled when you reached out and I. I [00:01:00] love this I love collaborating. I love learning from other colleagues. It's, this strange world we live in where dental medicine and other medicine is separate, but it really shouldn't be.

Dr. Jessica Lee: And so I've really enjoyed learning from you, learning from other dental specialists and I think it's great when we work together. So I'm happy to be here. I am, like you said, double board certified. I am primarily trained first as an ENT surgeon, so I did medical school and then did a five year residency.

Dr. Jessica Lee: And I've been out in practice for over 10 years now. But really starting at the end of my residency, I was already starting to just have these questions of hang on. Like why, does, this happen and how come this happens to some patients and not others? And we had a, personal situation in our family with one of our kids' health.

Dr. Jessica Lee: Where we actually ended up treating her problem with a dietary modification. It just was like a light bulb went off. 'cause people are often like, where did this start for you? And I'm like, honestly, that was the moment it [00:02:00] started. 

Speaker 3: Yeah. 

Dr. Jessica Lee: Because I realized nowhere in medical school or residency training did anyone tell me about the power of food as medicine.

Dr. Jessica Lee: And then I had witnessed it in a miraculous way with my daughter. And so that was like the spark that was thrown into the, patch of sticks, right? And from there, I just, I've learned more on my own. I ended up getting a second board certification in lifestyle medicine, which really focuses on trying to treat and prevent chronic illness by modulating nutrition and exercise and sleep and toxin exposures and stress management and personal connections.

Dr. Jessica Lee: And and then from there I just, I keep, like I said, I keep being more curious and I keep learning more. I've taken herbalism medicine classes, I've taken classes on mold illness, and I just, like I said, I just keep wanting to learn more so that really, so that I can put together what I learn and take it back to the patients I'm seeing.

Dr. Jessica Lee: And in some ways just feel like I have a better breadth of options to discuss and treat with [00:03:00] them. 

Dr. Rachaele Carver: I think that's, we talk about that a lot, about what's in your toolbox, right? A conventional dentist or maybe a conventional MD has this tiny little. Closed off box, right? And then when you start learning all these other things, it's just like our toolboxes expand, right?

Dr. Rachaele Carver: Because it's not to say what's in those small little conventional boxes are wrong or not good, because obviously they're fantastic and we need those kind of things. But when we get into these diseases, like these chronic issues, that little box doesn't hack it, right? It's just, it's not enough to really uproot all the, causes that we see in our society today where we just have an explosion of all these chronic issues.

Dr. Rachaele Carver: Which I think most people are really awakening to the fact that they are lifestyle issues and. I think the challenge is most of us know we probably shouldn't eat McDonald's every single day. But we do because why? Because we're tired, we're stressed, we don't have time. All these kind of things.

Dr. Rachaele Carver: And again, when we take that whole kind of holistic WH look at [00:04:00] life, it's why, are you stressed? Because the more I practice and the more I get into that kind of energy and the emotional space, it's like these things about not having time. And while they may be true, sometimes they're excuses because we're, pushing down some of the other root causes that are allowing us to feel more stressed.

Dr. Rachaele Carver: We can go down that rabbit path. 

Dr. Jessica Lee: Yeah. No, it's to me the ultimate definition of integrative is it's both toolboxes, right? It's not just conventional medicine toolbox, and it's not just complimentary or alternative medicine. It's the combination. And that's where I think, at least in my practice, my patients see the most success is when we're.

Dr. Jessica Lee: We're putting together. And a lot of times you can alter how much of one or the other you use based on how how much modification like you said you wanna do to your lifestyle. 

Dr. Rachaele Carver: Yeah. And that's so important because every person, I think sometimes where conventional medicine can fail, like in the example of prescription meds, is that [00:05:00] we're giving everybody with a similar symptom of the same drug, but every person is unique.

Dr. Rachaele Carver: And so that's where that integrated they're throwing around the word personalized medicine now, but it's really true. We're all very different. And if I've taught people who've worked with me, remember you're treating a person, not a tooth. Because you could have four different treatment plans for the same kind of tooth situation, but you have to take into consideration that, that person, right?

Dr. Rachaele Carver: So that's, I think that value in, mixing both of them. And sometimes when I first went down on the path, I hooed conventional medicine, like almost 90%. I was like, no, it's just all bad. But then as you're working, you're like, that's not true. Sometimes I need these.

Dr. Rachaele Carver: And in my patients where I like, oh, sometimes the combination of ozone and antibiotics works better than just ozone. And even in my own daughter, she was coming down, she had just this horrible breath and like her mouth was fine. I was like, there's something in her gut. Something is just brewing there.

Dr. Rachaele Carver: And when [00:06:00] she ended up coming down with a pneumonia, she didn't have the symptoms of pneumonia, but I took her and had some blood work done and one of the bacteria and I was like, you know what? I'm just, I gotta nuke it. I gotta nuke it and start over. And so I did, I gave her the antibiotics, and probably a year ago I would've been like, I never will I give my child in, but it did what it needed to do.

Dr. Rachaele Carver: Like it completely eradicated whatever was brewing in there. She hasn't had that since. And then just, I'm building her back with the right probiotics and she's a teenager, so trying to get her to eat better is a challenge. But I was like and the reason why I decided to do that is because I had a patient come to me.

Dr. Rachaele Carver: She had a dental infection, I had given her antibiotics. And she said, you know what? That really resolved all a lot of my gut issues too. And I was like, okay, all right. Be open-minded. Let's, like it really just gave me pause and I was like, okay, yes we need, that combination, right? Yeah. We live and learn and we all and I think [00:07:00] that's what's so valuable about working with patients and learning from each other because sometimes we can get stuck in our ways.

Dr. Rachaele Carver: And maybe for the betterment of all of our patients. Having that open mind I think is really valuable. 

Dr. Jessica Lee: I think that's the key. It's open mind, it's curiosity, it's a healthy amount of skepticism and it's it's the conversation with the patients, like you said. It's just sitting down and having saying, look, this is what the evidence shows.

Dr. Jessica Lee: Let's talk about what you want, what you wanna prioritize, and then let's come up with a treatment plan that we both feel comfortable with. 

Dr. Rachaele Carver: Yeah, I think that's great. And sometimes I don't really know, like sometimes we'll come in and with a problem and I'm like, I just with all my training, like I can't see what the problem is.

Dr. Rachaele Carver: And my first question will be, what do you think is wrong? Yeah. Patients are like, they're living in their own body because I'm like, okay, what what are you feeling? I think we've so much lost so much of our intuition. And so I'm like, really? Tap in? What are you thinking is, I had one the other day and he's I have an [00:08:00] abscess.

Dr. Rachaele Carver: And my hygienist was evaluated and she said, she's I don't think he has an abs. And I said what what is he saying? And she said, he's really determined. And I said, then take an x-ray. And sure enough, he had an abscess. Even though there were no clinical signs. I was like, see, we gotta believe that the patient, and it's interesting.

Dr. Rachaele Carver: Let's get into the ENT stuff. So I think one of my biggest questions always is, especially in the last, I don't know, maybe five to 10 years, I just see so many cases of swollen tonsils and I'm always trying to figure that out. Is it their breathing? Is it do they have a food allergy?

Dr. Rachaele Carver: So maybe talk to us about some of the common causes of swollen tonsils. 

Dr. Jessica Lee: Yeah, that's a great place to start. Because so many parents with kids obviously will come in with that same question. And a lot of I got a lot of referrals from dental practices in town with just Hey, they have [00:09:00] big tonsils.

Dr. Jessica Lee: Should we do anything Right? And I think the first thing I do is explain that your tonsils and your tonsils are just one type of tonsil, but we refer to them as tonsils. But really you're referring to I think the palatine tonsils, which are the ones that sit on the sides of our throat, towards the back of the throat.

Dr. Jessica Lee: Those are the ones you can open your mouth and see. You also have to tonsils on the back of your nose called your adenoids, and you actually also develop tonsils on the back of your tongue called lingual tonsils. And they form literally a ring. It's called wall DI's ring. And that is like your first defense mechanism.

Dr. Jessica Lee: So as we are developing a growing or little babies think about it. Babies are putting everything in their mouth. They're breathing in all of these things that their body has never seen before. And so this ring of tissue is part of the immune system and it is primarily responsible for teaching the body what.

Dr. Jessica Lee: Do we need to be concerned about and learn to fight against with antibodies versus what is just normal, right? So that's gonna be the [00:10:00] things you're inhaling in the air, like dust and animal dander and pollens, and that's potentially chemicals, right? It's also gonna be all the foods that they eat.

Dr. Jessica Lee: And it's gonna be everything because again, kids are very oral and they're, testing the world with their mouth, right? So that said, this tissue serves a very important purpose. Now what can happen is if that stimulation is like a tsunami wave then you'll sometimes get very rapid growth of those tissues and it can reach a point where it causes a functional problem.

Dr. Jessica Lee: So the tonsil tissues, and I'm gonna group them together, but I know we're referring to the ones people see in the back of their throat, those typically are going to start to grow bigger around age three. And that growth goes on for about five years. So between the ages of three and eight.

Dr. Jessica Lee: Is when those tonsils tend to be the largest. And I would say the adenoids, which are the ones in the back of the nose, they're probably more like three to six years old. That's the active growth phase. So when I'm [00:11:00] seeing a child who is three or five and they have larger tonsils, I'm saying, okay, that's not all that unexpected for this age group.

Dr. Jessica Lee: But the question is it causing a problem? And so then that's where we go into asking parents about their breathing patterns. Like you mentioned. Am I noticing while I'm talking to mom and dad, is the child sitting in the exam chair with their mouth hanging open and just constantly breathing through their mouth?

Dr. Jessica Lee: 'cause that's a, flag for me, right? We're asking about strep throat infections. We're asking about how many times of the year they get sick with kind of cold symptoms, allergy symptoms, right? All of these things, food sensitivities, all of these things can play a role in those tissues.

Dr. Jessica Lee: Maybe potentially getting so big that they're actually causing a problem. And that leads us into kind of treatment option, discuss. 

Dr. Rachaele Carver: What about the adult who says, I've heard this multiple times they've always been large so you know, at that eight years old, do they tend to shrink back down or because [00:12:00] why does somebody who's 40 years old have chronic?

Dr. Rachaele Carver: Is it a chronic situation or is that their anatomy? I never really know what to say when somebody says that. 'cause I think, 

Speaker 4: well, 

Dr. Rachaele Carver: but not everybody has big tonsils like that. But 

Dr. Jessica Lee: yeah, so you're right. So that active growth phase kind of ends around 6, 7, 8 years old and then there's a, just a stagnation period where the tissues stay the same size, but you remember that the person, the body is getting bigger.

Dr. Jessica Lee: So there can be a relative decrease in how much space that tissue takes up because they stop growing, but the rest of you keeps growing. Then when you're in your kind of teenager, early adulthood years is when we really start to see the tissues shrinking. So they do. They called, it's called involution.

Dr. Jessica Lee: But again, remember this tissue's primary job was to teach your body. And by the time you're about 20 years old, you've pretty much been exposed to most of the things you're gonna be exposed to in life, right? So we don't really have to rely on that tissue [00:13:00] as much. So it does start to shrink away to the point where I have people in their older decades of life whose tonsils are so small that even myself as a trained professional, looking in their throat, I'm like looking, and I'm like, did you have your tonsils out?

Dr. Jessica Lee: And they're like, no. And I'm like, okay, they just shrunk. Like pretty much all the way. So now that's the expected course, but you're right, you're gonna meet someone who they are in their forties or fifties and they've got like big tonsils, and I would say that's not the norm.

Dr. Jessica Lee: I would say that's the exception. And again, my questions then are. Is it causing a functional problem? Are you having recurrent infections? Are you having chronic inflammatory symptoms due to it? Are you having sleep or breathing problems because of it? 

Dr. Rachaele Carver: And so let's say we rule out the breathing stuff and you're concerned like is there some mild chronic inflammation?

Dr. Rachaele Carver: What would you do to investigate that further? 

Dr. Jessica Lee: So obviously we always [00:14:00] start like you said, we gotta talk to the patient, we gotta see what their body feels like. I want them to be aware of what their body feels like and hear from them. And we just take a really good history to look at is this something that occurs with seasons of the year or is it something that's year round?

Dr. Jessica Lee: Is it occurring mostly when you're sick with a viral upper respiratory illness? Or is it happening completely randomly? And what are those symptoms? There are a lot of, remember the throat, that place in your body is an intersection between the upper airway, so the nose and sinus cavities.

Dr. Jessica Lee: The mouth, so everything going in your mouth. And then from below, like lungs esophagus and GI tract. So when someone comes in with a sore throat, I have to think of all those different things as potentially being contributing factors. So we start going through it, right? We start asking all the questions about do you have nasal itching, sneezing, runny nose, congestion?

Dr. Jessica Lee: Do you have reflux or laryn pharyngeal reflux symptoms? Do you have any history of asthma? Are you [00:15:00] having infections? There's a lot to cover when it's assessing for that. But I think that's the point, right? If, you just say, this person's having chronic sore throat, let's take their tonsils out little bit like your name of your podcast.

Dr. Jessica Lee: If that's not really the root cause, then they may continue to have symptoms even once that tissue's gone. So I always think it's important to, to try to find the reason, and sometimes we can treat it without surgery. And obviously like we said, in some cases surgery is a very good option.

Dr. Rachaele Carver: Yeah. I know there were some studies that were showing that removing of the tonsils in children might not be the perfect solution that, and I don't know if that's because those are really airway cases. And really we need to grow the jaws like just removing that tissue doesn't really solve the problem.

Dr. Rachaele Carver: I don't know. Can you talk a little bit about why those studies were showing that? 

Dr. Jessica Lee: Yeah. So I think you're referring to specifically like the obstructive sleep apnea kids or even [00:16:00] just the precursor, which we call sleep disordered breathing. Those kids, there's been some studies that say okay, we took their tonsils out 30% of 'em still had sleep apnea afterwards.

Dr. Jessica Lee: So why was that? And you're exactly right. This is where this collaboration and this multidisciplinary approach is so paramount because those kids not only had large tonsils and adenoids, but they probably also had maxillary deficiency, right? Maybe their upper jaw was a little too small or a little too narrow.

Dr. Jessica Lee: And so the growth pattern of their face and their facial skeleton has put them in a position where it's not just treat one thing, it's look at the big picture. How do we help a little bit here, help a little bit there, help a little bit down here. And then at the end of the day we've optimized not only their craniofacial growth, but also their airway.

Dr. Rachaele Carver: And I love that because I think sometimes, again, depends depending on our experience and our expertise. We're [00:17:00] looking at what we know and we're forgetting everything else. I was just talking to you earlier about my vision training, right? One of my eyes was like ignoring, or my part of my brain was ignoring stuff that my eye was seeing.

Dr. Rachaele Carver: So in the same way that we're not trying to, but again, based on our own experiences, we can miss these things. And that's what I see about 90% of people have a deficient maxilla. Like none of us are really growing wide enough or forward enough. So that's the upper jaw we're talking out. So when the upper jaw doesn't expand or move forward, then that lower jaw is trapped.

Dr. Rachaele Carver: Most of the time our upper jaw overlaps the lower jaw, and so then that lower jaw remains posterior. There's also the tongue, right? If we didn't sometimes with breastfeeding, that actually is. You're training the tongue how to have suction up of the roof of mouth because it's the tongue's job to create that width in the maxilla and help push it forward.

Dr. Rachaele Carver: So if that tongue isn't going on the roof of the mouth and pushing it forward we have like lazy [00:18:00] tongue or a tongue thrust or something like that. That's another issue we have. So again, it's like looking, this is why I always get frustrated sometimes with conventional orthodontics because we just look at the teeth and we make the teeth straight, but we ignore all the reasons why they became crooked in the first place.

Dr. Rachaele Carver: And if we don't really do the expansion and train the tongue where it's supposed to be, we often get relapse and sometimes even joint issues because we move the teeth. In a way that the bo, the body had already adapted, right? They became crooked because the body was like, this is where I feel comfortable.

Dr. Rachaele Carver: And then we artificially move it back with braces, and then everything else has to then mal adapt in another way. And again, to all the, fashion, we've talked about that on earlier podcast that, that's the big thing. And what's so important, especially for dentists we ideally wanna see kids at age one.

Dr. Rachaele Carver: We can identify these things at a very early age. And so you can get that interceptive treatment the [00:19:00] myofunctional therapy. We have all sorts of cool little guards and all that. And man, when those kids are compliant, it works so well and so fast. It's so satisfying to see that. One of my, my office manager's granddaughter, she was just frustrated.

Dr. Rachaele Carver: She at 10 years old was like, I don't like this. There's something wrong with my mouth. Help me out. And we just put her in expanders. In three months. And she's so proud of herself. That's what's so exciting, right? Because she took it upon herself to be like, grandma I, want help. Can you help me? And so we brought her in and just with these expanders was so amazing to see her teeth, everything just widen right up her breathing.

Dr. Rachaele Carver: Just super exciting. 

Dr. Jessica Lee: It is, it's very cool. I have to give like a shout out to the, dental specialist here and the orthodontic specialist that I collaborate with because I am lucky that we have a group here in Charleston who, this is what we do. Like we meet and we teach each other.

Dr. Jessica Lee: Like I've learned so much more about maxillary deficiency, which really isn't a term that we use a lot in the [00:20:00] ENT residency, right? But then they've also learned so much about like the adenoids and the tonsils and other things that can cause airway inflammation and cause trouble with the airway.

Dr. Jessica Lee: So it's been, I think. You cannot go wrong if you're working with a provider who is in one of these kind of multidisciplinary groups, whether it's 

Speaker 3: formal or informal. 

Dr. Rachaele Carver: Absolutely. Absolutely. Like I said, we all have our focus of expertise, but there's so much more beyond, and when we start to put the whole body back together again, we're like that's so great.

Dr. Rachaele Carver: So I was just talking to a colleague who works at Harvard Medical School and we're been talking to him about helping teach these kids this whole big interdisciplinary approach. And I said Harvard is. Poised in a great position because you have the medical and dental students right there.

Dr. Rachaele Carver: So if we can start them collaborating at this at the very beginning, we're gonna have so much more success in both, in all fields of medicine and dentistry. So now, fingers crossed we'll see what comes of that, but, so let's just a [00:21:00] little bit about, the other big thing we see a lot is tonsil stones.

Dr. Rachaele Carver: So tell us a little bit about what that 

Dr. Jessica Lee: is. 

Dr. Rachaele Carver: What 

Dr. Jessica Lee: are tonsil stones? They're, they are the bane of everyone's existence if you have them. They are so frustrating, and I know patients come in and they are just, they're done with it. So tonsil stones are, they are truly little pieces of material that are in your tonsil.

Dr. Jessica Lee: We call it a stone because it really does calcify like a stone. It is typically a result of it's never one thing is it? It's a result of the shrinkage of the tonsils. So we did talk about how those tonsils will shrink away as we get older. So while I will very rarely see tonsil stones in kids, tonsil stones are usually an adult problem because as that tonsil shrivels, I tell people, think about a grape and how it shrivels down to a raisin.

Dr. Jessica Lee: That's what your tonsils are doing. So now you've got all these little furrows and pockets and crips that can collect food debris. So if you're eating and your mouth is mixing all the saliva and you're swallowing, and there's little bits of food [00:22:00] debris that get in there, okay? So that's like step number one.

Dr. Jessica Lee: Step number two is dependent on the microbiome in your oral cavity, in your oropharynx. And if there's a predominance of certain types of bacteria, then you are more likely to get tonsil stents. And then they start to make their way out, right? Which is where people start to feel them. It can feel like a popcorn kernel stuck in the back of your throat.

Dr. Jessica Lee: It can be really agitating. And then of course, if you are lucky enough to get one out, you'll often smell a really foul odor associated with it. That's the sulfur that's actually part of that. Back to the microbiome. It's a sulfur compound that you're smelling. So for better or worse, the fast answer of how to deal with tonsil stones is remove the tonsil.

Dr. Jessica Lee: Now, do I recommend that to everybody that walks in the door? Absolutely not, because I also have seen that some people get tonsil stones in waves. Some people get one batch of them and never get them again. Some people get them and get them their whole life. And so I think you have to [00:23:00] if someone comes in and said, I've just started getting these two weeks ago, I'm gonna be like, look, let's talk about all the different things that can make it easier to manage them.

Dr. Jessica Lee: But it is very possible that these are not gonna be a lifelong thing for you. So we don't really jump. Tonsillectomy is out there as an option, but it's not the first thing I jump to. I always talk about dental hygiene. Most people, by the time they're coming in to see me, they already do that.

Dr. Jessica Lee: They're already bl brushing and flossing and using a mouthwash. Even just, I tell people literally gargling with water after each meal. Like just something to mechanically remove that food. Debris doesn't have to be medicated. Even just gargling with water is really helpful to prevent it. 

Dr. Rachaele Carver: So do you know what those species are that are more common in people 

Dr. Jessica Lee: with tonsil stones?

Dr. Jessica Lee: It's not, clear, to be honest. The most common species the most prevalent species in our throat are obviously streptococcal. So people think of strep as bad like strep throat, but there's plenty of different types of streptococcal bacteria that live in our throat that are [00:24:00] actually very helpful to us.

Dr. Jessica Lee: And so even in patients with tonsil stones, that remains the most common. So we don't have as much information to say. I guess what I mean is there's not enough information to manipulate yet. You know what I mean? Yeah. 

Dr. Rachaele Carver: And oral saliva tests are becoming more and more popular. So I'm just curious.

Dr. Rachaele Carver: If we do a couple, it would be nice to see a study on everybody with tonsil stones, let's just do the oral saliva test, and that would give us and maybe that's been done. I don't know that's gonna make me go search PubMed later. But yeah, because that's a really good first step, I think.

Dr. Rachaele Carver: Say, Hey, why don't you go get one of these saliva tests? Because if we, if it's a certain type of bacteria, then your dentist especially if you have more of a biologic or you have a health coach or a nutrition specialist. We can try to figure out how can we change that microbiome so it doesn't keep happening because that versus surgery is a little less invasive. Right 

Dr. Rachaele Carver: And so like we always know we can go to surgery, but also if [00:25:00] that's a sign that the oral microbiome is off, what other things could be happening? Because if we're swallowing that all the time. So that could lead to other gut issues as well.

Dr. Jessica Lee: Yeah, and that's a lot of the kind of next step of again, I talk with patients about gut health and reflux disease and how that can impact even up into the throat. Interestingly, talking about like microbiome and strep and tonsils. So there are plenty of studies that will support the use of a certain type of probiotic, strain of strep to prevent strep throat.

Dr. Jessica Lee: And I don't know if you're familiar with it, but it's, strep K 12. And I will tell you that personally, I've started recommending that as a first step before recommending tonsillectomy for a lot of people with recurrent strep. And I've had a, the vast majority of people not need to come back for tonsillectomy.

Dr. Jessica Lee: And so you will find there's case studies and systematic reviews and it does seem to be helpful in reducing the incident. So it's very exciting because like you said, we don't quite, we don't quite [00:26:00] have that enough information to do that for stones, but I think that's in the future, I think that's coming.

Dr. Rachaele Carver: Yeah, definitely. And speaking of strep I've read some studies and heard people talk on other podcasts about chronic strep being related to mold sensitivity and mold infestation in the sinuses. I don't know if you're familiar with any of that and how that could be connected. 

Dr. Jessica Lee: In general, when you are in that world and talking about mold illness and things like that and mold exposures, the bottom line is chronic mold exposure will put your body into a state of slight immunosuppression, is how it works.

Dr. Jessica Lee: And so if that's the case, then any slightly. Pathogenic bacteria. So any bacteria that might could cause a problem in your body has a better opportunity to cause a problem. Yeah. So again, we all have the strep bug that causes strep throat. We all have it in our system. It's just a matter of whether or not the rest of that microbiome is keeping it in check.

Speaker 4: Yeah. 

Dr. Jessica Lee: [00:27:00] And so then if you add in something like mold exposures where someone's slightly immunocompromised, now you've given that strep the opportunity to cause a problem. 

Dr. Rachaele Carver: Yeah, and I think that's really important that we have, are starting to realize more and more when we study all these microbiomes throughout the body is that we've got to get away from the idea of trying to kill everything that we think is bad and actually supporting the environment so everything's in balance.

Dr. Rachaele Carver: Agreed. Like we talk about in the oral bacteria, there are certain like we call them red type bacteria. And certain species that are so bad, but they're present in health, yeah. It's just the numbers, right? How, what in the environment, like you said, is there mold, is there some what other toxin is creating this poor environment that's allowing them to become pathogenic?

Dr. Rachaele Carver: Because it's also interesting certain different species of bacteria, right? So there was an article from this oral saliva test bristle Health is the one that I use a lot. [00:28:00] And they were talking about a specific, now I'm gonna, now it's gonna go out of my brain, but a specific type of bacteria found in the mouth that they were saying this can cause colon cancer.

Dr. Rachaele Carver: Oh, fuso, fusobacterium, nucleo. But it was only a subset of the fusobacterium nucle atom. Only one type one strain. So you have all fusobacterium. So that's also where we gotta be careful with some of these saliva tests too. Exactly. Which strain are you testing for?

Dr. Rachaele Carver: Because. Not all of them are bad it might just be one subset there. So again, it's really interesting and the nuances of the microbiome are what's the challenge and why there, there's so much research surrounding that, which is really exciting. And think when we learn, when we start to learn our own genetics and our own know, there's so much easy way of testing our microbiomes nowadays that that's how we can really get into that unique, personalized treatment for a lot of people.

Dr. Rachaele Carver: So I think that's, certainly, and then with AI coming in, that's [00:29:00] certainly, could be the, I mean I, we are on the, frontier of something and we'll see what it looks like in 10 more years. But it is 

Dr. Jessica Lee: exactly, 

Dr. Rachaele Carver: it's gonna be interesting. It's 

Dr. Jessica Lee: very 

Dr. Rachaele Carver: interesting. Let's move on to the sinuses. So we talked about this when I first contact you, 'cause I'm like I take these 3D x-rays and I see sometimes you see like almost like a a lake in there, right?

Dr. Rachaele Carver: So it's just fluid that maybe is filling part of one or both sinuses. Sometimes I see polyp that almost looks like a mushroom cloud, and that in some areas. So maybe talk to me about and, most of the time, I would say 99% of the time, the patient feels nothing. They have no idea that there's something going on.

Dr. Rachaele Carver: And so my first question is always have you recently been ill? Because if we've had any kind of upper respiratory infection yeah, our sinus may be full. And that's usually when we see, I guess not always, but sometimes when we see more of a symmetrical kind of fluid base there.

Dr. Rachaele Carver: But I'm always curious about that. But those little weird polyp things, I'm like what is that? [00:30:00] Does that be there? Is that a problem? 

Dr. Jessica Lee: It's the, joy of the incidental finding, right? Where you're like now we gotta track that down. Yeah. So with sinuses and sinus findings there's a pretty easy pneumonic that we learn in residency.

Dr. Jessica Lee: That is the first thing we think about. So it's F men, it's FMEN, and it stands for fungal, cusal, encephalocele, or neoplasm. And that's like the thing you think about if you have a diseased sinus right now, if you have diffuse, like if all the sinuses are in gray, which means that they have a lot of mucosal thickening or maybe some actual fluid in there, you're gonna think more along the lines of like chronic sinusitis, allergic rhinoc, sinusitis eosinophilic disease, things like that.

Dr. Jessica Lee: But if it's just for you guys with CBCT in office now, a lot of times again, people will come to me with their CBCT scan and all we see really is the maxillary mostly. And you'll just see, like you said, a little mushroom, like a little bump, and people are like, what is that? Do I need to worry [00:31:00] about it?

Dr. Jessica Lee: So that's most often what we call a mucus seal or mucus retention cyst. And the vast majority of these are going to be asymptomatic and they're benign. They are the result of blockage of a mucus gland, probably from some irritation in the past, right? It could have been weeks ago. It could have been years ago.

Dr. Jessica Lee: We don't know unless we have a previous scan to compare it to. But in general, think of it like a little mucus bubble and if the patient is completely asymptomatic and if there is no sign that it's going to cause any other problems, and I'll come back to that, then generally I tell people, this is not something you need to worry about.

Dr. Jessica Lee: We're not gonna, we're not gonna do anything. We now that said, if these mucus bubbles get so big that they fill the entire sinus, then usually those patients are gonna have some symptoms, mostly pressure, maybe some even eye pressure discomfort. They may start to have sinus infections because it's blocking the natural drainage pathways.

Dr. Jessica Lee: So those are times where I say, [00:32:00] okay, we probably are gonna have to do something surgical for this. So that's the most common thing. That's the little mushroom thing. Yeah. You mentioned like it sometimes looks like a lake where there's like almost a straight line and it's gray below and black above.

Dr. Jessica Lee: And that's because it is an air fluid level is what that's called. So again, if someone's sitting upright in a chair and we scan their face and there's fluid in the pocket of their sinus. Then you're gonna see that kind of lake appearance. The difference I often tell people is if you're getting a CT scan where you're flat on your back and you're going through the scanner, then that air fluid level is gonna look like it's up against the back wall of your sinus because gravity is gonna pull it that way.

Dr. Jessica Lee: So those are usually findings of fluid in the sinus, and that's most commonly gonna be pus. So you're right, it's gonna be someone who is either actively sick or was recently sick, usually on nasal endoscopy. If they're coming into clinic, I'll do a nasal endoscopy exam, which is a camera exam, and usually we can see like a stream of pus and mucus streaming out of the sinus and into the back of the nose.

Dr. Jessica Lee: In those [00:33:00] cases. Sounds delicious. The joy. It's the joys of being an ENT, right? Snot and 

Dr. Rachaele Carver: puss and all, and spit and all this stuff. Oh yeah. We see all that good stuff in the mouth too sometimes. And it's hey and we're weird, right? 'cause we're like, oh, that's so cool.

Dr. Rachaele Carver: Look at this. 

Dr. Jessica Lee: So satisfying when it's better too. 

Dr. Rachaele Carver: Yeah. And we say we get mucus seals a lot of times, like on the inner part of our lips. I got 'em all the time when I was pregnant. I don't know why. Never had 'em before. Haven't had 'em since. But, and usually we you can bite 'em and break 'em and they can go away.

Dr. Rachaele Carver: You can't really do the same when it's up in your sinus, but it's good to know. So some kind of, and the body sometimes uses mucus right to wall off a toxin or something like I think. That's cys are even like fibromas. And fibroids in the uterus. These are all kind of ways of walling something off to protect the body.

Dr. Rachaele Carver: So I always find that kind of fascinating. What was the e [00:34:00] that you mentioned in your mnemonic? 

Dr. Jessica Lee: Yeah, so encephalocele. So you're not gonna see that in the cheek sinus, like from a dental scan, but in the full CT sinuses. That's something that we think of if we're seeing like ethmoid region or sphenoid region, which is up near the part of the skull that separates brain from the sinuses.

Dr. Jessica Lee: Yeah. But the other one I wanna bring up, 'cause you did mention like walling off, so this is a good time to talk about it. So the, F right was fungus. And so I have seen patients come in with dental scans and they have just this mass of gray in one of their cheek sinuses. But there's sometimes little clues, like if there's bright white spots inside of the gray that can be calcified material and that can be an indication of fungal disease. So usually these are called fungal balls or myomas is what they're called. And patients can be completely asymptomatic and have a huge one sitting in their sinus because, like you just said, I think the body is trying to wall it off and to protect the rest of the body.

Dr. Jessica Lee: Now, [00:35:00] in some cases it's successful, but in some cases it's not. And it will actually start to stimulate more secondary bacterial sinus infections, and that's when pat patients become aware of it symptomatically. And then in those cases we have obviously treatment options. But yeah, 

Dr. Rachaele Carver: for stuff like that are you using like antifungal, nasal sprays, or is that something where you can give the oral and that will take care 

Dr. Jessica Lee: of it?

Dr. Jessica Lee: So for fungal balls, you have to surgically remove them because there is a physical presence of an irritant and you have to remove the irritant. So antifungals don't work. So antifungal, nasal sprays the point to remember with that is it's not going to reach your sinus, right? So if you're using an antifungal nasal spray for some type of intranasal thing, then that.

Dr. Jessica Lee: That's potentially okay, but it's not going to go into the sinus because the nasal cavities are very narrow and slightly tortuous. And if someone's never had sinus surgery, their sinus openings are sometimes a [00:36:00] millimeter or two millimeters size and off to the side or up to the top, or way at the back.

Dr. Rachaele Carver: So thinking about that we have like neti pots and all these kind of nasal navage is a big popular one. Does, but is that really getting 

Dr. Jessica Lee: into those cheek sinuses? So if you've never had sinus surgery, the chances it is not getting into your sinuses, but it's still extremely helpful.

Dr. Jessica Lee: Like I'm a big fan of saline rinsing because again, a lot of the mucus that people are having problems with that they're symptomatic from, it's coming from one of two places. It's either coming from the mucosal tissues in the nose. So most specifically the turbinates. And those have a lot of mucus glands, which again, rinsing that area which you are going to reach with the saline rinse is gonna be beneficial.

Dr. Jessica Lee: But even if it's a sinus issue, I will still recommend rinsing because remember I said sometimes I'll see that little stream coming out. We wanna keep that pathway open and the [00:37:00] longer a thick purulent drainage sits there, the more swollen that opening gets. And the opening will sometimes just completely swell shut.

Dr. Jessica Lee: And now we have a stagnant sinus infection with no way to drain. 

Speaker 3: So 

Dr. Jessica Lee: I tell people if even if we see a sinus infection, we see sinus drainage. If you keep those saline rinses going, you're going to encourage that flow so that the hole stays open and the sinus is able to exit all of the stuff it needs to get rid of.

Dr. Rachaele Carver: So do you recommend as a prevent we're in springtime now. The pollen counts have been crazy high here in Massachusetts this year. I don't know if elsewhere, but, so somebody who maybe has seasonal allergies, is this something you'd recommend maybe they did once a week or what? What are your general recommendations?

Dr. Jessica Lee: Yeah, absolutely. Because again, back to that first cause, which is that it's really intranasal mucus that bothers people, especially with allergies. So absolutely, if you have seasonal allergies incorporate a saline rinse into your regimen [00:38:00] during that time of the year where you're bothered by it.

Dr. Jessica Lee: Especially if I will tell people when they have grass allergies that are really bad. If you are out and you're mowing your yard and you come inside, you wanna get that stuff off of you as much as possible. So you Change clothes, you jump in the shower, wash it off, you do a nasal rinse, get it out of your nose, and already just with a very simple step like that, you can reduce how much you are continually being exposed to for the next several hours.

Dr. Jessica Lee: Yeah. 

Dr. Rachaele Carver: Yeah. What about I know sometimes, and I can't pinpoint why it happens to me, but I know other patients talking to too, like sometimes I wake up in the morning and one of my nostrils is totally clogged. What's that about? 

Dr. Jessica Lee: Why is this this Is, do you flip sides to get it to open up and stuff?

Dr. Jessica Lee: I often have, 

Dr. Rachaele Carver: once I wake up and stand up, it usually clears. So then I think, oh, is my lymph not draining? Like, why, like why, is it just sitting there overnight? Yeah. [00:39:00] Why won't it drain? Probably and my mouth draining. 

Dr. Jessica Lee: It's sometimes, again, it's never one thing, right? So what you're feeling typically is going to be nasal congestion.

Dr. Jessica Lee: And I use that word very specifically because it's usually the vasodilation. So the expansion of the blood vessels in the nasal cavity, which is a normal process that happens overnight across all of our body, right? All and during, when we sleep. All of our blood vessels actually relax a little bit and our blood pressure goes down slightly.

Dr. Jessica Lee: And there's a, there's reasons for that. So that happens in our nose as well. And when the blood vessels get bigger, you feel congested, right? That's the feeling that we describe as congestion, but we're asleep for it. Now, most people aren't going to be aware of it until they wake up. But then, like you said, as soon as you stand up and you move around your, body is back to its daytime settings and you're fine.

Dr. Jessica Lee: Now, a lot of people will say it's not that quick, Dr. Lee it takes me a good hour to feel like [00:40:00] my nose clears out. And that's usually a combination then of other factors. So you've got the physiologic response, but then you've also got, for instance, someone who may have a dust mite allergy.

Dr. Jessica Lee: And your bed is literally your hot bed of dust mite. Location. So you just spent eight hours laying in all the dust mites that you're allergic to. I should 

Dr. Rachaele Carver: wash my sheets more often. You're telling me. 

Dr. Jessica Lee: Got it. If you, have a dust mite allergy, right? Not everybody does. Yeah.

Dr. Jessica Lee: The other thing is nighttime reflux. I think people don't realize that overnight, if you have really significant reflux, the gravity is no longer helping you because you're lying flat and that stuff can come all the way up and actually reach the back of the nose. So they've done studies to look at a specific gastric compound called Pepin.

Dr. Jessica Lee: It's a enzyme, and they can find samples from the back of the nose that have pepin in them for people that have these types of symptoms. So it tells us that [00:41:00] reflux can reach as high as the back of your nose. In fact. Oh, this is great timing. I had a patient yesterday and I see her for ear stuff, but she was like, do you remember when I was having that nasal congestion?

Dr. Jessica Lee: And like kinda headaches and just like pressure in the back of my around my eyes. And she said, did you know that I finally made the connection? She had really severe reflux. She ended up having surgery, which helped her reflux, and it completely cured her nasal congestion and her headaches that she was waking up with because hers was reflux related.

Dr. Jessica Lee: So again, there's a physiologic component that is somewhat normal. And then when you start adding in other inflammatory kind of factors, that's when people start to say, hang on, this is not normal. 

Dr. Rachaele Carver: Yeah. And I think that's true. I was thinking like this morning I woke up congestion. I'm like, what did I have for dinner last night?

Dr. Rachaele Carver: And my husband made this big roast, heavy protein in my meal. And I was like, I didn't take my digest [00:42:00] digestive enzymes last night either. So even though I don't feel the reflux, I always I used to many years ago when I was first navigating this whole alternative medicine, I had gone to an ENT because I had annoying postnasal drip.

Dr. Rachaele Carver: And I was like, you just said that's postnasal drip. It's fine. I was like, but why do I have it? And a lot of it was the stomach and the gut, everything was just out of whack and out of balance. So I never had the sensation of heartburn, per se, what most people feel. But I think that's really important to know that you can have reflux and not really, you don't necessarily feel the burning.

Dr. Jessica Lee: Right. There's, different types of reflux, right? You have. Acidic reflux. And that's what most people call reflux. That's the heartburn. That's the indigestion, that's the sour taste in your throat. And that's definitely the most common type that people think of. But you also can have non acidic reflux.

Dr. Jessica Lee: So you can have acid coming up, or sorry. You can have gastric kind of juices coming up that are not overly acidic, but they have other enzymes in them that can [00:43:00] still cause tissue damage up in the throat. And then you also have a connection from a nerve standpoint. So there is known connections between the nerve that, so this is all vagus nerve property.

Dr. Jessica Lee: And when you have reflux even into the bottom part of the esophagus, which by some cases might actually be considered normal and physiologic, it can actually cause symptoms up in your throat mediated by this nerve compound or nerve reflux. And that in the ENT world, we call this laryn pharyngeal reflux or LPRD.

Dr. Jessica Lee: So add disease onto that. And that's what causes a lot of like postnasal drip, chronic throat clearing, chronic cough. Maybe a little bit like of a globus sensation, like it's hard to swallow. Usually patients like that are going to notice it like a little bit worse after meals or overnight when they've been laying flat all night and they wake up first thing in the morning.

Dr. Jessica Lee: Especially dependent, like you said, on what did you eat for dinner the night before? Do you drink alcohol with dinner? Are you overweight? Is [00:44:00] weight pushing up on the abdomen all night? Things like that. 

Dr. Rachaele Carver: Yeah, I talk to a lot of patients the more I've seen this and tried to investigate.

Dr. Rachaele Carver: Think a lot about of sleep apnea. I originally thought it was just an anatomic thing, but then the more of these 3D X-rays I was doing, I was like this person has a huge airway on the CBCT, but they have sleep apnea. This person has an itty bitty airway, but they don't have sleep apnea. So I was like, okay, there's more than the apnea.

Dr. Rachaele Carver: Like what is the diaphragm doing? Just like you said, right? The breathing and the pressure differential. So I've been trying to learn more about breathing patterns and how to train patients to get that vagus like that is so important. Get that working properly, get the breathing properly.

Dr. Rachaele Carver: Breathing is the fastest way to train the vagus and to turn it on or off. I think it's interesting that you said that because that has a lot to do with reflux. Sometimes we see, like in the teeth, they're completely eroded away. From acid. But some people say no, I don't have reflux it can be this silent one.

Dr. Rachaele Carver: [00:45:00] Or sometimes we see that apnea with that wearing of the teeth too. And that's, that makes me think more of diaphragm issues, vagus nerve issues, all those kind of things. So again, looking beyond my expertise, what else is happening when you look at the whole picture together, which is the thing that's really, I 

Dr. Jessica Lee: think there's I think there's a lot of things, and I bet you see this in the dental world too, that are, the way I describe it to patients is we're gonna look at the structure and the function.

Dr. Jessica Lee: And that kind of goes back to even what we talked about with tonsil stuff, right? I'm looking at the physical structures. But I'm also gonna ask about the symptoms that give us a clue to more of the microscopic functionality. And you have to, look at both. Because if you just treat one and not the other, most of the time your patients are probably still gonna have some kind of symptom that didn't get better.

Dr. Rachaele Carver: I, that's so important. Yeah. The function. That's what that made me think about. The orthodontics again, right? So we're thinking about the structure and how the teeth look, but not necessarily the function, right? And so we can [00:46:00] then sometimes screw up all the joints and stuff because they look straight, but maybe they're not coming together exactly how all the muscles and the joints and everything want them to, and then you end up with symptoms.

Dr. Rachaele Carver: It's, and if you read the fine print and Invisalign instructions, it says you'll likely need occlusal. Adjustment at the end but I wonder how many people are actually told that and no, to make sure because as dentist we look and we're like, yeah, your teeth look great.

Dr. Rachaele Carver: They're nice and straight. Perfect. You're good. Done. Yeah. 

Dr. Jessica Lee: Same thing in the nose, right? We do, people do a sep I had, again, had a patient came in today, she's yeah, a septoplasty, but I still have X, Y, and Z. And I'm like, yeah, your nose looks great. Nose is nice and straight, but she's got all this other chronic inflammatory stuff going on with her sinuses and her gut.

Dr. Jessica Lee: And I'm like that was part one. This is part two. 

Dr. Rachaele Carver: Yeah, exactly. So that's so important that you can help your patients in that way and say, yeah there's, a little bit more to it than 

Dr. Jessica Lee: that. Yeah. And honestly, like you said before patients are smart. People are [00:47:00] smart, right?

Dr. Jessica Lee: People know. We get maybe, I don't know, I hesitate to say how many minutes I get with patients, but I often run late because I like to spend time with patients. But let's say I get 30 minutes with a patient they spend all day with their bodies and they've had a lifetime with their bodies.

Dr. Jessica Lee: And I think that. Certainly sometimes people may be on the ends of this pattern, but most people are very aware of hang on, something's not right with me. Yeah. And you have to, I think you have to honor that and say, okay, I don't see anything, but let's keep looking 

Dr. Rachaele Carver: we're coming up to quite the end, but I wanna just touch, this is a very big topic that we could talk for probably five hours about it, but we hinted to a little bit about allergies and I know that's really common for a lot of people and there's probably no simple answer to this question.

Dr. Rachaele Carver: It's probably not fair to ask it, but what do you think is a lot of the root cause of, allergies? Is it genetics? Is it diet? Maybe just speak a little bit about, like I said, this is a huge topic, but maybe just for those people who suffer, like from [00:48:00] allergies, is there anything besides the prescription drugs and stuff like that, is there something else they should maybe investigate as a Yeah, 

Dr. Jessica Lee: so but that's the, you want the elevator version?

Dr. Jessica Lee: Yes. Which we can do. So what I explain is allergies are an immune system dysfunction problem. The, that is the root cause. The immune system has somehow become hyper responsive to an antigen or a compound that it shouldn't be responding to that way. So that's the first and foremost thing. So if you go back and look at what causes immune system dysfunction, it can be a lot of different things.

Dr. Jessica Lee: There absolutely is a genetic component. If you have a parent or two parents who have allergies, you are 25 to 50% more likely to have allergies yourself. Okay. So there's definitely that piece to it. But I have a lot of patients who, they were fine and all of a sudden they got some really bad viral infection and then they developed allergies and asthma.

Dr. Jessica Lee: So we know that the viral [00:49:00] infections can change the way the immune system functions. We see that with COVID recently, but it happens for all different types of viruses too. And then when we think about it that way, I think it helps people understand that to get the most benefit from your treatments you have to think about, is this supportive of my immune system or not?

Dr. Jessica Lee: So a lot of, I think concern is for people that this medication's just. Blocking my symptoms, but it's not really fixing the underlying problem. And I'm like, yeah, I agree. And some people that is fine. Some people are saying, that's okay for now, but I wanna come back later and dig deeper. And that's okay.

Dr. Jessica Lee: I think that the ultimate corrective type of treatment is immunotherapy. So that is I mean if we wanna call it something fancier, call it microdosing, right? We're microdosing your antigen that you're allergic to so that your body can learn to become tolerant to it. And that is the ultimate, and not [00:50:00] everybody responds to immunotherapy, but for people that do, it is life changing and those patients feel better and they don't need the medications.

Dr. Jessica Lee: And ultimately that immune system dysfunction has been in some ways corrected, right? So that to me is, always an option worth talking through with people. Now that's a big ask because immunotherapy, I will tell people, often takes about five years to successfully complete. So it's a big ask.

Dr. Jessica Lee: So in the meantime, or for someone who's not ready to do that or can't do that for whatever reason, we do have obviously your standard over the counter medications, those are gonna be intranasal steroids, intranasal antihistamines, and oral antihistamines predominantly. The funny thing is most people start with an oral antihistamine and they don't do any nasal sprays.

Dr. Jessica Lee: And I'll explain that. If your symptoms are mostly allergic rhinitis, which is nose, you wanna use a nasal spray because you're getting the medicine there fast without a lot of the systemic or full body side [00:51:00] effects. So those are the conventional things. And then we always talk about, just like we talked about earlier with the saline rinses, we always talk about preventative measures, whether it's washing sheets, weekly in hot water for dust mites and room air purifiers.

Dr. Jessica Lee: So we have a lot of different things depending on what your testing shows. But that brings me to a good point. A lot of people assume that they have allergies and we do allergy testing and it's completely negative. And then they're like, hang on a minute, wait a second. That's also a very important piece of it because if you're, taking allergy medications based on an assumption and you don't feel better, then you need to pause and think, hang on, we need to take a closer look at this.

Dr. Jessica Lee: 'cause there could be something else going on. Then to move into kind of a broader integrative sphere, there are so many papers that support, use of probiotic strains, use of acupuncture, use of herbal medicine sauna. There are just, I have like pages and pages of [00:52:00] papers that I've read through that I'm like, oh my gosh.

Dr. Jessica Lee: For people that are looking for more, there are so many other options out there. And again, not everything is for everyone. Like you said I don't tell everyone to follow the same treatment pathway because every individual is unique but you, that's where you just have that conversation and you find what works for that person individually.

Dr. Rachaele Carver: Definitely, yeah. I love like being able to give the options and then a person will usually say something will resonate with them. Oh, that's interesting, or, oh, I've read about that. I've been intrigued. So that's awesome. And I often when I think of allergies again, I think beyond, it's that whole gut, right?

Dr. Rachaele Carver: There's something, because the immune system is right there, right? The gut. Yeah. Lining thick. The immune system's right there what's, and we're being assaulted daily with all the toxicity in our environment today. It's not surprising that so many people have these allergies, but it's exciting to think that you, there is a way you can [00:53:00] eradicate them.

Dr. Rachaele Carver: Some people think I'm just gonna have allergies forever. So when you're talking about immunotherapy, would it be an example like a peanut allergy? I know I had a friend, their kid was like eating one peanut m and m so often or whatever to try to get rid of that. Do you have any.

Dr. Rachaele Carver: Inklings or maybe an answer of why that when we were growing up, nobody had a peanut allergy. Why is it that our kids' generation, why is this so prominent today? 

Dr. Jessica Lee: Yeah, I think there's a lot of theories. I don't think anyone has the golden answer, but a lot of the theory is that for a little while, and this is where we live and learn, but for a little while, medicine's directive to parents was to not give their kids potentially antigenic foods like peanuts until they were older.

Dr. Jessica Lee: To reduce the risk of an electric reaction. And we now know that was incorrect advice. And there were some really landmark studies that came out of Israel where [00:54:00] they looked at kids who were fed peanut based products at a very young age, and there was a much lower incidence of peanut allergy.

Dr. Jessica Lee: And so our pediatric guidelines changed, which is appropriate. And they said, now we think you should start introducing things earlier, right? And that goes back to remember what we said tonsils are teaching the immune system. A peanut's gonna pass by your tonsil, right? So the tonsils gonna take a piece of it and introduce it, then it's gonna get into the gut and the gut lining if it's healthy, right?

Dr. Jessica Lee: Which is a whole nother discussion of nutrition. Yeah. But if it's healthy, it's going to help teach the body about these different foods that we're eating. Because I think the numbers, like 70% of the immune system cells actually live just underneath the lining of our gut. So if the gut's doing its job and if they're getting this exposure early.

Dr. Jessica Lee: Then, and the immune system is functioning the way it should, then we don't see that progression to allergy. So I think that's a big piece of it. At least that's Monday morning quarterbacking it and saying, oh, that was the wrong [00:55:00] advice back then. And now that's, oh shoot, we 

Dr. Rachaele Carver: got it wrong.

Dr. Rachaele Carver: Oh, surprised. 

Dr. Jessica Lee: But I think you're right. I think the modern world that we live in no one, I say, no one can live a toxin-free life. No one can live a stress-free life. And it is difficult, I think, to eat in a way that is not in some way inflammatory just because of the modern world we live in, the us right.

Dr. Jessica Lee: We, everyone is doing the best they can. And I think the more that we, as doctors and practitioners are helping and encouraging and saying, Hey did you know that maybe we could do this instead of that, and it might reduce your exposure to X, Y, or Z? I think we're just, everyone's trying to move in the direction we should all be a 

Speaker 3: van.

Speaker 3: Yeah. 

Dr. Rachaele Carver: And I think patients are asking to that all the time. That's why. I I talk about binders a lot because I'm like you can do all the best things. And binder minerals are so important to me because our foods have become so deficient, right? And at that basic cellular level, right?

Dr. Rachaele Carver: We need the minerals, right? We need those [00:56:00] the, vitamins and that really is helpful. But I was I listened to a podcast the other day and I was so disappointed. This, I think he was a PhD scientist. I, he's his ac there's tons of accolades about him. He has written a ton of books published hundreds and hundreds of papers been cited by so many people.

Dr. Rachaele Carver: But he said we don't need supplements. There's no, there's not a single study that shows supplements work. And I like you. My mouth dropped also, and I was like 

Speaker 4: If you could see the video right now. Yeah. 

Dr. Rachaele Carver: I was just like, 

Speaker 4: what is he? 

Dr. Rachaele Carver: And, he's on one of, and it was on one of the most popular podcasts in the world.

Dr. Rachaele Carver: And so I was like, this is so devastating to hear him say that. And I think I'm like, that's so weird because there's so much that's in. But he was, and he was saying you eat well, you don't need it. I'm like, okay but in the world we're living in today, right? I'm like it was as if he was living in a bubble.

Dr. Rachaele Carver: And I get, yes, ideally we shouldn't need supplements, ideally, [00:57:00] right? Like back in the day we got all our food from, or all our nutrition from our food, but that's not today's reality. So I was like, Ugh. Really taken aback by that comment. 'cause I was like no, Ask any physician, anybody who's doing blood work, how deficient we all are.

Dr. Rachaele Carver: Why are we so chronically inflamed? Like, why is there so much chronic disease? And again, at that cellular level, it's coming down to just depletion, right? If we don't have the building blocks to create cells, we're gonna manifest all sorts of things. So it's just geez, but 

Dr. Jessica Lee: It's one of those things too, where I think that's.

Dr. Jessica Lee: I don't know. I try never to make blanket statements like that because again, every person is unique. We can talk about population based metrics and public health measures. And in those cases maybe you would say, oh, it's not worth supplementing whatever. But like when you come down to an individual and you look at their individual labs and their genetics and their history, I don't think you can make that [00:58:00] statement.

Dr. Rachaele Carver: I I know it was, I loved your reaction because I was like, yes, that's exactly how I felt too. I was like, what is he talking about? But he also, he is a researcher, right? So he is not with the patient. So to I'm 

Dr. Jessica Lee: sure he is way smarter than me when it comes to whatever his specialty is that I just 

Dr. Rachaele Carver: think 

Dr. Jessica Lee: that's 

Dr. Rachaele Carver: harsh.

Dr. Rachaele Carver: Yeah. I thought I was, yeah. Very surprised. But, 

Speaker 4: well, as we're wrapping up, Dr. Lee, is there anything else you'd love to leave the audience with? Any other tidbits or good 

Dr. Jessica Lee: information? I, again, this is fun. I enjoy doing this. I like just talking and collaborating, so thank you for having me. I, my leaving remark actually may seem like it has nothing to do with ENT, but I think that the most important message that patients can sometimes get or people can get right now is to be your own advocate.

Dr. Jessica Lee: Because I think the way modern healthcare runs, you get very little time with your doctor and a lot of times that time is not allowing you time to tell your [00:59:00] story or to ask your questions. And so I always tell people, be prepared for your visit. Have your medical records on you. Don't assume that the doctor already has them.

Dr. Jessica Lee: Write your questions down and if you don't get all the questions answered, make another appointment or ask if you can message them in the portal. I think that I wish we had more time. I wish I had more time with patients and I think a lot of doctors do, but. The fact of the matter is we don't.

Dr. Jessica Lee: And so I, I always encourage people to be their own advocate, to speak up, to get a second opinion. If they feel like they weren't heard. And I think that's one of the most 

Dr. Rachaele Carver: important things to remember. I love it. I started when I would have a new patient, especially somebody like that, who would come with all this questions, and it was becoming more stressful for me.

Dr. Rachaele Carver: 'cause all I wanted to do was sit with them for two hours, but in the busy day, we're like, this doesn't work. So this is where I think telehealth can be great. So I started doing on Fridays especially if it's a new patient from far away, I do, I will do a Zoom call with them. And so I'm like just totally focused on them.

Dr. Rachaele Carver: And [01:00:00] that has just been such a game changer for me because I, it's outside of my regular clinic, which isn't feasible for, everybody. And I still have the ability to do that because I work for myself, right? Sometimes in the greater medical system, that's not always that's not really an option.

Dr. Rachaele Carver: But hopefully, things are getting shook up a little bit and people are wanting other things. So like we said, who knows in five, 10 years, everything's starting to look a little different. But and I love that. I think that's so great that you offer 

Dr. Jessica Lee: that as a service. I wonder, 

Dr. Rachaele Carver: and it's so enjoyable for me because I just, I really can focus and I really can be present instead of them calling me to go check this and do that, or have another patient because yeah, like you said, so many people just, they wanna be heard.

Dr. Rachaele Carver: You just want somebody who will listen. And it's just the way that our modern healthcare is like, there's just not the time because the expenses are so high and you've gotten to do all this and it's just too much of the business is, was taken [01:01:00] off the head of the the art right of medicine.

Dr. Rachaele Carver: So hopefully we're there's so many of us out there now that are and as a patient, that's what I want too. Absolutely. I always think about how do I wanna be treated? I still in my office, you can call any time of the day. There is nobody is just off for lunch.

Dr. Rachaele Carver: That drives me crazy. You know when the whole office is just off for lunch and I'm like can't you link or we still make personal phone calls we have the automated system too, but still the day before and that's not even heard of anymore, 

Dr. Jessica Lee: Oh, I know.

Dr. Jessica Lee: If I call a patient back, which I do a lot because I think patients wanna hear from me, they don't wanna hear it after it's gone through a telephone chain, right? Yeah, But people are like, oh my gosh, you actually called me. I'm like, yeah, of course. I called you. And they're like, no one, I've never had a doctor call me.

Dr. Jessica Lee: And I'm like, what? This is crazy. Of course we should be calling like, yeah. But anyway, I 

Dr. Rachaele Carver: know. 

Dr. Jessica Lee: Well, 

Dr. Rachaele Carver: it's 

Dr. Jessica Lee: good days of 

Dr. Rachaele Carver: times. Thank you so much. If somebody wants to learn more or is there a way they could reach out to you if they had [01:02:00] any, questions? 

Dr. Jessica Lee: Yeah, absolutely. I love, honestly hearing from people and I love questions.

Dr. Jessica Lee: So you can find me on social media. My Instagram handle is @entchat, so ENT like ear, nose, throat. And then chat is CHAT. And then you also can find my website, it's www.integrativeenthealth.com. I do have a way where people can reach out to me to see if they are interested in working together in different formats, but I also have a lot of just like blog posts and I'm doing more and more uploads of like free kind of resource handouts.

Dr. Jessica Lee: In fact, I actually have like a c craniofacial growth airway one that I'm getting ready to upload. It's a, it's pediatric focus, so that'll be really exciting to have available for people too. 

Dr. Rachaele Carver: Great. Thank you so much for doing what you're doing and I'm so glad the universe brought us together and have to make my way down to Charleston and hang out with your little group collaborative so I can keep learning more too.

Dr. Rachaele Carver: Oh my God, we'd love to have you. It'd be great. Thanks everybody for listening. If you [01:03:00] have any questions, please reach out. We'll put all of those contact information in the show notes. And otherwise, have a wonderful day. We'll see you on the next episode.

Hello, I'm Dr. Rachaele Carver, a board certified naturopathic biologic dentist, and a certified health coach. Did you know that over 80% of the US population has some form of gum disease? Many of us don't even know that we have this source of chronic infection and inflammation in our mouth that's been linked to serious consequences like heart disease, diabetes, stroke, dementia, colon cancer, kidney disease, even pregnancy complications.

Would you like to learn how to reverse and prevent these chronic debilitating conditions without spending a lot of time and money at the dentist? Join me for my six week course where I will teach you the root cause of disease. You'll learn how to be your own best doctor, are you ready to get started?