The Breathing Triangle® with Dr. Madan Kandula, Co-Founder and CEO, ADVENT

Ben Wagner  01:30

Hello everyone, and welcome to the Medical Alley podcast. My name is Ben Wagner and I am so excited to host today's episode. We're joined today by Dr. Madan Kandula, who is the founder and the CEO of ADVENT, a nationally recognized pioneer in ENT medicine. They specialize in office based breathing triangle solutions, and we'll talk about that in just a moment, what that is, essentially treating nasal blockage, sinus, snoring, and sleep apnea health concerns. Big challenges facing a lot of people. I know plenty people in my family are dealing with this every day. Also, we're delighted to have ADVENT joined as a Medical Alley partner in 2023. So Dr. Kandula, it's great to speak with you today. 

 Dr. Madan Kandula  02:12

Great to be here. Thanks for having me. 

 Ben Wagner  02:13

So let's, you know, first off, ADVENT is growing like crazy. And you've — we're recording this on the 14th of December. But you've got a location opening today in Maple Grove, Minnesota. 

 Dr. Madan Kandula  02:25

Yeah, exactly. Yeah. Ribbon cutting today inMaple Grove. So that'll be that's our fourth location here in the Twin Cities. It's been great, great reception. And we've been able to serve a lot of folks here so far. 

 Ben Wagner  02:36

Well, great to see you grown in the Twin Cities, too. I want to get started though with kind of your path of how you got to where you are today. And I understand that you are by no means the only doctor in your family. 

 Dr. Madan Kandula  02:48

No, I'm the, well I'm the baby and my family, my nuclear family. And so my both my parents are physicians. I've got two older sisters that are docs they are both married, and their husbands are physicians. So I was predestined to probably do what I'm doing. 

 Ben Wagner  03:05

It's a family business. 

 Dr. Madan Kandula  03:06

A little bit. 

 Ben Wagner  03:06

Yeah. But so take me to kind of where you've been and how you got to where you are today. I know you and your wife co-founded ADVENT in 2004 in Milwaukee. Kind of take me to how you got there and really, you know, how did you, what inspired you to to found this business? 

 Dr. Madan Kandula  03:24

Well, I mean, it's a long story. But I'd say we founded the business almost out of necessity. I was trained as an ENT, my wife's an audiologist. We were actually working in another practice in Milwaukee from 2003 until 2004. Left that practice, started ADVENT in 2004, really just with the intention of being the best ENT I could be, my wife Gwen being the best audiologist she could be, and just trying to serve our community. And, you know, I was an early adopter for new technology. And bringing that, those new technologies in and having really I call it a passion for serving our patients in the way that we that I felt was the right way, sort of started the ball rolling where people started coming, you know, kind of we started to get sort of known. And then people would be coming into Milwaukee from, you know, locally, and then eventually throughout the state, and then eventually kind of flying and all that kind of good stuff. And so what I recognized, though, over that sort of early phase of the practice was that the things that people were coming to see me for, the procedures that I was doing are things that I thought I'd be able to actually teach other people to do it and the way that I do it or did it and then be able to actually serve more more folks. So kind of the pathway to that has led us to the ADVENT that we're really talking about today, started from nothing, you know, then went to one office and I was a solo doc for 10 years. It was a pretty decent part of our history. We're 19 years old. Ten out of those 19 years, we had one clinic in Milwaukee and the last you know, few years we've been growing and that's growth intentionally and growth, you know, I think we'll talk about the specifics around that. But really, I think the other aspect of our growth was understanding the power of the treatments that we were delivering and trying to be laser focused on the treatments that had the most impact. So yeah. 

 Ben Wagner  05:16

Okay. Well, on your website, your focus says simple sinus and snoring solutions. I wanted to make sure I got that right. So how does ADVENT treat these sort of breathing or sleep issues differently? Because you hear about it all the time. 

 Dr. Madan Kandula  05:31

Yeah, I think really the best way I can describe it is we took the model that existed, and completely blank slated it, and then built it back up again. And the reason I'm saying that is for sleep apnea in particular, which is a very prominent condition, period, and a prominent condition that we treat, the healthcare system that has grown up around it is broken fundamentally. So as a specific example, if you have sleep apnea, you're more likely to fail in your treatment than to succeed. And so at ADVENT, it's just understanding those dynamics, understanding that obstructive sleep apnea as a specific example, is a throat issue 100% of the time, and we are nose and throat specialists, so kind of making sure that we are focused and laser focused on the areas that we're treating and making sure we're able to communicate those areas to the world. And then bringing the simple solutions that you kind of just mentioned into the mix. So it allows us to start at the beginning, which is the nose, make sure those areas are working properly, make sure we're keeping somebody's throat open properly, and doing it in a manner that I would want it done unto me. So if I were a patient, if I were a patient, I would want a process and a system exactly the way that ADVENT is. And that's really the mold that I've you know, that is the mindset I have. And that is the model that we've created. And we'll continue to refine it. And as new things come on the playing field, will vet them, we'll determine if they're going to be beneficial to the majority of our patients, and if so we'll figure out a way to incorporate those things. So our model is clearly and totally focused on the patient that we're serving. And we are, in a way we're subservient to those — our patients needs, if that makes sense, which makes all the difference in the world. And, you know, for me what that means, and as an organization, what that means is we're able to deliver outcomes at a level that nobody else can compete with. 

 Ben Wagner  07:25

It's interesting you say that most sleep apnea cases they fail. Yeah. And it's interesting, but then I think about kind of individual cases within my own family. And it's not so hard to believe, because most of the time, it's the CPAP machines, and it doesn't work. They don't want to and whomever it is, they don't like it. And you give up and you just go back to the status quo, the way you live your life, which is not great. I guess why is this awareness around sleep apnea is so crucial? What are some of those misconceptions maybe that people are not understanding? 

 Dr. Madan Kandula  08:01

I think one of the first perceptions, conceptions is the fact that, that this is a throat issue. I really feel like people and when I say people, I mean patients, but I also mean providers make it more complicated than it needs to be. And as an example, the CPAP machine that you just described, is not a — it's not a user friendly appliance, period. End of sentence. I'm a human being, I recognize that I would rather not sleep with a machine by my bed and a hose and a mask, yet the medical community has deluded themselves into thinking that, hey, that people are just magically going to accept this. So I think the basic understanding of the condition has not been explained properly. And hopefully, we might be able to help today. And then the treatment options have not been explained properly. And then given those two facts, I'd say, well, that's going to be impossible for for if people don't understand what's going on, and the wrong treatments are being used on the wrong type of patients, then that's what's going to deliver poor results. And the degree of failure in this space isn't just — so just when you think about it, there's about 20% of the adult population in the United States has obstructive sleep apnea. About 20% of those people have been diagnosed, most of the people who have been diagnosed aren't successful in the treatment. So there's the 80% of people who have sleep apnea who aren't diagnosed. And so I'd say that part of the reason that that 80% doesn't go and get a test, which is very easy these days, is because they see their friends, their relatives, you know, colleagues, whomever, fail in this process, and they say, I don't want that to be me, I wouldn't want that. So I think all of those things, you know, stack up the odds against individuals who have these issues. And at ADVENT, all we simply are trying to do is one patient at a time, deliver the right treatment in the right sequence for each individual patient and we've got a very dialed in process to allow that to happen. And again, the thing that matters if somebody has these issues is number one that we can help to, you know, create an accurate diagnosis. We can make sure that they clearly understand what's going on. We can make sure they clearly understand what their options are, and then we can deliver those options to actually deliver a result. Talk is cheap, you know, but results matter. And results are the only thing that matters. And for us, I'd say we give our patients that we see their best chance for success. And that's, that's why we're growing honestly. I mean, you know, I guess people will kind of sometimes look at our growth and kind of wonder, well, what's going on there? I'd say, 'Well, we were doing the right thing the right way.' And I feel a very powerful pull towards getting closer to people who have these issues. That's what's propelling our growth. What's propelling our growth is the purpose that we have as an organization to serve people out there who have these conditions that are not just not being served, but they're actually being mistreated right now. 

 Ben Wagner  11:08

Or missed, it sounds like altogether. 

 Dr. Madan Kandula  11:09

Missed. It's almost like yeah, I guess missed, mistreated. And it's, I think, again, you know, when I was a solo doc seeing, you know, patient after patient, I think what ended up happening that's created this circumstance that I've now created, is I kind of let their anger and angst seep into me. So one patient at a time was telling me their story. And each of those stories almost to the man or woman was a story that started with, you know, it started with somebody who had a problem who went and connected with a system that gave them oftentimes more of a problem, and in fact, made them feel bad about the problem that they had to begin with. So by the time somebody got in front of me, they almost had this sort of beaten down dog mindset, which is kind of like, back in the day and to this day, people come to ADVENT because they're looking, they have a bit of hope. They have a, they've heard something, they've talked to somebody, they might have heard our messaging, and they say, You know what, maybe they can, they might be able to do something. And we don't take that lightly. So if somebody comes to us with a sense of hope, then we do everything in our power to make sure that we're delivering on that promise that they've heard from from other folks. 

 Ben Wagner  12:29

And I want to hear more about kind of your your treatment options, specifically, the breathing triangle solutions here. But I also too want to take this a step further and do the consequences of living with sleep apnea. You know, what are some of the health consequences essentially, of not treating this? 

 Dr. Madan Kandula  12:44

Yeah, I mean, I think you could look at it two different ways. One is the quality of life impacts. And then the other is the actual health, physical body impact. The broad category for both of those things is if you have, and just so everybody's clear, the breathing triangle is the nose and throat. So it's basically if you think about an upside down triangle, you know, from your two nostrils and the back of your throat, those are the three areas that any human being has to breathe. And if those areas are compromised, your life is going to be compromised. If somebody has sleep apnea, the bottom part of that triangle, the throat part of that equation is too small for the body. What's happening is they're stopping breathing, they're shutting down breathing at night. Almost assuredly, the nose part of that is also compromised. So just to kind of building blocks it, this isn't rocket science, and the breathing triangle is a construct that is something we've had to create because the current way of thinking wasn't really working for people. So again, if people are following this, we've got somebody with a throat issue almost assuredly have a nose issue. And for us, it's just making sure that we are able to establish, 'Well, what's going on' and getting those areas open. But back to the question, I'd say, what if somebody has sleep apnea, and it's not being treated properly? Basically, like on the quality of life side of the equation, their life is compromised. They have a potential that isn't being fully realized. And most of the patients we treat don't realize how bad they've had it until we get them out of that cage, meaning that what does that look like? It means being tired, it means having headaches every day. It means just not being present in the life that you are supposed to have. The other thing with sleep apnea is it also likely means if you have sleep apnea that's not being treated, that it also means that the people in your household that generally are there to care and love for you find you kind of annoying and you're a problem for them too. So there aren't many medical conditions where the person who's suffering is suffering and the people in the house are suffering. And it creates this sense of shame. I think in many of our patients, they have this sort of this gnawing sense of of there's a problem here and I don't feel good about it. From a medical standpoint, the consequences of untreated sleep apnea are pretty much, if you list I'll name some of these things, but if there's a laundry list of things that you don't want in your life, they will come to you if you have sleep apnea that's but not being treated properly. So heart attack, stroke, diabetes, depression, erectile dysfunction, you know, you go on and on down the list. So actual physical issues, issues that some of those especially the cardiovascular issues, if somebody has untreated sleep apnea, and the downstream events that occur from that do you in, so if you have a heart attack, you can die. If somebody who has sleep apnea has a heart attack, and then passes away from that heart attack, and they do an autopsy, they will say on the death certificate, you know, cardiac arrest, you know, some version of 'It's a heart problem.' If they had sleep apnea, the silent killer was actually the sleep apnea. The sleep apnea untreated created that heart problem that did somebody in. So part of the problem with sleep apnea is it is the Grim Reaper. It does do people in, it just doesn't leave its calling card on death certificates. And so what that means is that this cycle perpetuates itself, and people kind of, I don't know how you say it, now that we've created some degree of awareness, I think there's starting to be this thought of gosh, if if your Uncle Sam just passed away from a heart attack, and then you say, 'Gosh, Sam snored, right? I think he had sleep apnea. He didn't get that treated.' I think people are starting to connect the dots, which is an important thing. I think the one individual that I think created some awareness around this concept was Reggie White. So he died from a consequence of sleep apnea. His wife, I've talked to her many times, and she has tried to lead the charge to get that awareness out there. But, you know, how do you say this? I think there has been some greater awareness around it, but not as much as there shouldn't be. 

 Ben Wagner  16:49

I mean, those are the serious consequences. But you mentioned the day to day, I mean, coming to work, an employer is going to see, well, this person's productivity is down. You know, that's, that's kind of the broader look at all that. So there's, there's just a lot to that. 

 Dr. Madan Kandula  17:04

There's a lot. And it's almost like, there's so much chatter that gets created from this issue, that it almost it almost makes it harder for people to focus and say, 'Hey, guys, you know, yes, this guy's got a heart attack, and he's got high blood pressure. And he's got, he's got depression. And he's always dragging. And he's always kind of just not living his best life.' And so forth and so on. And I think it can kind of get confused and all that. And on the flip side, I'll say, those kind of individuals, when we get them in and treat them properly and get their sleep apnea treated properly, their breathing issues treated properly, we've basically sort of cut off that pathway towards the end that was coming, and that person's life is impacted in a positive way that I think we have yet to do an adequate job in representing that change. So if that makes sense. We see it, we stop it. And that's great for that individual. But, you know, what would be powerful would be for that individual, you know, it's almost like that particular individual had a story that was turning page by page, chapter after chapter of this diminished life, leading to a shortened life. And all of a sudden, on in chapter six, something happened that now, you know, had you open the second book up, which is this new life, which is a longer life and more robust, full life. But people kind of don't really understand when things got flipped over, if that makes sense. We see it every day. And it never gets old for us, but I think it I think if more people understood how powerful that, you know, flipping the narrative is, I think they'd be more willing to do something, take action. 

 Ben Wagner  18:56

Well, I think it goes back to that point of people have seen what has not worked, and it prevents them from seeking care on their own. I see it in my own family. 

 Dr. Madan Kandula  19:07

Sure. And that's, how do you say, they're right for, you know, they take the information that they have and they're making conclusions off of it. And yeah, I would say, I mean, it's as kind of annoyed as I am to say what I'm about to say, I'm going to say it, which is that, you know, in a community where ADVENT is, I know there's a place where those individuals can go where we're going to do the best in our ability to get them treated properly. In places where ADVENT doesn't exist, I have no confidence that the same is going to happen, which, how do you say it, which is a powerful driving force to me to make sure we are expanding and getting out to as many places as possible so we can prevent these tragedies that are, you know, that are underway, but you know, I guess again, people are justified in their interpretation of the standard of care as it relates to breathing issues, sleep apnea in particular. But even, you know, we kind of the nose and throat, or I'm sorry, the nose part of things and the sinus part of things, too. There's a lot of folks who suffer with those issues that don't have sleep apnea that they too are negatively impacted and part of the negative impact is they don't have access to simple treatments that exists in this day and age that can benefit them. So yeah, I mean, it's a, I don't know how you say, the good thing when the system is so fundamentally broken is that there's, you know, there's many opportunities for making individuals and making populations better. 

 Ben Wagner  20:38

Solve problems. Yeah. And improve lives. And it must be just so rewarding, I can't imagine, when you see someone who's able to finally breathe through their nose. 

 Dr. Madan Kandula  20:48

Yeah, it is. I mean, it just breathe periods, I guess. Yeah, I don't know, there's a duality here. It's a powerful thing. And it never gets old for me and for any of our providers, one individual at a time. That's great. But the duality is there's the gratification of the people that we're able to help. And it's, you know, one story at a time, powerful. But the duality for me is, as powerful as that is, to me it's the tragedy is the group of people who don't have access to that those services, which are, you know, in my opinion, anybody who can't get into an ADVENT location, so those are the people, those ongoing tragedies are the reasons that gets me up in the morning. And it drives me and it drives me crazy that it still has to be that way. So yeah, it's both things. I mean, I'm certainly, I live my life in gratitude and I am very proud of the work that we're able to do as an organization, one individual at a time. But I also live my life with purpose, and part of that purpose is acknowledging the gratitude for the work that's been able to be done and seeing the massive need that's out there that, in my opinion, for me, in our organization, you know, there is not an end of the runway, meaning that, you know, as fast and as sort of fierce as ADVENT grows, there's a population of individuals out there who could use some help. And, you know, and we're talking millions of millions of people, and, you know, we'll be the change that we want to see in the world. And it is, it's a wonderful thing, without any doubt. 

 Ben Wagner  22:26

You mentioned that growth, which we touched on a minute ago, 18 locations now across four states. That new location here, there's four now in the Twin Cities. You kind of touched on, you know, you're solving a problem. So when you're solving a problem that leads to growth in a good way. What does that growth, what does that continued growth look like to you? 

 Dr. Madan Kandula  22:44

You know, I really, honestly, I think the growth, the pace of growth, it will pick up. So, you know, this year, we'll have opened eight clinics. Next year, we're on pace to open 12. And even that's not, you know, that isn't the pace that I want to have. The pace that we will have is going to be faster than that. Because we have, there's a need, because there's a purpose. It is measured and methodical. I mean, everything we do at ADVENT is very process-driven, from, you know, you name it. From our marketing to how we run our clinics, there's a reason for everything that we do, and a mindset about how we do it. So in order — we need to protect and preserve that, and we have, and we will, but we've sort of, we've been really working hard on the foundation of this organization. That foundation that we've been able to build over the last two to three years is capable of running at a faster pace, which will allow us to help more people. So you know, basically, we'll see, you know, ADVENT will be coast to coast. That is our strategy, and we will be there as quickly as is humanly possible. And my job in this organization is to make sure that the humanly possible is driven to, you know, driven to succeed. So, yeah. 

 Ben Wagner  24:00

Well, that's great to hear. I'm curious too, about kind of your view on this on this entire industry. You know, you're solving a great need here too. But, you know, where do you see this field of sleep medicine, sleep treatments going over the next decade? And, you know, maybe where do you see some opportunities for innovation? 

 Dr. Madan Kandula  24:20

There's tremendous, a tremendous need that's out there. There's a tremendous opportunity for innovation. The awareness around sleep over the last five years in particular is profound. So I think for the first time ever, people acknowledged the power of sleep and just as a clear statement, if there is one thing that you could do to benefit your overall health, it is to improve the quality and quantity of sleep that you're getting. Even above and beyond exercise. Even I'll take it above and beyond diet, other things. Now somebody some other folks might have a different order but sleep is on the very few, the tippy top, like if you're, you know, sort of creating your list of what's important, sleep's gonna be right there. Because it's your time, your body's time to mentally and physically recover. And if you do not let your body do that, you are always sort of a day late, dollar short kind of a thing. So there's an immense awareness that's there. And though here's what I will say is that there's a lot of people who talk about sleep, and they talk about how complicated it is. And there's so many factors. And, you know, there's sort of insomnia and this and the other thing, and I'd say, that's all true. But the reality as it relates to sleep is the most important thing, the single most important thing that most people can do to improve their quality of sleep is to make sure that their airway is functioning properly. If you want to ruin your sleep and ruin your life, plug up your breathing triangle. Plug up your nose, plug up your throat, and I'll guarantee you diminish live diminished sleep 100% of the time. If you want to optimize your sleep and optimize your life, you will do what you need to do to make sure those areas are working properly. And that's the thing. And that's actually not hard. That's simple. So that airway part of sleep, which, EMS, the fire department, if somebody's having an issue, if you dropped down on the ground here, we didn't know what's going on, we call them, they would come in and they would follow the ABCs in that order. The A in ABCs is airway. They would make sure that your airway is open before they worried about your breathing, before they worried about your heart. And really, from a sleep standpoint, it's the same, it's the same thing, meaning that it starts with an airway that's functioning. Most people actually in this country, most adults have airways that are compromised. It's a long story about why that is. But so most of us are negatively impacted. And so if we can help to make sure those airways are open properly, those breathing triangles are open properly, that one step would be the most important first step in getting that quality asleep. And then once somebody is able to breathe properly, then we can worry about some of these other factors. But until somebody is able to breathe properly, in my opinion, none of that matters. Really, I mean, it's not like it's completely irrelevant. But I'd say no, let's start with the A, let's start with that airway. Let's make sure that's working. And then we'll move on from there. And that is not, how do you say, the way I'm saying that and the attitude that I'm bringing, when I'm saying that isn't something that most people have heard before. And again, I would, I'd venture to say the most people will kind of hear about sleep and yeah, it's important and but it's really complicated. And we don't get enough sleep and there's caffeine and this and that the other thing. But I'm telling you, it actually is that simple. It starts with the A it starts with the airway and when that is right, everything else else has a chance of being right. And when it's wrong, 100% guarantee that everything else will be impacted by that. 

 Ben Wagner  27:52

And I'm somebody who still struggles with this. And I try. I've leaned into a lot of this research recently and trying to breathe through my nose. But as somebody who's lived my whole life like that it's a real challenge. It's a real challenge. 

 Dr. Madan Kandula  28:07

Absolutely. Yeah. And I think that's where again, I think there's, a lot of the information out there is good, and it's well meaning, the whole thing of mouth taping, breathe through your nose, all that good stuff. That's great if your nose works, but if your nose doesn't work, you're in for a miserable night. And then so it's like, I appreciate the thoughtfulness and the awareness around these sleep issues. But I sort of find it problematic and bothersome that like even like as you just described it, there's a lot of people like you who are like, 'I know, I'm supposed to breathe through my nose, but I can't breathe my nose.' And it's possible there isn't something on going on anatomically that's contributing to that, but it's probable there is. And so therefore, like in somebody, an individual like you who's you know, trying to optimize their quality of life and their sleep, and is trying to do the nose breathing and the nose breathing isn't working, what if you found out just wow, there's it's actually not as open as it's supposed to be? And what if there was a way to take care of that issue in a simple office based manner? That's what we do at ADVENT every day. And that's again, that impact is profound. And the especially for somebody where it's been going on for their entire lives. It's hard to know how impactful that is until that weight that's been you've been carrying around has been lifted off your shoulders. 

 Ben Wagner  29:29

Well, Dr. Kandula, I really appreciate your insight, your time, the work you're doing. I do want to give you an opportunity to maybe touch on something that we might have missed, or at least somebody who's listening at home and they say how do I get started in all this? 

 Dr. Madan Kandula  29:44

Yeah, I think we covered a lot of good territory. I mean, I think depending on what they've got going on, you know, our website, ADVENT's website has a lot of information even if you live in an area where you don't have access to us. We are in Wisconsin, Illinois, Indiana and Minnesota currently, and we'll expand from there. But again, for people who are just sort of hearing what I'm saying and thinking like, 'Jeez, this is something that might be beneficial for me,' there's a lot of good information there. If you're in an area where we're at, then obviously it's very, very easy to get in, have things checked out. And, you know, yeah, I think other than that, I think we kind of like I said, I think we cover a lot of good ground. I guess I would just sort of leave the audience with saying that there is hope for these issues. There is a different way. And for people who are suffering, you don't have to live like that. And for people who are suffering who've gone into a system that hasn't treated them so well, you shouldn't be treated like that. And that's kind of all I'd say. I mean, I think there's hope that's there. And we'll kind of you know, like I said, we'll try to keep fighting the good fight. 

 Ben Wagner  30:51

Well, congratulations on your growth and continued success. We're delighted to have you as a partner here in Medical Alley, too, so we're looking forward to seeing seeing what's next for you. 

 Dr. Madan Kandula  31:02

Perfect. No, you guys have been a great partner. I appreciate all the support. I mean, especially here on your home turf in the Twin Cities. I mean, you guys have been wonderful with our clinic openings and a lot of good relationships and networking, so much appreciated. 

 Ben Wagner  31:17

We appreciate that. Thank you. That is Dr. Madan Kandula, the founder and CEO of ADVENT. Website is adventknows.com if you're interested in checking that out. That has been another edition of the Medical Alley Podcast. I appreciate you for listening. I would have one ask. If you're not already a subscriber to hit the subscriber button on medicalalleypodcast.org. We're also on Spotify, Apple Podcasts anywhere you get your podcasts. Thank you for joining us. Have a great day.