Ep 331: Inside My MARPE Journey with Hallie Bulkin, MA, CCC-SLP, CMT®, CPFT™

Hello, my friends, and welcome back to the Untethered Podcast. This is your host, Holly Balkan, and this is episode 331. Wow. Okay. So this feels like a full circle moment for me because I'm going to be sharing a very personal journey, which I've done before with you all. But I'm embarking on yet another journey and it's one that many of you have been asking about since I first hinted at it on Instagram. I guess it wasn't such a hint. I was like, hey, I'm doing this. And I'm. I'm talking about my Marpy journey, my Marpi expansion journey with the amazing Dr. Spitlana cabal. So I'm going to bring her on the podcast in a couple of weeks. If you guys have questions, definitely, like, message me at Hallie Balkan on Instagram and let me know what questions you have. But I wanted to just do a little solo episode on this and tell you why I'm doing it and what I believe is going to be happening based on my consult and everything. So those, this episode is really for those of you who are curious about airway health, craniofacial development, myofunctional therapy, what it really looks like to undergo expansion as an adult, especially with the support of a knowledgeable airway focused provider. And this is not my first rodeo. Right. I have done this with the DNA Vivos appliance, but I think, like for the last little bit of my journey, I think I need something a little bit stronger. And so I know this is super invasive, but here we go. All right, let's jump in.

Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest.

Posture, tongue up, lips closed, teeth apart, breathe through your nose.

Let's get started.

Foreign.

All information, content and material of this.

Podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a.

Substitute for the consultation, diagnosis and or.

Medical treatment of a qualified health care provider. So let's start with the basics. What is marpi? What does it stand for? MARPI stands for Mini Screw Assisted Rapid Palatal Expansion. So unlike traditional expansion, and again, I'm not a dentist or an ortho, I'm just sharing based on my knowledge and what I'm learning through my own journey. But unlike traditional expansion, which is usually done in like children and it might be anchored to the teeth, right? You know, yes, you can do expansion in adults too, with other appliances. But Marpi in particular uses mini implants. And so in my case it'll be six screws. And these are inserted into the palate, into the hard palate, the bone. These act as like anchors to basically help split the mid palatal suture line and widen the maxilla. Now that said, they are using a, I feel like they kept calling it a pieza, which is basically going to be a guide to help split the suture for me when I have this put into my mouth. So it's not going to fully split the suture like with the appliance. A lot of people have told me, oh, it's really painful or, oh, there's just so much pressure because they're using the appliance to split everything. But the split is going to, I think most of the split, I don't know if it's a full split, but I think most of the split happens during the procedure when this is inserted for me. So I think that will help decrease a little bit of the initial, like pain level or pressure that a lot of people experience. I think they'll still be pressure for sure, especially as I'm turning the appliance, but hopefully it'll be mitigated a little bit compared to when we don't have that suture split happen during the installation of the appliance. Okay. And I say installation of appliance and I feel like I'm like putting a fridge into my mouth or something. All right, so. So this is typically used in adult patients where the suture is already fused. It can happen with, you know, in kids as well. So there are children who have, who also get marpi. But, you know, traditional expansion may not be as successful because of that, the fuse and like the pressure and everything that it takes to, you know, actually force the bone apart at that suture line. And so the expansion device with the MARPI applies gentle pressure over time to like reop the suture. You know, if you're not having it fully split or partially split by the by, you know, with the procedure when it's basically installed in your mouth. So why am I doing this? Everyone's like, okay, Holly, this sounds awful. This sounds, like, really super invasive. I don't know why you want to do this to yourself. Like, why are you doing it? Look, I don't really want anything invasive in my mouth either, but I just turned 40, and I feel like I'm still young. I feel like I have a lot of life ahead of me. And. And so, look, this wasn't a quick decision. You know, I've done my research. I've had. I had my consult. My kids are in expansion with Dr. Koval, and everything she said would happen for them has happened. And, you know, I just feel like, here's why I'm moving forward. Number one, I've had this persistent post nasal drip. So I had nasal surgery just over three years ago, and while my breathing improved and my inflammation, my body went down. And things greatly are so much better than they were before. I've had this, like, lingering post nasal drip ever since. It is disruptive, it's uncomfortable, it's frustrating. Like, I can't. I've tried, like, all different kinds of ways to, like, mitigate it, and it comes and goes. But we. We suspect that part of it could also be because my narrow palate may still be contributing to, like, limit limited nasal airflow, which we. I mean, we don't suspect that. We know that that is happening and so that we suspect that maybe this is happening because of that. Um, and so it could be impairing my drainage. Now, when we did look like my sinuses in general are open, but they're small, and my nasal cavity and turbinates and all that fun stuff that I had surgery on three years ago, Everything's open. My airway is open. Air can flow, but the spaces are still smaller. And it's not because of a lot of inflammation. It has to do a lot with, like, the structure of my bones at this part, this point. And that is why I'm, like, really more willing to go into something like this at this point, because I feel like I've exhausted everything else. The second reason is jaw pain and TMJ fluid flare up. So in the last month alone, my left jaw has. I don't want to say it's locked up, but, like, I've woken up and I'm like, oh, I can't open my mouth. It hurts. Like, it's actually painful. Not just uncomfortable, but painful and, like, tense. And I couldn't chew I honestly couldn't chew. And then I remember, like, later in the day, one day this happened where I was starting to chew and I couldn't chew and I was having, like, pain, and I was like, okay, something's happening. I don't like it. This is new. Let's nip this before it gets worse. Thankfully, these episodes have, like, resolved within an hour or a couple hours, but it's very clear to me that something structural is off. And so I believe that this is related to the. My underlying asymmetries in my maxilla, my upper jaw. And so let's talk about the facial asymmetry. This is, like, point number three here. Reason number three. So my left side of my maxilla is actually turned in a bit. This has been visible to me for years. And I actually, when I did a consult with a colleague in the myo space, you know, she had said to me, well, can you go back and find photos? And, like, look and see. See, like, when you think this started. And I have. I have to go back and look and see, like, even further back. Honestly, I haven't gone, like, so, so far back. But it was. This was present in my 30s. This was present in my late 20s. So this was. This is something that's been visible to me for a while, and it's been in photos for a while longer than I've even noticed it happening. And so the point here is this asymmetry is throwing off my entire bite. It's. It seems to be throwing off my jaw mechanics, my masseter, especially on that side, on the left side, where I'm having that pain occasionally, or I guess not occasionally, but times now it feels fatigued by the end of the day. Like, when I'm talking a lot, my. I didn't realize how much my masseters feel tired and, like, tight, and it's kind of weird. And so for someone who uses their voice as much as I do, loves to eat, who loves to exercise, who loves to be, like, active and do, like, all kinds of things. Like, this is not something I can ignore because it's constantly present. And by the end of the day, I feel like my mouth is exhausted. And that's weird for me. But I also once had a patient who was in her twenties who came to me before she got married for myotherapy because she was like, I'm exhausted by the end of the day. And she was carrying a lot of tension too. And I'm like, I remember her case so well, and I feel like that's Where I'm at now, at 40 now, she was in her 20s, but at 40, I'm like, wow. She was tired by 10am, like, she was a realtor. She was in her 20s, she was about to get married. And she's like, I have a cup of coffee. I have a couple calls with clients. And by like, 10am I'm done. I can't talk anymore. My mouth is tired. My. Like, my face feels exhausted. And I was like, wow. And now, now I'm starting to get what she was talking about. But for me, it's like, more so at the end of the day, of course, I'm talking right now. And I'm like, my masseters feel a little tight. My masseters feel a little tired. I'm on my second episode that I'm recording today, and I. Wow, Fascinating. Okay, and then number four, I'm noticing some tongue scalloping and some mouth breathing at night. I occasionally will wake up with, like, you know, I don't want to say I have dry mouth necessarily, but my. My tongue is scalloped, my mouth is open. And so I have these signs that, like, I'm mouth breathing and I'm maybe struggling with proper tongue posture. Right. The scalping for sure tells us that. And so this just points to a lack of space in the palate and nasal airway. And so I did get expansion with the Viva. I want to be clear. I got expansion with the vivo. The Vivo CNA appliance. It was not just tipping my teeth, it was structural. Like, my palate grew. We have the. The cbcts to prove that. But I feel like I was in it for two years. I only wore it for, like, eight hours a day. They wanted me to wear it, like, 16 hours a day. I was like, that's not. That doesn't work with my lifestyle. Now I'm gonna have this marpy in my mouth 24 7. So does that work with my lifestyle? No, not really. But here we are. Live and learn, right? And so instead of going back into something that I feel like did a good job but didn't complete the job, I want to just go straight to the thing that I feel like is going to complete the job so I can be done with this in a couple years and, like, not have to do this anymore. So what is the plan? So my plan, what my treatment plan generally looks like is Dr. Koval will place the Marpi expander and guide expansion. She'll also, as I mentioned, like, she will be using the PSA to cut that It'll guide her so she can cut properly down my suture line and help that help my maxilla split and everything, like kind of from the get go, which is crazy. I need about 5 millimeters of expansion. This is actually relatively modest compared to some cases. So that's a good thing. Because of this. And this was a big concern of mine going in. It's not, it shouldn't now there's no, there's no promises, right. But we do not believe that it will, that it's going to alter the shape or appearance of my nose. I know this is something a lot of people worry about. Some people don't really care. Like I'm okay with having a big old space in the center of my teeth. That doesn't bother me because I'm going to be very public about my journey. So like, I don't need like some people will have like a flipper or they'll have, you know, some composite or something added to their teeth to kind of close up that space a little, especially, especially if they're in professional settings. And so while that's something that I know, like different practices offer, I don't know, maybe I will do that. But as of right now, I'm thinking no, because this is literally what I do for a living and I'm totally okay with having the spaces there. So I'm most concerned about my nose shape because I had the nose surgery three years ago and when I went under, I was going under general anesthesia for a septoplasty for the back part of my nose. The back like part of my nose was turned inward toward the left side. And so we fixed that. We reduced my turbinates and we also reduced nasal swell bodies. I was like, well, if I'm being a general anesthesia, can you get rid of the bumps on my nose and make my nose a little bit straighter? So I ended up doing a rhinoplasty at that time time as well. And so that was because it was like, you know, we went from a closed procedure to an open procedure. And because of the shifting in my nose and everything, I just want to make sure that like my nose would not be impacted by this. Like, I don't want, don't want to have any issues with my nose. But also I really like the appearance of my nose now and I don't want to change that. So anywho, we don't believe it will change the appearance of my nose. Dr. Coval has worked with other patients that also had these concerns and they were able to keep the nose, like, the way that it looked. So there's that. I mentioned that we will use the. The PSA to cut the suture line. And that basically helps to make sure that expansion is really very clean. It's precise. And this is why I trust her, because I feel like she is very advanced in what she's doing. She modifies things to meet the patient's needs. I. I know that I will not be turning the appliance, like, the entire time. It will just be in the beginning until they tell me that I've turned the expander enough to get that five, you know, millimeters or so of growth that we're going for. But the device will be in my mouth for about eight months. I believe once this. Once the seizure separates and we've got the 5 millimeters of expansion, that's when they will remove, like, the metal bands that are around my teeth. But they'll leave the central part of the appliance with the screws in my palate to maintain the results during that retention phase. And I believe that will stay in while I continue to. And I don't know if the appliance fully comes out at eight months or if that's when they're going to take the bands off, but it's one of the two. We'll get clarification on that. And then they basically will use the Invisalign to help guide my teeth forward. So, you know, what about. I was like, what about the teeth? We're going to have all these gaps. So the orthodontic work, basically, I'll start with the lower Invisalign during the expansion phase, and that will help guide some growth while I'm doing the upper expansion. And then after my upper expansion kind of wraps up, that's when we'll transition to an upper Invisalign. And each tooth is basically starting with my first front teeth. Like, each tooth will slowly be moved forward one at a time. And so this will allow us to close the gaps that are created by expansion without actually collapsing the lateral and forward gains that I get. Because when I did the VNA Diva suppliance, I followed that up by closing gaps using Invisalign. But the way that we. I guess the way that it closed the last couple trays, like, really retracted me to get those. Those spaces fully closed. And, like, live and learn, right? So I did have more expansion now or then than I have now, like, when I finished the Vivos DNA appliance, but definitely don't want to collapse any of the expansion that I get. And so this methodology that that Dr. Koval uses preserves the widened palette. It supports my airway, it's going to improve aesthetics, and so it's basically going to do that while respecting the function and the balance and everything. So, anywho, I know this is a lot of information, this is a quick episode, but I wanted to give you guys an update on, like, what I'm doing, why I'm doing it, what it's going to look like. There's still so much to unpack, but that's why I want to bring Dr. You know, Kowal back on the podcast soon. She's been on before. She's going to come back. She spoke to us in the membership. She's amazing. She'll walk us through all things Marpi expansion, adult airway work and more. But if you're listening and you have questions about Marpi, about expansion, about adult ortho, um, she is an orthodontist. So anything else related to these topics or my journey, just like I said, DM me on Instagram at Holly Balkan. We will gather your questions and address them in the episode when she comes back. All right, my friends, thank you so much for joining me on this very, I don't know, maybe vulnerable and exciting journey. Because I've done other expansion, people are like, why are you doing more? Well, because I'm in the space and I, you know, I know too much information. Expansion isn't just about straight teeth. It's about breathing better. It's about living with less pain or no pain. Optimizing your whole body, like whole body health. Right? Everything. Like the, the mouth is the window into your body and your health and everything is so interconnected like we always talk about. So I'll be sharing updates along the way. I can't wait to see how this transforms my wellness from the inside out. I do feel like I'm pretty healthy now, but I'm excited to see what else happens. So until next time, breathe well, sleep deeply, give yourself permission to expand, literally and figuratively, and I will talk to you all soon.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myot air weight and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources at all I offer@halliebalkin.com or pop over to alliebalkin on Instagram to get all the latest updates.