Ear, Nose, and Throat w/ Dr. Craig Zalvan

Episode Information

March 1, 2021

ENT (Ear, Nose, and Throat) Physician Dr. Craig Zalvan talks about educating young singers, GERD, LPR reflux, the importance of eating a plant-based mediterranean style diet, and much more

Topics Include:

• How he knew he wanted to be a doctor from the time he was two years old
• How he loved every medical specialty but eventually decided on pursuing a career in otolaryngology because it is a mix of hands-on surgery, treating patients and research
• How he treats singers with trauma of their vocal faults
• His passion for educating the next generation of signers about using their voices correctly, to prevent long-term damage
• That rest, hydration and humidification are the best treatment for a sore throat
• About his internship at Dana-Farber Cancer Institute, researching the early binding of HIV and T cells
• A bit about how cells communicate with each other
• That the answer to reflux, diabetes, heart disease and many other medical conditions lies in following a plant-based Mediterranean style diet with meat/chicken/fish/eggs up to 4x a week, no dairy and alkaline water
• How Doctorpedia takes away the wondering of what I’m reading and looking at online [with regards to my health] by providing important information that’s pertinent to a particular problem with experts in the field.”

Highlights

• “About 90 plus percent of why somebody needs to come see me is due to trauma of the vocal folds, whether it’s using too much, too often, oftentimes some of the younger singers especially are working multiple jobs and doing multiple gigs. And just like anything, you use something too much, you’re going to end up causing some damage.”
• “Sore throats happen for many, many reasons. And the vast majority of them are usually viral illnesses and colds and certainly not necessarily COVID. But if you start developing other symptoms, then you should definitely get a COVID test.”
• “Ultimately I decided on ears, nose and throat or otolaryngology, because it is a wonderful mix of the medicine. You really have to know all your medicine, because almost every single ears, nose and throat disease has some kind of head and neck manifestation and it’s also surgical. So you can take a person that’s not responding to treatment and actually do something with surgery to make a change for that person to help them with their problem.”
• “I was fortunate at the time that I had met one of the researchers at Dana-Farber Cancer Institute. I had a lot of interest in research and ended up with a summer job that turned into an internship type thing that I did for multiple years. And I was able to do some pretty amazing research in the tumor immunology lab. In fact, it was a lot of the work on the early binding where HIV would bind and the T cells. So it was fascinating.“
• “My research was published a couple of years ago in the journal of American Medical Association showing that this diet-based approach, namely a plant-based Mediterranean style diet together with alkaline water can treat acid symptoms in the throat, as well as if not better than twice a day dosing of the proton pump inhibitors.”
• “Today where your schedule has to be double booked and we’re all busy typing into computers, it’s very easy to forget that there’s a mother, a brother, a sister, a father sitting right across from you. And, frankly, I kind of look at everybody and say, “If this were my family member, how would they want to be treated? And how would I want to treat them?””
• “I would like patients to know that they’re coming to see somebody that is going to listen to their problems and issues and hear them as a person, not just another number or another person on the schedule. And that I’m an out of the box thinker and I’ve been known to think a little differently, try things a little differently and be willing to look beyond where others have looked. And that’s kind of the basis for my practice over these years.”
• “I think the biggest compliment that I get from a patient is when they send me their relative or send me a close friend, that they felt that I was able to help them, that they were listened to and that they want to send that information to someone who’s close to them and important to them.”
• “I think the information online is fantastic. The problem is there’s so much information and so many possibilities without much training or understanding, that people tend to misdiagnose and over-diagnose. So I think that although the internet is an amazing tool and obviously a huge wealth of information, it can also be dangerous because it’s not well controlled and there’s really minimal guidance for a regular person to just go online and look up medical issues.”
• “It’s a sad story in that I see a lot of young teen singers and beautiful voices, very gifted, and they come see me two weeks before they’re going for an interview, or they have an upcoming performance that they’re rehearsing for and they’re having problems. And unfortunately they’re having problems because they’ve had problems for months or years and have been ignoring it. And now they want the quick fix before the next event.”

Relevant Links

• Doctorpedia Profile
• The Institute for Voice and Swallowing Disorders
• Appointment Booking Site – ENT and Allergy Associates

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello, and welcome to the Doctorpedia podcast. I’m your host Daniel Lobell, and I’m honored to be on the line today with Dr. Craig Zalvan. How are you?

Dr. Craig Zalvan: (00:32)
I’m fantastic. Thank you for having me.

Daniel Lobell: (00:34)
Thank you for doing this show. I have a lot of questions for you. There’s so much that you do that I have no idea what it is, but before we start getting into any of the medical stuff, I love to hear about the background of the doctors I’m speaking to. I know, because we talked for a minute before we started recording, that you’re in New York. Did you grow up in New York?

Dr. Craig Zalvan: (00:55)
No, actually I’m from the Boston area – a little bit in the South Shore, did my undergrad in the Boston area. And then I was lucky to come to New York for my residency and medical school.

Daniel Lobell: (01:06)
Are you a Red Sox fan?

Dr. Craig Zalvan: (01:09)
It depends on the year.

Daniel Lobell: (01:12)
[Laughs].

Dr. Craig Zalvan: (01:12)
Being in New York, I’m never for a loss with any of the sports teams.

Daniel Lobell: (01:17)
I’m sure. What part of New York are you living in?

Dr. Craig Zalvan: (01:20)
So I’m a little bit north of New York city in Westchester. And it’s just really the suburbs right above the city itself, which is fantastic from the ability to get in and out of the city, utilize it. And also for medical reasons, there’s just so much going on in the area, which has been fantastic.

Daniel Lobell: (01:38)
Westchester is beautiful. My wife went to Purchase College and my cousins live in New Rochelle.

Dr. Craig Zalvan: (01:41)
I know both places well. I do some teaching at the Purchase for some of the opera students.

Daniel Lobell: (01:51)
Is that something else that you do, opera?

Dr. Craig Zalvan: (01:54)
No, but a big part of what I do is treat singers. So a lot of the young singers are the ones that we’d like to educate so that they don’t have to come see me down the road, avoid trauma, avoid problems with the voice.

Daniel Lobell: (02:07)
Let’s talk about that a little bit, because I do want to hear more about your background and we’ll go back to it. But what are some of the top things that singers don’t know that you’re able to inform them, that helps them in the long run in this respect?

Dr. Craig Zalvan: (02:23)
Well, about 90 plus percent of why somebody needs to come see me is due to trauma. It’s trauma of the vocal folds, whether it’s using too much, too often, oftentimes some of the younger singers especially are working multiple jobs and doing multiple gigs. And just like anything, you use something too much, you’re going to end up causing some damage. And if we can educate these younger singers to be more protective of their instruments, then chances are they’re not going to have some of the longer-term problems. And that’s really where the focus of education is. There are of course many other things that can affect the voice and many medical problems and issues that people have, reflux disease is another. And the bottom line is by teaching people what can go wrong with the voice and what to look for, they’ll know to come in sooner rather than later if they do develop a problem.

Daniel Lobell: (03:20)
Do you ever have a patient come in to work on their voice and you say, “Listen, you just don’t sound good. It’s nothing to do with anything I can help you with. You just suck as a singer.”

Dr. Craig Zalvan: (03:31)
Well, I typically don’t say that, but people don’t have to be great. They just need to enjoy it. And if they enjoy it and that’s what they want to do, then I’m going to be here to help them be able to do that to the best of their ability. So yeah, I’m usually a little shy of telling people they suck.

Daniel Lobell: (03:50)
[Laughs]. I’m only teasing. I want to make sure that I’m saying this correctly, is it otolaryngology?

Dr. Craig Zalvan: (03:57)
Yeah, so that’s ears, nose and throat doctors.

Daniel Lobell: (04:00)
So that’s what you are, right?

Dr. Craig Zalvan: (04:00)
Yes, I’m in otolaryngology. I trained in Manhattan and at a lot of really great institutions. And then I did a fellowship, an extra year in laryngology, which is specifically disorders of the throat. So voice, swallow, cough, and reflux disorders. And that’s my specialty where the majority of my practice is focused.

Daniel Lobell: (04:26)
It’s kind of fortuitous that I’m interviewing you today because I’ve had a sore throat for two days.

Dr. Craig Zalvan: (04:32)
Come on over and I can put a scope in and we can figure what’s going on.

Daniel Lobell: (04:37)
I don’t know. It might be a little far for me to go across the country for it, but I don’t know what could be causing it. And in these times of COVID now, your mind always goes to the worst place, but I’ve tried to temper that with the fact that I otherwise feel great, thank God.

Dr. Craig Zalvan: (04:53)
Yeah. I agree every time anybody comes in with anything, our first thought is COVID, fortunately now I’m vaccinated and certainly anybody listening, I hope everybody goes out and gets whatever vaccines available to them. And it’s taken away a lot of the fear of all of our patients. Again, with my specialty, everybody’s coming in coughing and choking and singing and spitting and I’m in direct fire. So fortunately I did not get COVID and now I’m vaccinated so it sort of takes away that fear. But sore throats happen for many, many reasons. And the vast majority of them are usually viral illnesses and colds and certainly not necessarily COVID. But if you start developing other symptoms, then you should definitely get a COVID test. Nowadays you can walk across the street and get a COVID test. But other general colds are most common, overuse of the voice, certainly somebody who’s doing lots of interviews and talking all the time, that leads to sore throats and reflux disease. That’s a common one, usually not the acute onset, but more of the chronic sore throats and discomfort.

Daniel Lobell: (06:07)
What are some things that you recommend to people to do to alleviate a sore throat, asking for a friend. Not really, for me.

Dr. Craig Zalvan: (06:14)
Yeah, sure. The simplest thing is this: rest, hydration, humidification. And if you need to, things like a Tylenol if it’s really uncomfortable and honestly, if there’s no other symptoms and things get better in a couple days, then there’s no worries. Clearly if the symptoms persist, they get worse, you start developing fevers, other problems with swallowing, coughing, then you want to get looked at and evaluated, but certainly giving it a week or so seems reasonable. And again, you don’t sound like you’re too deathly ill right now.

Daniel Lobell: (06:52)
Nope. Feeling thankfully pretty ok. I think this all started when I stayed up till four in the morning, two nights ago, working.

Dr. Craig Zalvan: (07:00)
That could do it. Yeah. So rest, hydration, humidification. Absolutely.

Daniel Lobell: (07:07)
I heard you say rest as the number one thing and immediately, my mind went to, “Oh, that could be it.”

Dr. Craig Zalvan: (07:14)
Might be it.

Daniel Lobell: (07:15)
So let’s go back to you in Boston or in Massachusetts as a kid. Did you want to be a doctor back then? Was it already something you’d planned or was it something that came later in life for you?

Dr. Craig Zalvan: (07:27)
A lot of people have these stories, but I knew since I was two years old.

Daniel Lobell: (07:34)
Really?

Dr. Craig Zalvan: (07:34)
Yeah. My grandfather died and I just remember always wanting to help and my parents remember that. I’ve had laser focus on becoming a doctor the whole time, there was never a thought of anything else. I love science and I did a lot of research and certainly love the research and science aspect of medicine, but I just always wanted to help people. And the way that I thought I could best help would be through medicine.

Daniel Lobell: (08:06)
How did your grandfather pass away if you don’t mind my asking?

Dr. Craig Zalvan: (08:09)
Unfortunately he had a heart attack, which today would have been completely preventable.

Daniel Lobell: (08:14)
Really?

Dr. Craig Zalvan: (08:16)
Yeah.

Daniel Lobell: (08:17)
Was it your initial impulse to go into cardiology?

Dr. Craig Zalvan: (08:22)
No. I was one of those medical students that would call my mother every week and say, “Mom, this week, I’m going to be a pediatrician.” And next week I wanted to be a cardiologist. And then I wanted to be an internal medicine doctor. And then a surgeon. And I loved everything that I learned about. And ultimately I decided on ears, nose and throat or otolaryngology, because it is a wonderful mix of the medicine. You really have to know all your medicine, because almost every single ears, nose and throat disease has some kind of head and neck manifestation and it’s also surgical. So you can take a person that’s not responding to treatment and actually do something with surgery to make a change for that person to help them with their problem. And of course there’s a lot in ears, nose, and throat that needs to be researched. So there’s that science aspect of it and a lot of the unknown, which is something I find very challenging and interesting

Daniel Lobell: (09:24)
Is that why you fell in love with it because you have that hands-on element to it but you also can treat it without surgery. Is that unique to ENT?

Dr. Craig Zalvan: (09:37)
Yeah. ENT and truthfully all the surgical subspecialties are really a great mix of medicine. So you have to really know and understand medicine, but it’s also surgical so that you can really do something with your hands to help people with their problems.

Daniel Lobell: (09:56)
Were your parents or are your parents doctors as well?

Dr. Craig Zalvan: (10:00)
No, not at all. Nobody in my family, I’m the first physician in the entire family.

Daniel Lobell: (10:06)
So what do your folks do?

Dr. Craig Zalvan: (10:06)
My dad was in the men’s clothing business. He had a couple of stores in the Boston area that I would actually work in on the weekends and over summers. And so he sells men’s clothing. The interesting story about that is people would often come to me and say, “Hey, can you help match this short and pants combination?” Now what they don’t know is I’m color blind, but I can tell you, I think I created a lot of interesting trends in Boston.

Daniel Lobell: (10:34)
Yeah.

Dr. Craig Zalvan: (10:36)
[Laughs].

Daniel Lobell: (10:36)
You might be responsible for some crazy fashion that we saw in the nineties.

Dr. Craig Zalvan: (10:42)
Yeah, exactly. Eighties and nineties, I was working in Boston area and my mom was at home full-time

Daniel Lobell: (10:50)
Cool. I wonder, when you say that you’re color blind, does that have an effect on you as a doctor? I mean, are you looking at certain things, I guess it’s all kind of pink when you open somebody up. right? But are there different shades that mean different things? How does that affect you as a doctor?

Dr. Craig Zalvan: (11:08)
No, but the only thing that ever was an issue is back in medical school, when we were studying different stains with some of the slides. And really, you learn different cues. I can see every color – I just have some trouble distinguishing between shades of reds and greens, and that’s quite common. And there’s many other things that we look for in its place and it sort of just happens without giving it thought. So the short answer is absolutely no compromise whatsoever.

Daniel Lobell: (11:39)
Okay, cool. So you decided to go to New York to study. Why is that?

Dr. Craig Zalvan: (11:45)
I think that goes back to my research. I went to Brandeis University for undergrad and had a phenomenal undergrad education and pre-med education. And I was fortunate at the time that I had met one of the researchers at Dana-Farber Cancer Institute. I had a lot of interest in research and ended up with a summer job that turned into an internship type thing that I did for multiple years. And I was able to do some pretty amazing research in the tumor immunology lab. In fact, it was a lot of the work on the early binding where HIV would bind and the T cells. So it was fascinating. And, at the time at Brandeis, I worked hard and did fairly well and wanting to go to a medical school that had an MD PhD program. And I found Einstein in the Bronx to be a really top institution with an excellent research history. So I applied to many schools as many of us do and really loved that program and ended up coming to the Bronx and was there for four years, which was again a wonderful time in my life. Of course I realized very quickly that you didn’t need the PhD in order to do research. So I stuck with the MD.

Daniel Lobell: (13:08)
How did you like the Bronx?

Dr. Craig Zalvan: (13:12)
I loved it. It was the Morris Park area of the Bronx. It was just fantastic food. It was easy in and out of the city. Plus it was a beautiful campus, great gym, and it was just really a nice time in my life.

Daniel Lobell: (13:26)
My friendly comedian, Mark Schiff is from the Bronx and he has a joke about how it’s the only borough that has ‘the’ before it, the Bronx.

Dr. Craig Zalvan: (13:36)
That is true.

Daniel Lobell: (13:38)
And I loved the Bronx zoo growing up. Did you get the chance to check that out at all while you were there?

Dr. Craig Zalvan: (13:44)
Many times, it’s there, you just do it. It’s easy and there’s so much to see and even go for a couple hours with the friends from school. It was great. And even now, I brought my kids there many times and it’s a wonderful place to be.

Daniel Lobell: (13:58)
You mentioned that you were looking into research when you were in school, on T-cells attaching to HIV. I feel like I’m supposed to know about that, but I don’t. Can you tell me what that was about?

Dr. Craig Zalvan: (14:09)
So the research that I was doing was working on the signaling. When something attached to one of the T cells, which is one of the immune cells in the body, there has to be a signal that gets inside that tells the cell something’s happening and what should the cell do? So the lab that I was working in worked on that signal pathway, and it happened to be where HIV binds to the cell. That was the signaling pathways that we were working on at the time and not just for HIV, but the whole pathway of how cells talk to each other. And that was pretty early on in the pathway, understanding the pathways that cells talk to other cells. I’m very far removed from that today, but it’s far more advanced.

Daniel Lobell: (15:00)
I imagine that research is probably playing a role in whatever form it’s now taken with Corona, because that seems to be what I hear about anyway, the type of research that they’re looking at. Am I mistaken?

Dr. Craig Zalvan: (15:14)
You’re absolutely right. And basically all research is based on everything that’s been done before and certainly with Corona where the spike proteins and how that binds to cells, that’s where we’re trying to make sure that we have good vaccines so that the spike proteins of the virus can’t bind to cells. And then we can get rid of the virus by using this immune reaction. And so much more is understood nowadays. It’s just amazing how they have a vaccine in our arms in pretty much less than a year. It’s just unbelievable. Unfortunately variants are coming out, but I’m hopeful that we’ll start seeing some of these vaccines that if we need them, will help with these variants also.

Daniel Lobell: (16:04)
I liked the language you use talking about the cells talking to each other. It gave me a funny visual in my mind, But what are we talking about? When you say something like that, the cells talking to each other, do cells actually communicate with one another?

Dr. Craig Zalvan: (16:19)
On so many different levels. So there’s communication directly by one cell touching another cell, there’s chemical mediators that cells secrete something that tells another cell what to do. Everything is always in constant communication in the body, whether it’s the nervous system or on a cellular level, different metabolites, all of this is all constant communication,

Daniel Lobell: (16:47)
Do the cells ever fall in love with each other?

Dr. Craig Zalvan: (16:49)
They definitely do, the heart cells in particular.

Daniel Lobell: (16:55)
[Laughs]. I just thought of a stupid joke. They’d be cellmates right?

Dr. Craig Zalvan: (16:58)
As well. It’s a different kind of cell.

Daniel Lobell: (17:01)
[Laughs]. But you’re serious. The cells in the heart really do fall in love. Is that why we associate the heart with love?

Dr. Craig Zalvan: (17:08)
I don’t know where the heart comes from with love. It’s a good question. I don’t know where that derivation is. Maybe Cupid, I guess.

Daniel Lobell: (17:15)
But that’s interesting. When you say they do actually fall in love in the heart, what does that mean? How do we know that cells have fallen in love?

Dr. Craig Zalvan: (17:24)
If they’re getting along nicely, you’re able to go run a marathon. If they’re not liking each other, then you get a heart attack.

Daniel Lobell: (17:32)
So maybe instead of taking all these bypass surgeries, people should go for cell therapy, talk to the cells and see if they can’t work it out on their own.

Dr. Craig Zalvan: (17:45)
Well, you’re bringing up bypass and I’m a big believer. A lot of my practice has a diet-based approach. In particular, I treat reflux using diet, but cardiovascular disease is one of the nation’s biggest killers. A lot of it is actually preventable and reversible and mostly has to do with our diet. We really eat a pretty poor diet in this country. And that’s why we have such high rates of heart disease, diabetes, strokes, cancers, and the same with reflux. That’s why we see so many people with refluxes. Just our diet is terrible.

Daniel Lobell: (18:20)
Are you a proponent of a plant-based diet?

Dr. Craig Zalvan: (18:23)
So I propose a plant-based Mediterranean style diet. Everybody knows nowadays that a Mediterranean diet of fruits, vegetables, grains, and nuts is by far healthier. Five years ago, when I’d tell people to switch over to a mostly plant-based Mediterranean style diet, they would look at me like I have three heads.

Dr. Craig Zalvan: (18:49)
Today, everybody gives me a little nod and looks down and says, “Yeah, I know, I’ve heard about this.” And the data clearly is showing that the more plant-based the diet, the healthier the diet is for you. Now, what I’d say to my patients is 90 to 95%. What that means is you can have plant-based, fruits, vegetables, grains, nuts almost all the time. And about two or three times a week or if you want to go wild and crazy three to four times a week, you have a couple ounces of whatever meat you want. I don’t differentiate between eggs, chicken, fish, pork, steak – in my mind, they’re all the same. And I don’t believe dairy is a healthy drink for us – we weren’t meant to drink the milk of another animal.

Daniel Lobell: (19:39)
I have been dairy-free for well over a year. And I’ve been much happier for it.

Dr. Craig Zalvan: (19:43)
Yeah, happier and healthier, it’s not good for us. And especially with reflux, I see people as a subspecialist who have been treated by multiple doctors, they’re on multiple medications many of which have potential side effects, and then you get them to switch over to a different diet. And within weeks they’re feeling markedly better. What’s really interesting is you see a lot of patients come back and say, you know, “I don’t need these medicines for acid anymore.” And “Oh, by the way, I don’t need this medicine for my type two diabetes,” same with blood pressure because these diseases are diet-based diseases.

Daniel Lobell: (20:23)
It’s so funny to me, when I think about it, how medicine probably started out in terms of “Take these herbs and spices or whatever it is”. And then it gets so advanced, only to come back around to “Okay, let’s go back to the basics, to the diet.”

Dr. Craig Zalvan: (20:38)
You know, it’s funny, but it’s always been the same because even the medications are based on herbs and spices and it’s all about isolating one specific compound and that’s what the medications are. And honestly, they’re amazing if you think about how these medicines work. Take proton pump inhibitors, for instance, these are the medicines like Omeprazole that suppress the stomach acid – it’s genius how well they work. You take this pill and the stomach stops secreting acids fairly well, not completely, but fairly well. And so then everybody thinks, “Well, if you have an acid reflux problem, you just take these pills.” And of course, then the philosophy became both, “Oh, you’re not better? You need two of the pills. And oh, you have to add on another pill also.” And so now you’ve got these people coming in and they’re on 15, 16 different pills. And for all their different medical problems, because they’re all being treated with one specific compound, whereas diet is ultimately what will fix a majority of these people’s issues. And let’s not forget these medicines have side effects.

Daniel Lobell: (21:41)
Right? Let’s go back a minute to reflux. What is causing reflux? Can you break it down for me, for the listeners on a very basic level? What is reflux, what causes it and in what type of environment are people more prone to it in?

Dr. Craig Zalvan: (22:03)
It’s a great question. And obviously there’s one simple answer. It is a diet-based disease, much like many of the other chronic diseases that we see in the country. But first of all, there are two types of reflux where, when somebody hears the word reflux, they think about GERD, which is gastroesophageal reflux disease. And the typical symptoms of GERD are heartburn, indigestion, usually more of an abdominal type symptom. And that is something that the gastroenterologists typically take care, though I can tell you for a lot of my patients, GERD goes away when we treat them, what I treat is a different type of reflux,

Daniel Lobell: (22:45)
LPR?

Dr. Craig Zalvan: (22:45)
LPR, laryngopharyngeal reflux.

Daniel Lobell: (22:46)
There was no way I was even going to try to say that.

Dr. Craig Zalvan: (22:46)
And that’s why I did it for you. It makes it easier. I say it every day, like 50 times a day. So LPR is reflux that comes up and affects the throat and the symptoms are very different. So most people with LPR are going to come in complaining, “Doc I’m clearing my throat all the time”, or “I feel a lump in my throat”, or “I have a chronic recurrent sore throat.” I don’t believe reflux causes voice problems, but when people have a problem with their vocal folds, reflux can make that worse. Some people have some trouble swallowing and also chronic recurrent coughing. All of these can be due to acid and digestive enzymes from the stomach that can irritate the throat area. And that’s called LPR and the two different diseases because people that have LPR do not necessarily have GERD and vice versa.

Dr. Craig Zalvan: (23:46)
So it’s all part of the same anatomy because in order to have reflux, you have to have acid come up from the stomach into the throat. But the stomach and the esophagus are very well-protected against acid. So it’s easy that any acid that goes up into the throat can damage the throat, but leave the esophagus alone. So that’s sort of what LPR is and GERD. And that is refluxing. And really there are many causes of reflux, but the major cause is our dietary indiscretions. Now, classically people are told to avoid coffee, tea, chocolate, soda, greasy food, fried foods, fatty foods, spicy food, alcohol. Sorry, I just ruined your night.

Daniel Lobell: (24:33)
[Laughs]. My night, that was my next hour.

Dr. Craig Zalvan: (24:35)
Then the next hour, there you go. So those are not causes of acid reflux, which is commonly thought by most people. Instead, those are triggers. Those are items that can make your reflux worse or set it off. Again, what you eat is the cause. So that’s why we focus on a diet-based approach. And that was published a couple of years ago in the journal of American Medical Association was my research showing that this diet-based approach, namely a plant-based Mediterranean style diet together with alkaline water, which is water that has a high pH, the opposite of acid, can treat acid symptoms in the throat, as well as if not better than twice a day dosing of the proton pump inhibitors. And so that’s now the regimen that we use here to treat people who have reflux that affects their throat. And of course will help with their gastroesophageal reflux as well.

Daniel Lobell: (25:34)
So basically somebody comes in, you say, “I’m putting you on this diet and go and pick up some alkaline water and call me in the morning.”

Dr. Craig Zalvan: (25:43)
In a sense. A lot of my patients have already seen multiple doctors and have had multiple diagnoses for their symptoms. And coming in they’ll often be very skeptical of a diagnosis of reflux or more skeptical when I tell them, “No, you don’t have reflux.” So sometimes the history, hearing their story, looking at their examination gives me a good idea of what’s going on. But for those that are in question, we can actually measure the acid levels in the throat or the simple test. It’s a small tube that goes in the nose that measures acid in the throat only. And that can show me that there’s acid that is present or isn’t present, which helps me make that argument. But essentially, yeah, at the end of the day, if I’m thinking reflux is a big cause of the problem, then I’m going to explain to them that a diet-based approach works. And as I said earlier, people are a lot more amenable now to trying diet, not just for reflux, but it’s pretty common knowledge now that diet is going to help you with your heart issues and your overall health and people are pretty well-informed, certainly in my area here. There’s a lot of people that are into more holistic approaches and they want to exercise more for longevity and they know that diet is a big factor. So it’s not been as difficult for me to get people to make these dietary changes.

Daniel Lobell: (27:16)
Well, that’s encouraging.

Dr. Craig Zalvan: (27:16)
I think it’s commonplace. We turn on the news all the time and there is another segment about another article on better health with this type of Mediterranean diet and this disease is treated with diet and it’s much more commonplace now.

Daniel Lobell: (27:33)
Have there been studies done to understand why some people are able to eat a certain diet and not deal with reflux, whereas other people suffer from the same diet?

Dr. Craig Zalvan: (27:47)
Well, there are multiple factors that result in reflux disease. So the anatomy, for instance, there are some people that have anatomy issues that can predispose to reflux. Obesity is clearly one of the big ones and chronic obesity leads to hiatal hernias and lack of muscle strength that leads to weakening of the sphincters that are sort of the gatekeepers of the esophagus and the stomach and the throat. And over time, those can be damaged, leading to reflux disease. In addition, viruses play a big role. It’s interesting, COVID is on everybody’s mind right now, but what’s one of the biggest side effects that people with COVID complain of early on? Loss of smells. And that’s because the COVID virus itself can bind to the area in the nose where the nerves are for smell and viruses directly can cause nerve damage.

Dr. Craig Zalvan: (28:49)
So we also know that a lot of people, if they’re exposed to a variety of different viruses in their throat, it can alter their sensitivity. So all of a sudden, somebody who’s never had a problem with reflux in the throat, no symptoms, now, all of a sudden they’re clearing their throat, coughing and having a burning sensation because their normal acid levels are now exaggerated in the sense that they’re more sensitive to them. So viruses can increase sensitivity in the throat. And that’s why sometimes people have new onset symptoms. There’s really many different factors that go into reflux disease, but again, tying it all together, diet is the biggest cause of the short term episodes, as well as the long-term chronic nature of the disease.

Daniel Lobell: (29:36)
Now, because you’re bringing up the throat with regards to Covid, I’ll bring this up. I asked another doctor about this. We cover our nose. We cover our mouth for COVID, but the ears, which are connected through the same thing, not so much. And he told me that it was a good question. I think it might have to do with the mucus membranes in the ear that are more protective. Is that something you could expand on?

Dr. Craig Zalvan: (30:03)
Yeah. So the ears have their own protective covering inside. It’s called the eardrum and the eardrum prevents the mucus membranes that are inside the middle layer from having anything go out the air into the air itself. So our eardrum is protective. Just like water doesn’t go into your head through your ears. If you get water in there, you can’t get anything out of your ears. Now, if somebody has a hole in the eardrum from trauma or a tube as a child put in, then that can certainly lead to air escaping. So some people, if they sneeze and they have a hole in the eardrum, you can get some stuff out of the air. I know it sounds gross, but it’s true. And in that case, COVID would be an issue, but really, the biggest issue is sneezing and coughing. And that really is where the majority of particles can come up that can have COVID.

Daniel Lobell: (31:01)
Can I pitch you an idea that might make us both very rich?

Dr. Craig Zalvan: (31:04)
I love any idea that could make me rich.

Daniel Lobell: (31:12)
Eardrums for the nose.

Dr. Craig Zalvan: (31:12)
They have them, but one problem is that you have to be able to breathe.

Daniel Lobell: (31:20)
[Laughs].

Dr. Craig Zalvan: (31:20)
You know, you can put some tape on the mouth and your eardrum idea on the nose, then all sneezing and coughing would stop permanently.

Daniel Lobell: (31:30)
Right. I heard somebody say about the masks with COVID: They say that two masks are more effective than one. And then someone else said, “Three masks is more effective than two.” And somebody said, “If you put enough masks on you won’t breathe at all. And then you definitely can’t get Covid.”

Dr. Craig Zalvan: (31:45)
[Laughs]. Well, that is very true.

Daniel Lobell: (31:46)
[Laughs]. Let’s talk a little bit about the doctor-patient relationship. What do you think are the most important facets of that relationship?

Dr. Craig Zalvan: (31:57)
I think that that’s really not something you can learn in medical school. I think that relationship is the most important part of getting a patient to feel comfortable, open up and give as much information as possible and then be receptive to treatment. And I think that that doctor-patient relationship is really based on being available for your patients, being able to help them with their problems and understand them, listening to patients is something that is really hard to do nowadays with these computers that we have to all enter data into, but really listening to what the patient’s trying to say, rather than just what they’re saying. And I think having some compassion and understanding that, even as trivial as a problem may be, it’s a big problem for that person because they wouldn’t come here to my office if it wasn’t something that was bothering them.

Dr. Craig Zalvan: (33:01)
And so I think that’s the important part of understanding really what your patient’s trying to say and talk to you and they want to be heard and more importantly, not dismissed. And again today where your schedule has to be double booked and we’re all busy typing into computers, it’s very easy to forget that there’s a mother, a brother, a sister, a father sitting right across from you. And, frankly, I kind of look at everybody and say, “If this were my family member, how would they want to be treated? And how would I want to treat them?” I mean, I guess it depends on which family member, but that’s another story.

Daniel Lobell: (33:39)
[Laughs]. What do you wish your patients knew coming in?

Dr. Craig Zalvan: (33:47)
What do I wish they knew? That’s an interesting question. I think you got me. Well, obviously when they leave, I can tell you what I wish they knew, but coming in to see me, I think that I would like patients to know that they’re coming to see somebody that is going to listen to their problems and issues and hear them as a person, not just another number or another person on the schedule. And that I’m an out of the box thinker and I’ve been known to think a little differently, try things a little differently and be willing to look beyond where others have looked. And that’s kind of the basis for my practice over these years. Again, that’s because I’m a subspecialist.

Dr. Craig Zalvan: (34:42)
So people for instance may be hoarse and they’ll go to the ears, nose and throat doctor. And nowadays of course, everybody gets diagnosed with reflux and put on medication, but I like to look that next step further and see, “Well, I don’t think it’s reflux. What else is going on?” And then ask the next question, “Well, why is that going on? And that’s what I’d want my patients coming to see. I’d like them to know that I like to think a little bit out of the box or a lot out of the box and take that approach of trying to understand why something is a problem, not just what the problem is.

Daniel Lobell: (35:22)
I like that answer.

Dr. Craig Zalvan: (35:24)
Thanks. So just off the cuff, it’s an interesting question. I don’t think I’ve ever been asked that before.

Daniel Lobell: (35:32)
Well, you can scratch that one off the list now. Eventually you’ll get to a point where you’ve been asked everything. What’s the biggest compliment a patient can give you?

Dr. Craig Zalvan: (35:46)
I think the biggest compliment that I get from a patient is when they send me their relative or send me a close friend. I think that to me is the biggest compliment, that they felt that I was able to help them, that they were listened to and that they want to send that information to someone who’s close to them and important to them.

Daniel Lobell: (36:09)
I guess it goes back to your joke. It depends what they think of the relative that they’re sending you.

Dr. Craig Zalvan: (36:14)
Very true.

Daniel Lobell: (36:17)
[Laughs]. But I’ll take the optimistic view on that. What’s your view on the online health space and do you encourage or discourage your patients to look online for information before they come see you?

Dr. Craig Zalvan: (36:29)
I’m a huge fan of knowledge. I believe that the best adherence to treatment comes from a well-educated person. And certainly with my treatments, I provide my patients with tons of stuff to look at, to read, to go online. And I think the information online is fantastic. The problem is there’s so much information online and there’s so many possibilities without much training or understanding, that people tend to misdiagnose and over-diagnose. I can tell you most people who come in, sit in my chair, they’re worried about their throat discomfort. They’re just waiting for me to say, “You don’t have cancer.” And many are convinced their symptoms are cancer, because they looked it up on Dr. Google and they are convinced that there’s something growing there. So I think the internet is an amazing tool and obviously a huge wealth of information, but it can also be kind of dangerous because it’s a tool that’s not well controlled and there’s really minimal guidance for a regular person to just go online and look up medical issues.

Daniel Lobell: (37:47)
Well, I think that’s where Doctorpedia comes in. In your opinion, how do you think Doctorpedia can best assist the online health space?

Dr. Craig Zalvan: (37:57)
Well, I think the major focus of Doctorpedia is to do just what I said, it’s providing important information that’s pertinent to a particular problem with experts in the field who can help tease through all that information and let somebody read or look at a video or understand what symptoms might be or could be, but also under the guidance of some informed information. So again, it takes away the wondering of what I’m reading and looking at, and if it pertains to me. So I think by getting together a lot of experts in the field or the various fields of medicine, you’re providing an encyclopedia so to speak of all the different medical issues and problems in a space that’s easy to navigate and provides information that a patient can walk away and say, “All right, I have these symptoms. And based on what I just saw, it’s probably not cancer, but I do need to get it checked out.” And I think that that’s really the major focus of a site like Doctorpedia.

Daniel Lobell: (39:10)
Maybe we should change the name to, “It’s probably not cancer”.

Dr. Craig Zalvan: (39:14)
You know, you’d be surprised, but I can guarantee you not just in my specialty, in every specialty, people walk in that door and they are afraid of cancer. Understandably, of course. But, it’s something that I see almost every time I use a camera to look at someone’s throat, that’s the first thing they’re waiting for me to say.

Daniel Lobell: (39:35)
Yeah, well now it’s probably also, “I hope it’s not COVID.” Talking about COVID, I know that some patients have been reporting a post viral cough after recovering from COVID 19 – what’s causing this phenomenon?

Dr. Craig Zalvan: (39:51)
It’s actually a very interesting phenomenon that we’re seeing much like I said earlier, how we know that people lose smell because COVID itself virus can affect the smell nerves. We’ve known for years that many viruses can affect multiple nerves. So for instance, we know that people who get shingles, they often have a rash across their chest or on their back, that rash goes away. But they’ll complain of months or years of pain in that same area. There’s nothing there, but the virus itself has caused damage to the nerves. So in the head and neck area, we know people can have viruses that cause acute loss of hearing in one ear, acute loss of smell. And this is even before COVID, we’ve seen this for many, many years. Viruses can also affect the vocal folds, they can cause weakness or paralysis in the voice box and can change sensitivity.

Daniel Lobell: (40:45)
Can you remind me about the sensitivity that you mentioned earlier?

Dr. Craig Zalvan: (40:52)
Sure. So many patients will come in and tell me this typical story. So for instance, chronic cough is what we’re talking about. Well, they’ll tell me “Oh, three months ago I had COVID” or “Three years ago, I had a bad respiratory infection” before we even saw COVID. And they’ll tell me that their symptoms were horrible and they felt really terrible and all that got better, but ever since that time, they’ve been having a cough, it’s been terrible. They’ll tell me this story, “Doc, I got a tickle in my throat right over here”, and they’ll point to the lower throat left or right side. And they’ll say, “When I go out in the cold, or if I’m talking or eating food, drinking liquids, odors, perfumes, I get this tickle and then a cough and I’ll have these coughing spasms.” Now that’s the typical story. And most of these patients are diagnosed with asthma. They’re diagnosed with cough variant asthma. And in fact, they don’t have asthma. The cough is coming from the throat itself because that nerve was damaged by that virus. And now their throat is extra sensitive. And that’s why any of these stimuli can set off these coughing spasms.

Daniel Lobell: (42:04)
So interesting. Before I got married, I went to Las Vegas and had a bachelor party and I smoked cigars for like three days straight with my buddies and my throat was killing me at the end of it. And to this day, whenever I smoke a cigar, which I rarely do anymore, there’s a heightened sensitivity. But before that I could smoke cigars anytime, I never had a problem. So did I damage a nerve that weekend in my throat that’s triggered by smoke now, what do you think that could be?

Dr. Craig Zalvan: (42:41)
You probably didn’t damage the nerve by smoking, but you certainly did cause some damage to all the tissue in that area. And there are chemicals like chemical exposures that can lead to changes in sensitivity. And maybe that is what you did with that cigar smoking. So a simple bit of advice. Don’t smoke cigars.

Daniel Lobell: (43:05)
[Laughs]. Man, I didn’t see that coming from a doctor. So I thought this was interesting. The prevalence of the chronic cough is higher in Europe and America than it is in Asia and Africa. Why do you think that is?

Dr. Craig Zalvan: (43:19)
Well, again, there’s always multiple reasons. There’s never just one thing. And I’m a big believer that no problem comes from just one issue. There are multiple factors. Again, you look at the dietary background of both these areas, Western society versus some of the other societies. And our diets are really poor or high meat diets, high dairy diets, whereas most of the other areas are far more vegetable-based diets. So diet itself is a big factor, also to the exposures to different types of viruses and with COVID in particular, it’s hard to say, cause COVID’s everywhere, we don’t hear much in the news about COVID in Africa and South America, other than Brazil, we just really get it focused on here. But it’s everywhere and COVID affects people the same way everywhere. And why is there a higher incidence of costs? Primarily because we have a higher incidence of doctors, we have higher incidence of diagnosis and testing. And I think that you see that reported far more often and no one’s really done studies where you go from country to country looking at the exact incidents of cough and then why they’re coughing.

Daniel Lobell: (44:46)
That’s interesting.

Dr. Craig Zalvan: (44:46)
It’s a good question. I don’t know the exact answer as to why there is such a difference, but there are many factors that go into why one disease is more prevalent in another area.

Daniel Lobell: (44:59)
Yeah. Did you ever, because of the stuff you’ve been repeating about diet, have you ever read any of the work from Dr. Esselstyn or Dr. Dean Ornish?

Dr. Craig Zalvan: (45:10)
I do. And I know them well, absolutely. How about T Colin Campbell? He wrote a book called The China Study.

Daniel Lobell: (45:18)
I read that book.

Dr. Craig Zalvan: (45:18)
Essentially that book is sort of the early basis for a lot of these other people that you’re mentioning. And they all have one thing in common: There’s clear science and data showing that the more plant-based the diet, the healthier it is for the body and that most of our chronic diseases that we see in our country, heart disease, diabetes, stroke, and cancer are because of the diet. It’s not genetics, it’s not the environment, it’s the diet. All these books come out that talk about the same thing. You go on this plant-based diet. And with Esselstyn, you can see reversal of cardiac disease.

Daniel Lobell: (46:00)
That was pretty impressive.

Dr. Craig Zalvan: (46:02)
It’s very impressive. And there’s more and more information that comes out on a daily basis now on diet and how it works and how it functions and how it can reverse these diseases.

Daniel Lobell: (46:14)
I used to have a joke about how the very first story in the Bible is a dietary one where man got put on the easiest diet of all time. You could eat anything except for one tree. We couldn’t even keep that going. So we never had a diet down. It seems like it’s probably the big challenge of all of human history. Maybe we’ll get it eventually.

Dr. Craig Zalvan: (46:39)
Well, it is. And I think a lot of it has been propagated by a lot of the recommendations that you see that come out, the food pyramids and whatnot. There’s a lot of influence from industry and in our country, the dairy industry, the meat industries, they’re huge and they’ve got lots of money and that’s why you see a lot of them still on the food pyramid.

Daniel Lobell: (47:04)
I think there was a study on sugar in the 1970s that was paid for by the sugar company that said that sugar was great for you. So I know you’ve given a lot of lectures over the years and I’m going to try and say it right. I’m sure I’ll already have forgotten. Otolaryngology?

Dr. Craig Zalvan: (47:21)
Otolaryngology.

Daniel Lobell: (47:29)
So I know you’ve given a lot of lectures on otolaryngology topics. What was the focus of your most recent lecture and what topics will you be lecturing on next?

Dr. Craig Zalvan: (47:40)
I think the most recent lecture I did was for the American Academy of Otolaryngology at our national meeting. And it was all in zoom, of course. And I did this with one of my partners, Dr. Jonathan Aviv, who’s also a member of ENT and Allergy Associates. The focus of the lecture was on the use of a diet-based approach to treat reflux disease. So I explained to otolaryngologists around the world, how, first of all, we reviewed reflux disease, LPR, laryngopharyngeal reflux. And then I talked about how a mostly plant-based diet will prevent and reverse these diseases without the use of the medications, the proton pump inhibitors. And I’ve actually been giving this lecture to the Academy for the last couple of years. And it’s always interesting to see how many people will email for the papers that I give my patients and how do you get them to change their diet and I want to do this for myself. It’s a topic that’s important because I do believe that it’s becoming far more accepted to go the more holistic diet-based approach than it used to be.

Daniel Lobell: (48:59)
It would be funny if you were giving the lecture to a big room of people while they’re all eating steak dinners.

Dr. Craig Zalvan: (49:04)
Yeah. Well, that has happened, believe me. And let’s just say they still finished their steak dinners, but with maybe a little bit of guilt.

Daniel Lobell: (49:13)
[Laughs]. You hear all the forks dropping.

Dr. Craig Zalvan: (49:13)
But interestingly enough, I’ll tell you, there has been many people that I’ve spoken to who will email me or run into me six months later and tell me that they are now completely plant-based and they’ve given up their meat because much of the information that I’ve given to them or at least given them some direction to look up other sources like many of the books that you just mentioned, those authors. And as far as my next lecture, I’m doing a lecture for singers. I’m actually going to do a primer for young singers primarily at the school age. And my goal is to introduce the entire topic of voice, what voice is, how it works and functions, and then real importantly, going into what can go wrong.

Dr. Craig Zalvan: (50:04)
And the focus of the lecture is going to be, “What are the symptoms? What do you need to look for that you might feel or hear, even if others don’t?” And that the sooner you get intervention, the far better off you’ll be. It’s a sad story in that I see a lot of young teen singers and beautiful voices, very gifted, and they come see me two weeks before they’re going for an interview, or they have an upcoming performance that they’re rehearsing for and they’re having problems. And unfortunately they’re having problems because they’ve had problems for months or years and have been ignoring it. And now they want the quick fix before the next event. And again, my goal is to get these younger kids to learn how to prevent this damage so that they can go on and have a very fruitful career with their voices. So that’s our next lecture

Daniel Lobell: (51:06)
You should title the lecture “This is the Voice.” [Laughs].

Dr. Craig Zalvan: (51:06)
[Laughs]. Exactly. I’ve seen some of those people by the way.

Daniel Lobell: (51:13)
Oh yeah? [Laughs].

Dr. Craig Zalvan: (51:14)
Yeah.

Daniel Lobell: (51:17)
I imagine you probably get a lot of great singers that come in, people that I would know.

Dr. Craig Zalvan: (51:22)
Yeah. And you know what’s interesting? Well, I can’t give names, but being in Westchester, just North of New York city, there are a lot of Broadway singers and singers at the Met that work in the city, but live up in the suburb area. And, I’ve been fortunate to develop a good reputation amongst the singers up here so that a lot of them refer each other to me. Again, that’s back to your best compliment you can get from a patient is another referral.

Daniel Lobell: (51:51)
They’re singing your praises. [Laughs]. Stupid, but it works.

Dr. Craig Zalvan: (51:58)
It works. I like it.

Daniel Lobell: (51:59)
What do you do for your own health other than keeping a healthy diet?

Dr. Craig Zalvan: (52:04)
I think diet is the most important factor in staying healthy. And certainly I do that, but I’m also very active. I’m a huge fan of Peloton. I think it’s the best thing since sliced bread, certainly during a pandemic. But I’ve been doing Peloton before that. So I do my spinning and do yoga and then just a lot of quality time with the family. I’ve got a dog and we do lots of walks and hanging out and having fun, laughing. All this I think is what keeps us happy and healthy. And the two go very much together.

Daniel Lobell: (52:42)
Well, I agree with that. And I also will second what you said about the Peloton. I just got one and I’m loving it.

Dr. Craig Zalvan: (52:48)
Yeah, it’s great. It’s really terrific.

Daniel Lobell: (52:51)
Just for me, next time you have a singer come in and they just suck. Come on, one time.[Laughs].

Dr. Craig Zalvan: (52:58)
I can’t do that. I just can’t do it. It’s not going to happen. Maybe I’ll recommend they go into speaking instead of singing.

Daniel Lobell: (53:10)
No, I know. Doctor Zalvan, it’s been a pleasure talking with you.

Dr. Craig Zalvan: (53:14)
Absolutely. I totally agree.

Daniel Lobell: (53:16)
I learned a lot as well. Thank you so much for doing the show.

Dr. Craig Zalvan: (53:21)
Really it’s my pleasure. And thank you. This is a wonderful interview and I’ve thoroughly enjoyed it and enjoyed sharing some of this information.

Daniel Lobell: (53:29)
All right. Thank you. Take care.

Daniel Lobell: (53:36)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.