I am amazed at how the basics of medicine so easily slip most of the medical profession’s grasp. Why do we think, that what is the most basic tenant in CPR, establish Airway, Breathing, and Circulation, only applies in acute situations?
The airway is tantamount to healing in every patient, not just the acute patient. If not for friends, who are excellent sleep dentists/orthodontists, I would still be clueless. Thank goodness I was open to them, because their message of establishing an airway in a chronically ill patient is not only important, but maybe the reason patients are chronically ill.
I find with disease, especially chronic disease, that there is rarely just one “tack” causing the pain if you will. Often it is many “tacks” causing the pain and you have to remove them all to have success. There is an order to tack removal as well. Therefore, my physical exam always starts with the airway. Airway, as noted above, determines whether you can breathe (duh). Breathing is essential for life (double duh-(I am a child of the 70 and 80’s and refuse to be hip)). We intake oxygen (I think I remember this from med school) and let off carbon dioxide. Without oxygen, well, ummm, we die.
It seems rudimentary, but what happens when people are chronically deprived of oxygen? Every time they sleep or exercise, or better yet just try to sit up straight (this positions the tongue in the throat so their airway is narrowed, so sitting up straight is not an option for a lot of people and should be a warning sign of airway issues) their oxygen levels drop, and they are not able to create energy in their cells and give off waste, which cannot be removed through breathing. These factors set up inflammation, which becomes chronic, and then, let the parade of chronic fatigue, fibromyalgia, depression, anxiety, autoimmune disease etc. begin. So many of these names are just labels for the body not compensating well for lack of oxygen.
Often, I have patients come in with a specific diagnosis in mind, that they want to address, that they see as the underlying problem to their chronic issues. A lot of the time it is Lyme disease, and they have testing to prove it. They are not wrong about having this infection but treating this without addressing their airway (and gut) first would be incomprehensible. It is especially incomprehensible when you understand that to heal from any disease you have to give the body the tools it needs to repair itself. Oxygen is one of those tools. The airway is how you get that oxygen. Let us look at an example.
I had a beautiful young lady come into the office for help with treating her Lyme disease that had to here before been unaddressed It is tempting to keep things “simple” and just say “Let’s focus on this diagnosis.”, which has been proven by urine DNA testing (this testing is very unlikely to be a false positive). Using this tactic, I would have had to ignore her other symptoms, which were actually more important for her immediate future in healing than going after her Lyme infection.
She had had Chronic fatigue since she went into adolescence (Her body grew, increasing her oxygen demand, but her airway stayed small.) She gets headaches when she naps. She could not sleep on her back, and never felt rested, no matter how much she slept. I would have to ignore that her overbite was noticeable from across the table and that her teeth were crooked and she’d had to have teeth removed for overcrowding. I would have to ignore that her sister, who was sitting next to her, had beautiful teeth and grew up on the same wholesome diet. I would have had to ignore the severe tongue tie that had been unaddressed since birth, the extremely narrow arch of her mouth, and the correlating narrow airway.
So what to do? First realize, that her tongue tie has led to a tongue that cannot move forward and apply pressure to the jaw so that it could grow with the rest of the body (bone molds and reorganizes based on pressure). Once the tongue tie is addressed, then we will focus on helping the tongue remold the mouth through a sleep orthodontist that understands that straightening her teeth is not a “cosmetic” procedure (she was told her teeth were fine by her dentist-wah?) but rather a life-altering intervention. We would support her airway during her jaw expansion with an oral device for sleep to help move her tongue forward and increase the size of her airway.
I would then write a paper so this beautiful young lady’s pain would not be for naught and the numerous doctors who missed the obvious reason for her illness may read this and learn. Check!
I find it almost embarrassing that we in the medical profession never truly evaluate the patient for this issue, but you can’t evaluate what you were not taught to be important, so I am hoping this can maybe be an issue you can explore with your doctor or better yet an airway specialist, like a sleep dentist/orthodontist, to rule this out as a contributor of your chronic disease.
All together now, A…B…C…D (D stands for ‘Damn, we are obtuse as a profession sometimes’!).
Dr. Nathan Morris, MD